Is DOH better prepared to handle public health risks?

The reactive behavior of DOH with regard to the MERSCoV scare, instigated by a group of travellers on a certain Saudi-Manila flight, who were allowed by authorities to go through and out the airport terminals back to their respective residences, and whose names were subsequently publicized (may I point out, violating an individual’s right to privacy i.e. not to have her name publicized without prior knowledge and her consent (the public’s need to information should not prejudice the individual’s right over her personal medical records especially if these hold sensitive information.  Physicians have sworn to safeguard information about their patients, therefore DOH is aware too.  An apology is due to these people.  The media, journalists!, who were party to the publication should apologize too.  This is the very reason I wrote in a previous article that freedom of information in the wrong hands is world war III), the whole sordid affair stemming from an agency’s failure to do the simple job of quarantining these passengers while at the airports, calls attention to old issues within the agency which continue unresolved.

One is effectiveness of it’s structure and personnel.

The DOH has the perfect structure in that it has presence, centers and personnel, at the national down to the barangay or village level.  While services and facilities are decentralized, or managed by the local governments, the DOH has adequate clout to influence the local decisionmaking process. 

There’s a mandate, similar to that for day care centers of the DSWD, that every village shall have a health center (so long as the minimum population requirement is fulfilled).  These village health centers (or, barangay health stations) are normally headed by a midwife, usually a resident.  When there’s not a midwife in a village, the health center is placed under the midwife of a neighboring village.  Hence, one midwife can have two or three villages in her care.  A midwife is required to be present for a minimum number of days a month in the health center.  On these days, the midwife, assisted by trained health worker volunteers from the village, administers the mandated primary health care check ups, medical supplementation, the works.  Incidentally, the volunteer health workers are in reality the “worker bees” in the structure.  They do home visits of all households in the village and during these visits they do monitoring reports (using various checklists) of the household’s members’ health, counseling on the side, administration of basic medications, the nitty gritty works. (And this is just a small part of the totality of their village work!)  Without them, there’d be no honeycomb, primary health care will not stand.  I/NGOs covering the areas have and continue to render funding support for complementary services and facilities.  The midwife sits in the Barangay Development Council, and together with the Barangay Councilor for Health, report on the health situation of the village and make recommendations as to its improvement, these may be made part of the barangay development plan

At the municipal level, there is the Municipal Health Office which takes on the higher levels of health care that the village health centers don’t do.  It is managed by a doctor (Municipal Health Officer) assisted by a team of nurses, who is a permanent member of the Municipal Development Council which is headed by the Mayor.  In addition, there is the Local Health Board.

Then there is the Provincial Health Office and the Provincial Health Officer who like his municipal counterpart has permanent seat in the Provincial Development Council which is headed by the Governor.  Tertiary health services at this level is lodged with the Provincial Hospital.

The three tiers of public health care providers – village, municipal, provincial – are supposedly linked seamlessly via a referral system. 

And then, the Regional Health Office which renders policy and financing support to lower levels, and is under the Congress(wo)man. 
Then finally the Secretary of Health and his or her team at the national level in Metro Manila.

I know, right?  You’d think with this structure, the country must have overshoot the MDGs on health eons ago.  It should have.   

But public health in the country is trapped in the hands of politicians who mold it into whatever form they imagine public health to be.  Scarcity may justify politics, but to the extent that decision time to, say, purchase a vial of basic medicine takes as long as years? It denies people the right to health (access and quality recovery). 

It doesn’t help that the DOH continues to blunder in its leadership role.  It extols the public to be proactive in it’s regard to it’s health because that approach is less costly, but then the agency itself has not effectively demonstrated this behavior to the public.  DOH itself is reactive.  A similar scare, SARS, came and went, but up to now nothing’s been put in place that should’ve lowered the public’s risks to SARS and improved resilience if and when SARS does strike.  If Typhoon Yolanda/Haiyan were a massive health event, is the nation and public prepared? 

The agenda on public health reform should include strategies that would get local politicians on the side of public health, or at least those that matter. It is imperative therefore that DOH managers and personnel be political savvies, this on top of their medical expertise.  When the Mayor refuses to sign requests for basic medical supplies, would you pout, shrug it off, and try your best to forget the whole thing, or, politically savvy that you are, you’d pout, too, yes, but afterward you’d roll up your sleeves and work out a brilliant negotiation strategy.

A learning from my experience in evaluation of municipal and barangay or village level projects is that, the ultimate reason vital projects are killed off prematurely was not so much as due to the Mayor’s or Barangay Captain’s refusal to support the projects as to the failure of LDC members to take the initial refusal in good stride and plan a come back with their most brilliant negotiation moves, because there could be other compelling reasons for the Mayor’s or Barangay Captain’s reticence than the overused and worn out “health is simply not his priority” observation; the real reason could be that he’s inexplicably irritated at your face and can’t stand it talking to him; the longer he hears it talking the bigger and heavier and angrier he writes N-O No.  On the other hand, a favored one’s smile given his way will throw him so high he’d approve anything.  Either way, it has nothing to do at all with cover to cover knowledge of DILG’s Local Development Planning Manual!  Indeed, we are at times silly and trivial human beings!  Anyway, to continue.  I/NGOs provide training support to LDCs to learn to become skilled negotiators but results haven’t taken off as intended, because the training is given only once.  The training ought to be phased with on-the-job workshops, practice, and mentoring in between.  One can’t have become overnight  a master negotiator, can one?     

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