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Health workers decry loss of fellow front liner

By Joseph Cuevas

Members of the Jose Reyes Memorial Medical Center (JRMMC) Employees Union-Alliance of Health Workers held a protest rally last August 3 to denounce the death of their fellow health worker who died of Covid-19 they said was due to gross negligence of the hospital management, the Department of Health (DOH) and the Rodrigo Duterte government.

Judyn Bonn Suerte, a JRRMC employee and active union member succumbed last July 31 to Covid 19. He was among the 20 health workers of the hospital infected last month.

In a statement, Cristy Donguines, President of JRMMC Employees Union said that Suerte’s life would have been saved if it had been immediately treated by JRMMC and not brought to Dr. Jose N. Rodriguez Memorial Hospital where he died. 

“It is painful to think but it is clear to us that this is a major negligence of the hospital management and the DOH itself due to their anti-health workers protocols,” Donguines said.

She added that the management blindly implemented the DOH’s defective protocol that led to the death of a health worker of the said hospital.

DOH has instructed all medical center chiefs and hospital directors that all employees admitted to their respective hospital with severe COVID-19 cases should be transferred to any designated exclusive COVID-19 referral hospitals.

The union revealed that the JRMMC has no free re-swabbing test for its health workers after undergoing quarantine protocols.

“It should be one of the protocols to be implemented by the hospital to ensure that they are really fit to work. Worst, in order to make sure that they are really fit to work, they need to pay for re-swabbing test outside of the hospital that costs P5,500.00 for drive-thru and P4,300 for walk-in tests,” it said.

Colleagues mourn the death of Judyn Bonn, an employee of the Jose Reyes Memorial Medical Center who recently died due to COVID-19. (Contributed photo)

‘Generals infesting health response

Meanwhile, more doctors and other health care workers agreed with 40 medical associations who earlier asked the Duterte government to again implement an enhanced community quarantine period in Metro Manila.

A statement signed by almost 200 doctors and health care professionals and issued on Second Opinion Facebook page reiterated that the quarantine was a public health measure aimed at saving lives by stopping the spread of disease.

It also rejected the government’s “military type quarantine” it said is oppressive and devoid of scientific sense and health purpose.

The signatories prescribed the immediate removal of DOH Secretary Francisco Duque and all generals and czars “infesting” the Inter-Agency Task Force (IATF) and replace them with team players from health and related fields.

In addition, the petitioners asked:

* active and aggressive recruitment of health workers;  

* immediate provision of substantial funding and financial support for both national and local government interventions; 

* continuity of care from the primary to the tertiary levels, and between public and private health facilities;

* enhancing capacities in testing, tracing, isolation, and treatment at the institutional and community level, and utilizing appropriate technologies in the promotion of preventive; and

* public health measures and immediate improvement of COVID-19 data processing and management.

President Duterte has placed Metro Manila and provinces of Bulacan, Rizal, Laguna and under Modified Enhanced Community Quarantine starting today. tomorrow, August 4 as recommendation of IATF to President Duterte.

According to DOH, as of August 3, Covid-19 cases has risen to 103,185, including 5,032 new cases while there had been 4,823, infected health workers and 38 deaths. #

Record number of COVID-19 ‘recoveries’ mere window dressing, expert says

The decision by the Department of Health (DOH) to categorize coronavirus patients with no or mild symptoms as “recovered” is mere cherry picking and window dressing, a community medicine expert said.

University of the Philippines College of Medicine professor Gene Nisperos said the decision is problematic as it was applied to many cases a World Health Organization (WHO) guideline meant only for individual patients.

“The WHO guidelines were only meant for individual cases. What the DOH did was to apply it en masse,” the medical doctor explained.

“These recommendations are for individual patients who are assessed and cleared by physicians. Simply extrapolating this to massive data is problematic,” he said.

In its July 30 update on coronavirus cases in the Philippines, the DOH reported 38,075 recoveries in a day.

DOH case bulletin for July 30, 2020

Citing new protocols in the US and Europe, the DOH said Thursday it is now tagging patients with mild or no symptoms as “recovered” 14 days from the onset of symptoms or by the date of specimen collection.

With nearly 40 thousand new “recoveries”, the DOH said the Philippines now has 65,064 patients who have recovered from the virus on the day it reported a record number of new cases at 3,954, bringing the country’s total to 89,374.

Nisperos however said even if the new protocol is a new DOH data management style, it remains inconsistent as it leaves out from the list of active cases the number of validation backlog that currently stands at 37 thousand.

The DOH said there are 22,327 active COVID-19 cases in the country.

The medical doctor said the DOH is merely cherry picking and window dressing the data.

“The data is being presented to fit a narrative instead of the narrative being based on the data,” he added. # (Raymund B. Villanueva)

Beyond capacity and overwhelming incompetence

by Maricar R. Piedad

The Philippines has been in varying intensities of community quarantine for 124 days—a world record in terms of the longest lockdown response to COVID-19. But the fight against the virus is still far from over, and now it seems like the country is back to square one—overwhelmed hospitals, rising number of cases, and overall chaos. All those days in lockdown have been wasted because of the Duterte administration’s louche decisions and inaction on building up the healthcare system’s capacity for COVID-19 response.

The government, more than ever, should acknowledge the graveness of the crisis. It should prioritize implementing solutions to flatten the curve rather than push business-as-usual measures towards so-called recovery when the imminent threat of the pandemic continues to stare every Filipino in the face.

So far, the measures it has taken—lockdowns, limited triage testing, and waiting for a vaccine from other countries—have been passive.

On the verge of collapse

The current healthcare system is now operating close to its maximum capacity with cases exceeding 63,000; already reaching the projection of cases 60,000-70,000 by the end of July and cases is increasing by almost 1,000 daily. Still, government has no clear and concrete plan to expand testing triage and capacity.

The sluggish COVID-19 testing is prolonging the country’s fight against the virus. Only a small portion of asymptomatic cases are being detected because of the absence of mass testing. Compared to the rest of the world, the Philippines has a low number of asymptomatic cases. But this is mainly because less than one percent of the country’s total population has been tested for COVID-19, almost six months after the first reported case. As of writing, only 1,009,511 individuals have been tested.

According to the adjusted estimates of the University of the Philippines (UP) as of July 13, the mean number of hospitalized patients is 23,747 and it can reach up to 28,024. As of now, the total hospital bed capacity is at 15,548, with 1,661 ICU beds, 10,410 isolation beds, and 3,477 ward beds. There are only 1,938 mechanical ventilators available. This means that hospitals may need to double their total number of beds before the end of July to accommodate these patients.

However, hospital bed capacity only increased by about 2,019 beds since last month’s total bed capacity of 13,529, according to the Department of Health (DOH). There was also no significant addition to the mechanical ventilators available which are important to treat critical cases. There was also no notable increase in the COVID-19-dedicated ward and ICU beds. Considering that more suspected and probable cases will be needing hospitalization, the influx of patients seeking medical attention will be beyond the country’s healthcare capacity. The exponential increase in the number of confirmed COVID-19 cases will overwhelm the healthcare system in no time and hospitals will be forced to deny patients due to the lack of facility.

The ICU bed occupancy rate, which is a huge indicator of critical care capacity, is already at 41.2% as of the latest DOH data drop. Ward beds are at 57.1%, and isolation beds are at 48.4% occupancy. Majority of the ward and isolation beds occupied are also located in private healthcare facilities. This is despite public hospitals having more COVID-19-allocated beds. This could mean that majority of COVID-19 patients are compelled to receive treatment from private institutions charging higher hospital bills and out-of-pocket expenses due to limited benefit packages from the Philippine Health Insurance Company (PhilHealth).

Out-of-almost-empty-pocket

Ballooning COVID-19-related expenses of Filipino patients is another major issue that the government should address. The medical bills of some COVID-19 patients have ranged from hundreds of thousands to millions of pesos, depending on the severity of the case. For instance, the bill of one recovered patient reached Php1.312 million for a 15-day confinement. According to the patient, a huge chunk of the medical bill were charges for laboratory tests, doctors’ professional fees, intubation, and the ventilator and respirator she used throughout her admission. Though all her medical expenses were fully covered by PhilHealth, this is no longer the case for COVID-19 patients admitted in accredited hospitals from April 15 onwards.

At the start of the pandemic, the Duterte administration assured the public that it has individuals infected with COVID-19 covered. However, PhilHealth announced in early April that it would no longer shoulder all expenses and would instead implement case rate packages for confirmed and probable cases effective April 15. According to PhilHealth Circular 2020-0009, patients with mild pneumonia can avail of a maximum coverage of Php43,997, while moderate and severe pneumonia patients can have a maximum amount coverage of Php143,267 and Php333,519, respectively. Critical patients, on the other hand, can access a Php786,384-worth maximum benefit.

But PhilHealth computations for these packages contradict the government’s assurances and may not be enough to cover the numerous medical procedures COVID-19 patients must undergo. Medical expenses in excess of the case rates will be paid out-of-pocket, and the amount could be considerable. If the patient with the Php1.312 million medical bill for example had been confined after April 15, PhilHealth would have just paid the Php333,519 maximum coverage for severe pneumonia patients. The remaining Php978,481 or almost 75% of the patient’s total medical bill would have to be paid out-of-pocket.

The abrupt economic shutdown resulted in most Filipinos losing income and struggling with the recent rise in the cost of living, especially the poor and vulnerable. Many of them can ill-afford to pay for medical expenses and may no longer consult doctors despite having symptoms.

Burning Out

Aside from the health infrastructure, the government also needs to reinforce the country’s human resource for health. Even before the pandemic, Filipino doctors and nurses were already treating patients beyond their capacity.  According to the Philippine Health Review 2018, there are 3.9 doctors and 8.6 nurses for 10,000 people. This medical worker to patient ratio is a far cry from the World Health Organization (WHO)-recommended 10 doctors and 20 nurses for every 10,000 population.

A Philippine Institute of Development Studies (PIDS) study also noted that, in a 24-hour set-up, 1 doctor and 2 nurses will be needed to treat 6 ward patients. Critical care patients will need 1 doctor and 1 nurse each as well as other special healthcare workers such as a pulmonologist, intensivist, infectious disease specialist, and mechanical ventilator technicians.

The available healthcare workers in the country will not suffice. With no significant addition to the health workforce, the country’s doctors and nurses will be overwhelmed and exhausted. There will also be a greater risk of infection for medical workers since having more patients could mean more exposure to COVID-19. There are already 3,805 healthcare workers infected and 35 of them have already died. 

The DOH decision to reassign physicians under the Doctors to the Barrios program is another sign that there are not enough doctors in COVID-19 treatment hospitals and reinforcements are urgently needed. However, only 5,216 health workers have so far been hired to fill the DOH-approved 9,297 slots for emergency hire. This slow hiring means medical frontliners continue to work beyond their capacity to treat the piling number of COVID-19 patients. The DOH itself has also noted the difficulty in hiring health workers because many of them have private services that they cannot leave. It also does not help that the entry level salary for healthcare workers is low. For example, a medical laboratory technician—which is under salary grade 6, can only earn up to Php 15,524 per month.

The country’s shortage of personal protective equipment (PPE) is also contributing to the huge number of infected health workers. According to the WHO, the global shortage of PPEs is affecting healthcare workers worldwide. This shortage could have been eased if the country had the means to manufacture its own PPEs, such as a local textile industry. But the country is reliant on imported PPEs. The Philippine Exporters Confederation Inc. (PhilExport) stated that despite factories’ willingness to produce PPEs, they cannot simply do so because of the lack of fabric and other materials. Had there been a Philippine industry for essential health protection needs, infection among front liners and in general would have been minimized.

Overcoming incompetence

The Duterte administration’s failed COVID-19 strategy in ending the current health crisis exposes its incompetence and lack of sensibility. The 124 days spent in lockdown and the opportunity costs incurred during this period have been wasted because the government failed to effectively intervene and keep the healthcare system from collapsing. It should now set its priorities straight and put all hands on deck to amplify health responses.

The government is not prioritizing funding for the healthcare system and social amelioration but it is pushing for ill-timed programs that will allegedly help in the country’s economic recovery. A concrete example is the continuation of the Duterte administration’s “Build, Build, Build” program despite the more pressing need to reallocate more funds for COVID-19 response.

The Philippine Program for Recovery with Equity and Solidarity (PH-PROGRESO) of the government shows that it is more inclined to save big businesses first before the Filipino people. The huge budget allocated for private corporations’ benefit should be realigned to help the overwhelmed healthcare structure. Fiscal measures for health and economic recovery should go hand in hand instead of pitting one against the other since overall economic performance is very much reliant on the well-being of the Filipino work force.  

Inadequate and relaxed response to COVID-19 hinders the Philippine economy from fully opening. It has only been two months since the gradual operation of businesses and since workers returned to their respective workplaces but the government is already losing control of the situation. Aside from the uncontrollable spread of the disease, hospitals are now reporting that they reached their maximum critical care capacity. Forty-eight hospitals already reported that their ICU beds are now full, and it is alarming that 50% of these hospitals are located in the National Capital Region (NCR). Meanwhile, Cebu City—which is the new epicenter of the disease in the country, is also nearing the danger zone in its critical care capacity. If the population of the Philippines’ major economic hubs keep on getting sick, then it will be much harder for the economy to recover its losses.

The government must protect first the Filipino people from the COVID-19 threat. Majority of Filipino workers are at risk of contracting the disease. The economy cannot recover without a healthy workforce to power it. According to UP’s analysis, half of the Philippines’ major economic contributors are considered high risk spreaders of COVID-19, such as construction workers, security guards and commercial drivers. Many of them are minimum wage earners lacking adequate social benefits and protection. This makes them more vulnerable to infection and with limited means to pay for expensive COVID-19 treatment.

The government should speed up the efforts in broadening and building up testing and hospital capacity.  More than ever, it should make healthcare accessible and affordable for every Filipino. This includes making COVID-19 testing and treatment free for all. The pandemic will not be over as long as infected Filipinos are not isolated and treated due to the lack of facilities and expensive healthcare.

In the end, the entire Philippine economy will suffer if Filipinos are not protected from this disease. The economic downgrade will be far greater if the coronavirus crisis lasts longer. The government cannot afford another lockdown since it will not only endanger the economy but will also bring intense hunger and more hardship. It must act now and prevent the health system from collapsing and the Filipino people from succumbing to both the pandemic and to poverty. #

The unbelievable indifference of the Duterte administration

By Sonny Africa

The Duterte government insists that it is successfully responding to the COVID-19 pandemic. The reality is a little bit different – it hasn’t done enough, and is planning to do even less.

The coronavirus is spreading faster than ever. It took over three months to reach the first 10,000 confirmed cases but less than a week to add the last 10,000, at over 57,000 to date. University of the Philippines (UP) researchers forecast between 100,000 to 131,000 cases by the end of August.

Characteristically, the government’s containment measure of choice was a military lockdown – among the fiercest and longest in the world. It justified this as harsh but necessary, repeating a favored talking point used to justify all sorts of sins.

The effect on the economy and the people was certainly brutal.

The country was plunged into the worst crisis of mass unemployment in its history with 14 million unemployed and a 22% unemployment rate in April 2020, by IBON’s reckoning. The combined 20.4 million unemployed and underemployed are over two-fifths (40.2%) of the presumed labor force. These correct for serious underestimation in officially released figures.

The joblessness and collapse in livelihoods are expected to ease as restrictions are relaxed. But whatever improvement will still not be enough to return to a pre-pandemic state.

The country’s gross domestic product (GDP) is projected to contract by 2.0-3.4% for the whole of 2020, according to the government’s Development Budget Coordination Committee (DBCC). The World Bank has a slightly more optimistic projection of -1.9% while the International Monetary Fund (IMF) and Asian Development Bank (ADB) see it worse at -3.6% and -3.8%, respectively.

This will be the worst growth performance in 35 years since the -7.3% (negative) GDP growth in 1983 and 1984. But if the low estimates materialize, it will also be the biggest decline from positive growth ever recorded.

As it is, the economy is well on the way to its fourth straight year of slowing growth. It already contracted at -0.2% growth in the first quarter of 2020 with just two weeks’ worth of lockdowns. The second quarter figures that will come out in August will be much worse.

Unhealthy response

No one is likely to have thought that the worst public health crisis and economic decline in the country’s history would be enough to spur the Duterte administration to reform its anti-democratic and anti-development ways. It didn’t.

The government’s military-dominated COVID-19 response team has proven unfit for purpose and the steeply rising cases today point to the protracted lockdown being squandered. Yet the rise in reported cases do not even give the complete picture.

To date, there’s a validation backlog of over 15,000. The positivity rate of 12.4% meanwhile indicates that testing is still, months into the pandemic, far below the levels needed. Local transmission is still gaining momentum even as other Southeast Asian countries have already stopped theirs.

The hazy picture is a poor starting point for the contact tracing, isolation and selective quarantines needed. But the rise in COVID-19 cases is sufficient to show how social distancing and other precautionary measures can’t go far enough.

Assuming all pandemic-related deaths are accounted for, the 1,534 reported deaths are still relatively few and the number of daily fatalities fortunately fewer than the peak in March. This may however soon change as the virus spreads in the coming weeks and as the health system becomes overstretched even just by those who can afford it.

Hospital capacity hasn’t been beefed up so much as portions of it carved out at the expense of non-COVID-19 cases. The National Capital Region (NCR) and Cebu are the pandemic’s epicenters in the country. As much as 19 NCR hospitals are at or nearing their capacity of ICU beds for COVID-19 patients – 14 of which were acknowledged by the Department of Health (DOH) last week – while Cebu’s hospitals are already overwhelmed.

Hyped assistance

The inadequacy of the health response is more disturbing in how the time for this was bought with lost incomes, small business closures, joblessness and hunger. Tens of millions of Filipinos even suffered more than they should have because of similarly inadequate emergency relief.

At the start of the lockdowns, 18 million beneficiary households were promised Php5,000-8,000 in monthly cash subsidies for just two months. That right there is an immediate problem – the lockdowns are running on four months now, since mid-March, with only partial easing in June.

Emergency subsidies reportedly reaching 19.4 million beneficiaries under various programs of the departments of social welfare, labor and agriculture sounds impressive.

However, the aid was very slow in coming. Most beneficiaries had to wait 6-10 weeks before getting their first monthly tranche.

The aid is also very stingy. Taken altogether, the first tranche of the cash subsidy programs only amounts to an average of Php5,611 per beneficiary family. Over the last four months this comes out to just Php11 per person per day.

The government has even recanted and said that only 12 million beneficiaries will get the second tranche. But the number of those who will actually get this second tranche may be even less than that. The government is invoking bureaucratic difficulties to explain why only 1.4 million of the 12 million have received this tranche to date.

These emergency cash subsidies are also much lower than the latest official poverty threshold of Php10,727 monthly for a family of five. Yet this miserly relief will even seem generous in the period to come because little more is forthcoming. The official government policy was succinctly put by the presidential spokesperson recently: “We cannot afford to give ayuda (aid) to keep everyone alive.”

Business as usual

The Duterte administration’s lockdowns precipitated what may be the greatest economic collapse in Philippine history. The lockdowns per se are of course temporary – indeed, as too the pandemic, even if this will linger for at least another year or more.

Though temporary, the simultaneous demand and supply shock to the Philippine economy, other countries, and the global economy as a whole is unprecedented in the modern era. The world economy is said to be undergoing its worst recession since the Great Depression.

Yet apart from a momentary surge in emergency relief and despite lip service to the economic crisis, it bizarrely still seems to be business as usual for the economic managers. There are a couple of reasons for this.

The most basic is how the economic managers – and most of our political leaders – are blinded by the free market dogma imbibed over four decades of neoliberal globalization. There is a rigid faith that market forces will be enough to meet the pandemic-driven economic challenge. This is matched by an inability to grasp that responsible state intervention is needed not just to deal with the crisis but for long-term national development.

But there is also an extreme narrow-mindedness common among many afflicted by that dogma – that ‘creditworthiness’, ‘competitiveness’ and ‘investor-friendliness’ are not just a means to but actually ends of development. The people who make up the majority of the economy are peripheral and ever in the margins.

These go far in explaining the lack of urgency and, apparently, seeing the current crisis as an inconvenient but minor speed bump on the highway to free market-driven progress.

Fragments of a response

Genuine attention would start with immediately coming up with a plan fitting the vastly changed pandemic-driven crisis conditions. Nearly six months into the pandemic, all that the people have are fragments – including fragments which are self-evidently exaggerated to give the impression of substantial action.

The economic team came up with a “4-pillar strategy” in April that was eventually rebranded as the Philippine Program for Recovery with Equity and Solidarity (PH-PROGRESO). Supposedly worth Php1.7 trillion or an impressive 9.1% of GDP, this figure was grossly bloated by double-counting of interventions and their sources of financing, by conflating actual spending with merely foregone tax and tariff revenues, and by including additional liquidity from monetary measures.

The Inter-Agency Task Force Technical Working Group for Anticipatory and Forward Planning (IATF-TWG for AFP) released its We Recover As One report in May. This seemed more detailed, comprehensive and forward-looking. There are some relevant health and education measures.

But some very important measures are missing – expanding the public health system, social protection to help everyone in need, and protecting jobs, wages and workers’ rights. Trade, industrial and agricultural measures also seem oblivious to unsound fundamentals, the global crisis, and accelerating protectionism. On the other hand, unfunded feel-good platitudes are aplenty.

The economic managers started working with Congress on a Bayanihan 2 bill in June. This replaces the Php1.3 trillion package that Congress originally proposed but which the finance department summarily shot down ostensibly for lack of funds. The Bayanihan 2 proposal is now just one-tenth in size at Php140 billion.

At present, the stinginess of the economic managers is the biggest binding constraint to addressing the pandemic, alleviating economic distress of poor households, and economic recovery. The Php140 billion is much too small compared to the magnitude of the crisis at hand. At the same time, the sweeping insistence on infrastructure as a magic bullet and on sacrosanct debt servicing means continued unproductive spending rather than on what would have the greatest development impact.

A Philippine Economic Recovery Plan was supposed to be made public at the pre-SONA forum of the economic and infrastructure cluster on July 8. But this was not presented and is still strangely kept secret. Neither the Department of Finance (DOF) nor the National Economic and Development Authority (NEDA) websites share this with the public, and a direct request was declined.

It’s five-and-a-half months since the first confirmed COVID-19 case in the Philippines, and about four months since declaring a public health emergency, a state of national emergency, and the start of lockdowns. The Duterte administration has throughout portrayed itself as doing everything it needs to.

In reality, it seems to be doing as little as it can. A new anti-terrorism law was apparently even seen as more urgent than clinching a stimulus program. This languid COVID-19 response is bringing us to the edge of the precipice on both the health and economic fronts. #

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Kodao publishes IBON articles as part of a content-sharing agreement.

On the BBB fix: Why do you build me up?

by Jose Lorenzo Lim

In its recent pre-SONA forum, the economic team spent the most time talking about four years of infrastructure accomplishments. On the other hand, there was next to nothing about the government’s plans for economic recovery from the serious crisis brought on by the pandemic. The misplaced emphasis on infrastructure during the pre-SONA forum only reflects the misplaced emphasis on infrastructure as some kind of magic bullet for the country’s development.

The Philippine economy has a basic problem – it is dependent on external and temporary drivers of growth. These include overseas remittances and foreign investments especially for business process outsourcing (BPOs) and manufacturing. Yet COVID-19 wreaked havoc on these. Overseas remittances fell by 5% in March as thousands of OFWs were repatriated back to the Philippines. BPO investments are slowing down more than ever and export demand is weakening from a sluggish global economy.

The economy lacks substantial and sustainable internal drivers of growth such as from developing the core productive sectors of agriculture and manufacturing. Yet, instead of developing these, the government is looking to infrastructure spending to spur growth even if this is superficial and short- term.

More than any other government since the Marcos era, the Duterte administration is extremely dependent on public infrastructure spending to boost growth. It has been relying on infrastructure as a major economic stimulus long before COVID-19. The longest lockdown in the world delayed implementation of various infrastructure projects around the country.

Yet the government is still hell-bent on pursuing a grand infrastructure program amid the pandemic and despite its actually bleak accomplishments so far. The government says it will revise its list of infrastructure projects to adapt to COVID-19. But does it really have the will to shift the focus of its infrastructure program, or even the capacity to fully implement this?

2 out of 75

The Philippines was said to lag behind its neighboring Asian countries in terms of infrastructure. The Duterte government dreamed of building high-impact infrastructure projects through the Build, Build, Build (BBB) program.  BBB aims to build more railways, urban mass transport, airports and seaports, more bridges and roads, and new and better cities. The program is estimated to cost Php8 to 9 trillion from 2017-2022.

The BBB program originally had 75 infrastructure flagship projects (IFPs) composed of transportation (53), water resources (15), power/energy (4), and social infrastructure (3). The government said these projects would facilitate efficient movement of goods and help bring down production costs in the country. They would also improve the income of rural families, encourage countryside development, and create 1.7 million jobs by 2022.  These are grand claims considering that the 75 IFPs were mainly concentrated in the National Capital Region (NCR), Region III, and Region IV-A and IV-B which are the trading centers of the country.

Altogether, the 75 IFPs were estimated to cost around Php2.1 trillion. The government planned to tap official development assistance (ODA) and the private sector to fund these. Of the 75 IFPs, ODA would fund 57 worth Php2 trillion, public private partnerships or PPP would fund 6 worth Php23.3 billion, and government budget would be allocated for 12 IFPs worth Php138.5 billion. This means that most of the 75 IFPs would be funded with loans from various countries.

The status of the projects was telling of its progress. Data from the National Economic and Development Authority (NEDA) shows that only two out of the 75 IFPs were completed in November 2018.  These were improvements along the Pasig River from Delpan Bridge to Napindan Channel (Phase IV) and the selective dredging of the Pulangi River. It is also worth noting that the Pasig-Marikina River Channel Improvement Project has three other phases that started as early as 2009. Only Phase IV was constructed during the Duterte administration. NEDA’s last update on the status of the 75 IFPs on July 2019 reported the same two projects as being completed. 

38 out of 100 before Duterte steps down?

In November 2019, the Duterte government announced that it revised the list of IFPs from 75 to 100 in order to ‘streamline’ the list and make it ‘more feasible’. This was due to the slow rate at which projects were going. With their new list, the Bases Conversion and Development Authority (BCDA) expects only 38 of the 100 IFPs to be completed by the time Pres. Duterte steps down.

The 100 IFPs are composed of projects for transport and mobility (73), water resources (10), urban development (9), information and communication technology or ICT (6), and power and energy (2). The list is primarily composed of economic infrastructure to make the country more palatable to investors, which has basically been the basis of infrastructure planning for a long time. Noticeably, the current infrastructure program lacks social infrastructure, which is much needed by Filipinos to live humanely and decently.

The 100 IFPs are worth around Php4.3 trillion and ODA is the biggest funding source. There will be Php2.4 trillion funded with ODA, followed by Php1.2 trillion through PPP, and Php172 billion funded solely from the General Appropriations Act (GAA). The glaring over-reliance on loans and private sector funding reflects the sore absence of government capacity for these.

Leading the ODA funders for the 100 IFPs is Japan with a total of around Php1.3 trillion in loans, China with Php700 billion, and the Asian Development Bank (ADB) with Php273 billion. Data from NEDA as of June 2019 show that the Philippines has already received US$8.1 billion worth of ODA loans from Japan, US$2.8 billion from ADB, and US$273 million from China.

The short-sightedness of the government’s infrastructure program was really highlighted during the outset of the COVID-19 pandemic. The government had to scramble to convert evacuation centers into quarantine facilities to absorb the rising number of COVID-19 cases. More alarming is how just recently 11 hospitals in Metro Manila have reached full capacity for their COVID-19 dedicated beds.

The government announced a few weeks ago that construction of some road projects under the 100 IFPs will resume. Still, COVID-19 has to a certain extent compelled government to announce that it will come up with a revised list of the 100 IFPs to cater to the country’s health needs.

In line with reviewing the current list of 100 IFPs, the government could reconsider large projects such as the Metro Manila Subway Projects Phase 1 and the Safe Philippines Project Phase 1. Instead of spending on these import- and capital-intensive projects, the budget could instead be used for subsidizing jeepney modernization. This would benefit more Filipino commuters as well as support the employment of thousands of jeepney drivers.

The controversial Kaliwa Dam should also be reconsidered for the environmental and community impacts combined with the nature of the onerous loan agreement.  Another project that could be shelved is the Bataan-Cavite Interlink Bridge. The huge amount spent to shorten travel time may not deliver commensurate returns, and the money is likely spent better on more urgent pandemic-related needs. Additionally, the Safe Philippines Project Phase 1, a CCTV surveillance system project, may just make Filipinos more unsafe especially in the current repressive political environment.

The ODA loans are specifically for these projects but the government can negotiate with Japan, China and the ADB to realign these towards the country’s more urgent needs. These lenders say they are focused on promoting development so the Philippine government should not be afraid to hold them up to that intent.

The government has not yet released its supposedly revised list of projects because of the pandemic. The public is waiting to see how much of the revised list includes health, housing, and education-related infrastructure.  COVID-19 may also have pushed the implementation of some projects back, and the public deserves to know about delays and how many would be completed before President Duterte steps down.

Complementing the New Normal

The BBB program gives the impression that building more infrastructure per se is the key to sustained long-term economic growth. This notion is reinforced by the visible short-term stimulus that large-scale construction provides. New bridges, roads, airports, and railways also seem to give palpable gains. The real economic question however is not just whether there are benefits but if these benefits are worth the costs.

Improving mobility around the country, which comprises majority of BBB projects, is not in itself enough to improve the country’s economy. Without active promotion of agriculture and manufacturing, the improved infrastructure will mainly benefit just the service- and trading-oriented sectors that dominate our shallow economy.

Infrastructure can contribute to long-term economic growth if it helps push the country’s agricultural and manufacturing potential. Policy changes are needed for this to happen. The government has to protect and support agriculture which unfortunately has been backsliding especially with rice liberalization. Additionally, the Filipino manufacturing sector is waning due to investment liberalization that favors foreign investors at the expense of nurturing domestic capital. The country’s policies are even more misguided amid increasing protectionism and departures from liberalization globally.

The government should release the revised infrastructure list immediately. As healthcare has become the priority, the government should add more social infrastructure like hospitals to help deal with congested health facilities. More socialized housing units could also help decongest urban settlements in the country and help prevent the spread of the coronavirus.

Moreover, policy reforms such as protecting agriculture and the manufacturing sector to complement the country’s revised infrastructure plan can result in long-term economic growth to benefit Filipinos. Dealing with the COVID-19 pandemic in a way that prioritizes the people’s well-being should be the present challenge and government should realign its infrastructure program to complement this. #

Higher inflation for poorest Filipinos underscores urgent need for continued cash subsidies

by IBON Media & Communications

Research group IBON said that the higher inflation is problematic but particularly burdens the poorest Filipinos. Inflation rates for the 30% poorest households are higher than the national average.

Especially amid historic joblessness, this affirms how the government should continue giving cash subsidies as income support, the group said.

According to the Philippine Statistics Authority (PSA), headline inflation rose to 2.5% in June 2020 from 2.1% in May 2020.

Behind this uptick are price increases in: transportation, particularly tricycle fares; alcoholic beverages and tobacco; housing, water, electricity, gas, and other fuels; and communication.

However, the 3.0% inflation rate in June for the poorest 30% of households was higher than the headline inflation rate of 2.5 percent.

This means that the cost of living is rising fastest for the country’s poorest households.

IBON said that this is troublesome for millions of poor families suffering interrupted incomes and stingy emergency relief. 

IBON said that the rise in inflation despite repressed consumption during the lockdown is worrying and points to problems in supply and production.

The government is primarily responsible for ensuring these especially during a public emergency.

For instance, the group said, the notable increase in the transport index shows the government’s weakness in ensuring this vital public service.

Rising prices especially for the poorest affirms the urgency of continued income support, IBON said.

The number of beneficiaries getting the second tranche of emergency subsidies should not be limited. The 18 million poorest Filipinos, including the 5 million wait-listed beneficiaries of the Social Amelioration Program, should receive both the first and second tranches of the Php5,000-Php8,000 per-month emergency aid, said the group.

The government said that only those residing in enhanced community quarantine (ECQ) and modified ECQ areas will be getting a second tranche.

This is only 8.6 million families of the original 18 million target beneficiaries, and 3.5 million households of the five million wait-listed.

This also means that 10.6 million beneficiaries now in general community quarantine (GCQ) and modified (MGCQ) areas will have to make do with just their first tranche.

With the cost of living fast rising amid an even worsening pandemic, limiting the number of beneficiaries getting the second tranche of emergency aid is unconscionable, IBON said.

The government should even consider additional tranches for vulnerable households that continue to reel from lost livelihoods and income, said the group. #

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Kodao publishes IBON articles as part of a content-sharing agreement.

Hatid Probinsya and Balik Probinsya, more harm than good?

by Casey Salamanca

The national government’s program of sending people back to their hometown recently came under fire for spreading COVID-19 in the provinces. For example, Tanauan town and Baybay City in Leyte each recorded their first respective confirmed COVID-19 cases last May 28. Both confirmed cases were among the first and so far only batch of beneficiaries of the Balik Probinsya, Bagong Pag-asa Program (BP2). Meanwhile, in the war-torn city of Marawi, nine confirmed cases are beneficiaries of the Hatid Probinsya program.

BP2 and Hatid Probinsya

BP2 is a pet project of President Duterte’s long-time trusted aide and now Senator Bong Go. Executive Order 114, which enabled the said program, came two days after the Senate adopted Go’s resolution urging the executive department to formulate and implement a Balik Probinsya program.

BP2 is a “long-term program of the government intended for Metro Manila residents who want to go home to their provinces for good”. It reportedly aims to decongest the National Capital Region (NCR) and is mostly targeted at people from urban poor areas. It is also packaged as “redistributing wealth” by bringing development to the countryside.

According to BP2’s website, the first batch was composed of 112 individuals from the province of Leyte. Leyte Governor Dominic Petilla said that most of them are workers who lost their jobs due to the Luzon-wide lockdown. BP2 has three phases of intervention, namely short-, medium-, and long-term.

The short-term intervention provides beneficiaries transport, cash assistance of Php15,000, and livelihood opportunities. All government programs, activities or projects with funding will be adapted for the program.

The medium-term intervention involves projects or programs for implementation after the lockdown and lifting of travel restrictions. This includes establishing new special economic zones in Visayas and Mindanao, among others. The long-term plan includes passing of laws deemed important for rural development.

The program’s goals look good on paper but its pretentious character is exposed by the absence of concrete plans for strengthening rural production. Beyond the program’s promises, what work will people going back to their hometowns really have?

Likely not much, because the program’s vision of developing the countryside is still under the framework of neoliberalism which continues to destroy the country’s agricultural sector. The special economic zones the program envisions to build will, if anything, just cater to the needs of foreign capital but with scant domestic linkages and contributions to national development.

The long-term plan includes the passage of the Duterte administration’s priority bills like the National Land Use Act and giving tax incentives to tourism industries – both have the potential to hasten land conversions. Even legislation supposedly giving incentives for agriculture is more inclined to push for more destructive corporate plantations. There is also the self-serving political logic and push for shifting to a federal system through Charter change.

On the other hand, Hatid Probinsya is intended to help individuals stranded in Metro Manila by quarantine travel restrictions go back to their home provinces. This includes overseas Filipino workers (OFWs). The program arose after reports of thousands of OFWs stranded for more than a month in quarantine facilities. BP2 trips have been temporarily suspended to prioritize the Hatid Probinsya program.

Infecting the provinces

In the absence of a mass testing program, BP2 and Hatid Probinsya are turning out to be additional sources of COVID-19 transmission in some provinces. It is a disaster slowly unfolding especially with the healthcare capacity in rural areas much lower than in NCR.

Mass testing means testing all suspected cases whether symptomatic or asymptomatic, testing all close contacts of positive cases, regular testing of all frontline healthcare workers, and testing for surveillance of high-risk communities or vulnerable populations. Testing is crucial to detect cases, isolate carriers, and trace contacts to contain the spread of the virus.

The Department of Health (DOH) claims that its expanded risk-based testing broadens the coverage of persons to be tested. However, according to the Department Memorandum No. 2020-0285, RT-PCR testing is still based on a prioritization scheme.

RT-PCR is the gold standard for COVID-19 testing. In the Hatid Probinsya program, locally stranded individuals (LSIs) are tested only using the rapid test method. Scientists and medical groups do not recommend relying solely on rapid tests to check if individuals are positive for COVID-19. Their results are not that reliable and hence of very limited use in infection control.

The country’s current healthcare capacity is also still not suited to respond to pandemics like COVID-19. It is very much privatized and uneven between regions; thus access is an issue.

As of June 27, the NCR recorded 17,450 total confirmed COVID-19 cases surpassing scientists’ projection of 16,500 cases by the end of June. As of June 26, the region has 2,487 isolation beds, 1,071 ward beds, 569 ICU beds and 879 ventilators dedicated to COVID-19. The 10 doctors per 10,000 population and 12 nurses per 10,000 population in the region generally meets World Health Organization standards (10:10,000 for doctors and nurses). However, there are much fewer physicians and nurses in regions outside Metro Manila.

According to DOH Region 8, there are 499 total confirmed cases of COVID-19 in Eastern Visayas, of which 68% or 341 cases are returning residents, as of June 27. Of these returning residents, 293 are LSIs, 45 are OFWs, and three are BP2 beneficiaries. Leyte, which accounts for 40% of the cases in Region 8, is the destination of most of the returning residents who tested positive with COVID-19.

Meanwhile, in the Bangsamoro Autonomous Region in Muslim Mindanao (BARMM), there are 58 confirmed cases, with the province of Lanao del Sur having the highest number of cases at 35. This includes the nine returning residents confirmed to be COVID-19 positive in Marawi City.

Eastern Visayas has only two COVID-19 testing centers, both are located in Tacloban City. Of the two, one is a private testing center and the other one, the Eastern Visayas Regional COVID-19 Testing Center, is a public facility. BARMM, on the other hand, has only one testing center, the Cotabato Regional and Medical Center, located in Cotabato City, Maguindanao.

The majority of licensed COVID-19 testing centers in the country are in the NCR, accounting for 29 of the 67 total centers. This could be a factor why Metro Manila is the top region with total number of cases—higher testing capacity results in more cases detected.

In terms of facilities, the province of Leyte only has nine ICU beds, 203 isolation beds, 50 ward beds, and 10 mechanical ventilators dedicated to COVID-19 cases, as of June 26. Data from the 2018 Field Health Service Information System (FHSIS) shows that there are only 57 medical doctors in Leyte, including 7 doctors in Ormoc City, 4 doctors in Tacloban City, and 117 public health nurses.

Quarantine facilities in Region 8 are currently running on full capacity prompting the Regional Task Force 8 and local government units to request for a 14-day moratorium on the national government’s Hatid Probinsya program.

Lanao del Sur meanwhile reported 3 ICU beds, 30 isolation beds, one ward bed, and four mechanical ventilators exclusive for COVID-19 cases. There are only 31 medical doctors and 16 public health nurses. In the city of Marawi there are only 2 doctors and 2 nurses.

In the whole region of BARMM, the doctor and nurse ratio per 10,000 population are 0.8 and 3.8 respectively. For Region 8 the ratios are 2.5 doctors per 10,000 population and 6.6 nurses per 10,000 population.

The increase of confirmed cases in Leyte is disproportionately affecting healthcare workers. On June 16, of the 59 new cases reported in Region 8, 22 are hospital workers. Of the 59 new cases, 52 are from Leyte. As of June 27, there are already 94 healthcare workers infected with COVID-19 in the region.

Ill-conceived plan and self-serving agenda

The Hatid Probinsya and Balik Probinsya programs are proof of government’s ill-conceived COVID-19 response. The less able rural areas are now bearing the brunt of the lack of a cohesive response plan that addresses the gross socioeconomic and healthcare incapacity of the country.

The government failed to maximize the three months of lockdown to start the mass testing, tracing of all contacts of positive cases, and isolation and quarantine needed to contain the spread of the virus. It also did not increase the health system’s capacity to treat all COVID-19 cases.

Instead of focusing on boosting the country’s healthcare capacity, the government apparently even used the pandemic to boost the political career of Palace favorites and to push for more neoliberal and authoritarian policies. Injecting a self-serving political agenda undermines the competent health response so needed by the people.

The administration’s prescriptions and practice to deal with the health crisis are not working. This only makes the call for an alternative approach that contains the virus and cures patients, instead of compromising them, even more urgent. #

Health advocates file petition for mass testing

By Joseph Cuevas

Health professionals, workers and women filed a petition before the Supreme Court last Friday, July 3, asking the executive branch to implement mass testing and provide accurate and reliable data to the people on the coronavirus 19 or Covid-19.

Citing the people’s right to health under the Philippine Constitution,  the petition for a writ of mandamus shall compel the Department of Health and other agencies to conduct pro-active mass testing, aggressive contract tracing and effective isolation, and treatment of Covid-19 positive cases to contain the spread of the virus.

The 74-page petition was filed by Citizens’ Urgent Response to End Covid-19 (CURE COVID) spokesperson Judy Taguiwalo; Coalition for the People’s Right to Health convenor Dr. Joshua San Pedro; Bahaghari bational spokesperson Rey Valmores-Salinas; Migrante International chairperson Joanna Celeste Concepcion; GABRIELA Network of Professionals secretary general Lovely Ramos; Drug, Food and Allied Workers Federation-Kilusang Mayo Uno secretary general Debie Faigmani; BPO Industry Employees Network president Mylene Cabalona; Alliance of Concerned Teachers-National Capital Region Union president Vladimer Queta; UP-Pantranco Driver’s Association vice-president Ernesto Lizada; homemaker Marites Arboleda; and K-12 student Via Leigh Hernandez.

The petition is seeks “accurate, timely and complete information with regards to Covid-19 situation including onset of symptoms, history of exposure, co-morbidities, whether the subject is a medical frontliner, data when specimen is collected and actual case validation backlog from the government.”

The National Union of Peoples’ Lawyers, counsel of the petitioners, said that the omission of proactive and efficient mass testing amid the COVID-19 pandemic has shown that a systemic and normalized violation of the right to health engenders the impairment of other human rights and liberties, such as the rights to travel, livelihood or work, education, and access to justice

In a statement, CURE COVID pointed out that many health experts said that mass testing is very important in the country’s response to the pandemic.

Mass testing enables countries to identify the extent of the virus’ transmissions among the populace, the group said.

It added that with honest and prompt information, governments can systematically and scientifically trace, isolate and treat the infected and contain the transmission.

“Unfortunately, the [Rodrigo] Duterte administration has fallen very short of doing this. Last April 3, retired general Carlito Galvez, chief implementor of the National Task Force on Covid-19 (NTF Covid), announced that the government will implement mass testing by April 15. This obviously did not happen, as the number of testing needed to ascertain the extent of Covid-19 transmissions has consistently fallen short of the NTF’s very own targets,” CURE COVID added.

The group also said instead of mass testing, tracing, isolation and treatment, the government heavily relied on a militarist response to the pandemic, putting the country under the world’s longest lockdown that resulted to abuses, unnecessary restrictions and undue curtailment of civil liberties.

According to the health department, 38,805 have been infected that resulted in 1,274 recorded deaths as of Friday. #

Ang sinapit ng mga drayber

“Dati, kami ang kinakawayan. Ngayon, kami ang kumakaway [para mamalimos].”–Joel Caligayan, tsuper ng jeep biyaheng Rosario-Cubao

The Old and New Bilibid Prisons in the Time of Pandemics

More than a century ago, Philippine prisons reeled from a flu pandemic. History might be repeated without adequate healthcare for prisoners and drastic interventions to stem the Covid-19 outbreak.

By Aie Balagtas See/Philippine Center for Investigative Journalism

Will the Philippines repeat the deadly record of the 1918 influenza pandemic in its jails and prisons?

On May 21, Henry Fabro, chief physician of the Bureau of Corrections, said fatalities in New Bilibid Prison (NBP) reached an “alarming” level: five inmates died in just one day.

At least 80 prisoners died from May 1 to May 19. The figure surpassed the prison camp’s average mortality rate of 50 to 60 deaths per month. Most deaths came from the Medium Security Compound, where inmates were cramped after returning to prison amid the Good Conduct Time Allowance (GCTA) fiasco.

“The numbers are alarming, that’s why I immediately hired two additional doctors and several nurses,” Fabro told the Philippine Center for Investigative Journalism in an interview.

“We wanted to contain it. So far, we were able to pull the death rate back to two per day,” he added.

In May, 40 out of an estimated 28,000 NBP inmates tested positive for Covid-19. One death was attributed to the highly contagious disease.

The death toll due to Covid-19 rose to 15 in June: 12 from NBP in Muntinlupa and three from the Correctional Institution for Women (CIW) in Mandaluyong, according to the Bureau of Corrections.

Fabro believes half of NBP inmates are infected with the virus. However, gauging the true extent of the contagion – with scant testing that yields “snail-paced” and “unreliable” results – is impossible, he said.

Case in point: two inmates were discharged from the NBP isolation area because the Department of Health said they tested negative for the virus, Fabro said. Days later, the health department said it made a mistake.

“We had to repeat the test and expand it to those they (inmates) interacted with,” Fabro said.

Reliable testing, he said, is important to slow infections in penitentiaries and determine which prisoner should be isolated.

This was not the first time a global pandemic tore through Philippine prisons. In 1918, more than 300 inmates throughout the country died. There were nearly 200 deaths at Old Bilibid alone. Back then, the national prison was right inside the capital Manila, on Oroquieta Street in Sta. Cruz district.

A 2009 study titled “The Philippines in the World of Influenza Pandemic 1918-1919” by historian Francis Gealogo said “almost all of the [Bilibid] inmates became sick of the disease during the height of the epidemic in October and November 1918.”

“Among the 2,674 cases of this disease treated during the year, 71 cases of lobar pneumonia complications occurred with 31 deaths. Almost all of the inmates had influenza, and of those who contracted complications in their respiratory organs nearly half died,” he said.

Gealogo said hospitals were so overcrowded during the flu outbreak that 1,897 Bilibid patients who could not be admitted were treated in their own brigades. “Due to influenza and pulmonary tuberculosis, the death rate for the year 1918 was higher than that of 1917,” he added.

The Annual Report of the Secretary of War published in January 1919 said a total of 378 inmates from four prison facilities died during the pandemic.

Old Bilibid had the most deaths with 193. It was nearly double the number of the previous year, which recorded 107 deaths.

Outstations were not spared. The report said Ihawig Penal Colony in Palawan had 72 deaths, San Ramon Penal Farm in Zamboanga City had 45 and Corregidor Island, 68. In 1917, Iwahig recorded 23 deaths, while San Ramon and Corregidor had four and 39 deaths, respectively.

The Old Bilibid Prison, built during the Spanish colonial regime in 1866, is now Manila City Jail.

A century ago, pulmonary tuberculosis was the chief cause of morbidity and mortality among prisoners.

Today, deaths in prisons are a result of multiple problems, such as poor healthcare services, lack of facilities and lack of government manpower and resources. The NBP hospital inside the maximum security compound, for instance, cannot adequately serve the overpopulated prison, and renovations were put on hold because of the lockdown, Fabro said.

The prisoners’ fear of isolation and hospitalization are another factor, Fabro added.

Inmates are also refused admission in hospitals, even in those run by the government, the official said. A nongovernment organization (NGO) working with prisons made the same observation, explaining that inmates are often turned away because they do not have money and relatives to accompany them. Prison guards are not allowed to accompany inmates in hospitals.

The coronavirus outbreak has made the problem worse.

Fabro said hospitals often rejected inmates by claiming they were operating at full capacity. “Recently, a dialysis patient was refused because the hospital learned that NBP has Covid-19,” he said.

The Department of Health did not respond to queries on hospital policies on the admission of sick prison inmates.

Fabro said emergency cases from NBP and the CIW were not spared of the apparent discrimination.

“Our Alpha Patient [of Covid-19] in CIW was refused by different hospitals in Mandaluyong. After hospital shopping, her relatives found a hospital that accommodated her,” Fabro said.

The Alpha Patient, or the first Covid-19 case in CIW, died on April 27. #

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Aie Balagtas See is a freelance journalist working on human rights issues. Follow her on Twitter (@AieBalagtasSee) or email her at aie.bsee@gmail.com for comments.