 the Stop COVID Deaths webinar series palapit na po ng palapit ang ating one-year anniversary and we are really glad and happy that you choose to join us in this learning journey as we continue to address your concerns about COVID-19. Our discussion for today was our opening remark speaker, I believe, during webinar number 27 last year and he remarked that health is not only linked to economy, and his presentation was met with a lot of requests and we are now due to insistent public demand bringing him back, but now as our main discussion for this afternoon. So the COVID-19 pandemic po, it magnified the unacceptably low level of investments in the public health system. So when this pandemic started, we didn't have any testing labs, bed spaces or even personal protective equipment for an outbreak of this magnitude. At the heart of this crisis was a shortage of health, human resources, and embarrassingly enough, we had allocated relatively low wages po para sa ating ma-frontline health workers compared to other countries, especially our neighboring ASEAN siblings. Magandang hapong po ulit. I'm Dr. Raymond Francis Asarmiento. Masaya po kami ulit na. Sama-sama po tayong ayong hapong ito para sa webinar number 43 and always I'm very glad to share hosting duties with my partner in crime and my mentor who is the Special Envoy of the President for Global Health Initiatives and also our adjunct research faculty at the National Telehealth Center, Dr. Susie Pineda Mercado. Dr. Susie. Hey, Raymond. Kamusta ka na jyan? Good morning, good evening, good afternoon, everyone. And for everyone who's watching on the playback or those who are watching on Facebook or on YouTube. Magandang araw sa inyo na imbag naadlao. Mayad naadlao, maayong umto. Hello, everyone. I mean, I'm looking at where everyone's coming from. There's a shout out here from UP Open University, Kessun City, Maraming na nunuod Surigao, Bohol, Aklan, Pasay Iloilo, Negros Oriental, Albay, Takloban Leyte, marami pa po. Welcome. Thank you so much for joining us today. We have a very important topic. Pag-usapan po natin yung sahod na mga healthcare workers. We're taking a little bit of a break from our discussions on vaccines, but not really because we have a video message for all of you. TV UP, please go ahead. Ako po, init pabakuna na. Nalawang araw na. Ula na mag-ulang-ulang ng sabad. I feel great now. I had some fever yesterday afternoon. Slight fever, sinap. So happy naman ako doon because that means the vaccine was kicking in. Kanin ang hapon po, init pabakuna na po ako ng Sinovac sa Philippines General Hospital. Observe ako for 15 minutes because I have low risk ako. And then after 15 minutes, pinauwi na kami. Parami ng parami na po ang mga variants ng SARS-CoV-2 na dumarating dito sa ating bayan. Nagpapasalamat na kakita PGH. Para bin-organize Maximo Rao. UPPGH was the very first. So none of the other hospitals were willing to inject until Director Ghapli Gaspi had his injection. So that was really historic. He was the first person in the Philippines to have a legally approved vaccine injected into him. And then we followed. So I'm very happy. I'm very happy that people are finally realizing that the best vaccine is the vaccine that is already here. I do hope everyone when they are told that their vaccine is ready for them that they will go ahead and get vaccinated. Sa aking palagay, bakuna lamang ang makapipigil sa pagkamatay ng 100% lalong-lalong na sa madaling panahon ay dapat kohanin na. Tulamang ang paraan para baka ahon tayo pare-pareho sa pandemiyang maraming buhay na ang inagaw. Lalo na sa aking mga kapwa doktor, kapwa guru, mga nurse, mga lolot-lola, kapatid, nana, itatay, at ilang bata. We are now seeing a light at the end of the tunnel. Truly talagang kita mo na yung dulu ng tunnel. Parang matatapos ito, we will be able to end this pandemic. As long as everybody is given the vaccine, magpabakuna na po kayo. Huwag naku kayong mangalama. This is a responsibility for ourselves, our family and our community. Samasama ko talagang pagpabakuna. Thank you very much. It's Chancellor Menchit Padilya, UPEVP Ted Herbosa, and UPE College of Medicine Dean Charlotte Chong, were among the first who got vaccinated. And truly we are hopeful, but we will be more hopeful if there's more money that goes into paying our front-line workers. And that is our topic today. Ikingan po natin ang isang dalubhasa po sa economics. Pag-uusapan po ang bakit, limang bakit, pero panong napakababan ng sweldo ng sahod ng ating front-liners? Kasi akikita natin ngayon na napakahalaga ninyong lahat. You are all very important. And yet, the resources that are going into healthcare is not enough. So we're going to talk about that today. So over to you Raymond. Thank you. Nag-ulap po ako dun sa ating opening video. Pag-uusapan pa? Let's go. That was a pleasant surprise and hopefully that will inspire all of our attendees who are joining us via YouTube, joining us via our live streaming sa Facebook who are also wanting to be able to watch this via the playback. Sana po ay mas-inspire po kayo na magpabakuna kung di pa po kayo nagpapabakuna. But for those who are joining us for the very first time ang ating structure po ng ating webinar, obviously we will have our main discussion followed by short actions from expert panel po and then we will go on to the Q&A and kaya po nang nakagolean po natin nito ang mga recent na mga webinar episodes po natin. Mayro po tayo mga tatawagin from our audience na magbubukas po na kanilang video and will be able to ask questions ng live po sa ating webinar. May we have po our thank you to the very hardworking team and always nagsusurprise po sa ating those who comprise the stop COVID-19 webinar series team. Maraming-maraming salamat po. These really are our siblings na po. And hopefully we continue on to provide value to provide meaningful information to all those who are watching us wherever you may be kung an dito po kayo sa Pilipinas na sa ibang bansa. Over to you Dr. Susi. Well thank you very much for that Raymond. I think our topic today while it's about health systems very very important and next week babalikan na naman natin Although this is very relevant to COVID-19 kasi para it's going to take some time it will be a big effort to do the vaccination so we just want to make it what should I say, make it known that there are issues in the system that need to be addressed. Okay go ahead Raymond I think people want to know about these certificates. Okay for those to continue to ask po ang mga certificate po natin as of today all certificates or at least those who are eligible to receive certificates po ay nabigay na po for all webinars from 1 to 42 so if you feel that you are eligible should have receive an electronic certificate alongside a copy of the presentations please let us know there are those who are also clamoring for perhaps a change in the name like we have mentioned in previous webinars please be very very careful on how you input your name in the registration link because it's automated po and that will be how it will be reflected in the e-certificate as long as you have spent at least 50% of the webinar duration mabibigan po kayo ng certificate Okay, Dr. Suzy Let's start Okay, babatingin ko na Raymond yung mga tagarizal medical center ngayong daw nagsayit na kanilang pag-vaccuna Go! Pag-vaccuna tayo The vaccine is safe you can use it and we really have to just be united on this and I'd like to greet also we have some people Raymond from outside of the country you have a rundown on that parang nga nakita ko in Taiwan So, komusta po kayo dyan sa Taiwan? I think I saw that already Think them of Saudi Arabia What else ay mo? Who else do we have? Well, we have those who are joining us well, internationally po I think our attendees from let's say the Niagara Falls our regular attendee Niagara Falls, Ontario, Canada one from the Middle East specifically Abu Dhabi there are those from the MAM Saudi Arabia Doha, Qatar Deragazi, Pakistan I think that's the first time from Pakistan also from Bandar Seribigawan in Brunei, Jakarta, Indonesia Metaling, Jaya, Malaysia and also very first time po ito I don't know how to pronounce this I think it's OMAG or OMA Northern Ireland So nandun po tayo sa United Kingdom napapanod din po Maraming salamat po Okay, and we are also being joined by many regular listeners from the Department of Education So welcome po senyong welcome po senyong lahat So we're now going to our opening message and we've got a very special guest who was formerly the national statistician of the Philippines and was head of the Philippines Statistics Authority She is currently vice president for public finance at the University of the Philippines We'd like to welcome Dr. Lisa Brasiles Dr. Brasiles Mam Lisa, welcome to the webinar Thank you very much, Dr. Susie Dr. Raymond It's really my privilege to share this opening message to this very important discussion Panang ito talaga straight to the stomach or to the heart of our frontliners kaya maganda siyang pagusapan Sa nakita po nating sa video kanina na no March 1 una po yung nabigyan ng COVID-19 ng vaccine against COVID-19 yung ating frontliners specifically sa PGH So in my mind that's really great recognition by the country of how they are so important to us now they were most important to us also before but now with the pandemic talaga yung kailangan natin sila so in my mind great recognition to give frontliners the first vaccines However, our webinar is asking the question in my mind hanggang do nalang ba recognition that we will thank and give them the first vaccine So compensation is important So I really want to put importance in the webinar series I just want to put context in our discussion As coming from statistics and specifically from official statistics before meron po tayong magagalaproducto ng datos at information na binibigay ng Philippine statistics authority meron po tayong tinatawog na system of health accounts Ito gong system of health accounts provides a standard for classifying health expenditure according to three access consumption, provision and financing The Philippines subscribes to the standard set globally of coming up with a system of health accounts and actually we have regularly reports from the Philippine statistics authority on our Philippine national health accounts na binibigay po tayong report on economic growth quarterly Pero ang contribution ng health sector na dumpo siya sa tinatawog na satellite accounts Gusto kong in my mind our discussion now will focus on one aspect of our health accounts This is the aspect of provision Ating health workers are the providers of our health services So in the report of the PSA in 2019 meron po tayong na sabi tungkol sa inputs ng health system, health sector in producing goods and services for activities covered by the health sector Ang rich information na makikita natin dito sa health accounts and you can always go to the website of the Philippine statistics authority But I focus on the main report where in 2019 pre-pandemic the country's health expenditure reached 792.6 billion pesos in 2019 100.9% higher compared to the previous year in 2019 Nag-increase na by almost 11% yung health expenditure ng kabuuan in the whole Philippines Are you supposed to share your screen po ba mam? Well I can share my screen I'll do that Thank you very much I believe you can see now this is actually coming from the website of PSA I just grabbed In this report of the national health accounts in 2019 makikita po natin na talaga po umakiat yung health expenditures current po ito ha in current pesos and also health expenditure total health expenditure increased by 7.9% pero kasi po gusto kong itutukan yung if you don't mind I will skip because I know that our distinguished speaker and the risk discussants have more to say later I just want to focus on this part of the report where itong factors of provision ito yung sinasabi sino ang nagbibigay ng ating health services sinasabi dito in terms of growth rate in 2019 and I'm looking at the second paragraph compensation of employees grew faster umakiat naman po ang compensation in the health sector and it says there however mas magaki yung share ng growth doon sa tinatawag na materials and services used ito po pink na part so ang bulk ng spending for provision ay napuputa dito sa materials needed for health care ang compensation ito po siya yung yun yung share niya ang next consumption of fixed capital if you will look at that ito yung mga infrastructure yung mga equipment and to support the health services and other the green one is just an aggregate of all other expenses for factors of provision so makikita po natin na pre-pandemic umakiat naman po ang compensation but the question is sa ating webinar ngayon sa patpumak mayro paputayong isang product ng Philippine Statistics Authority ito po yung annual survey of business establishments of Philippine business establishments and I will not show anything there I would just like to report to you that which institutions provide health care for us na po ang bulk po talaga ang nagbibigay ng health care services hospital nasa ka nila po talaga nandun po ang ating health workers sa hospitals next po ay yung mga dental services clinics, yung other nurses so yung makikita na datos doon sa annual survey of Philippine business industry but I would like to focus on one statistic that I saw there where in 2017 sorry po 2017 lang yung nagrab ko from the website it says there that in 2017 yung ating annual compensation of paid employees on average 232,000 pesos so that's about 20,000 pesos per month on average so 2017 na nang po pero nun yun pero na yun I don't think na umakiat siya masyado so I believe this is the context of the discussion where sapat ba yung compensation na bini-bigay sa health workers given that it gives so much to us so my message is that there are data that show us the situation of the health system as well as our our frontliners now I will say something personal no last Wednesday ako po at yung ating asawa ay test for general check up I'm so blessed di ko masyado na kakasakit pero every time I have engaged med with our frontliners like the medical technologists that get roadblood the the technicians who got my X-ray dapaka ang galing-galing ko nila iba po talala yung bensayaman na yung Filipino ano po so I really appreciate our frontliners now naku po itong ating magsasalita ngayon baunabaw ko ako ako sa ating main speaker doctor Ernesto Pernia kasi bos ko po siya dati nung nasa ako acay secretary na socio-economic planning development to end my message gusto ko saan ang ikot siya si doctor Pernia sa kanyang pinakalitas na libro virtuous impatience what our country needs in this fast changing world so the context really is this pandemic and in one of these essays in this book which was actually published by the business world on November 26, 2012 but for me this essay is still so relevant he wrote a question that has nagd even ordinary folks is why our country has lagged so far behind its Asian neighbors the answer may partly lie with our highly elastic patients what we probably need is virtuous impatience or a strong sense of urgency this discussion is urgent compensation to our front liners manami po sa lama good afternoon everyone thank you doctor Raymond, doctor CC thank you very much that's vice president Lisa Bersales of the University of the Philippines in charge of finance and yes indeed we are going to have a very important speaker who's going to talk to us about why we need to increase the salaries so let's go back to Raymond because I think you're going to do your regular fun poll may we have that displayed on the screen thank you so the first couple of questions really will be asking ang demographics ng ating before we go into some more, a little bit more technical questions po I'll just read off what I'm seeing on the screen and hopefully will be able to move on to the technical questions the first question po for our fun poll or audience survey what place are you viewing the webinar from so choices po NCR Northern Southern Luzon, Central Luzon Eastern Visayas, Western Visayas, Central Visayas Northern Eastern Mindanao Western and Central Mindanao Northern Mindanao and then outside of the Philippines the second question is what is your line of work very very consistent po just like our three previous webinars when we started this nalagang marami po ang nanonod from the nursing sector po but we all once from the medical field pharmacy, midwifery, public health education, legislation, media at yung ating favorite ang ating others so saan pa po mas mahimay po natin ang others po na ito we also have those number three oh this is the technical question na po but before we go on to the technical question I'd just like to give a rundown of those who have already signed up and really trying to attend kasi po nakalampo tayong technical glitch it was pegged at 500 but hopefully more and more of our attendees are able to join. I'm seeing that we are now numbering including the panelists 785 attendees here in this webinar so hopefully mas marami po po ang mag-join at maka-attend especially those who are coming in from Kabuga o Ilokosur Danau City in Sibu, Carmen Bohol, Mondragon Northern Summer and Baiz City in Negros Oriental with the arrival po of the AstraZeneca vaccines and also the continuing allocation and distribution of Sinovac vaccines we hope that all of you will be willing to take the COVID-19 vaccines that are available and will be distributed in your areas very very soon. For our question number three among the six major Asian countries which includes Indonesia, Malaysia, Philippines, Singapore, Thailand and Vietnam the Philippines has so please complete the sentence number one, option A highest COVID-19 case load option B, largest economic contraction option C, slowest economy to recover and option D all of the above. Okay Question number four our second technical question the doctors in Vietnam get paid two thirds higher than the doctors in the Philippines and overwhelming majority said I hope you will watch until the end of this webinar so that we will know if this really is a true statement. Number five question the doctors in Singapore get paid ten times more than the doctors in the Philippines may know many doctors in Singapore just based on the answer and our last technical question the nurses when medical technologies are the lowest paid among the six major Asian countries also overwhelming majority at 94% Okay, I think I'll turn the floor over to Dr. Susie for the introduction of our main resource person Okay, so before we do that Rima I'm going to ask the team to put in our Facebook because say I'm getting some messages that people were not able to enter so can we post on the chat box and you can just share it with your friends who were not able to enter how to get on YouTube or Facebook livestream I think there are more people who wanted, there we go, so live on FB so please just send that to your friends who were not able to enter na pakutay sa 500 Okay, before we go to our main speaker we have some interviews from TVUP TVUP, please go ahead Maraming yung naging workloads nila manong two friends yung isa ay sa research siyan ng papasas na mga samples so before hindi niya yung work so niya niya yung naging work Sa tingin ko talagang nadagdagan ng kanilang kasi sa damin ng mga pasyemping na kailangan nilang atinan kasi yung mga nurses yung mga talagang malalapit sa mga patients yung ganoong mga pasin ang trabaho Yung papilala ko ng health worker na talagang hindi na siya haras nakapaubis sa kanilang Ponte lang ang trabaho but we were greatly affected because some of our staff were locked down in their provinces kasi at that time na self-vacation leave sila others, walang transportation so ang magyari ay pwonti lang ang trabaho pwonti lang desens na nakakapuso merong mga incentives like ko niya de magi-intubate ka so merong additional costs yun and I think lang na I cannot tell about the others pero there are positions na relatively mas mataas ang rates kapag COVID positive I work in an outpatient setting wala ako sa hospital magmaman po ako ng clinic naman dito sa clinic kakaroonan takot yung mga they are scared to go to the clinic wala kaming masyadong sick visits so definitely our compensations have been affected when you work in the hospital overwork ka, underpaid ka sa amin naman wala kaming masyadong work ano pa rin kami ang revenue namin bagsak because we don't see sick patients anymore may hazard pay kami pero hindi siya ganong compensated unlike sa co-government ang laki ng kanilang hazard pay during the peak of the pandemic kumonti talaga yung mga patiente for me kahit pa paano we had some basic salary pero not comparable to what we've had before the COVID hit some voices from our counterparts, our colleagues so we asked about kitasweldong tapi kasi natin deg deg stress sa COVID-19 may deg deg sweldong frontliners and you can put your questions in the Q&A box I'm already seeing some here and put them in the Q&A box and we'll try to answer them and also get an understanding of what you're thinking this is so important as we move forward hindi katoored lang nandate parang sobrang deg deg stress sa frontliners and yet hindi pa natin nakikita malaking pagbabago sa compensation whether that's hazard pay, whether that's salaries and then there are differences between private sector and public sector and expert chapo ay isang economist he's one of the leading economists in the country he is professor emeritus of economics of the University of the Philippines School of Economics and former secretary of social economic planning at NEDA so it is my honor to introduce to you doctor Ernesto Perna who will present to us compensation salaries of healthcare workers throughout the region doctor Ernie, welcome to the webinar thank you doctor Susie how are you? how are you? i'm okay i'm ready ready to go we're looking forward to getting a hold of your book on Virtus Impatiens i think you hit the nail on the head there masyado tayong hindi ba we really admire all our frontliners and this has been really meant to help our frontline workers now of course we can't do something about the salaries of the healthcare workers right now talk about it and it looks like what you're saying is that ko lang ng urgency parang masyado tayong itba tayong masyado paano ba yan doctor Ernie? well we are patient we are for bearing we are very tolerant and uncomplaining compared with our asian neighbors we tend to overdo it to our undoing in terms of the economy and our own personal well-being okay so we're going to listen to your presentation but before that i'd just like to welcome all those who are only able to enter the webinar now i'm getting this message just 90 sila mahapasok mahapasok na kayo dun sa mga iba sabihin nyo na po ay din po masok through facebook or through youtube okay doctor Ernie go ahead with your presentation we are awaiting this okay so i'd like to show my yes this is the my presentation health is economy well this is a very meaningful title because what this notes is that health and economy are inseparable couples they are an inseparable couple and so we have to attend to both of them at the same time not one over the other and then the subtitle we reap what we saw as to do with the extent to which we invest in something say healthcare that is the extent to which we can benefit from the healthcare system so that is the title of the presentation next slide please so this is my the structure of my presentation which you can readily see so where we are coming from as you know we were all in an anus horribilis in 2020 and so how do we explain how we address the anus horribilis and then how do we move to an anus mirabilis to a year that is more you know year that will be better will be more auspicious to us and moving towards post pandemic new world and then so I have in toward the end I talk about sewing to reap in the short run or reap in the medium to longer run next slide please okay so health and economy are intimately linked they are as I said they are a very intimately lovingly loving couple and they are interactive thus health is economy or economy itself poor health adversely affects economic productivity and on the other hand but economy hurts health through livelihoods and incomes of people there is no trade off between the two they are equally vital one does not have priority in essence which is called priority over the other except in timing which is the timing of intervention in this corona virus pandemic given the Philippines poor health system capacity intervention should have come very early in Vietnam with lockdown imposed and east or lifted in a timely manner as the health system capacity improved unfortunately government moved slowly and was conservative in spending vis-a-vis our Asian neighbors such as South Korea, Taiwan Vietnam and Thailand next slide please okay this is I just saw very briefly the performance of the economy and I'll show you the good and the bad of that performance next slide please this is the good these numbers really highlight the spectacular performance of the economy between 2016 and 2019 just before the pandemic the best numbers ever achieved by the country more or less in contemporary Philippine economic history in terms of GDP growth the economy expanded by 29% in four years in four years 29% and till 2020 so the Philippines was also poised to become an upper middle income country from middle income country in 2020 but this was all spoiled by the 2019 pandemic in 2020 our inflation was very well within manageable and very modest well within target our unemployment rate and under employment rates were at their lowest since early Philippine contemporary economic history and then we had we had the lowest poverty incidence also achieved in 2018 only 16.7% from 23.5% in 2015 we had a good fiscal space and the national debt was one of the better ones in the Aztian region and that is why we got high credit ratings BBB plus to A minus and also we were doing our build build build the program that is infrastructure investment spending doubled to 4.5% as a share of GDP compared to past to the past five years and even earlier next slide please okay this is the bad part because this is now the 2020 and as you know whereas the economy expanded by 29% in the previous year before 2020 it contracted by 9.5% in 2020 meaning that the economy had function of the economy dwindled to 19.5% from 29% because of the what happened in 2020 and the numbers on the right hand side of the graph show the different forecasts of different financial institutions including the Philippine government what this tells us is that to be back to our pre-pandemic growth performance it's likely to be achieved late in 2022 or maybe even in 2023 already because of the deep recession that the economy went into in 2020 next slide please so this is the current situation the Philippines has a reputation of the highest COVID-19 case load in this part of Asia vis-a-vis population despite the world's longest continuous lockdown and secondly the economy the slowest to recover among Asian countries and this is attributable to differences in health system capacity considering its large population our population is next only to Indonesia but Indonesia is a huge country geographically and also we have the highest inequality in ASEAN and the highest poverty incidence so we really have a lot of homework to do in terms of addressing these issues and then we have this pandemic that aggravated or exacerbated their conditions as regards our health system capacity the Philippines has severely under invested or under zone the health system capacity of A. healthcare workers medical doctors, nurses, medical technologists and so on in terms of the remuneration and welfare and this is shown in the next slide and then secondly we also under invested in social infrastructure social infrastructure is to distinguish hospitals health centers and laboratories from roads and bridges and airports they are called physical infrastructure we also under invested in this social infrastructure and I will also show something in figure two on table in the subsequent slides next slide please okay, this is the annual salary of healthcare workers in ASEAN in 2020 so pretty recent data and so you have the medical doctors would be the top line, the top curves there nurses would be the numbers in red and also the line in red and medical technologies below that you will notice that we have a higher annual salary for medical doctors compared with Indonesia only Indonesia is 24 something a dollars, US dollars per capita, we have 26 but compared with the other countries we are really lagging behind but then when we go to nurses we are really at the bottom we are really seller-dweller there we have the lowest 9 okay, 9 these are yearly salaries 9800 something for the Philippines 24 something for Malaysia 19 for Indonesia 19,000, 20,000 for Thailand 15,000 for Vietnam and Singapore is way out of line it's a sui generis country it's really a city state and then medical technology is the same thing we are really at the bottom also and being at the bottom is not just a small difference to the next higher it's really a huge difference if you can and then I'll show this in a table also to make it even clearer next slide please this is the corresponding table where the data are also spelled out there for doctors, nurses and medical technologists so as I've said it's really among nurses and medical technologists that we are really at the real low bottom doctors not too bad but only compared with Indonesia but compared with other Asian countries we are also miles behind those other countries in terms of compensation for medical doctors this data are I think they are averages for both government as well as private practitioners next slide please these are the specialists these data are just on the Philippines these are the specialists and so I think are the best paid among among these practitioners so and so you have the differences in salaries there and then let's go to nurses next slide these are the different salary grades for nurses kawawa nungan talaga nursing attendant level one nursing attendant one and then it goes it increases over the salary grades but it's not really something to crawl about and again if we had we had only data on other countries comparable data then we would also be doing a pathetic in terms of what we are doing or what the nurses are getting next slide please this has to do with hospital beds number of hospital beds available per 10,000 population in ASEAN countries but these are different years and you can see again we are at the bottom kawawa talaga at the bottom and as I've said we have a youth's population next to Indonesia and we have high poverty incidents the highest poverty incidents among these countries and the highest inequality income inequality among these countries and we have this kind of you know capacity hospital capacity again this reflects our neglect our under investment in health system capacity both social infrastructure as well as human capital in terms of warm bodies providing healthcare services next slide please okay next slide is just these are the numbers corresponding to the bar graph in the previous slide go down I'm sorry no no no go back please one slide ahead yes these are hospital beds so Indonesia is the next lowest okay and then so let's go now to spending in compared with other Asian countries for COVID next slide okay matagal lang ano transition okay so this is graphical presentation of the comparative COVID response spending in Asian countries we are at the bottom there we are at the left right most and you know the the total spending these are the numbers are in orange and then the per capita the the numbers of the percentage those numbers in percentages are the spending total spending as a proportion to GDP and the the per capita numbers are per capita numbers here they are below I'm sorry the total spending is on top of the bars and the per capita spending are below the percentages in orange okay next slide this will just again just represent these are the numbers that you saw in the background and there you are okay the lowest this is for the whole year of 2020 okay and then I just noticed recently that the Philippines in February so very late February 2021 ramped up spending by 65% so instead of 23.11 it's now 28.12 billion us dollar spending so now catch up on Filipinas but the kind of late too late the hero in 2020 early in 2020 what we did in 2020 we started small low spending and little increments over time what the other countries did was big bang big bang spending really bold spending and that is why they were able to address the COVID crisis and also alleviate the pressure on the economy so this explains these numbers explain why we have the highest to recover among Asian countries kula yung anon natin timing really is very important in terms of stimulus as well as in terms of addressing a major health crisis I don't know why we do it that way it's it has to do with lack of sense of urgency lack of virtuous impatience the other countries are more the culture of virtuous impatience or sense of urgency is much stronger in the other Asian countries this is something that is it's not impossible to learn it's just a matter of changing our the way we do things it's not a cultural transformation event it's just that we need to have a sense of urgency hindi po hindi bukas na lang next year na yun ang anang atitun po hindi na yun itong amount ngayon hindi po hindi nga naon next slide please next slide I show this are the benefits of the different countries the budget deficit because of the ramping of spending talagang tumataas ang deficit at saka yung debt level also yung atin again the the rise in these numbers or the changes in these numbers were over time little by little the others as I've said big bang impact next slide what has been timid in spending or little by little because they wanted to preserve our credit rating among major credit ratings agencies fits, moodies and standard and poor okay but then if you look at the other countries they ramp up their spending early really massive big bang spending but their credit ratings were not affected this credit ratings are these are the latest but if you compare them with in the previous year they are about the same hardly any change same thing with the Philippines we really lost out we did not spend as much last year but we also we still got the same credit rating no advantage in slow spending or late spending next please what are the implications where we are because we failed to spend or so or invest adequately in health human capital and social infrastructure tables 5 to 7 suggest despite sharply ramping up COVID spending in 2020 the five Asian countries other than the Philippines maintain their respectable credit ratings based on 2019 deficits and debts implying that the credit rating agencies have adjusted their rating norms owing to the pandemic if Philippines therefore could have markedly ramped up its COVID response spending and still keep its likewise respectable credit ratings next slide okay now I'm toward the end of my presentation so sewing to reap in the short run okay so we need much increased spending we repurpose some of the physical infrastructure budget to social infrastructure budget in order to increase our increase or improve our health system capacity more hospitals better equipment and so on in this in these hospitals in these establishments and this should include investments in to fortify the health system capacity raise remuneration and working conditions of health care personnel and build or improve social infrastructure spending to the provinces we should have we should have more hospitals laboratories, medical schools like PGHs UP PGHs in all regions I think that is one that Senator Villanueva is pushing PGHs in all regions or spending in these areas of concern are long overdue actually and they really should have been done because they will magnify the impact on other stimulus measures such as physical these stimulus from physical infrastructure to include digital connectivity, social amelioration program and assistance to distressed micro small and medium enterprises and unemployed workers most of these are covered in the accelerated recovery and investment stimulus for the economy the arise bill which unfortunately has not been passed and that bill is what we call a demand stimulus what we need during a crisis like this, like what we have is demand stimulus not supply stimulus meaning stimulus coming from demand for purchases spending by households not improving the capacity of suppliers to provide goods and services and I think there is this bill by our colleague in the school of economics to Congress to Stella Kimball who is pushing for another Bayanihan next slide please so let's now talk about the medium to longer run we need to foster, strengthen our public private enterprise partnerships ala Bayanihan spirit means mutual trust and empathy to make them more efficient but keeping them at arm's length to forestall corruption such public private partnerships will ease the demands on the government's fiscal situation government should take friendly and collegial not adversarial stance vis-a-vis the private sector for a unified effort toward the country's development goal another bullet is a push for passage of long spending economic bills public service act foreign investment act liberalization act etc and then regarding foreign direct investment we have already trimmed that to the minimum that we could trim under the 11th fiscal foreign investment negative list the rest have to be addressed by legislation or constitutional reform by the way the Philippines remains the most restrictive in ASEAN regarding the entry of foreign direct investment compared with Vietnam the Vietnam's economy is 100% open to foreign direct investment foreign direct investments so we also need to vigorously invest in science technology and innovation Philippines spending on this has remained at 0.15% of GDP since 2000 since early 2000 making the Philippines the persistent seller-dweller among other things in science and technology in ASEAN next slide the final slide so we need to recoup lost opportunities from failed population management by fully implementing the reproductive health and the responsible parenthood and the productive health law and adequately funding a national program on population and family planning to address among other things unwanted pregnancies and stunted children as you know we have zero to five among zero to five years of age stunting is around 33% one third of children, Filipino children age zero to five are stunted because of many of them unwanted pregnancies meaning unprepared mothers to be pregnant so this problem of teenage pregnancies which is again a specter in terms of what the situation is in ASEAN because in all those other countries those teenage pregnancies are not a problem anymore and then as you know the birth rate this year is going to increase by around 18% with around quarantine babies due to the thinly spread health services including family planning program during the pandemic we also need to boldly invest in the environment and nature protection and disaster risk reduction preparedness and management we need to heed Pope Francis' lauda to see what we can do on caring for nature or common home second to the last we need to develop culture or habit of sense of urgency which I mentioned earlier or virtues and patience so things get done faster again in ASEAN we seem to be the most patient and tolerant of delays manya na na lag behind this other countries if we do the above and other suggestions from the other speakers plus other from other speakers we can work on the objective of the Philippine Development Plan 2017 to 2022 which were crafted during my time post pandemic to lay the foundation for inclusive growth of the high trust and resilient society and a globally competitive knowledge economy thank you very much and thank you very much for your patience ok thank you very much that was Dr. Ernesto Perniaformer Neda Secretary let me just open my camera ok and gosh I have a lot of questions thank you so much Ernie I opener for many of us I've got lots of questions I think our audience has questions but I also feel very frustrated and I might venture to say I feel a little angry that we've seen so much suffering among our frontliners and to know that we could have been spending more that's a bit painful but let's take this up later on in the panel I'm not a reactor but sorry I have a reaction let's go to your next reactor silo nalang mag-react mo na kasi medyo nag-emo tako do ok pa well we have an excellent reactor panel for today we have three in actuality let us start with one of the top actually help economists in the country he is a professor at the Department of Clinical Epidemiology at the UP College of Medicine may may we call on dr. panel thank you very much if I may just share my screen briefly can I be allowed to share my screen go ahead sir you should have sharing ability ok here it is so I just like to show a few slides to compliment sec Ernie's presentation earlier it's an honor to join the forum with sec Ernie one of our professor in the school of economics where I trained and he's right in pointing out that we did under invest in our healthcare system and this is actually not a recent phenomena it has actually been several years of under investment as what this slide would show although I can only go back to 1995 as far as this graph is concerned but it already shows where we came from in terms of growing our economy and growing the extent of our health expenditures and our closely compared neighbor Thailand already had more than double the size of our economy up in 1995 and their health spending rapidly over time we did have an increased rate of spending starting late 2000s up to present but this is also being tempered by the size of our economy as well so as our economy grew our health spending also grew but it came from a very low base meaning our economy was definitely a lot smaller as a result we were not actually the system was not actually able to keep pace with the growth of the population and its needs and the graph on the left of your screen shows the beds per 100,000 population ratio actually shows that over time from 1990 to 2014 it actually showed that government beds even declined in terms of the ratio to the population and whatever growth in the number or the ratio of hospital beds is being compensated by our private sector and this actually shows that over time in the late 2010 period we really did not get much investments in the health sector that led not only to a reduction in bed to population ratio but also in the upkeep of our facilities and on the right you see comparison across regions in terms of the capacity of health centers at the time in terms of their ability to provide capacity which is actually the most common blood test you can possibly request. Another factor perhaps that could explain our performance in dealing with COVID is the fact that our health system is fragmented in terms of its service delivery and financing structure. What you see here is that there are at least six payers or sources of health spending in the country. This was the data set that our national statistician referred to earlier that there are many players in the health sector and these sets of players actually make their own autonomous decisions and in particular I'd like to emphasize that while health care spending grew over time and much rapidly since the year that growth is actually being driven by out-of-pocket spending meaning individual families spending for health care and this was quite evident when COVID hit that the capacity to implement interventions on a more uniform or standardized manner was pretty difficult because of number one having to deal with many autonomous local government units that can make costs on their own but also that funding for health care services flows out through many sources and in most cases out-of-pocket those that have the means are the ones that are able to actually pay for health services. So thank you very much and good afternoon. Okay, thank you so much. We didn't really expect that we'd have a lot of grabs but it was helpful to visualize and just for comparative analysis of the work. Dr. Suzie. Okay, so we've got another panelist sorry, let me fix that. We've got another panelist. I'm very honored to introduce somebody I've known for a long time and I was calculating I've known this doctor for more than 40 years because seguro we knew each other when we were toddlers now. We were together in so I'm very honored to welcome to our program Dr. Carlos Lavalle is an ophthalmologist and he's from the Galileo Surge Center and he's going to give our view from the perspective of the private sector so kalo ay welcome to the welcome to the webinar. Hello, hi Suzie hi Ray and the rest of the panel just going straight to the well this is the micro view we've had the macro economic view this is more micro despite you see the health policies of the government detrimental to the health profession the health profession remains an attractive career path for many many unfortunately use it as a jumping board to wiener pastures but many also choose to stay and unfortunately because of the lack of infrastructure and economic development nationwide in rural areas it causes a maldistribution of physicians for example for data that I checked a few years ago 70 to 85% of ophthalmologists that means eye doctors are actually in the zone so that remains that leaves about 20% visayas at nil danao and of those in Luzon 60% are actually report their base as metromonila so they may go out to other provinces outside of metromonila but their base is metromonila so that just shows the large maldistribution of physicians especially for ophthalmologists then despite an annual production of 40 to 80 board certified ophthalmologists in the country the ratio of an ophthalmologist to the general population is 2000 to 100 million Filipinos that's one ophthalmologist to take care of 50,000 Filipinos I think this is partly due to lack of strategic support for healthcare manpower development although this is part of the universal healthcare app there are no resources that are devoted actually to fulfilling that manpower development or the lack of that now as individuals a good number are attached to government training institutions despite being in private practice in fact some rendering almost free service to train residents and to treat charity patients some joint civic organizations like Rotary Club or Lions in doing eye surgical missions for one they try to fit the charges and fees in case rates for example and no balance billing policies of field health but you see sometimes like what we mentioned before sometimes the government doesn't support such moves by the private sector in fact the restrictive policies of field health has reduced this surgical the cataract surgical rates in the ASEAN that's a number of cataract surgeries per 100,000 population is the lowest in the Philippines one is that a lot of doctors are not allowed well all of Talmaldis are not allowed to do more than 50 cataract surgeries a month and only 10 at most per day so quite contrary to the vision 2020 which the Philippines is signatory of to reduce the cause of blindness in the country and cataract remains one of the reversible causes of blindness yet we are restricting our physicians for fear of fraud now some individuals some people in private sector will resort to working with organizations or individuals to reduce the financial burden of patients so as was pointed out earlier by Dr. Carlos Panelo it's at 60% at least our outpatient expenses despite field health giving it's reimbursement a lot of expenses are actually out of pocket and those out of pocket expenses pay eventually for the salaries of the doctors and nurses and all the other frontliners one of the reasons also why sometimes the private sector has to have huge sort of profit margin is because field health delays reimbursement for example in our center there's a delay of 60 to 90 days before they reimburse us so we're actually financing field health services so they ask, field health asks us to deduct already the field health reimbursement at the point of care but then they don't pay us until 60 to 90 days later and sometimes you're not even sure of getting paid now adopting new technologies to keep optomic services at par internationally we're very good at that and we actually how do we pay for that when we we charge private patients or paying patients higher and we're actually subsidizing the services for the less fortunate and then what we can also do and sometimes many of us do is go beyond our useful professional borders like for example I promote vaccination for COVID preventive healthcare especially for diabetes and the curative aspects of my care and of course one of the things that we can do to contribute to better healthcare expenditures by the government is to pay the right taxes which is probably quite one of the most unpopular things I'd say here but paying the right taxes will probably redistribute some of the the wages on healthcare so that to equalize or reduce inequality in our economy now as an organization the private sector also has a role aside from individual members participating in activities I name professional society should learn to be more politically involved now doctor sometimes mistake being a political with being politically apathetic being political does not being being partisan but have a stand on policies particularly in health cultivate a sense of what as doctor Pernia says as he coined virtues in patients not remain passive but proactive and even proactive what I mean by this participating in government initiatives like the health technology act or the council bring out issues with congress on health development before help LGUs in the use of era and the development funds so that it goes to health care rather than just other non-productive activities so I'd like to say that while the government has its failings healthcare professionals in the private sector and their professional organizations either by individual actions or group activities can also contribute to health development so act within the budget so to speak so the very act I think of saying in the country is already a patriotic statement by many of our individual health workers particularly the lowest paid or the nurses, the med techs even the therapist or respiratory speech therapist et cetera taking part in organizational and management initiatives in promoting and making delivery of care more efficient would be one role of the private sector making more organized and taking a more organized and systematic approach in health care delivery like creating networks to reduce fragmentation of the health care system which actually the coordination between the different health care systems is one of the costs of our fragmented health care getting other means of funding to spur health care development as a stop cop measure also works we have a lot of programs that are funded by NGOs like Fred Hollow's foundation for example rotary and lions as I mentioned earlier but these are as I said stop cop measures we still have to have health care expenditures increased by the government so I just like to end by saying that while private practitioners in the private sector have to act according to a defined business model in order to be sustainable meaning revenues must increase in order for us to increase the wages of frontline nurses illustrating maybe another aspect of the intimate relationship between the health and economy the government is not so limited it can borrow much more it can spend much more in fact it behooves the government to remember where the private industry cannot deliver services however that is not to say that the private sector is not doing anything it cannot be a one way street though we can do more the private sector can do more but the best way forward for us is through government support implemented in a more holistic approach not just looking at it on a public health perspective thank you for inviting me to react and I hope to answer questions later on that's all thank you very much Dr. Carlos Naval from the Galileo Surge Center thank you for sharing for sharing your views from the point of view of private practice and what the private sector can do and what the possibilities are I went to turn over to Raymond because we have one more we have one more reactor go ahead thank you Dr. Naval and Dr. Susie for our final reactor we have the special assistant to the PGH director but he is also the assistant program leader for the Philippine primary care studies group none other than Dr. Rafael Marfori Dr. Rafi good afternoon Dr. Raymond Dr. Susie thank you Dr. Perna for an enlightening presentation Dr. Susie I feel like I have to react to all the that's been said because it's all very important to me from my work in both the tertiary level here at PGH and in the primary care research field we do whole systems research for over three years now and it's helped to inform also our loss so let me just share a few slides for this it's quite clear that COVID has certainly added new problems which makes hazard pay an obvious choice but I don't think that in a single word we can finish this webinar by saying dag dag swell do ba ang frontliners dapat and it's done but I think COVID also exacerbated long standing problems which prompts us to ask aside from the swell do na dag dag shouldn't we also be asking is that enough is that already fair or are there unresolved issues beneath that sentiment because the sentiment underlying this question is that we in the health sector particularly that the people perhaps have been undervalued even before COVID and I just want to unpack this without negating the economic aspects of the question because it's certainly very important so let's start there from the obvious one of compensate well and in the public sector at least has had some good results here recently you know you do things like have a base salary that's increasing that's from VP Lisa Bersalis presentation but successful public hospitals have added a bonus to this the more workload there is the more bonus there is to go around and we copied that model for primary care even if the payouts from field health aren't as big in primary care we saw good results at least in job satisfaction when the workload is commensurate to a bonus but then this does not explain observations like in some public hospitals where we operate you have vacancies lasting for years unfilled and this is a good public hospital that I'm mentioning right now in a relatively progressive and thriving province where the standard of living is quite good and this is after the salary standardization law so clearly the monetary compensation isn't the whole picture maybe if we copy from the best employers in the world you have all those rankings one of the consistent advantages is advancement or career progress they nurture you you have something to look forward to maybe it's a promotion or a raise they develop you and you are involved and you stay in that job of human resource management that I think should apply to health care in my private sector experiments right now we're thinking of maneuvers like equity or giving a stake co-ownership for example in that clinic so that the doctor or the nurse who is now a stakeholder or stakeholder in the enterprise is involved and has buy in and wants to develop that enterprise for the long term locality or community but still a lot of what I've been discussing applies more to doctors maybe in a way to nurses but we need to expand the scope of this discussion coming from the COVID experience where we saw health care is a team effort yung sinasabi na ating frontliners hindi lang doctors yun contact tracing had a lot of footwork house to house which relied on barangay health workers widwives and emergency medicine doctors you have your vaccinators in all likelihood mostly nurses you have your swabbers and the PCR tests being taken and run by medtex labtex so now you'd be thinking something like okay let's compensate the entire health team let's move to team practice and that's more fulfilling it will be more rewarding but here you start to see it's becoming quite unwieldy this is very costly now just to recruit and retain hopefully retain we're not even sure if it will work to retain them and we haven't even addressed other health human resource questions like the quality of that care the ongoing development and learning the medical supplies they need to have a fulfilling and meaningful practice the data they must collect and so on and so forth because without these supports it's like asking our health workers to practice in a vacuum and that is a strong factor for them to leave to not stay, to not stick around it's like asking a race car driver to sit through manila traffic they won't love that situation they would rather leave it they'll walk away so they need to feel effective they need to be effective we're starting to see the limits of this entire line of thinking which unfortunately and we're learning this in the global health community that it's too much of an employment frame of mind we're treating our health workers just like employees and there is a livelihood aspect to this but my point here is that it's not only that if you step back for a moment and consider that they're still doing this work decades into these under investments that Sakpernya has described we are still doing our work I think that speaks to an inner motivation or set of beliefs and aspirations that we have to tap into also we have to harness and in fact reinforce with our own kinds of investments as health planners and we will get a positive response in a way that maybe aim to get that kind of response that kind of fire them up into their job you know this is the most humane profession and if you want to find examples of that I guess look no further than my professors here I guess at PGH it's quite known that many have continued to serve and teach without compensation a more extreme example for love of the game in India where the village health worker concept was born the health workers up to today, since the 60s they do the health part of their job voluntarily and they are compensated more using assets they have a peace of mind on the side that they have a patch of land here a grove over there that their livelihoods taken care of and they are still passionate about the health work and they are also given training and trust and competencies from their team as valued members of a health team which in turn spills over to the trust of their patients as health experts in their own right and they have stayed they have not left their rural areas so this all goes back to the economic or employment approach being incomplete and I'm saying this example from India for a good reason we need to shift our frame of mind from employees only to actually stakeholders in building up the things that have been under invested they're all interrelated as were described earlier and the way to do this is by investing in them we don't just have to pay them we have to grow them side by side like build the health enterprise together with them they are a crucial part of it and they want it to work so let's make it work so that they can do their jobs effectively so going back now it's incomplete but it has to be part of it let's expand this now and we like to in our research group make this more memorable with a set of E's to equip or to enable and some of the things we've done are to give tools like up to date this is a highly respected very credible and quite expensive outside of research online resource that doctors utilize but we gave it up to the level of nurses, midwives even barangay health workers and we had some good feedback and good effects so it's quite groundbreaking to make health record system we designed this with their workflows in mind we designed it for the entire team so the users of this single system that we've developed are the doctor, the nurse, the midwife the lab tech, the med tech, the pharmacist the barangay health worker for some tasks it's customized for them to make health work efficient and easy the service delivery network itself this is in the UHC law I regard these as enabling factors because they allow their prescriptions for example to render service that would not otherwise have been there so it's like equipping them with tools the private lab outside the private pharmacy attached to the network across the street after they prescribe the patient can go there and actually get what was prescribed and it's very fulfilling also for the providers and has good health outcomes of course and skills skills I would categorize as equipping them because again it allows them capabilities to do their job that wouldn't be there before empower leveling up a little now how does this differ from enabling one thing we did well let me just outline all of them for speed you can empower and I know this is a word that is often overused with policies team functions the protocols in place at the workplace and licenses or societies nod to them to say you are authorized to do so and so then we're talking about the authorities that are within their scope of power now to render to their patients so for example a policy like actually let me do this in reverse assume that we have nurse practice in the Philippines a good example historically is China with its barefoot doctors they were called I mean look at the economy of China now by investing in barefoot doctors in I think the 70s I think they prove the thesis of sequernia that economy is health but I think I fully believe that our nurses are probably far more competent than those barefoot doctors Filipino nurses are amazing doctors I think were only given certain types of training so assume that we have nurse practice and they could prescribe things they could diagnose things within their scope properly trained through curricula that have been vetted by CHED that is an empowerment example and with that you wouldn't need because we don't have that we had to invent instead a team function of approval so our electronic system allows the midwife or the nurse in the barangay station to prescribe something electronically to diagnose something electronically even if their license says they can't because the electronic system safeguards them from printing that or finalizing the record meanwhile the doctor will look at that same electronic record far away in the rural health unit maybe in the city and look at the entire clinical record and it's as if they're working on the same chart he will approve or she will modify it or send it back electronically and only at that point can they now print this as a prescription and this is an empowering function not to mention that the patient gets services right at the barangay level as if the doctor were there and this now allows policies that are also empowering like for patients to be told you have to go through the barangay station first because we don't want to skip that level when we would be flooding the city health office or the rural health unit if we all skip the barangay level we skip the nurse and there's only one doctor for 30,000 people so these all work together empowerment just allow me to linger because it's something that's gas gas but I don't think it should be and let me just take a side trip here because there are now implications if we think this way on capacity building these are all capacities at the individual group or societal level and finally an emergent property I think here at the near the end already is with all of these we would get an endearment of our health workers to the public maybe to policy makers they will be held in higher regard because they are effective they are inspired, they are capable higher esteem with greater responsibility even at the lower levels outside of hospitals where the funding is hardest right now and tightly integrated and valued within the health systems that they serve so how does this translate into policy just briefly, I think it implies that we need to have a more comprehensive approach and use a more holistic framework we cannot just reward our health workers economic beings when they are functioning and proving to us how much of human carers they are let's support them in their work in a total way health systems wise I think it implies brave new regulations and licensing, the obvious example is nurse practitioners of course with proper safeguards and curricula and that now implies that we need also reforms in education professional education that leads to this cadre I think it implies that we must target decisively we know the root causes I've tried to trace them briefly here we should take aim specifically at those root causes particularly for doctors because they are so difficult to attract to the rural areas as Dr. Naval was saying but it will take too long to develop the rural areas until doctors and nurses gravitate there so I think our better option would be to rotate them and to be creative about this follow the example of oil rigs as just an example a theoretical example in other words limit the dosage to the hard areas difficult areas they don't have to permanently stay there but by rotating them keeping them in touch with the cities and their colleagues they also don't permanently leave and my personal favorite recruit the right med students in the first place because with those proper motivations that I mentioned earlier need to be harnessed I think we've won half the battle and the rest of it we can now is less of an uphill battle to win with the compensatory mechanisms and just to echo other speakers talking about the private sector the maneuvers I've described I think you need less red tape than government to do them and the private sector is that maneuvering space HR management is probably much faster there so yes I am calling for innovation we are moving already as a country from deployment to employment hopefully but I think I've been calling for a movement beyond employment also to something a little more comprehensive with enablement, empowerment and endearment and all of this is grounded on a view of health workers so the compensations should be about investing in them as stakeholders in the health system so thank you and I welcome the questions also in the discussion Thank you very much, that's Dr. Aftimari Fori who I think gave us a very fresh perspective on how to think about compensation that it's not money and getting paid but it's about professionals who are actually drawn to serve this and we're actually dedicated because they have a calling okay we're going to call everyone back for the panel let's call VP Lisa Bernales Dr. Ernie Purnia Dr. Carlo Panelo Dr. Kalloy Naval Dr. Aftimari Fori and I understand Executive Vice President Tedra Bossa is also with us and we're putting on their camera okay okay We're putting that on Raymond can we tell let our panel know who is in the audience okay so right now we have people who are interested to us and just like po sa nakagaliyan po we have a pharmacist who is well ask the questions our questions I think her name let me just pull it out po I think her name is Sarah she's from the Philippine General Hospital may we have ma'am Sarah to ask the first question from the audience Good afternoon po sa inyong lahat so happy po to have this opportunity to join you in this webinar usually pag sinabi hospital or health care we always have in mind doctors and nurses and really we mentioned the pharmacist so I am happy I was given an opportunity to be with you para kaya po pano makita rin naman so as doctor brazalis mentioned earlier that we can give recognition to health care workers so I think it's high time that the general public, example the media will also be aware that the health care does not only comprise the doctors and nurses but also other paramedical professionals okay so nung nag-lecture si doctor pernia medyo nalungkut ako doon sa statistics na kanyang minigay because of yung kinocompare tayo with other Asian countries so really no napakana nungkut na marami tayo when it comes to population siguro when it comes to working force mas marami ang Pilipinas compared dito sa mga ito and if you think of working force and doon palaagay ang tax so, ang question ko why is it that as in spite of the big population and big working force in the Pilipinas bakit maliit pa rin ang ibinibigay napondo sa ating health care budget ilang ko pa ang pwede kong itanon sige po pa isa isa po muna mam so we could go through the whole question mam Sara, thank you so much so mam Sara po although she's from the hospital she represents only a fraction of our health care workers and as you can see from our poll audience survey there are those who are attending right now more than half of them from Metro Manila the next will be from Northern Luzon and also from and then the next is from Central Luzon Western Visayas and then Southern Mindanao so we hope that is something that will really encompass the general sense of how do I say this general sense of maybe frustration from our health care workers po as it relates to this topic and maybe we could start the ball rolling go ahead in the interest of time let's also get the other question and then let's have a discussion so the question was so let's go to our other member of the audience wants to get a question so let's hear both questions and then let's have a discussion as a group so let's introduce our other member of the audience okay so I think we have someone from if I believe Dr. Sumalinog who has the most upvoted question can we have her open her video so she could ask her question to the panelists Dr. Maria Anafe Sumalinog okay so it doesn't seem that she's opening her video Dr. Susie I think let's go ahead and have this discussion why are we spending so little and I think just to get the discussion rolling I don't think this is something we haven't thought about before so I think my question would be um why is it so difficult to make changes like this what makes it so difficult to have change not like we haven't tried I'm sure has tried very hard teds on the panel as well Rafi you've been working on the ground why is it hard to make changes I think the question has to do with why are we not spending enough we have a big population precisely because we have a big population and we have a smaller GDP in other words I can say GDP of course domestic product is like a pie a pie for the family if you're pie your cake or suman whatever it is is only so so much and you have so many children it's really hard to give sufficient portions portion to each one of them because for example our national income or GDP is I think about 60% of Thailand but Thailand has only 68 million population we have 110 million population so paano yan so talagang mahirap mahirap ka maka makabigay ng tamang ang gusto whatever each one wants or deserves say it's a very simple thing 68 million versus 110 million and the pie the national pie of Thailand is bigger than ours it's about as I've said it's a little less than double our national pie so talagang Thailand will be better off than filipinos it's a very simple very rudimentary example lang to make make it understandable we have some of our panelists who want to talk to each other so we're going to ask EVP 10 to make a comment and then Rafi for you the question is very unique and I will share my experience when I was under secretary of health and of course as part of that we joined the national economic development authority which plans are economics where we will spend so the NEDA has this big plan for each administration I was in the previous administration and I saw there that help was lumped together with social services I was fighting for help to have it specific because of the changes we wanted to implement things that secretary pernya actually talked about needed to come out but it's not floating at the level of the national economic development authority because it is hidden under all the social and I'm sure secretary pernya so as fighting for that I was attending all the meetings and until we have more economists that actually realize that health system is a very complex and it's closely related to economics in fact there is an economic index they call the human development index and it looks at number one average length of life years lived which is your longevity of your people the second is the level of education that your people use which I think is although education it's health related because people are healthier if they're well educated and the third is their economic how much they can earn money so with that index dapat, mapocus natin mapalutang many of our colleagues have pushed for the UHC so we're in a dynamic process now we passed the UHC law we passed the IRR but suddenly COVID hit us so COVID created this environment napinakita yung lahat ng gaps ng health system natin lumitao, lumutang kaya pasalamat ako sa COVID lumutang lahat niya at ang gaps in the infrastructure and now we need to replan kasi, I think the old plan needs to be revisited and we need to replan in the new normal and I really welcome your group for taking on this problem of health and economics thank you happy yes ma'am Suzy so very provocative question so pardon my response but to be very frank change requires power and that brings us to I'll try to avoid being political but we've had several decades already where the health just wasn't the priority but this brings the question of we have to look at we have to trace the whispers of power now and I'm raising this because I see hope because I'm not raising this out of despair I'm seeing changes like at the very extreme do we still need government when power is devolving to the cell phone just to be tongue-in-cheek about it but to give a hint of where alternatives might lie where we can still have safeguards and channel through other means of power what we want as a health sector because we're quite strong second as you said I work on the ground and when UHC was the priority before COVID hit we've been talking as a university to various governments because the UHC law devolved finally resources to the local governments it's been commonly said that system in terms of responsibilities and managerial roles without devolving the resources to carry out that responsibility and I think one thing that the UHC law achieves would be to to actually devolve those resources in some form and so riding on that tide we developed a technical assistance program what I saw in my talks with different LGUs is really that's another alternative I saw provinces that are acting very fast one in particular has invested at least 1.5 billion in infrastructure alone and the other is also in their own right versus others with slower progress or you'll see it in the news if there's corruption or what and it gets reflected again going back to Sekpernya's thesis as things like of health there or the response to COVID so there are alternatives I think technologically and socially we need to get ahead of it otherwise the trolls will win and there are also institutional I think alternatives if we want the power to make these changes yeah just going to I mean Kalloy you mentioned a lot of things that need to change what do you think he's keeping us from well I think one of the things that you see the difference because I treat some foreigners for example for them if there's no health insurance there's no health I mean for them health should be free I mean they pay 20% co-pay and they complain but in our society you see 60% 50% out of pocket you go to government hospitals to shell out a large amount to get the health care that you deserve and yet we are so used to that system we are so passive we are so just so used to paying for personal health care that people are just so like Dr. Perna said so patient so for bearing it has also to change since we are signatory to the fact that health is a right then our citizens should have the right to demand government to spend more on health Karlo you've been you've worked in the department of health a couple of times and you've seen some health secretaries under secretaries directors tried to do things differently and what happens to them when they try to do something bold well of course it's not easy to change a bureaucracy because there is a sort of like a culture that you have to swim against as a current and I recall our earlier conversation before this webinar started that there seems to be such kind of an attitude pervasive in the public sector not just DOH that this is already okay and our citizens cannot demand for anything more I'd like to go back to the point of spending earlier that was raised and I agree with Dr. Perna that I think the primary constraint really is that we can only increase spending for health if our economy also grows and there is that binding constraint there to begin with but there are also other aspects of healthcare spending that needs to be understood and worked on and I would like to point out that apart from the issue of not having enough money is being able to prioritize where to spend available money and this has been an issue that has hounded the health sector, the DOH and field health as to what healthcare services to prioritize and which segments of the of the population to prioritize in terms of available government subsidies and sadly we have been spending our government subsidies almost equally across the population and not really providing preferential treatment or that actually gets the least of all health services and even if you are able to prioritize properly there is also this issue of the capacity to spend the department of health's budget has increased by more than five times since 2010 but the average spending is roughly around 60% per fiscal year of which it's a low number actually about 80% is obligated into contracts meaning it has already been bidded out and there are services for coming but since these were not delivered within that fiscal year they're passed on to the next and in the same thing essentially happened with available COVID funding which is I think why Dr. Perna also mentioned that we spent quite little and quite late compared to our neighbors because our system was also unable to immediately absorb available funding and are actually still struggling to spend whatever Bayanihan 1 and Bayanihan 2 has generated which is why the question for Bayanihan 3 remains hand over I mean BP Bersalis you've been working on statistics Carlos just raised a point about there's money but it can't be spent so if we're looking at is this a problem that's unique to health you've looked at statistics of the country and you've looked at the national health accounts is this a problem only in health or in general all sectors are not able to spend the money Dr. Susie it's it also covers other sectors like education so as Dr. Perna said it seems that the government is under spending what I see from statistics are education and health and in fact we now have a multi-dimensional poverty index hindi lang siya yung poverty line income based poverty index measures deprivations of Filipino families saan poor ang Filipino sa access to services number one sa basic education siya yung number one na most deprived ng Filipino families in the sense that only half of Filipino families have at least one high school graduate pero alam ko po na nang K-12 pero at the time na kinukay yung datos ng mga 2018 ganun po ang situation natin only 50% of Filipino families have at least one high school graduate nakakaya di po ba and the next po after education is health at nakapervasive ng statistics na out of pocket pa rin po talaga ang source ng mga Filipino households to spend for their health as all of the discussions have said hindi po siya linear problem itong compensation for health workers it's really a complex interaction of all of these issues kaya siguro po hindi pa nangyany yung call for better compensation kasi yung problema so yun po but because the pandemic has brought to fore itong ating problem sa health in my mind as Dr. Ted said na medyo magpapasamag din tayo sa COVID-19 kasi nilabas na yung problema sa health system so I believe this is the time to be impatient great I think we are on the precipice at the edge of edge of a cliff where we can really where we can really make a difference we can take that leap and get to a better healthcare system because of what COVID has done but this opportunity this window might close if we don't rally the troops together if we don't shout out in a louder voice if we're not impatient okay we're at the top of the R and I'm very mindful of your time very grateful for all our guests Raymond do we want to just quickly answer the questions on the opinion poll okay thank you Dr. Susie so for the first question for the opinion poll among the six major Asian countries Indonesia, Malaysia, Philippines, Singapore, Thailand and Vietnam the Philippines has which poll is the correct answer option A highest COVID-19 case load option B largest economic contraction option C slowest economy to recover and option D all of the above who would like to answer po so we're going to ask I think he's on mute yes I think secretary Ernie is on mute oh no no you're asking all of the above all of the above okay okay thank you thank you the next question the second of four technical questions the doctors in Vietnam get paid two thirds higher than the doctors in the Philippines true or false? true okay thank you sir question number three three of four the doctors in Singapore get paid ten times more than the doctors here in our country true okay sir and then lastly the nurses and medical technologies are the lowest paid among the six major Asian countries true again okay thank you secretary Ernie thank you so much you were asking the person who gave those numbers yes sir we just wanted to reiterate for the benefit of our attendees sir okay okay so we're going to now ask everyone to just give a parking statement we're gonna start with VP Lisa please go ahead thank you doctor Suzy yung parking statement ko po tingan di po nating yung regional if we go low hanging fruit in my mind pwede po siguro we engage the local government units do on sa area nila baka pwede si lang mong ordinance ba yung nabug-dug-dug at least for their government workers so malaki ang problema but we are all together now is the time, thank you okay thanks a lot doctor Perna Ernie go ahead yeah i think our problem with the spending is not so much that we don't have the funds but it was a question of timing timing when to spend kasi ka ilangan like Vietnam for example in 2020 was still below the Philippines in terms of per capita income na yun naka overtake na in Vietnam no because they grew asian country that grew positive 2.9% in Vietnam growth in 2020 so if Vietnam was able to do i think among the asian countries Vietnam was the best able to handle the COVID both on the health side and the economy side so why couldn't we have done that as well so it was a question of timing of spending so smart being smart in when to spend so that it will have an impact on what you are targeting so and the other thing is i wanted to say is that i think we need to have a public, private the what do you call it? fund a trust fund so that this fund can be used to supplement the salary the basic salary of our healthcare workers kasi kulang talaga yung funds from the government kasi maraming tayong punduhan pero yung anong if the private sector provides say what 30% of that big fund of that trust fund it will be more possible for us to improve the remuneration of healthcare workers thank you carlo your parting words thank you mam as a faculty member of the college of medicine what all this has impressed on me is that we can't really overemphasize the need for capacity building particularly in the public sector to make it more resilient and nimble to manage these challenges and COVID is a watershed experience although the lessons came at a very high cost and definitely the health system has the opportunity to actually reform in a way that allows it to become more resilient in the future and the academic community UP and other universities also need to look at the curricular offerings and the way we train our health workers moving forward on how to be more adaptable to these kinds of stresses in the sector the compensation to workers is going to be a heated debate but the fact that it is now being talked about is important and compensation should be looked at and not just in terms of the individual professions or specialties because as what we learned from this pandemic it was all hands on deck and everybody the frontliners in particular had to face the challenge head on with whatever resources we have. Thank you. Thank you very much. Well a lot of these changes that are needed for the initiatives and government is run by politicians and politicians respond to public opinion so I think the private sector and the government sector all band together and shout out for the demand for health demand for greater health expenditure for greater support for all initiatives both on the local government and national government side and also for the private initiatives. Thank you very much. Rafi. Yes, thank you ma'am. I just want to draw the distinction between investing in our health workers so they're happy with their pay and investing in our health workers so they're happy with their calling, their job. I think it's important kasi it's only when we frame the challenge that way and that's mind you a bigger challenge because the first question is very obvious no one will disagree with that. Our health workers deserve better pay period but that's too obvious frankly that's too easy as difficult as it is but if you frame that challenge that way that's the only frame of mind that will encompass everything that's been said today which is this problem has been here a long time it requires public and private it goes beyond the sweldo even if you address the compensation issue depending on the model it might actually as you said I think earlier ma'am it might work better in areas that are better off already and it will still leave behind the rural areas and the rest of the country because everyone said that this is a complex problem but with that kind of framing the criterion is the health workers and the families themselves we can fire them into the job not just from a pay perspective but to be awoken by the pay question towards the real deeper and complex challenge here which is they're part of a system we must invest in them system-wide Thank you Rafi Ted? Let me start with what Professor Pernia said health and economics are intertwined but I would say the politicians are the mistress so politics is the mistress and we are in the crux of universal health care we passed the law in 2019 we passed an IRR boom, we got hit by COVID-19 we weren't able to implement the IRR and the necessary changes that would have brought about some of these things but now we're looking at it and we're saying there may be some unintended consequences for friends who are doctors or surgeons or have decided to quit medicine altogether maybe it's because of low compensation compared to the risk what I want to tell the people listening is that you're all in the health care sector you're all health care workers you need to engage your politician you need to engage your economist you need to engage your local chief executive and with that engagement we will understand how to frame the changes we look at whether it's a delivery network at a local health system or at the top level like us in the university will we educate more people secretaries supported us when we said we're going to build a PGH in Diliman Mahidol University in Thailand I visited it's a top medical it's a top university but it's highlight is medical education they have five teaching hospitals we have one and we're the largest in the Philippines the concept really is we need to grow we can't only just raise the salary we also have to build the health human resource we have to answer the infrastructure gap and we have to fix problems in the health care system so with that thank you for taking on this topic I've been trying to insert this in my lessons but I find that the medical students are not interested in this I need an audience probably with the practitioners already because they feel these changes but I think this group we should replicate this and keep this discussion going this is another vaccine this needs a part 2 thank you okay we have we're fast at the top of the R and we're going to ask chancellor to give a brief summary I know this is going to be difficult but please give us a brief summary of the entire webinar well thank you it's been a very good webinar so it was opened by vice president for finance Lisa Bresales I think the message she gave is that there's data and that's for everybody to take a look and if everyone want to do it and he has a lot of data there is data on zeroing and health and maybe that is the beginning for our audience if you want to better understand it from secretary we heard it health is economy they're inseparable they have to be linked and interactive no trade-offs between the two and I think what is important to know is that just before the pandemic we were good we were being poised to become an upper middle income country but then the COVID came and of course now we've got all of these problems I think at the point that he raised for us to ponder after this webinar is that situation is that we had the longest lockdown our economy was lowest to recover we have under invested we had the lowest salaries for our professions and we have to ask ourselves now why is it that we have responded the poorest actually in terms of COVID so where is the problem and I think he he kept it by saying that the problem in the Philippines is that we lack a sense of urgency in patients so in the short time he said we've got a shift expenditure to fortify the health system raising the salaries improving social infrastructure medium term we've got to look at the public-private partnership and at the end again he goes back and saying that we've got to develop a culture, a habit of saying the sense of urgency on virgins in patients we had a couple of reactors Dr. Panelo actually agreed that the countries under invested he actually showed the graph showing that these were the problems since 1995 we have not even caught up and the biggest problem we have is that the health is fragmented and with the increase in economy increasing growth of course followed was the out-of-pocket investiture Dr. Kalain Val is a practising of thermologies who from the perspective of a privatisation he said that the problem with the Philippines is that in addition to the lack of infrastructure is the mal-distribution of positions he just gave us example his personal experience as far as of thermologies is concerned with 60% being in Luzon majority in Manila and he posed a very intriguing question and I want to say it he said if indeed cataracts remain the main problem in the country why is field health restricting the number of cataract surgeries to 50 a month a maximum of 10 a day and how can we cope with the numbers if the policies are not strategic you know I'd like you hearing about how the private sector can contribute he said well the private sector can help one pay taxes because we can pay higher wages to our health workers professionals and scientists can participate they don't have to be political they make a standard health we should not be passive but proactive and he said that working with NGOs is critical I'd like this line and he said the best thing that the private sector did for the health workers is that we stayed and that is a major contribution actually a major contribution to the country Dr. Marfari actually gave another framework he said it's not all about compensating it's really a question of compensating the team equipping them enabling them empowering them endearing them and you know all of these measures can actually be translated into a new framework where in the health workers are not new employees but they're actually part of the whole system and the whole framework I guess for the final messages it's just a few words one line from each from Dr. from VP Prasali said you know it's time to look at the regional angle not just national for Secretary Bornyard's staff it's not about funds it's smart it's about funding of spending from Professor Panelo he said the academic community need to look at curricular offerings train our health workers better from Dr. Naval a shout out that the private sector will have to work closely with the government sector and from Dr. Marfari invest on the health workers so that they are happy with the pay and the calling and this is the best framing of the challenge from EVP Ted in finding the solution we've got to engage the politician the economist the local chief executive executive for the better framing of the problem the challenge and the solution so in sum we are so tolerant of our system we are so patient maybe it's about time if you say healthy survival maybe we should demand government to pay back to you Susie and Raymond thank you very much that's Chancellor of UP Manila Menchip Padila and indeed I think it's been a great webinar thank you to all of our speakers who made the time to be with us today there's an opportunity COVID has given us has given an opportunity to show how important health is and that we cannot continue to go on this way under spending under prioritizing and not not providing our healthcare workers whether it's with material or material or social support that they need so this is an opportunity for all of us and a time to reflect on how we should not be passive and we need to be impatient okay so next week we've got a great line of speakers next week we're going to have a national town hall meeting for hospitals and again you're going to Dr. Gaplegaspi who is going to be talking about how to continue to keep healthcare workers safe even if there's a vaccine Ted Robosa is going to open the program we're going to have speakers from Sibu and from Davao no no Sibu and the Lang Center of the Philippines so don't miss it next week we're going to do this now we are getting ready for our first anniversary and in order to do that we have something special for all of you so please stay don't leave because after the music and the video we're going to ask you all to open your cameras your videos so we can take some pictures so bear with us because we want to have photos of all of you who stayed who stayed today and I guess Rafi that's part of endearment we are going to want to have a photograph with everyone after this okay so I'm going to turn over now to Raymond okay thank you Doctor Susie so uliti lang po natin yung po just right after this webinar pag atapos po ng kanta at ng video we will be allowing you to open your videos po so we could take our very first stop COVID deaths webinar series group photo so maraming salamat po sa ating more than 1,150 atenbis who are still on the call and we hope to be able to see you again next week same time same channel po it's been really a pleasure and we hope to be able to learn more from our national town hall meeting next week so makita kita po tayo let next week March 12 12 noon go to 2pm we are displaying po the results of our polls but we hope that you had the opportunity to answer our post test so that you could gauge your learnings from this webinar so thank you so much and we hope to see you next week it's a date together let's stop COVID deaths so keep safe keep healthy and see you online my until my say his name to realize it's fine to be afraid just hold on to the word he gave this time will come to pass because this salvation makes a last you'll carry you to see the break up the others pained from my fears the others now's before my tears went right behind the last but right behind the last I look into myself and ask do I have strength to carry on but God our lord was this go on need you here to keep me strong I'm here to hold the line I'll keep my word until my head's dying my fears the others now's before my tears went right behind the last I look into myself and ask do I have strength to carry on but God our lord was this go on I need you here to keep me strong I'm here to pain before my tears pushing on the spider tears these things through another day