The Covid-19 pandemic is likely to last till 2024, or until all the 8 billion inhabitants of Planet Earth are fully vaccinated. This is the prognosis given by a number of medical experts, as new variants keep emerging. The road to medical normalcy in Europe has been reversed by the Delta variant. And now, the Omicron variant is casting a long dark shadow around the world.
How will the next Philippine administration manage the Covid containment program? Presidential aspirants need to go beyond giving the usual simplistic answer: spend more on the health sector, as if spending alone is the magic wand needed to prevent the virus from spreading around the archipelago.
In this connection, it is interesting to note that the Asian Development Bank (ADB), in approving the $1.5 billion Covid loan application of the Philippines in April 2020, came up with a “sector assessment” on health. The ADB staff drew a “problem tree” (see table 1) to show the purported root cause of the Philippine health sector’s crisis. At the bottom of the tree are the different health sector “consumables” or items that need to be funded in order to strengthen the capacity of the Philippines to manage the pandemic.
By looking at the problem tree and its identification of the root cause of the health sector malaise, one is immediately struck by the simplistic approach of the ADB staff in preparing the said problem tree. The staff apparently had no appreciation of the complexity of the problems hounding the health sector and their deeper root causes. To the ADB, it was all a question of lack of funding and the solution, therefore, is to mobilize financial resources to fill up the funding gap.
Of course, it is difficult to quarrel with the ADB staff in the listing of the “consumables” and health items needed to be procured in order to build up the Philippines’ capacity to manage the pandemic. What is questionable is the identification of “inadequate financing” as the sole or main root cause of the health sector crisis in the Philippines.
The ADB tree failed to cite decades-long government neglect of the national health system and the lack of an upgrading/modernization plan for the system to ensure that the entire population is able to enjoy the supposed benefits due to every citizen under the Universal Health Care law, a law that was passed just before the pandemic. Additionally, such neglect and lack of upgrading plan have been compounded by health sector misgovernance/corruption and neo-liberal policies favoring the privatization and commercialization of health and other public services.
Given the foregoing problems, it was not surprising that when Covid-19 hit the country in 2020, the initial response was chaotic, even anarchic. It took the government over a year before it was able to put in place the Covid-19 response and containment program suggested by experts from the World Health Organization. Today, the Philippines is the third country in Asia (after India and Indonesia) with the most number of Covid cases (Number 18 in the world odometer). The Philippines also landed last in Bloomberg’s survey in Asia of resiliency under Covid.
Shortage of funds as the root problem? Yes, funds were limited. But the government did not use this as an excuse to scrimp on health sector spending. It borrowed heavily from domestic and external sources. The rate of borrowing was so heavy the debt-to-GDP ratio of 39 percent in 2019 became 60 percent middle of 2021! And to think that the 39 percent debt-to-GDP ratio was achieved by the country after long decades (1980s-2000s) of servicing a swollen debt bequeathed by the Marcos administration in 1986.
However, having funds is not enough. Having a health governance system that can insure that funds are used wisely, judiciously and fairly for the benefits of all matters a lot. Right now, there is a public uproar over the following: a) massive corruption that attended the government purchases or procurement of protective health materials, b) the unexplained losses of the Philippine Health Insurance Corp., c) the unpaid payment of “risk allowance” to the health-care workers, d) the limited facilities of government hospitals, and e) the poor handling by the government’s Inter-Agency Task Force on Infectious Diseases of the series of lockdowns imposed on the country in 2020-2021.
Clearly, a health crisis is not a simple question of looking for funds to heal it. This is why the “theory of change” advanced by the ADB in justifying its Covid-lending program (Covid-19 Active Response and Expenditure Support) is simplistic. Accordingly, the overall goal of CARES is to mitigate the health, social and economic consequences of the Covid pandemic through the “ADB Approach,” that is, to provide budget support for the health, social and economic requirements of a borrowing country. Such a theory of change sounds nice except that it misses the other critical root causes of a broken health system. The failure to identify and address the other root problems is one explanation for the prolonged health agony of the Philippines.
Dr. Rene E. Ofreneo is a Professor Emeritus of the University of the Philippines.
For comments, please write to reneofreneo@gmail.com.