It's still early days into the new year and hell breaks loose already.
The Philippines recorded 5,434 new COVID-19 cases on January 4th – a part of what seems to be another upward trend in the country's records of coronavirus infections. The government announced a tightening of its coronavirus restrictions by placing Metro Manila under a stricter Alert Level 3 starting January 3rd; and nearby provinces Bulacan, Cavite, and Rizal starting January 5th. Metro Manila Development Authority also said that all metropolis mayors have "agreed in principle" that unvaccinated individuals must be banned in malls, hotels, restaurants, and public transport, except for essential trips, during Alert Level 3.
All these scenarios are not unfamiliar to us anymore. In fact, the often changing quarantine classifications and the enactment of new rules and policies – all with the aim to stop the spread of the virus – are nothing but just part of the "new normal" that we have created for ourselves.
But here is the thing: We, actually, could have had a different "new normal" – one where we are not afraid every time another spike is being recorded, and one where we are comforted by a proactive and not just a reactive public health approach.
Last month, I had a discussion with Atty. Henry Michael Yusingco, a senior research fellow at the Ateneo Policy Center of the Ateneo School of Government, about the priority areas that the next set of leaders should focus on. One of these, he said, is revamping the health sector.
In that discussion, Yusingco told me that the main cause of the many issues and scandals in the health sector is the great divide between public and private health, and how it is the private sector that dominates more. So, the next leaders should overhaul the public health sector and that includes investing in our public hospitals and community health centers, for example. If the people, especially the poor, have access to affordable if not totally free medical services, the health officials can have a better hand in controlling not only the spread of COVID-19 but also other more common diseases.
It is doable, according to Yusingco, but it depends on how bold and audacious the next president can be when it comes to facing the many issues in the country’s health sector.
Let us take the case of Costa Rica for example. In 1950, around 10% of children died before they turned one year old due to diarrheal illnesses, respiratory infections, and birth complications, among others. Barely half the population had potable water, which caused high rates of many different illnesses and diseases. Their average life expectancy was just 55 years. It all looked bad and hopeless.
But in the early 1970s, Costa Rica enacted a national health plan that expanded its social security system’s healthcare coverage. They also instituted a rural health program that made the kind of medical services that larger hospitals had available down to the community level.
The country spent more of its GDP (gross domestic product) on public health than did other countries of similar income levels. What set Costa Rica apart, as noted by public health professor and surgeon Atul Gawande in a New Yorker report last year, was how they spent the money – targeting the most readily preventable kinds of death and diseases.
Since Costa Rica found out that the biggest sources of lost years of life in the country were maternal and child mortality, their public health units directed pregnant women to local community health centers – not yet the larger hospitals – where enough medical workers were ready to prevent and manage the most frequent dangers such as maternal hemorrhage, newborn respiratory failure, and sepsis. Their health ministry organized regular nutrition programs to help reduce food shortages and underweight births; inoculation programs to reduce easily transmissible infectious diseases, and a network of community health centers to deliver affordable treatment for sick children.
By 1970, seven percent of children died before turning one year old; by 1980, only two percent did. The municipalities with the most proactive community health programs also posted the most notable declines in infant mortality. In the course of the decade, maternal deaths fell by 80%.
Gawande also shared in the report that every Cost Rican was assigned to a local primary healthcare team; each team would visit every household in their assigned population at least once a year to assess health needs. By 2006, nearly the entire population had been assigned with a primary healthcare team already.
Meanwhile, during the coronavirus pandemic, it was easier to contact each individual for their vaccination appointment because everyone had a dedicated health contact already. As of this writing, Costa Rica has already fully vaccinated 68.8% of its population — higher than the Philippines's 45.3% and the world's 49.8%. This is even higher than the US's 62%.
Here is the biggest difference: In the current health system that we have, patients come to the hospitals when they are sick. But in a health system that works on proactive measures, it is the public health aides who go to the patients.
If every neighborhood across the country has its own functional public health clinic, we can lessen the number of hospital admissions and avoid overwhelming the frontline workers once again every time another spike is being recorded. We should not normalize overwhelming the frontline workers moving forward.
Ideally, this "Costa Rica Model," as Gawande referred it by, is something that we can and should do in the Philippines, although, as Yusingco told me, that would require an extreme amount of commitment by an undaunted leader. But if Costa Rica could do it, why can’t we?
Looking at the enacted 2022 national budget, which shows that the Department of Public Works & Highways is receiving P786,600,000,000 while the Department of Health and PhilHealth as a whole are only receiving P268,400,000,000, it seems that the government still has not learned its lesson.
If this is any basis, we should expect more frights and scares in 2022 every time another spike is recorded. That, after all, is the “new normal” that this government has created for us.
Juju Z. Baluyot is a Manila-based writer who has written in-depth special reports, news features, and opinion-editorial pieces for a wide range of publications. He covers cultures, media, and gender. The views expressed are his own.
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