Editor’s note: Gene Alzona Nisperos is a graduate of the UP College of Medicine and worked as a community physician for 11 years in Mindanao before returning to Manila in 2004. He is a faculty at the Department of Family and Community Medicine, College of Medicine at the University of the Philippines Manila. He also serves as the president of the UP Manila Chapter of the All UP Academic Employees Union, as well as a board member of the Community Medicine Development Foundation.
Manila (CNN Philippines Life) — A group of major private hospitals in Metro Manila, together with two physicians’ organizations, recently came out with a joint statement calling for a “more unified approach” against the novel coronavirus.
The statement came at a time when a number of tertiary hospitals were grappling with the problem of increasing suspected COVID-19 cases and its toll on the health workforce, including those who had become sick or forced to go on quarantine due to unnecessary exposure.
Thus, the call for a unified approach under a centralized leadership was both timely and laudable. Coming from a group of major stakeholders in the medical community, it articulated a viable solution that was immediately doable within the purview of executive fiat.
The statement also presented a sense of urgency amid growing concerns of dwindling human and material resources. For the first time, these hospitals were being swamped with patients and their capacities were being stretched to the limit.
However, the statement also posited the conversion of government hospitals into central COVID-19 hospitals and the transfer of all COVID-19 patients thereafter. In this proposal, a few government-run hospitals would be designated as exclusive centers for all COVID-19 patients, while private hospitals would care for non-COVID-19 patients.
Therein lies the rub.
The proposition veritably passes the main burden of care for COVID-19 patients to the public healthcare delivery system, which itself is already overwhelmed with patients coming from poor and marginalized communities even before the COVID-19 pandemic. On top of this is the perennial problem of insufficiency, from staff and supplies to equipment and facilities, so much so that if government hospitals were a car, it would always be running on empty.
The sad state of public hospitals runs in stark contrast to that of private healthcare facilities, which are far better equipped, better staffed, and more strategically located.
The Philippine General Hospital, for instance, is always short on space for the indigent patients it serves. Its Emergency Room has a 25-bed capacity that can sometimes get filled with over 150 patients, which forces the ER staff to extend its occupied space way into the hospital’s hallways. The hospital also periodically experiences power outages and water supply disruption.
Such will never be the case for renowned private hospitals like Makati Medical Center or Asian Hospital and Medical Center, which boasts of world-class facilities and have space enough for coffee shops and restaurants to cater to their clientele.
In terms of health human resources, the discrepancy is even wider.
Around 60% of health professionals are in the private sector, which cater to 30% of the population. Only 40% of health professionals are in the public sector, which cater to 60% of the population.
The contrast is even more evident outside of Metro Manila. Of the 1,456 hospitals in the country, only one-third is government-run. Nonetheless, in terms of total bed capacity, both public and private hospitals have almost the same number. This means that there are fewer government hospitals but their bed capacities are bigger.
By location, almost 60% of all hospitals are in Luzon, while the remainder is equally shared by the Visayas and Mindanao. In major regional centers, private tertiary hospitals far outnumber those of government.
The situation gets dismal at the provincial level where, because of the devolution of healthcare, health institutions are under the local government units rather than the Department of Health. There are provinces where district hospitals only have a single doctor, or provincial hospitals so severely understaffed that municipal health officers are being prepared to go on hospital duty if needed.
In short, the public healthcare system is already bursting at the seams due to understaffing, poor funding, and years of inadequate support prior to the COVID-19 pandemic. Passing the burden of care to the public healthcare system amid the COVID-19 may push it to collapse.
And the poor will have nowhere to go.
Government hospitals cater to the poor, who travel far and wait in long lines just to be seen and treated. The poor wait in overcrowded emergency rooms in order to be admitted in similarly overcrowded wards because the choices they have are as limited as the space being afforded them.
And the poor are not just afflicted with COVID-19. Many non-COVID-19 patients have only these few government hospitals as their refuge: for cancer care, for rehabilitation, for life-saving surgeries, and for anything that elsewhere would have been difficult and expensive.
Yet here is now a proposal to further diminish that already limited space of the poor in this country. If government hospitals become designated as COVID-19 centers, every space taken as patients come in is a space denied to the poor. In a world of growing inequities pushed further by calamities and plagues, how is this acceptable?
If the approach is to be truly unified, then the private sector will have to actively work with the public sector and allow themselves to also be designated as COVID-19 centers. The dichotomy between private and public health institutions should be set aside so that the central leadership will have a free reign on utilizing hospitals based on capability, not ownership.
This is crucial as the fight against the pandemic moves from the urban centers to the provinces, where local government units (LGUs) do not have the authority over private hospitals in their areas. Doing so will enable the healthcare system to provide the best possible care for all COVID-19 patients.
Another logical step will be to temporarily re-nationalize the entire public healthcare system to ensure that everything is aligned and everyone is in step. Devolution has created a disjointed healthcare system and this must be fixed as the needs of the day become more imperative.
Given the decreasing numbers of health personnel as they are affected both by the disease and the quarantine, the government should do its best to hire additional health workers to augment the health workforce.
At this juncture, the Philippine healthcare system must act as a single machinery with all hands on deck. A kind of health solidarity between big private institutions and the public sector will provide both the leadership and the political impetus that will hopefully push the national government to act accordingly and expeditiously.