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OFWs press for scrapping of mandatory PhilHealth membership

A group of overseas Filipino workers (OFWs) and overseas Filipinos pressed their demand for the scrapping of the mandatory Philippine Health Insurance Corp. (PhilHealth) membership amid difficulties brought them by the coronavirus pandemic.

In a statement, Migrante International said OFWs have been facing job losses amidst the pandemic that is aggravated by “onerous government fees” such as the proposed PhilHealth premium rate increase this year.

The group said mandatory PhilHealth membership has been a burden for OFWs since the passage of the Universal Healthcare Act (UHC) signed by President Rodrigo Duterte on February 20, 2019.

The law requires OFWs to be PhilHealth members before leaving for work abroad.

Migrante earlier said majority of the OFWs have no use for mandatory membership as PhilHealth is practically useless in helping them pay medical bills when they get sick abroad.

Instead, Migrante said PhilHealth membership should be “voluntary for those with capacity to pay contributions.”  

Migrante also scored the corruption at the health insurance agency that has yet to properly account for at least Php 15 billion in allegedly misspent funds.

“PhilHealth has been used as a tool for unscrupulous health officials appointed by the President to amass billions of members’ contributions for their own selfish interests,” the group said.

“Why should contributors suffer by paying increased premiums in response to the agency’s lack of funds?” the group also asked.

Migrante demands “corrupt” PhilHealth officials involved be held accountable and prosecuted. 

Migrante also said OFWs believe that Duterte’s recent announcement to defer the collection of increased PhilHealth premiums is only a tactic to quell the anger and anxiety of the people especially during this COVID crisis.

“Merely deferring the increased premium does nothing to calm down the people,” Migrante said in its statement.

Instead, the group said OFWs want a genuine, pro-people, universal health care program through free and comprehensive medical and health services. # (Raymund B. Villanueva)

2020 Yearender: Economic lessons from Jose Rizal

by Sonny Africa

Wrapping up a cataclysmic year, Jose Rizal’s legendary quote is something for the Duterte administration and its economic managers to reflect on: “Ang hindi marunong lumingon sa pinanggalingan ay hindi makakarating sa paroroonan.

The worst economic collapse in Philippine history and in Southeast Asia is mainly due to the government’s stumbling pandemic response and lackluster economic measures in 2020. If, again, there is more bluster than action in 2021 then real recovery will be much farther away than it should be.

Big promises

The economic managers announced a grandiose “4-Pillar Socioeconomic Strategy Against COVID-19” in April. The “Grand Total” of Php1.17 trillion was equivalent to 6.3% of gross domestic product (GDP) and sought to give the impression of grand action. This number was extremely misleading though.

There was significant double-counting. Supposedly Php338.9 billion in government spending on emergency support and health measures was counted alongside Php615 billion in borrowing – almost half of which debt was not even really going to be spent on COVID response. Another Php220.5 billion in additional liquidity and tax relief was also added.

The latest package released in October corrects some of these deceits while introducing new ones. The “Grand Total” is now an imposing Php2.57 trillion equivalent to 13.8% of GDP. The borrowing was removed while emergency support and health measures increase to Php558.8 billion. Emergency support now includes supposedly Php132 billion in credit guarantee and loan programs for small business.

The value of the package is particularly inflated by Php1.31 trillion in additional liquidity from Bangko Sentral ng Pilipinas (BSP) measures, Php459 billion in estimated incremental loans to MSMEs, and Php61.3 billion in foregone tax revenues especially because of corporate income tax cuts under the Corporate Recovery and Tax Incentives for Enterprises (CREATE) bill.

These are still misleading. The additional liquidity and incremental loans cited do not mean actual investments or economic activity. Smaller businesses are not borrowing because of collapsed aggregate demand and uncertain market conditions – the “incremental loans to MSMEs” are just an illustrative extrapolation from a Php45 billion capital infusion to government financial institutions. Banks meanwhile are becoming more risk averse with non-performing loans already nearly doubling to 3.2% of total loans in October from 1.7% in the same period last year.

The big numbers seem to be designed for press releases and media briefings to convince the public that the Duterte administration is undertaking herculean efforts to boost the economy. The reality is very different.

Tiny action

Measured against the economic devastation from poor pandemic containment – including over-reliance on long and harsh lockdowns and under-investment in effective testing, tracing, quarantines and isolation – government efforts border on the trivial. The most recent official estimate of -9% real GDP growth in 2020 means that the economy will be Php1.74 trillion smaller than in 2019.

There has not really been any stimulus which, to mean anything, has to involve significant additional spending beyond pre-pandemic levels. The government originally projected Php4.21 trillion in disbursements in 2020. Upon the pandemic, planned disbursements increased only slightly by Php121.4 billion to Php4.34 trillion or just a 2.9% increase.

Measured in current prices, GDP in 2019 was Php19.52 trillion which means that additional government spending in 2020 will be equivalent to just 0.6% of GDP in 2019. The economic managers refuse to spend more because of their fixation on being creditworthy to foreign debtors. The stingy non-stimulus is due to their narrow-minded fiscal conservatism.

How to reconcile this with the Php500.7 billion figure allotted for COVID-19 response as of mid-December – consisting of Php386.1 billion under Bayanihan 1, Php6.6 billion under Post-Bayanihan 1, and Php108 billion under Bayanihan 2? Most of this spending comes from existing budget items – either discontinued programs/projects (Php306.7 billion), existing special purpose funds (Php109.3 billion), regular agency budgets (Php21.2 billion), and unutilized automatic appropriations/excess revenue collections (Php63.5 billion).

The Bayanihan 2 funds released also do not even seem to have been spent yet including for vital cash assistance. The social welfare department supposedly has Php6 billion budget for around 1.2 million beneficiaries. As of mid-December, only Php931 million has actually been disbursed to just 142,058 beneficiaries.

It is likewise with labor department emergency assistance of Php16.4 billion for around 800,000-1.4 million formal workers under CAMP, 500,000 informal workers under TUPAD, and 200,000 OFWs under AKAP. Only 350,000 workers have been reported to get assistance as of the first week of December.

The rigidity and obsession with creditworthiness unfortunately carries over into the New Year. The recently approved Php4.5 trillion national government budget for 2021 is 9.9% larger than the 2020 General Appropriations Act (GAA). This increase is smaller than the historical annual average increase of 11.1% since 1987. It is actually even smaller than previous budget increases of the Duterte administration in 2017 (23.6% increase) and 2020 (13.6%). So, again, there’s no stimulus there.

Devastating consequences

The Duterte government’s inadequate efforts are behind the extreme economic collapse and excessive suffering of tens of millions of Filipino families. The biggest blunder is the failure to contain COVID-19 – economic activity will remain repressed as long as the pandemic is raging. The administration diverts from this original sin whenever it invokes the false dichotomy between health and the economy.

The stingy fiscal response and inappropriate monetary measures come on top of that. The lockdowns and continued physical distancing have most of all caused household incomes, business investments and aggregate demand to collapse. These warrant a much larger fiscal response especially in terms of emergency assistance to households to improve their welfare and boost consumption spending in the economy.

Yet the economic managers were stingy in providing cash assistance under Bayanihan 1 – at the height of the draconian lockdowns – and only deign to give token amounts under Bayanihan 2 and in the 2021 national government budget. The trillion peso liquidity infusions gave the illusion of meaningful intervention but, with domestic and even global demand so weak, were really just pushing on a string with little or no results.

Measured as a share of GDP, the Philippines has the smallest fiscal response in Southeast Asia – which, along with the poor health response, goes far in explaining its experiencing the biggest economic contraction in the region. The economy is smaller today than it was in 2018, and will likely only return to its size last year at the earliest by 2022.

The insistence of the economic managers that the economy was going strong coming into the pandemic harkens to glory days that never were. Economic growth has been slowing in every year of the Duterte administration from 6.9% in 2016. This fell to 6.7% in 2017, 6.2% in 2018, and 5.9% in 2019. Average annual employment growth of 1.2% in 2017-2019 is the lowest in the post-Marcos era.

The number of employed Filipinos in 2020 has fallen to its lowest in four years. The 39.4 million reported employed Filipinos in 2020 (average for the whole year) is 2.6 million less than in 2019, and even less than the 41 million reported employed four years ago in 2016.

There were probably at least 5.8 million unemployed Filipinos and an unemployment rate of 12.7% as of October 2020, more than the official count of just 3.8 million if the nearly two million invisibly unemployed for dropping out of the labor force due to the pandemic shock are also counted. There were more unemployed Filipinos in 2020 at any time in the country’s history.

Domestic unemployment is bloated by displaced overseas Filipino workers (OFWs). The labor department reported over 680,000 OFWs seeking emergency assistance as of end-November. Deployments have also drastically collapsed with the 682,000 OFWs leaving in the first nine months of the year a huge 60% less than the 1.7 million deployed in the same period last year.

Household incomes are collapsing. Family incomes are only measured every three years with the last time this was done being in 2018. At the time, 17.6 million Filipinos were estimated to fall below the low official poverty threshold of about Php71 per person per day. In a worst case scenario of incomes contracting 20% without emergency cash subsidies, the Philippine Institute for Development Studies (PIDS) estimates the number to rise to as much as 29.7 million.

As it is, extrapolating from BSP Consumer Expectations Survey data, as much as 2.6-3.2 million households have had their savings wiped out by the pandemic economic shock. These are the vulnerable families whose income and livelihood losses were so large as to eat up their savings that were so low to begin with.

Lessons for 2021

The plight of tens of millions of Filipinos adversely affected by the pandemic and poor government response is not helped by the administration insisting that all is well.

The government could have pre-empted complete economic decline with a more rapid and effective health response as in Vietnam and Thailand. This remains the most urgent concern today. Unfortunately, despite relatively large numbers of COVID-19 testing, contact tracing and quarantining are lagging which means the coronavirus is still spreading. The vaccine-driven strategy is also not reassuring with emerging controversies around procurement, potential distribution bottlenecks, and self-serving preferential inoculation.

Economic distress in 2020 could also have been mitigated by a larger and better economic response of more emergency assistance, bigger support for MSMEs and domestic agriculture, and larger government spending on social infrastructure and services. These could also have been paid for with a more creative debt and finance mobilization strategy.

Instead, the Duterte administration’s poor health and economic response has resulted in the destruction of large swathes of service-oriented informal sector livelihoods, hundreds of thousands of displaced workers, reduced wages and benefits, worsened insecurity, MSME closures, and record joblessness. The wealthiest families and biggest corporations on the other hand will easily weather momentary income losses, with many even seeing their profits and market shares increase.

And yet despite a meager economic response, the budget deficit is soaring to record highs because of the collapse in revenues and continued misprioritization of infrastructure, militarism and debt service. Government debt is moreover bloating not to finance COVID-19 response but mainly to pay for unchanged government spending mispriorities.

The biggest economic lesson of 2020 is clear – the government has a vital role in economic development especially in times of crises. COVID-19 hit the entire world and the difference was in how each country dealt with it. The public has a right to decent governance which civil society groups and many other concerned Filipinos have been asserting throughout the year, many even at great risk to their lives and liberty.

Sustained administration disinformation and diversionary tactics seek to hide a plain fact: the government’s mismanagement of the pandemic and economy is behind the worst economic collapse in the region and in Philippine history. The coming year can be better only if the people keep working at changing the government and governance for the better.

As Rizal of course also asserted: “There are no tyrants where there are no slaves.” #

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

More LGBTIQ+, sex worker rights defenders attacked during COVID pandemic

There are more violence against LGBTIQ+ (lesbians, gays, bisexual, transgender, intersex, queer +) and sex worker rights defenders as the COVID-19 pandemic rages, an international human rights group revealed.

Ireland-based Front Line Defenders  said 50 human rights defenders (HRDs) protecting LGBTIQ+ communities and sex workers in 13 countries had been at risk between April and August 2020 when the pandemic had been at its worst.

“The results were stark. Activists around the world reported an increase in physical attacks, sexual assault, arrests, raids on their homes, and harassment by security forces during COVID-19,” the group said in a report last December 17, International Day to End Violence Against Sex Workers.

“Almost every week since COVID-19 began, we’ve received photos of violent attacks on the homes of LGBTIQ+ HRDs,” Erin Kilbride, researcher and author of the report, said.

The report said that apart from the virus itself, state responses to the pandemic have affected queer and sex worker communities in ways that worsen class, gender, sexual and racial injustices.

As they responded to emergencies, HRDs from these groups faced increasing risks of arrest, physical attack, and psychological trauma, Kilbride wrote.

Frontline Defenders cited Tanzania where it investigated a spate of attacks on activists’ homes after it became known locally that they were housing LGBTIQ+ people or sex workers at risk of homelessness, hunger and police violence on the streets.

Aside from the east African country, Frontline Defenders conducted fact-finding missions in Kyrgyzstan, Myanmar and El Salvador and interviewed respondents Tunisia, the United States, Ireland, Thailand, Malawi, the Dominican Republic, Indonesia, Zimbabwe, and Eswatini.

Also documented in the report are mass arrests at the offices of LGBTI rights organisations; closure of

HRD-run medical clinics; sexual harassment and detention of transgender HRDs at security checkpoints; homophobic and transphobic defamation portraying HRDs as spreaders of COVID-19; and severe psychological trauma over their inability to fully respond to the many dire needs of their communities.

 “The HRDs who gave their stories to this investigation are enduring violent attacks, raids on shelters, arrests, and rampant stigmatization for peacefully demanding access to food, shelter and healthcare for their communities during the pandemic,” the report said.

The group reported that activists around the world have turned their homes into emergency shelters for homeless members of the LGBTIQ+ and sex workers sectors, but have themselves endure severe physical, sexual and psychological trauma for helping their communities survive the pandemic.

“LGBTIQ+ and sex worker rights defenders have continued their critical, life-saving work during COVID-19 despite immense threats to their physical and psychological health. In addition to human rights advocacy and emergency response work, they are filling humanitarian gaps left by corrupt governments and discriminatory pandemic response programmes,” Front Line Defenders Executive Director Andrew Anderson said.

“Now more than ever, we affirm our call to end attacks on marginalized defenders doing life-saving work on the ground,” he added. # (Report and photo by Raymund B. Villanueva)

Surviving surgery in the middle of COVID-19

by Jose Lorenzo Lim

COVID-19 has struck the country’s healthcare system in a major way. The system became too overloaded that healthcare workers in August sought a two-week return to modified enhanced community quarantine (MECQ). Government has since been touting that the country’s active COVID cases are going down and that the healthcare system is unloading. But what was it like having a family member who needed minor life-changing surgery amid this pandemic?

Hospital 1

The night that we decided to take my grandmother to the hospital was when she nearly fainted, was feeling weak, and had a low heartbeat. It was already the second time that this happened. It was a night filled with questions – where do we take her? Is it COVID-19 free? Are they going to accept us? These were the things running through our heads when we decided to take her to our trusted family hospital (Hospital 1). There, even with the growing number of patients, there was an available slot in the intensive care unit (ICU) where they stabilized her. 

My grandmother’s cardiologist said that she needed a pacemaker to stabilize her heartbeat and bring it back to a normal level from 40 beats per minute to around 60 beats per minute. Pacemaker surgery would cost around Php250,000 for a single-chamber pacemaker alone. This does not yet include the professional fees of the doctors that would operate on my grandmother. Prices vary depending on the type of pacemaker – if it’s dual or single chamber, and if it can pass through a magnetic resonance imaging (MRI) machine. Additionally, payment would only be on a cash basis for the pacemaker.

My grandmother decided not to have the surgery and to just go home. She believed that the surgery was costly and not worth it given that she was already old.

Hospital 2

Just a few days after, she had another episode and nearly fainted again. This fell on the month of August when Metro Manila was put back on MECQ. We went back to Hospital 1, luckily was able to get another private room, and planned to have my grandmother get her surgery. Financially, it would cost around Php350,000 for the whole pacemaker operation which would have to be done at another hospital since Hospital 1 doesn’t have the facilities for this type of surgery. Before a surgery could take place, my grandmother had to get an RT-PCR swab test. Since she had to be operated on quickly, we had no choice but to avail of a Php12,000 test at the big hospital nearby (Hospital 2) that would show a result in 24 hours.

Hospital 3

My grandmother tested negative for COVID-19 with Hospital 2’s swab test. A negative result is said to have a validity period of only one week. On the day of her transfer to a medical center and hospital (Hospital 3) for the surgery, we paid Hospital 1 around Php100,000 for the doctor’s fee, private room, and medicines. We decided it was best that she have her surgery since the cost of her one-week hospitalization was like getting a pacemaker already. When we reached Hospital 3, they looked at her charts and found a problem. First, her doctor wasn’t really an affiliate at Hospital 3, and second, her chest x-ray showed some white particulates which is said to be an indication of COVID-19. Hospital 3 gave us two choices, either go home and treat the particulates or have a Php12,000 CT-Scan to check if it really is liquid in the lungs.

We took a gamble and went for the Php12,000 CT-Scan that does not have a senior citizen discount. They confirmed it was liquid in her lungs which could be indicative of COVID-19. We were stunned since she had already tested negative. We had no choice but to get her home, isolate her, find other options and rest.

The next day, we called her former cardiologist from Hospital 1 again. He just apologized and advised us to take her back to Hospital 1 because at her age she needed medical attention. My grandmother returned to Hospital 1 but was told that all COVID-19 isolation rooms were full. The accounting department told my dad that her only choice was to go to a tent that would cost around Php100,000 for a three-day stay inclusive of doctors’ fees. Of course, my grandmother chose to come home and continued her isolation.

Hospital 4

Luckily, we knew someone from another medical center (Hospital 4), a public hospital. Through connections, we were put in the emergency room. The plan was to get my grandmother to test negative for COVID-19 and find her a new cardiologist so she could be operated on. If she tested positive for COVID-19, then she would be admitted to the COVID-19 ward of Hospital 4. It was like going through a limbo of uncertainty.  While waiting for the result, my grandmother and father stayed at the emergency room and were transferred two days later to the COVID-19 isolation ward once a room was available. Eventually, my grandmother tested negative for COVID-19.

Of course, Hospital 4 did not have any private rooms so she had no choice but to go to the ICU where she met her new cardiologist who was affiliated with yet another medical center (Hospital 5). They quoted around Php500,000 for the whole operation with a single-chamber pacemaker.  We immediately agreed and scheduled the operation with the doctor. We left Hospital 4 with a total bill of around P10,000 which was reduced due to PhilHealth and a senior citizen discount.

Hospital 5

The transfer from Hospital 4 to Hospital 5 was smooth since there was proper coordination between the two hospitals. Of course, before being operated on, my grandmother had to undergo her third and hopefully last swab test. After getting her swab test, she was transferred to the COVID-19 isolation room and got her result in 24 hours. The test cost around Php2,500, which was way less than at Hospital 2.

After her negative result, her new cardiologist immediately decided to push through with the operation. The operation was successful. However, there were no private wards available and she ended up at the ICU again. After two days, she was discharged from the hospital and allowed to go home.

Health neglect

The experience of going back and forth to various hospitals was hell. This is what patients who need surgery are going through. If you have symptoms of cough or colds, then you are immediately tagged as a COVID-19 suspect and would have to go through anxieties on top of being sick. If you don’t have money, you won’t be fixed. We were very fortunate enough to have my aunt, uncle, and other family members to financially support us through this.

A family of five living under minimum wage wouldn’t be able to afford getting a pacemaker. While I do understand that each hospital has its own set of protocols, the additional cost of swab tests is really hard especially if you don’t have enough money. I can’t imagine the number of patients who have to delay their life-saving surgery due to the overcrowding at hospitals and the burden of producing money for the operation itself. I would even call it criminal negligence on the government’s part for not immediately addressing the COVID-19 situation of patients who need surgery.

PhilHealth and a senior citizen discount really helped to lower my grandmother’s hospital expenses, but then again the situation at Hospital 4 was that they didn’t have the facilities to carry out pacemaker surgery. The government should invest in our public hospitals so that they are able to do these minor surgeries. Patients are forced to go to private hospitals just to get a pacemaker implanted. We were shocked at the Php10,000 bill of Hospital 4 and I think that if government invests funds in our healthcare system then more patients would be able to access and afford life-saving operations.

In the end, its priorities will still depend on government’s political will or lack of it. The government could invest in social services, especially health, instead of allotting Php19 billion to fund a deceptive and destructive National Task Force to End Local Communism and Armed Conflict (NTF-ELCAC). The latter, which has been on a spree of terrorist-tagging activists and progressive personalities and institutions, appears to still be the government’s priority even while COVID-19, typhoon relief operations, and even the economic downturn, warrant much urgent and greater attention. #

Jose Lorenzo Lim is a researcher at IBON Foundation. His research topics include Build, Build, Build, the oil industry, and social services. Prior to IBON, he served as Editor-in-Chief of the UPLB Perspective for the academic year 2016-2017. When not in the office, Jose Lorenzo enjoys writing with his fountain pens and trying out new ink.

Duterte gov’t fails to meet its human rights obligations amid the pandemic

by IBON Media & Communications

The Philippine government is a signatory to the International Covenant on Economic, Social and Cultural Rights (ICESCR). The covenant obliges the government to take measures to prevent or at least mitigate the impact of the pandemic. Its gross failure to do so is leading to unprecedented but preventable suffering for millions of Filipinos.

The country’s poorest and most marginalized are being left behind by the COVID-19 response of the Duterte administration. On the other hand, wealthy creditors are protected and large corporations including foreign investors are getting their profits boosted.

COVID-19 spreading

The Duterte administration’s inability to contain COVID-19 is the clearest sign of its failure to address the pandemic. In Southeast Asia, Vietnam and Thailand show that an effective government response is possible. Yet the Philippines, adjusting for population size, has the second most number of COVID cases next to small city-state Singapore, and the most number of deaths.

The Philippines has over 4,000 cases per million population (more than double the regional average of around 2,000), and nearly 80 deaths per million population (more than triple the regional average of 26). This is despite the longest and harshest lockdowns and quarantine measures in the region.

Emergency aid falling

The government’s refusal to give meaningful aid is causing unparalleled suffering. The latest labor force survey reported 3.8 million unemployed Filipinos and an unemployment rate of 8.7% in October. IBON however estimates the real number to be at least 5.8 million, with an unemployment rate of 12.7%, if those who were forced out of the labor force by the pandemic or discouraged by the obvious lack of work are also counted. Earlier, private opinion surveys already reported 7.6 million families going hungry.

At least 12-13 million Filipino families, or the poorest half of the population, are facing economic distress because of the pandemic and the worst economic collapse in the country’s history. The administration’s Bayanihan 2 however gives emergency aid to at most around 3.3 million families, who are even getting just half as much cash subsidies as supposedly given under Bayanihan 1.

This is because the economic managers refuse to spend on emergency aid for poor and vulnerable families and only allowed a token Php22.8 billion under Bayanihan 2. This is a far cry from the Php238 billion in aid under Bayanihan 1 which has already been used up by beneficiary households. It is even worse in the proposed 2021 national government budget where pandemic-related aid falls to just Php9.9 billion.

As it is, with only nine days left in the effectivity of Bayanihan 2, the social welfare department has only given one-time emergency subsidies to a mere 64,839 beneficiaries at an average of just Php6,720 per family. The labor department meanwhile has only given CAMP support to around 350,000 workers.

The Duterte administration’s so-called emergency assistance is so small that it is just a token measure to give the illusion of responding. Tens of millions of Filipinos are not getting any help causing millions to go hungry and sink deeper into poverty.

Corporate profits rising

The government is also making inequality worse. While millions of poor families are neglected, large corporations including foreign firms are going to get hundreds of billions of pesos in additional profits over the coming years from big corporate income tax cuts.

Disregarding the critical need for revenues to respond to the pandemic, the economic managers pushed their Corporate Recovery and Tax Incentives for Enterprises (CREATE) Act and even dishonestly presented this as a COVID-19 stimulus. This is a willful violation of the obligation to mobilize the necessary resources for responding to serious health and economic distress from COVID-19.

Rights being violated

The proposed 2021 budget also violates human rights. The state has an obligation to devote the maximum available resources to combat COVID-19 and the economic crisis in the most equitable manner.

However, the 2021 budget fails to allocate resources in a way that prioritizes the public health crisis and the economic burdens the poor are facing. The proposed 2021 budget spends less on health and on emergency aid than in 2020. On the other hand, the budgets for infrastructure, military and police, and debt servicing all increase. Next year’s budget does not protect poor and vulnerable groups nor mitigate the impact of the pandemic on them.

The Duterte administration’s contempt for human rights is complete. It violates civil and political rights with its systematic political repression and killings of activists and alleged drug offenders. With its neglectful pandemic response, it also violates the social and economic rights of tens of millions of Filipinos. The country is even further away from the full and equal enjoyment of the social and economic rights enshrined in the ICESCR and even in the 1987 Philippine Constitution. #

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

PH labor market rebounding but not recovering – IBON

In reaction to the statement of the National Economic and Development Authority (NEDA) upon the release of the recent labor force survey, research group IBON said that the labor market rebounding as lockdown restrictions are eased should not be mistaken as ‘recovery’. More than people returning to work, the term should mean returning to the same levels of employment as before. Recovery can only happen with substantial economic stimulus including sufficient government financial assistance or emergency subsidies to workers affected by the pandemic, IBON said.

The official unemployment rate according to the Philippine Statistics Authority (PSA) is 8.7% or about 3.8 million unemployed in October 2020. NEDA compares the October unemployment figure with those of previous quarters (10% in July and 17.6% in April) to show as a sign of recovery.

But IBON noted that the number of employed fell by 2.7 million to 39.8 million in October 2020 from 42.6 million in October last year. The group also noted that labor force participation rate (LFPR) has fallen to a remarkably small 58.7% in October 2020, causing the labor force to shrink by 933,000.

IBON estimated a different unemployment figure.According to the group, if LFPR in October 2020 stayed at its 61.4% level in October 2019, the labor force would be around 45.6 million, which is 1.98 million more than officially reported.

IBON added this 1.98 million, which it referred to as invisibly unemployed, to the officially reported 3.81 million, bringing the real number of unemployed to 5.79 million and the real unemployment rate at 12.7 percent.

The group also said that though underemployment rate fell to 14.4%, this does not indicate that the quality of work has improved. This is most likely, IBON said, because many of the employed have stopped searching for work due to pandemic conditions and lack of job prospects with many small businesses closing down.

The group pointed out that the inability of the economy to recover thus affecting job creation is hugely due to the lack of a substantial economic stimulus. This pertains to government spending that can arrest economic decline through increased or revitalized economic production and strengthened consumers’ purchasing power.

But government’s response is too little for such a huge economic decline, IBON said. The Php165.5-billion Bayanihan 2 is niggardly for urgent attention areas such as health system recovery, financial aid to vulnerable sectors and support for agriculture and small businesses. IBON also hit the 2021 proposed national budget, that except for tokenistic allocations, is no longer providing socioeconomic relief to workers and financial assistance to agriculture and MSMEs.

Meanwhile, government’s economic managers are determined to retain the huge Php1.1 trillion budget allocation for infrastructure development as their main stimulus program and to propose corporate income tax cuts through the passage of the Corporate Recovery and Tax Incentives for Enterprises (CREATE) bill.

Recovery cannot happen with such government neglect of labor and the economy, IBON said. Scrimping on meaningful economic stimulus prevents the health system to cope with the pandemic and the workers to return to work. It also leaves behind the more basic economic sectors of agriculture and domestic manufacturing in creating more meaningful jobs, IBON added.

The economy may indeed recover from its collapse. But like such ‘recoveries’ of the past when no meaningful government intervention took place, it would take a while, if at all, for jobs and incomes to be fully recovered and improved, said the group. #

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

Promotion, protection of breastfeeding practices reap rewards

By Angelica Carballo Pago/Philippine Center for Investigative Journalism

Exclusive breastfeeding among infants 0 to 5.9 months has nearly doubled, from 30 percent in 2003 to 58 percent in 2019.

Women should still breastfeed despite the pandemic, even those found to be positive for Covid-19, according to a Department of Health (DOH) memorandum. This shows how the government has been relentless in promoting breastfeeding in the face of a formidable opponent – milk manufacturing giants who have made their way into the consciousness of Filipino mothers through massive advertising.

Despite the passage of the Milk Code 33 years ago, myths and unfounded beliefs persist amid aggressive promotions by milk manufacturers that claim to give a child advantage in terms of health and IQ points.

Only 35.1 percent of babies are exclusively breastfed until 5 months of age, according to the 2019 Expanded National Nutrition Survey of the Department of Science and Technology – Food and Nutrition Research Institute (DOST-FNRI), although exclusive breastfeeding percentages have been increasing since 2003, but took a dip in 2015.

Nathalie Verceles, director of the University of the Philippines Center for Women’s and Gender Studies, said the Milk Code was meant to protect the interest of mothers and babies from aggressive marketing strategies of formula milk companies. (See related story: Milk and the pandemic: Milk Code confusion cripples LGUs response for infants)

Mothers need support, according to Save the Children Philippines health and nutrition adviser Dr. Amado Parawan. A mother’s decision to breastfeed, he said, predates the birth of the child and will depend on what she believes – or is made to believe. This decision can also be affected by the support she gets – or doesn’t get – from home, work and community.

Maryjoy Mota shows the bottle used to feed baby Pia, when her family was able to scrape a few hundred pesos to buy formula milk. Photograph: Buck Pago

Here’s a timeline of breastfeeding policies and how they have influenced breastfeeding rates.

May 1981 – The International Code on Marketing of Breastmilk Substitutes is adopted by the World Health Assembly. The aim is to protect and promote breastfeeding by ensuring appropriate marketing and distribution of breastmilk substitutes.

20 October 1986 – President Corazon Aquino signs Executive Order 51 or the Milk Code with its Implementing Rules and Regulations (IRR). The Code regulates advertising of breastmilk substitutes, including infant formula, other milk products, foods and beverages, feeding bottles and teats.

1990 – Guided by the World Health Assembly resolutions, which state that “follow-on or follow-up formulas are unnecessary because after six months the baby starts to take complementary foods together with sustained breastfeeding,” improvements were introduced on the IRR, such as the ban on follow-on formulas. This was prompted by the 1987 Wyeth’s invention of follow-on milk for children aged six months and above that undermined the importance of breastfeeding. When the Milk Code was being drafted, follow-on milk was not yet invented. “Complementary food” includes food that is part of the local culture.

2 June 1992 – The Rooming-In and Breast-Feeding Act, Republic Act (RA) 7600, is passed, provides legal basis for rooming-in as a national policy to encourage, protect and support breastfeeding.

2003 – The exclusive breastfeeding percentage among infants 0-5.9 months stands at 29.7 percent.

2004 – The Task Force Milk Code begins discussion and debate on the first draft of the revised IRR of the Milk Code. Among those consulted was Swiss multinational Nestlé, who represented formula milk companies.

23 May 2005 – DOH Administrative Order (AO) 2006-0014 or the National Policies on Infant and Young Children is issued. It states that in times of crisis, breastfeeding is the first and best feeding option for infants and young children. It requires mothers and babies to remain together after delivery. Support must be given for mothers to breastfeed even in crisis or emergencies.

2006 – The Pharmaceutical Healthcare Association of the Philippines (PHAP) seeks a temporary restraining order on the revised IRR’s implementation. After initially denying PHAP’s petition, the court overturns its decision and issues a TRO on the revised IRR.

28 May 2007 – DOH AO 2007-0017 or the “Guidelines on the Acceptance and Processing of Foreign and Local Donations during Emergency and Disaster Situations,” states that “Infant formula, breastmilk substitutes, feeding bottles, artificial nipples and teats shall not be items for donation. No acceptance of donation shall be issued for any of the enumerated items.”

09 October 2007 – The revised IRR of the Milk Code takes effect after the Supreme Court partially upholds its validity. It strikes down certain provisions, such as the prohibition on advertising and promotion of breastmilk substitutes and introduces sanctions not found in the law.

01 April 2008 – The Department of the Interior and Local Government releases AO 2008-0055, or the “Guidelines on the acceptance and processing of foreign and local donations during emergency and disaster situations.” It endorses DOH AO 2007-0017 to all local government units.

2008 – The exclusive breastfeeding percentage among infants 0-5.9 months rises to 35.9 percent.

16 March 2009 – RA 10028 or the Expanded Breastfeeding Act, which amends RA 7600, is signed by President Gloria Macapagal Arroyo. It establishes standards for workplaces, health facilities (with the establishment of milk banks) and public places, and calls for breastfeeding breaks and designated facilities in the workplace.

Infographic by Alexandra Paredes

2011 – The exclusive breastfeeding percentage among infants 0-5.9 months rises anew, to 48.9 percent.

21 December 2012 – RA 10354 or The Responsible Parenthood and Reproductive Health Act of 2012 is signed by President Benigno Aquino III. It includes breastfeeding as an element of reproductive health care and provides a basis for breastfeeding promotion and education.

2013 – More than half, or 52.3 percent, of infants 0-5.9 months are exclusively breastfed.

2015 – The exclusive breastfeeding percentage among infants 0-5.9 months dips for the first time to 48.8 percent.

29 November 2018 – RA 11148 or the “Kalusugan at Nutrisyon ng Mag-Nanay Act” is signed by President Rodrigo Duterte. The law seeks to address the malnutrition of infants and young and lactating women.

2018 – The exclusive breastfeeding percentage among infants 0-5.9 months recovers slightly to 54.9 percent.

17 April 2019 – RA 11311 or “An Act to Improve Land Transportation Terminals, Stations, Stops, Rest Areas and Roll-On/Roll-Off Terminals, Appropriating Funds Therefor and for Other Purposes,” establishes lactation stations in transport terminals, stations, stops and rest areas.

2019 – Exclusive breastfeeding improves to 57.9 percent.

Infographic by Alexandra Paredes

11 May 2020 – DOH Memorandum No. 2020-0237 or the “Interim Guidelines for the Delivery of Nutrition Services in the Context of COVID-19 Pandemic” states that mothers who are asymptomatic, or those with close contacts, suspect, probable, or confirmed case of COVID-19 who do not have severe illness and/or who are not in respiratory distress, can continue breastfeeding, provided that they observe strict infection control measures.

15 May 2020 – DOH Memorandum No. 2020-0231 or the “Guidelines on the Standardized Regulation of Donations, Related to EO 51,” provides guidelines on how LGUs can help provide nutrition for non-breastfeeding children under 3 years old. While donations are banned as stipulated in various laws and orders, LGUs can procure formula milk and give them to identified families. The memorandum still upholds the promotion and protection of breastfeeding for infants and young children. #

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Sources:

Food and Nutrition Research Institute for breastfeeding data

Babymilkaction.org for Milk Code RIRR timeline

Milk and the pandemic: Milk Code confusion cripples LGUs response for infants

By Angelica Carballo Pago/Philippine Center for Investigative Journalism

The indiscriminate distribution and use of breastmilk substitutes, especially during emergencies, can change feeding practices and put babies at greater risk of illness.

What you need to know about this story:

  • Experts are calling for measures to ensure the health and safety of infant and young children, which can easily be undermined by the milk industry’s aggressive marketing initiatives.
  • The Milk Code does not ban formula milk procurement and distribution by local government units, provided they follow guidelines set by the Department of Health (DOH).
  • Marketing and advertising of products within the scope of the Milk Code, however, are prohibited. Donations of formula milk and breastfeeding substitutes from manufacturers and distributors of these products are banned.
  • Local government units are clueless to the finer details of breastfeeding and infant and young child nutrition laws, to the detriment of mothers, infants and young children in need especially during the current Covid-19 crisis.
  • Milk companies use disasters and crises to market their products, and DOH data show a rise in Milk Code violations during the enhanced community quarantine period.

Here’s one unintended consequence of the Covid-19 health emergency: Parents and guardians are desperately finding ways to feed their babies, with some even begging on the streets or on social media. With lockdowns making it harder to provide proper and adequate food for the family, their health and nutrition — especially of babies — are at risk.

Local governments attempted to solve the problem by distributing formula milk to mothers, only to find out that donations are not allowed by the Milk Code, a 1986 law regulating the marketing and distribution of breastmilk substitutes.

Worse, formula milk makers seem to be taking advantage of the situation to undermine strict government regulations, experts observed.

During the Enhanced Community Quarantine (ECQ) in March, Maryjoy Mota, a 37-year-old resident of Antipolo, posted on the Antipolo City Facebook group that her two-month-old granddaughter needed diapers and formula milk.

Maryjoy’s daughter, 17-year-old Hazel, had just given birth to Pia (not their real names), two weeks before the ECQ was enforced throughout Luzon in mid-March. Maryjoy’s post drew a hundred other comments from mothers and guardians in the same situation.

With Hazel giving birth to Pia two weeks ahead of her due date, the doctor immediately prescribed a formula milk brand, PreNan, developed for premature newborns. Weighing just 1.7 kilograms, the baby had to be placed in an incubator.

“We were not given any other options or brands, nor given any instructions or assistance to start breastfeeding,” Maryjoy said.

Even when Hazel went for check-ups at the barangay and the district health centers before she gave birth, there were no instructions on breastfeeding, which could have helped them save some money instead of spending it on formula milk, she said.

Maryjoy’s comment on Antipolo City’s Facebook page, asking for milk and diapers for her grandchild.

Sought for comment, an official of the Rizal Provincial Hospital System – Antipolo Annex 1, who asked not to be named, insisted that the hospital followed breastfeeding protocols. But Pia weighed below the 2.5-kilogram birth weight threshold and showed signs of sepsis, the official said.

The formula milk prescribed to Pia met the baby’s caloric requirements, which might not be sustained by breastfeeding, the official said.

But with no income, it was impossible to buy the 400-gram can of milk, which costs P641. Maryjoy’s common-law husband, Ricky, lost his construction job because of the pandemic, while Pia’s parents were unemployed teenagers.

While some local leaders were aware of the plight of new mothers like Hazel, the Milk Code posed an obstacle. Sangguniang Kabataan Chairman Arky Manning of Barangay San Isidro in Taytay, Rizal learned this the hard way.

The Department of Health (DOH) gave Manning a memo for violating Executive Order (EO) 51, or the Milk Code of 1986, by “accepting and distributing milk formula donations” given to mothers with infants in Taytay in April and May 2020.

Manning explained that it was part of the “Tulong Kay Baby (help for baby) project,a donation drive that he had organized with his friends. They bought milk and diapers using funds given by private individuals. No mass distribution or random donation of milk happened, he claimed.

Manning was one of the 291 violators flagged by the DOH from March 1 to July 24, largely covering the ECQ period in Luzon. Reports of violations came from the general public, submitted through http://mbfp.doh.gov.ph. MBFP, which stands for DOH’s Mother and Baby-Friendly Philippines, is the reporting platform for violations of the Milk Code and the Expanded Breastfeeding Act of 2009 (Republic Act 10028).

The list of violators included health workers, non-profit organizations, and local executives such as Manning, and Mayors Andrea Henares of Antipolo City and Marcy Teodoro of Marikina City.  Also on the list were celebrities such as Say Alonzo and Marian Rivera Dantes, who together with Nido, a brand that Dantes endorses, and the YesPinoy Foundation, were reported to have distributed follow-on formula. Dantes even posted it on Instagram to her 9.4 million followers.

EO 51 issued by former President Corazon C. Aquino, otherwise known as the Philippine Milk Code of 1986 or simply, the Milk Code, regulates the marketing of breastmilk substitutes, including milk formula, breastmilk supplements and other similar products by prohibiting the advertising and promotion, whether written, audio or visual, for such products. It adheres to the International Code on Marketing of Breastmilk Substitutes, adopted by the World Health Assembly in May 1981. Breastfeeding advocates have hailed the Milk Code as one of the strongest breastfeeding protection laws in the world.

The Milk Code’s Revised Implementing Rules and Regulations (RIRR), released 30 years after the law was signed, prohibits the donation of infant formula and breastmilk. Administrative orders from the DOH and the Department of the Interior and Local Government (DILG) further disallow the donation of infant formula milk and breastmilk substitutes in times of disasters and calamities.

According to data from the Food and Nutrition Research Institute, exclusive breastfeeding rates have continuously gone up in the last 10 years, reaching 57.9 percent in 2019. The global exclusive breastfeeding rate stands at 41 percent. The United Nations targets to increase global breastfeeding rates to 50 percent by 2025. (See sidebar: Promotion, protection of breastfeeding practices reap rewards)

Marketing is prohibited, the milk is not

Health Undersecretary Maria Rosario Vergeire said the law did not bar local government units (LGUs) from procuring formula milk.

“If local government units procure formula milk, the law does not cover it. EO 51 is a regulatory tool used by the Department of Health to regulate the advertisement of manufacturers that formula milk is more important than a mother’s milk. That’s our first objective — we would like to know that breastmilk is still the best for babies,” she said.

DOH Memorandum No. 2020-0231, dated May 15, 2020, laid down the guidelines on the standardized regulation of donations covered by the Milk Code. Formula milk and breastmilk substitutes can still be provided to those in need, with the following conditions:

  1. The local government unit buys it using its own budget (procurement);
  2. Breastmilk should still be the first choice and the procured formula milk is given to identified mothers/infants, not distributed en masse;
  3. Distribution, preparation and use of breastmilk substitute and formula milk must be done under the supervision of health and nutrition workers;
  4. There should be no brand name, logo or identifiable marks of the manufacturer; and
  5. No public relations, announcement or the likes may occur.

Dr. Mianne Silvestre, executive director of Kalusugan ng Mag-Ina (mother’s health) Foundation, echoed Vergeire’s explanation.

“The Milk Code is there to regulate the marketing and advertising of formula milk and breastfeeding substitutes, and not to penalize parents who give these products to their children,” Silvestre said. “Nobody goes to jail for feeding formula milk to their babies.”

Sharing a similar view, Dr. Paul Zambrano, a technical specialist at Alive and Thrive, a private initiative to reduce child undernutrition by improving infant and young child feeding practices, said: “Marketing (of formula milk and breastmilk substitutes) will undermine the practice of breastfeeding and complementary feeding with healthy food after six months. It’s meant to save lives. It is meant to prevent the top killers of children in that age group – diarrhea and pneumonia. ”

The problem, Silvestre said, was that formula milk was being marketed as the first option instead of breastfeeding. This goes against the hierarchy of infant feeding choices laid out in the Global Strategy for Infant and Young Child Feeding published by the World Health Organization (WHO), which states that donated breast milk from a wet nurse or milk bank takes precedence over formula milk.

Infographic by Alexandra Paredes

Even for Covid-19 positive mothers, the WHO still recommends continued breastfeeding and rooming of babies with their mothers. Transmission of Covid-19 through breastmilk or breastfeeding has not been established.

No guidance for LGUs

What can and cannot be done under the code does not seem to be clear to local governments, even to the DILG. In an interview with PCIJ, Interior Undersecretary Jonathan Malaya, affirmed that the ban extends to selective distribution of milk to identified mothers and babies and referred to the National Nutrition Council website for guiding policies.

Taytay’s Manning said no guidance came from any government agency, particularly the DOH or DILG, on how they could respond to the needs of mothers and their babies.

During the quarantine, local officials, such as Quezon City Councilor Ariel Inton, repeatedly appealed to the DOH to lift the ban on milk donations.

In a Facebook livestream, Inton, a lawyer, gave practical advice to barangay officials planning to distribute formula milk to their constituents. “Tell them that you are handing it out as loans or ask for coins so they won’t say it’s a donation, so you can give the children something to eat,” Inton said.

For Ynares, while the Milk Code has an important purpose, it can also be a “bane during crisis.”

“It poses a huge challenge for families and the government to provide essential nutrition required for child growth and development particularly during extraordinary times,” the Antipolo City mayor said.

A National Nutrition Council advisory said that LGUs should consider that some recipients of pandemic relief goods have young children and pregnant and lactating mothers. Families are supposed to be monitored by Barangay Nutrition Scholars and Barangay Health Workers, who will provide them with low-cost, one dish-meal recipes as well as recipes utilizing their relief goods.

But Maryjoy said there were no vegetables and nutritious food in their relief packs. The lack of proper nutrition may have affected her daughter Hazel’s milk supply, she said.

“The first relief pack we received had three kilos of rice, two cans of sardines, and two Lucky Me noodles,” she said.

There was one instance, Maryjoy said, when her family received a few kilos of rice and 16 pieces of dried fish (tuyo). To increase Hazel’s milk, Maryjoy bought malunggay and cooked it with noodle soup.

While the DOH had specifically instructed that assistance should be provided to breastfeeding mothers, Maryjoy said no one from her barangay came to ask how her daughter and granddaughter were doing. “They only gave me a 150-gram pack of powdered Bear Brand milk, only for her to drink, but none for the baby,” Maryjoy recalled.

The usual relief pack distributed by LGUs during the quarantine period contained a few kilos of rice, canned goods and instant noodles. The nutrition council however urged LGUs to include dark green and yellow vegetables; root crops; legumes, beans and seeds; fruits; poultry and eggs; meat or fish; and pasteurized fresh milk.

Only a few cities and municipalities were able to distribute fresh produce.

Maryjoy shows the 150-gram pack of powdered milk she received after lining up at the barangay hall. She believes the lack of nutritious food affected Hazel’s (not her real name) milk supply. Photograph: Buck Pago

“We are in a crisis situation, and even the government’s hands are tied because of supply chain problems. The local government units have to procure thousands and thousands of produce to give to their constituents who need it not now, but yesterday. That is the limitation, and we understand when canned goods are distributed given the situation,” said DILG’s Malaya.

Malaya pointed out that on top of the relief packs given to households, a one-time cash assistance was given in the form of the Social Amelioration Program (SAP).

“The family can go to the market and buy what they think is nutritious food for lactating mothers. The government has already provided funds for them and they can make that choice if they wish to,” Malaya said.

But for Maryjoy, the SAP she received had to be divided among three households.

The P6,500 is to be divided among three families, with each receiving P2,000, but I get to have the extra P500 because it was I who lined up for that money,” Maryjoy said. Most of what she got eventually went to repaying debt incurred when her husband lost his job.

Milking disasters

Breast or bottle? This question remains contentious. Since the Milk Code was enacted in 1986, the milk industry has taken advantage of every possible loophole to undermine the law. When the Milk Code took effect in 1987, international milk manufacturing company Wyeth invented the follow-on formula for babies six months old and beyond.

The Milk Code’s implementing rules and regulations (IRR) were revised to include a ban on advertising follow-on formula in 1990. A revised IRR was drafted in 2006, adding further safeguards 30 years after the Milk Code was signed, but this was challenged all the way to the Supreme Court.

A report released in May 2020 by WHO, United Nations Children’s Fund and the International Baby Food Action Network said that despite the pandemic, milk companies continued to skirt laws in many countries and continuously promoted their products.

“There is no guarantee that these donations will occur over the long term,” said Dr. Nathalie Africa-Verceles, director of the University of the Philippines Center for Women’s and Gender Studies. “The intention really is to introduce the product and to generate dependence with the belief and the hope that women will continue to patronize the products that they were provided for free initially.”

Studies have shown that mothers exposed to breastmilk substitutes were highly likely to abandon breastfeeding, and the indiscriminate distribution and use of formula milk put infants at greater risk of illness, which might be fatal.

A study in Indonesia in the aftermath of the May 2006 earthquake in Yogyakarta and Central Java found that the distribution and use of breastmilk substitutes resulted in changes in feeding practices. Uncontrolled distribution of infant formula exacerbated the risk of diarrhea among infants and young children during the emergency, the study found.

“(The Milk Code) is very relevant because let’s look at what the companies do during times of emergencies, they use it to try to market the product,” said Zambrano.

DOH data confirmed these observations. The health department noted that a rise in reports of Milk Code violations from the public began to occur in the week when the strict lockdowns  began, peaking during the week of April 6 to 12 with 90 cases.

Infographic by Alexandra Paredes

Apart from solicitations, there were product advertisements, such as Marian Rivera-Dantes’ Instagram post. Corporate and private donations also happened online, mostly through Facebook posts, according to the DOH data.

Zambrano pointed out that the relevance of the Code had always been questioned during emergencies. He recalled a situation in Cagayan de Oro after typhoon Sendong in 2011 when distribution of formula milk became rampant.

Silvestre downplayed the matter and said only a few mothers were unable to breastfeed their babies due to medical or physical reasons.

“These few cases are being hyped up to rationalize the lifting of the prohibition during emergencies. When in fact, it is during emergencies when we should intensify the protection of mothers to enable them to breastfeed their babies,” Silvestre said.

Formula milk manufacturers have been accused several times of unscrupulous means of advertising their products, targeting mostly low-income families or those who can least afford their product.

A 2018 report from Save the Children Philippines revealed that baby formula brands in the Philippines are using “aggressive, clandestine and often illegal methods” to get poor mothers to choose their product over breastfeeding.

Hospital staff also gave brand-specific recommendations to mothers who had just given birth, clearly a violation of the Milk Code. The report named Nestle, Abbott, Mead Johnson and Wyeth as the companies who are using these illegal tactics.

All four companies denied the allegations in separate statements sent to the Guardian in 2018.

Cheapest, but not the best

Hazel is helping her mother with their online selling business, earning a few extra pesos to help augment their family’s income. She expects breastfeeding to be temporary and will likely go back to feeding Pia formula milk.

Maryjoy said they had begun feeding Nestogen One to Pia, the cheapest in the market at P78 per box. It wasn’t prescribed by the doctor.

“But Pia doesn’t want it, she won’t swallow it,” Maryjoy said.

As Hazel handles deliveries and client meet-ups for their online selling business, Maryjoy has no choice but to give Pia formula milk. 

“I need to go back to school,” Hazel said.

Asked where they will get the money to buy formula milk, Hazel shrugged. –PCIJ, October 2020

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Editor’s Note: The real names of Hazel and her baby, Pia, were not used because they are minors.

Proposed 2021 health budget shrinks, neglects public health–IBON 

by IBON Media & Communications

Research group IBON said that the lower budget for the public health in the proposed national government budget for 2021 will keep health care inaccessible and expensive for too many Filipinos. The pandemic highlighted the lack of capacity in the privatized health system. IBON however criticized the merely fleeting increase in health spending and the cuts next year in important health areas.

The Department of Health’s (DOH) budget is at least Php171.5 billion in 2020, consisting of the Php104.5 billion under the General Appropriations Act (GAA) 2020, Php49 billion under the Bayanihan 1 law, and at least Php18 billion under the recently passed Bayanihan 2 (RA 11494). IBON noted that the proposed Php131.7 billion DOH budget for 2021 is Php39.8 billion or 23.2% less than this.

IBON said this indicates a merely short-term response to the pandemic and an unchanged trajectory of health privatization including allowing the public health care system to whither away. In particular, health infrastructure spending and support for public hospitals are seeing large cuts next year.

The proposed 2021 budget for the Health Facilities Enhancement Program (HFEP) covering the building of health infrastructure and purchase of medical equipment is just Php4.8 billion. This is 62.9% less than this year’s Php12.9 billion budget composed of Php8.4 billion under the GAA 2020 and Php4.5 billion under Bayanihan 2. 

The HFEP budget has actually been falling steeply under the Duterte administration in the regular GAAs even before the pandemic, IBON pointed out. It was Php30.3 billion in 2018, Php15.9 billion in 2019, then Php8.4 billion in 2020. The group also noted that the government’s Php1.1 trillion infrastructure program for 2021 only allots Php2.3 billion or one-fifth of one percent (0.2%) to the DOH, which is also a 36.7% cut from the GAA 2020. 

Health privatization-driven budget cuts for public health facilities like this have already caused public hospitals numbering 730 in 2010 to fall to just 433 in 2018.

The proposed 2021 budget for health workers and supporting the operation of DOH hospitals also falls by Php1.7 billion or a 2.6% cut, from Php64.3 billion in 2020 to Php62.6 billion next year. This is because the Php12.6 billion increase in Human Resource for Health (HRH) and DOH hospital budgets in the GAA 2021 from GAA 2020 is off-set by the discontinuing of Php13.5 billion in fleeting support under Bayanihan 2.

The government has played up how the 2021 budget for Human Resources for Health (HRH) Deployment increases to Php16.6 billion from Php10 billion in 2020 to hire 26,035 health workers. This seems urgent because the government doctor-to-population and government nurse-to-population ratios have been worsening under the Duterte administration, between 2016 and 2018 – from 1:32,644 to 1:33,909 doctors and from 1:17,269 to 1:17,769 nurses.

However, the health sector group Alliance of Health Workers (AHW) has pointed out how this increase is only temporary and does not indicate a sustained increase in health workers for the public health system. They highlight that 14,553 DOH plantilla positions will still remain vacant in 2021 with public hospitals still understaffed and government health personnel still overworked over the long-term.

AHW also points out that 23 of 66 DOH hospitals, which many of the poor depend on, will see their maintenance and other operating expenses (MOOE) budgets cut by Php4 million to as much as Php209 million. IBON meanwhile noted how the budget of two COVID-19 referral government owned- and -controlled (GOCC) hospitals will also be cut next year. The Lung Center of the Philippines sees a 2.9% budget cut to just Php405 million in 2021, and the Philippine Children’s Medical Center (PCMC) a 13% cut to just Php1 billion.

The budget of the Epidemiology and Surveillance program that is crucial in controlling the spread of diseases through timely data and research has already been cut by over 50% from Php263 million in 2019 to Php116 million in 2020. Yet despite its obvious importance in dealing with pandemics, IBON said, government proposes to reduce it further to Php113 million in 2021.

The budgets for the National Reference Laboratories (NRL) and Health Information Technology (HIT), which are vital in detecting, testing, databasing and reporting coronavirus cases and other emerging diseases, are also slashed.  The proposed allocations for NRL and HIT decrease from Php326 million to Php289 million, and Php1.2 billion to Php97 million, respectively.

The second biggest chunk of the proposed 2021 health budget, or Php71.4 billion, still goes to the Philippine Health Insurance System or PhilHealth. While noting recent corruption controversies in the agency, IBON pointed out that it is difficult to reconcile the unchanged budget with increasing health expenses of Filipinos. At the same time the group stressed that government resources are better spent on expanding and improving the public health system rather than subsidizing private health sector profits.

IBON said that the Duterte administration should increase funding for health infrastructure, personnel, and operations. Filipinos right to health and affordable health care cannot be realized if, as is happening today, more and more of the country’s health system is being turned over to the profit-driven private sector. The group stressed that this will always result in health care that is too expensive and health capacity that, as the pandemic has shown, is insufficient for public health emergencies. #

It really hurts: Economic infrastructure over health

by Jose Lorenzo Lim

The Philippine economy contracted 16.5% in the second quarter of 2020 which was attributed mainly to declines in manufacturing, transportation and storage, and construction. The Duterte administration is counting on infrastructure to stimulate the Philippine economy’s recovery. To do this, the Development Budget Coordination Committee (DBCC) is allotting Php1.1 trillion for the government’s infrastructure budget in 2021.

Are the planned infrastructure projects really what the economy needs right now after everything that’s happened this year? How much of the infrastructure helps fight the COVID-19 pandemic? Or is the government just building the same road and transport infrastructure from its pre-pandemic plan?

Unchanged priorities

Long before COVID, the Duterte government’s Build, Build, Build (BBB) Program planned Php8-9 trillion in infrastructure projects from 2017-2022. This included supposed high-impact projects such as railways, urban mass transport, airports and seaports, roads and bridges, and “new and better cities”.

The government’s priority for such infrastructure projects and economic infrastructure stays, as reflected in the proposed 2021 budget. The budget for the Department of Public Works and Highways (DPWH) is Php613 billion for roads (Php59 billion), bridges (Php157.4 billion), and flood management projects (Php125.8 billion). There are also allocations for local programs (Php176.1 billion), and the convergence and special support program (Php50.2 billion).

Interestingly, Php23.9 billion of the convergence and special support program is for access roads leading to tourism destinations, Php1.9 billion on access roads to airports, and Php2.5 billion on access roads to seaports.

The Department of Transportation’s (DOTr) proposed 2021 budget meanwhile spends Php107.4 billion on railways, aviation, and maritime infrastructure programs. Of this, Php107.2 billion will be spent on railways. The Rail Transport Program includes projects from the 100 infrastructure flagship projects (IFP) such as Metro Rail Transit (MRT) 3 Rehabilitation, the Metro Manila Subway, North-South Commuter Railway System, and the PNR South Long-Haul Project. The DOTr also proposes Php1 million on aviation infrastructure and Php166 million on maritime infrastructures.

The National Economic and Development Authority’s (NEDA) 100 IFP list includes 15 infrastructure projects targeted to be completed in 2021 worth Php181 billion. Eleven of these are in the transport and mobility sector, one is in information technology, one is in urban development and redevelopment, and two are for water resources. This affirms transportation and mobility as BBB program priorities.

However, the infrastructure priorities are puzzling and the government seems to be getting ahead of itself with all that interconnectivity infrastructure.

As it is, the coronavirus still hasn’t been contained over seven months since the pandemic broke out in the country. Many businesses aren’t able to reopen and many families are still jobless or have low incomes even with lockdown restrictions eased. It is not just unclear but actually doubtful that many of the infrastructure projects proposed will help all those who will remain distressed next year.

The pandemic also exposed how inadequate the country’s public health system is. First, in containing the pandemic with insufficient mass testing, contact-tracing, isolating and smart quarantining. And, second, in treating all COVID-19 and non-COVID-19 patients needing health care.

Health neglect

What is the state of the country’s health facilities? Government data shows that there are 1,236 hospitals as of 2017, 65% of which are private-run. Privatization has resulted in there being more private hospital beds (54,317) than public hospital beds (47,371) as of 2016.

These private hospitals that dominate the country’s health system are the same ones that are now charging exorbitant rates to COVID-19 and non-COVID-19 patients to attain their desired profitability. For them, health care is about returns to investment more than returning the sick to good health.

Privatized health is also the reason why bed capacity is falling further and further behind the country’s needs. For a profit-seeking hospital, excess bed and healthcare capacity is in effect idle capital and correspondingly a drain on profits.

The Philippines has never reached the World Health Organization’s recommended ratio of 20 beds per 10,000 population. Philippine Statistics Authority (PSA) data shows that the situation has even worsened from 14.4 beds per 10,000 population in 1990 to only 9.9 beds per population in 2014. In terms of community health services, only 47% of barangays across the country had health stations in 2018.

The country is very much in need of healthcare workers as well. The PSA reports a ratio of one government physician to 33,000 Filipinos, which is far from the WHO-recommended 1:1,000 doctor to population ratio. The number of public health nurses is also concerning at a ratio of 1 to 50,000 Filipinos. Add to this how Filipino health frontliners are themselves succumbing to COVID-19 due to poor working conditions and lack of equipment, facility, and financial support. The dearth in health facilities and health care workers will persist if the government continues to neglect the health sector.

Has the government’s infrastructure program been adjusted to meet deficiencies in health infrastructure highlighted by the pandemic? The government has actually touted some health-related infrastructure to help fight COVID-19.

The latest IFP list is yet to be released. In a recent interview though, Secretary Vince Dizon, Presidential Adviser for Flagship Programs and Projects, announced that 8 projects that could not be completed anytime soon had been taken out from the 100 IFP. These were replaced by 13 projects related to the digital economy, water projects, and healthcare.

Dizon said that the most important healthcare project is the Virology Institute that would be built in New Clark City. A Virology Institute could really complement the Philippine healthcare system, if only there were enough healthcare facilities to begin with. But the opposite is true.

A look at the Department of Health’s (DOH) proposed 2021 budget shows that the Health Facilities Enhancement Program (HFEP) only gets Php4.8 billion. This is a huge cut from its Php8.4 billion budget this year and especially compared to its Php30.3 billion budget in 2018.

The proposed HFEP budget is just as much as the DPWH’s Priority Bridges crossing Pasig-Marikina River and the Manggahan Floodway Bridges Construction Project valued at Php4.8 billion, which is just one of the agency’s projects in Metro Manila.

The country needs more health infrastructure more than ever. COVID-19 and non-COVID-19 wards are overwhelmed yet the government decides to slash the budget for health facilities and still prioritize economic infrastructure in the form of roads and bridges. Many other essential elements of the health budget are also being defunded in 2021.

Time to reprioritize

The onslaught of COVID-19 exposes the insensitivity of the Duterte administration and how irrelevant the BBB program is in meeting the country’s most urgent needs. Health infrastructure clearly needs to be expanded.

Yet the priority is still disproportionately for infrastructure projects supporting the profit-making of transport contractors, foreign transport sector firms, and corporations in the service- and trading-oriented sectors of the economy.

The government has to invest much more in strengthening the public health system, in building public health facilities, and in advancing health research and development. Health care workers also need to be protected, paid decently, and supported to be able to give Filipinos the quality and affordable health care they deserve. #