by Gene Nisperos, MD

The Philippine General Hospital is the face of our perpetually neglected public healthcare system. As the biggest tertiary training hospital in the country, it provides specialized and very specialized services and training. It is also the end referral hospital of other public hospitals. Pero ito din ang Ospital ng Bayan na sadyang pinabayaan.

The ever-increasing number of patients in PGH reflects the country’s worsening social conditions. The poor’s limited access to basic services, aggravated by their absent economic power and the prohibitive costs of healthcare, all lead them to this single health institution.

Thus, we need to take a close, hard look at the state of PGH and its patients.

A casual stroll from the PGH Out-Patient Department (OPD) to the wards can break your heart.

Patients. Families. All are trying their best to get a measure of the health services they need, never mind deserve. Some are eating their baon along the sidewalk. Others are desperately trying to make their patients more comfortable under the sweltering heat and crowd. Many have been waiting in line since 3-4am just to get in.

A walk through the Emergency Room (ER) can break your spirit.

Everywhere, quietly, patients find small consolation in cold metal beds, in stretchers, in wheelchairs, or even in monobloc chairs. They fill up any unpeopled space that they can find and comfort is a luxury that they will readily forego if only to get seen and treated.

And all of them want to be seen, need to be seen. Many have travelled long distances hoping to be treated for their various infirmities. But the hospital is always shorthanded. The 4000-strong health personnel are almost always never enough for the deluge of patients that come daily.

The ER, currently under renovation, only has a 25-bed capacity. But its daily census is easily north of 150. In the last three years, PGH’s patient census has steadily increased from 586,000 to 647,000 per year.

There are patients who should be in the intensive care unit (ICU) but are still in the wards. There are patients who should be in the wards but are still in the ER. There are patients in “ectopic beds”, or beds in departments other than that where the patient should be confined in.

There is just not enough beds or space. There is just not enough health personnel.

Yes, even the best that PGH can provide remains too little. And everyone can do with much more.

Yet in spite of these, for 2020, Congress deemed it fit to cut the PGH budget rather than increase it. Apparently, for our honourable legislators, the less than P3 billion per year allocation is enough and there are more pressing matters to fund, like the P100 million pork barrel they will each get.

To provide its patients with the barest minimum, PGH needs about P5 billion per year. So why give the hospital much less than what it needs to operate?

Limited funds nga daw kasi.

Currently, around two-thirds of PGH’s budget goes to pay for its personnel, whose numbers cannot match those of the patients, even with medical and health sciences students taking up the cudgels.

Because of insufficient budget, the hospital cannot hire the additional health human resources it needs. It cannot even regularize the contractual employees it has. Worse, it is looking to further subcontract the work being done by institutional/utility workers, the “manongs” who brings patients around the hospital for their labs, x-rays, and what not.

About 25% of PGH’s budget goes to its operations, which directly benefit its patients. Even then, supplies and meds are often lacking so patients need to buy these outside.

Some laboratory exams are unavailable so these have to be done outside as well. Basic equipment, like respirators, have also been subcontracted to private firms and their use have to be paid for by patients.

All of these amount to out-of-pocket expenses that are catastrophic for an already impoverished patient.

To be fair, the PGH Administration exerts effort to augment the hospital’s funds. Donations from private individuals and/or corporations help stretch the meager resources. But at the end of the day, patients and health personnel alike, including students, shell out money to cover for what the hospital lacks.

Either that or they become mute witnesses to the consequences of unmet health needs: morbidity if not death.

When government refuses to give enough funds, everyone suffers. Because in PGH, the need will always be much greater than what can be given. Sadly, this is being done to almost all public hospitals: they get less than half of the budget they need but are expected to operate fully, with VERY LITTLE support.

When health officials grow tired of asking enough to provide for what patients deserve, what is given is not even enough to provide for what patients need. When health officials console themselves by asking just enough to provide for what patients need, what is given is barely enough, so that patients expect even less.

This is government policy and it must be changed. THIS is the rotten system that refuses to see healthcare as a public good.

It is therefore right and fair to demand for a bigger budget for health and for PGH.

Every year, PGH should get P10 billion to give its patients the care THEY DESERVE. The hospital should not have to rely on the kind heart of philanthropists or on corporate social responsibility just to keep itself financially afloat. The hospital should NOT EXACT any more from the pockets of its patients and its staff.

The amount also enables PGH to hire and regularize enough hospital personnel to meet the ever-increasing demands of healthcare. The money affords the hospital enough to provide essential supplies and medicine, and ensures that the laboratory and diagnostic equipment are working.

If PGH is given the budget that it deserves, then it can fulfill its most important role: enable the poor and destitute to exercise, and maybe even experience, their right to health. #