 Welcome to Health Issues. I'm Dr. Teddy Herbosa, a trauma surgeon, an academic and faculty from the College of Medicine of the University of the Philippines, Manila. From 2010 to 2015, the university lent me to the Department of Health as an undersecretary of health where we implemented health reforms for the Philippine health system. This educational series on health systems and health policies and health reforms are critical as our country aims to provide health equity and quality healthcare to our citizens from all socio-economic sectors through a robust and efficient universal health coverage that all governments aspire to attain. Our health system has long mirrored the health system in the United States of America, which has now become the most expensive healthcare system in the world. In the early 1990s, our government officials decided that we can no longer copy the American model of an expensive healthcare for a high income country, but develop our system through one involving greater health equity for the poor and the disadvantaged. After our government decided to follow the Bismarck model of social protection and created the National Health Insurance Act of 1994, which eventually formed the Philippine Health Insurance Corporation, it was a health secretary, Alberto Cuasi-Romaldes, that initiated health reform agenda in an environment of a decentralized health system. This predated the national health insurance and by 2010, which was supposed to have been the deadline for universal health coverage by PhilHealth, only 54% of the population was enrolled. Also, the support value of PhilHealth was a low 30% of the total cost of healthcare, making our citizens spend a ton of money on out-of-pocket expenses. It was in this environment that we formulated the DOH program of Kalusugant Pang Kalahatan, directly translated as Help for All. We passed and revised the syntax law that allocated 85% of syntax revenues to healthcare. This was critical reform in health financing that fueled a resurgence for better health outcomes of the people. Recently, we have passed a comprehensive universal health coverage law. The Office of the President is due to sign this any moment. Our series will do and discuss many of the complex issues of health reform in a developing health system. In this episode, we have as our guest Dr. Emerita Faraon, a professor of health policy at the College of Public Health in the University of the Philippines Manila. We also have Dr. Carmen Sita Padilla, the chancellor of the University of the Philippines Manila, a medical doctor, geneticist, and research advocate. And to my right is Dr. Tony Boy Faraon. He's the vice president of the Zwilling Family Foundation, a non-government organization that have pushed itself to improve the health outcomes of our people. They will help us understand all the health policies in our country today. So, let me start with the first question and I'll invite anyone to actually dig in. What do you think are the public health policy issues that our health system needs to tackle as a priority reform? Good afternoon to everyone. I think the most important right now is to address the policies directed to sustaining the currently enacted universal health care bill. It also deals with giving how to ensure that our people get that universal health coverage that they want. So, the approach, as you know, we have been discussing that in the academy, we have been teaching that to our students, is the six building blocks. So, the six building blocks, of course the most important is governance. There are already existing policies here. But in the light of the new law, certain things must contribute to making sure that it is being given that all Filipinos are already covered. So, these are human resources, health information system, health regulation. I think there is already now fixed HSTAP, it's the HTA Center. Health Technology Assessment. Yes, and the Health Human Resources. Health Human Resources. I think it's being addressed also by the law. And the financing would be very, very different now. So, what are the existing public health policies? Are there in place? Do we have to make them? I think that's the next thing to do. So, those are the things that we should address. Correct. So, the way I look at it, it's like making the airplane, flying it and then as it flies, you're trying to make all the changes in the airplane. Yes. Chancellor mentioned, how does the academy contribute to all these health system changes and health system reforms happening and all the gaps, some of the gaps that have been mentioned? Actually, the University of the Philippines, Manila, UP Manila, is a major partner of the Department of Health. As we prepare these changes in the country, in relation to the universal health coverage law that we have at hand, they have commissioned UP Manila to conduct roundtable discussions on priority issues. So, right now we have a series. We're in each roundtable discussion. We bring in the stakeholders and try to get the ideas that are necessary to be included into the implementing rules and regulations. And I think that's very important because we have very limited data in relation to the concepts and reforms that we want. So, the stakeholders now are able to voice their ideas into this platform and hopefully give it now to the Department of Health. I mean, that's one immediate angle that I'm looking at. But going down the line, I think the University and not only UP Manila, but all universities will have to ensure that our next generation of health managers have these new concepts in place. And that means that we have to update our curricula. We have to update. We have to come up with courses, workshops to ensure that all the health managers from the high position to the low position are actually aligned as far as the guideline set by the implementing rules and regulations. Correct. So, you're saying what's important is data. And we all know that when we make policies and we make changes, it's got to be evidence-based. So, the role of the University of the Philippines, Manila, seems to be to generate that data and analyze. Analyze that data and be able to come up with solutions to gaps that you mentioned, gaps in the six pillars, whether it's human resources, whether it's healthcare delivery, whether it's financing. So, Doctor, I really want to bring in the whole community of colleges, universities and board because I think this is one generating data should be an effort of everybody in the academe. The gaps have to be identified. Budget should be given so that we can get the hard data. Without the hard data, we cannot generate good policies. So, one of the messages we want to send out to the community now is that if you want good policies to come out, then help us generate the data that's needed by the Department of Health. Correct. It's the era of data science and all this accumulation. How about you, Tony Boy? You work with the non-government organization and you go farthest. In fact, the non-government organizations are often forgotten in the formulation of health systems. I've often heard that in my own field in disaster medicine, the private sector, why did you not include us in your plans when you were changing? So, can you tell us more about what you do at the Swillig Family Foundation? Thank you, Ted. Well, basically, I think there's really a big role for non-government organizations and the private sector to play in this whole scheme of things, especially in relation to universal health care. As we follow the government that they keep on saying that it should be a whole of government and a whole society approach, non-government organizations really do play a big role in maybe, I should say, three things. One is really in relation to advocacy. Second is in relation to supporting the many players and main players, I should say, like the Department of Health, Field Health and local government units in terms of the implementation. And thirdly, in terms of engaging the communities to really participate in this new law. In the Swillig Family Foundation, we support the Department of Health in partnership with the academe in developing local leaders in terms of their leadership capacities and for them to really prioritize health as an issue and be able to invest and do responsive programs for their communities. So in the foundation, we have what we call the Health Leadership and Governance Program in partnership with the Department of Health and many academic partners such as the University of the Philippines to train these local health leaders, improve their governance and be able to come up with responsive programs. That's right. What we're seeing with what Swillig Family Foundation does is that we now know that health care is not only delivered by the health professionals. It's actually delivered also by local chief executive. And that's the group you actually target. You're able to explain to small town mayors and small town local chief executives why it's important to vaccinate the children, why it's important to give them maternal care, why it's important to have an ambulance to the nearest hospital for definitive care. Correct. And in so doing, they're able also to invest and be able to provide these services to their constituencies. I think this program, the Health Leadership and Governance Program is an excellent example of a private public partnership because we know our strength and we know where we can help and it is one program that can probably be expanded to cover all the local chief executives actually in the country. So it is a model that's worth duplicating for the rest of the Philippines. Maybe for the information of our viewers mentioned, let's talk about the National Institutes of Health because I know you were formerly the Executive Director of that before from the time it was born to the time it passed as long to today where it's now creating a new building and how many 22 institutes or something. Tell us more about it and tell the viewer what the National Institutes of Health at the University of the Philippines Manila can contribute to health systems reform, health reforms, health services. Okay, so let me just start by saying that the National Institutes of Health is really a family of 10 institutes ranging from child health, aging, genetics, epidemiology, health policy and so on and for centers. Although it is housed at the UP Manila, actually it's only a home but it's meant to cover the national needs, the national priorities in terms of research. The role of NIH is to provide data so that to the government so that we can come up with good policies. So we do have some good examples right now. When we talk about research output, I'm not just talking about publication. So you want publications so that is for the academe and for our work to be vetted out by local and international peers but we're looking for products. And for the information of everyone, the citations that we get at UP Manila are actually pulling the university in its right. So the products would produce for instance, Lagundi is one, we have Sambong, we have the diagnostic kit for Dengar. So we have a series of products that we are giving to the country so that they can be affordable to the ordinary Filipino. But the other thing that we're contributing actually is data that will be converted to policies. So we do have policies generated out of NIH. Of course one is my program, the newborn screening program that is now supported by the newborn screening act of 2004. We have hearing. The hearing data has been used as the basis for the law on newborn hearing screening. We have the rare disease law that was also based on data coming out of NIH. And of course we've been supportive of we're now an advocate of the universal health care coverage law plus the tobacco, the syntax and so on. So actually NIH is a home not only to UP but to many organizations in the whole country. So that we can produce a data that we can give actually to government. Correct. In fact most of the funding source really comes from our department of science and technology through the Philippine Council for Health Research and Development. So it's government science and technology money and it's a G to G program wherein scientists from national institutes of health will do the priority research, the national research. Unified health research agenda. So that's also the mandate of that NIH. So it's become a very important unit, institute in the University of the Philippines Manila and the University of the Philippines as a whole. Emer, so let's go to public health and how public health was practiced in the Philippines maybe a bit of history because our professors in public health were former advisors of former secretaries of health as well. And you've seen, you also were working in the Department of Health at a time when Undersecretary Belisario was actually there. So tell me from the historical perspective how all this, how the College of Public Health has been playing its role in terms of all the reforms that's been happening. Even the key points, maybe key points of contributions or maybe even I'd like to see things that didn't work so well, maybe ideas because we learn a lot in academia, we learn from our failures. We learn on things or projects that we proposed but were never implemented and everything. So, I think it was born in 1927. So 19... Institute, right? No, it was called, it was actually part of the College of Medicine. College of Medicine. So it was Dr. Hilario Lara during that time. So Dr. Hilario Lara was prominent. It was a national scientist and actually a faculty of the College of Medicine. And, of course, there was the drive to separate eventually and go to... It was called a hygiene at first, an institute of hygiene. Institute of hygiene. But it was Dr. Hilario Lara and that's why our hall is called the Lara Hall. The Lara Hall. So it was named after him but he was the one who pioneered it and I think part of the... It was not called the Department of Health at that time. It was called the Board of Health. So, there were money given for Dr. Lara to go abroad. I think it was Johns Hopkins and eventually the building that you see now, our College of Public Health, it's actually a donation by the Rockefeller Foundation. So, it was actually history creating itself. So, there were, there now currently because it's 92 years old, several departments. So, public health is actually health policy and administration to which I belong to. There's health promotion and education on the second floor that there's the epidemiology by statistics, nutrition. Third floor, you have microbiology and parasitology. Last but not the least, so we call it the seven dwarfs actually. And of course, the dean is there who head every department. The whole college is the environmental, that's the, I think the latest addition during the time of Dr. Vitassa. Correct. Occupational health. And occupational health. So, and that creates public health in itself. And of course, beside is the college of medicine, but it was an offshoot of the pioneering of Dr. Hillary or Lara. And in the 70s when the Western Pacific Regional Office of WHO became situated in Manila at the United Nations Avenue, you became a collaborating center. Yes. Which were in the, many of your faculty contributed to public health improvements in other parts of the Western Pacific regional member states. And I think many, some of the ministers are actually graduates of us. In the region. In the region. I worked in Malaysia as a professor at many of the ministers of health in the different states would come to me and show me their annual that they graduated from my university, the University of the Philippines. And it's the college of public health. And it's actually the flagship for, their flagship programs, the master in public health of which I think several secretaries of health are already also aluding probably your next guest. And there's also the master in hospital administration. And of course, the master's in occupational health. And our dear Chancellor is a graduate of the master's in health policy studies. So, of which also my department, it's part, it's under my department, the health policy and administration. So, that is how it started. So the part of the history and how we're trying to contribute. And it should be, I mean, it is a partner of the Department of Health all throughout the time. Not just the Department of Health, but the World Health Organization and all throughout the region in order to achieve what was established in 1979, the primary healthcare of which this all started. Is this continuing because I found this lacking because I come from the University of the Philippines and I was under Secretary of Health. I wanted to see a lot of that government-to-government links between the Department of Health and the College of Public Health. I think there was a time that there was, of course they were engaging as I said in the history. But there was also a time that I think waned. Wained, yes. But now there's a resurgence. Yeah, I noticed that. There's a resurgence. We have many. And yeah, as this Chancellor would say, it's not just many. There's numerous. And it's different. So the future seems to be that the College of Public Health and the National Institutes of Health and UP Manila will play, will intertwine itself with the Department of Health. Yes. And it complements the efforts of the Department of Health in achieving what you said, kalusugan pang kalatan or universal health care, which you started when you were... In fact, I think the Swilling Family Foundation is offering something to the College of Public Health as well, right? I think the Chancellor is the Chancellor. But let me go to what Swilling Family Foundation does. You've also, you're in the private sector. You're a nonprofit. Why was health chosen by your group? I mean to assist. Were there many gaps in your experience? And what were those gaps on the ground level? We, then we worked really on looking at outcomes in the beginning. And we found out that, you know, wait, ten years ago, really the health outcomes of the Filipinos is somewhat lagging behind the health outcomes of our neighboring countries. I guess at this point it still is the same. So the core of the work is how do we improve health outcomes? So when you look at health outcomes you talk about infant mortality. Maternal mortality. Maternal mortality. Deaths, yes. Maternal deaths. Non-communicable diseases. Nutrition. So that was the focus. So that was really the core. How do we improve this? And we found out that really the main responsibility at that time and until this point of time is really with the local government units, primarily because of the devolve setup of health. Hence, ten years ago we started working with several municipalities. There was a change, right? Because in 1991 we decentralized health care. Correct. 1991. In the era before 1991 it was a centralized health system where in the College of Public Health had an active role. When the district health system, the provincial hospitals and some regional hospitals were devolved to provinces, the control of health transferred from the Department of Health to local chief executives. Correct. The mayors, the governor. And in fact it was really fragmented in the sense that curative care or hospitals was under the governors and preventive care was under the mayor or is under the mayor. So the continuum of the health system preventive, promotion, emergency care, acute care, definitive care were all to different members of the government. Correct. Hence, we thought what do we need to do? And that led to the poor health outcome. Exactly. Because of the fragmentation, right? Exactly. Correct. So we started working with... Actually the local parlance then is that people said na politika. Well, it is. The politicalization of the health system led to doctors resigning from the district health system from the provincial hospital and going to the private sector. There was a migration to the private sector. And I think at that time as well, they devolved the responsibility to provide the services to these local government units. But somehow in terms of financing the finance work was kept at the central government. Correct. So I think that was the issue then. So we started working with mayors and unfortunately also at that time it's kind of difficult for to convince them to really prioritize health as an issue. Both governors and mayors primarily because health is intangible. Compared to building basketball courts, building roads. So they do not invest in health. Dry years, the basketball court used entertainment and drier for the grain. Exactly. So we started working with mayors and convinced them somehow to really prioritize health as an issue. And after several years, of course, we found out that it really improved the health outcomes. You had the statistics. You presented it to us. Exactly. During your time with... You improved mortality. The mortality went down. Infant mortality. Correct. The maternal mortality went down just by educating the mayors. By providing leadership and governance, interventions. Why health is important? Why health services are important? Correct. But there was still a gap and this is really in relation to the curative services because at the time we found out that they're now dying in hospitals. Correct. No longer in their homes. The hospital was under the governor. The governor. Sometimes they're not the same party. Exactly. The mayor is the opposite party and the governor is another party. Correct. Now we began working with governors for them to address their hospitals and improve practically. So that's where our work is now really doing work with... Because many of the governors during that time prior to me becoming undersecret was they wanted to renationalize their hospital because they found out it was expensive to run a 150-bed hospital. Correct. So they said they'll ask their congressman to just pass a law to renationalize and give it back to the Department of Health. Because he said the money wasn't transferred to them. Correct. And it was a political issue for them because they get criticized in their radio programs when they don't deliver the services. Hence, in the last cycle of our intervention in their program we worked with governors for them to integrate the system. That they worked with mayors and that they worked with their hospital chiefs on really integrating the health system. And I think this is where the universal health care bill or law is really gearing towards now. Really the integration at the provincial level. So we hope to work in that direction. So it's not really us lagging behind with what this being. Everything, I think, is falling into place. Yes. So, of course, it's a long way to universal health care per se. Of course, the losses as long as you are Filipino now that you are COVID. And that's my criticism to some people who talk about universal health coverage or universal health system strengthening. It's because they don't understand the context. I may be a more senior doctor having worked and seen the system as it grew from the time we were medical students, meant it is a few years ahead of me to today. And we've seen how practice, research, education has changed even the political side. So what do you think? I'll ask you because that question to me. We decentralized health care. Was that a good thing or a bad thing? I would always tell my students an analogy. So it's like in the United States, I think if you're 21, I think that's the legal you have to separate. So, you're on your own. No, you're on your own. You're on your own. So that's, I think what happened there. So, we are what? The Miss Universe contestants would say 7,107 islands when slow tide or different tide it's another island. It's fragmented. Each of those has a mind of its own. And in the bold setup, each one knows its own problems. Each one knows its own resources. So you can address their specific part. So that's, I think is the specific, but not everyone was ready. Correct. I agree with that. So not all children who part with their parents are ready. In fact, I think what's wrong with what happened then. What happened then is we just woke up one morning and the health system was already fragmented into three. But you have to do it now. But it looks just the law. And because it's the law, but I think people should have studied because some provinces, those provinces were in the family name of the local chief executive does not change, but the first name changes. They were able to build strong health system because of the continuity and as you know health systems are more continuous. So those are things that were not taken into consideration in the principle of implementing decentralization. The nature and spirit of the law is good. Yes. I agree. I think we all agree. I think we all agree because the local government is really close to the people. Yes. Yes. But there should be like conducting a symphony. There should be harmony also. So when you say you go this way, you should capacitate that person to go. They were not ready. But now in a default system, the department of health is merely on a guiding. So it develops the policy and then it hands it over. This is the direction to go. But how about the human resources? You know, the six, again we bring it back to the... So I'll ask you an academic question that makes it more even more complicated. We're talking about a federal form of government and there is a proposal for federalization. You're putting me in the spot. I think it's beyond my... No, but I just want to know your opinion because I don't think they're consulting again the health professionals and the health policy people. They're just creating this new framework to implement equity in governance. But therefore getting that it might destroy again our... Because we decentralize, we got rumbled up. Then we built up with field health and we built up with syntax. And we're now at the point where we can actually deliver better services. And then we're going to change it again with the federal government. Actually the law is trying to remedy that by providing an SDN, the service delivery network which is an effective functioning health system with the partnership of the private and all of us. Yeah, but before, we called it the local health system. The SDN. So in effect, it's actually giving a solution to the problem that was already encountered before. You are not ready, but here is now the SDN. And there's a partner But you said if you're going to federalism, the devolution is like we're on steroids going there. Federalism is the real thing now. You're really on your own. But are you really ready? So readiness is defined in so many aspects as well. Human resources. Again, if it's the health system, you deal with the six building blocks. I'll go to Menchit because Menchit did a program that is quite interesting and solves this fragmented health system. Can you talk about the School for Health Sciences and our graduates from the Latterized Program for Health Professionals and how it helped their communities? Actually, UP Manila has nine academic units. That's from medicine, nursing, public health, dentistry and so on. But one of the academic units actually is School for Health Sciences. School for Health Sciences. And where is the campus of that? We have three right now. One in Baler, one in Coronadal and one in Palo. Palo is a group because yes, yes. I think, you know, this is, I would like to look at this as a very successful model because whereas we talk about Braindrain and people living, here is one program wherein I'm able to keep the graduates, 90% of my graduates who are in the Philippines. In the local community? Yes, yes. My retention rate is 90%. Wow. The recruitment of the student is actually from the community. So you get the top high school graduates in the public school system. They have to be nominated by the local government because they have to go back to the government after one. So it's a, they really are connected to the local unit. But it's a ladder-wise program where they start as a midwife and then they have to they will become a nurse and then become a doctor. But if you look at the program intertwined in the academic component is their return service. Yes. What's happening now is that I guess, you know, the love for your home is really, it grows with the program. So what is important now is that the recruitment, as I said, from the community is maybe one of the major factors why it is a very successful program. It may be a good model that can be considered, you know, down the line. We're actually setting up two more campuses at the moment for this. Our luck, right? We have two more that's coming up. But maybe, maybe that's one model. I think, you know, what we should do for our, for the new concepts. Can I agree on the successful model of the training? It's step-latter, right? It's step-latter. And then nursing. And then they can go to nursing if they're intelligent and then they can go to medicine. Well, if they want to become a doctor. But as we talk about new reforms right now, what I'm seeing is we should really look at the best practices from the community, the private sector from the academy and see which ones will align with the new reforms that we want. We don't have to start all over again. But without the proper modeling for these new concepts, it's going to be very difficult. My second comment is that we cannot just change things overnight. The transition actually to the new, to the reform system is going to be crucial. So the transition may take, may really take well, the milestones I think for the transition is going to be crucial. So they're really very innovative solutions, right? So the concept ladder model of health human resource, which is an answer to brain drain. You also did something in the UP Manila that actually is now being copied, right? The doctors of medicine were asked to sign a contract when they enter medical school. I have a daughter who's studying now in medicine. I have to sign a contract. Can you explain this return of service agreement? So the return service agreement actually is it's really a platform where in our graduates can serve the country before they decide on leaving the country. There's color ng bayan, right? But the concept is depending on the duration of their curriculum it ranges from two to three years. But it's really just to stay in the country and serve the country. Majority of them still stay behind in fairness. Very few really decide to leave but I think what's important is that the return service agreement is actually it really concretizes the opportunity to really serve in the country after you graduate. Correct. I think the important thing is that you're doing your service return service after you graduate because you're already a professional that can really who can help the Filipino patient. In fact, what happened there is when we created that return service agreement and I was at the Department of Health I noticed that many of those that signed up for the doctor to the Barrios program which is a program of the DOH to serve doctorless areas many of them were coming from that return service agreement model signing up to work one, two years and then earn a master's in public management together with the service. I think what is important for us government and the Department of Health and Academies if we really want the return service agreement to be implemented nationwide we have to create opportunities where they will go because right now for the return service agreement that we are implementing the graduate has to look for the job or look for the residency and there's really no budget for their funding with the law right now I can see that they will be employed by government which I think is an improvement of what we're offering so once again I'm saying that UP Manila is willing to look at many other models we have many lessons to share so as we expand this on a national scale will be more than happy to to share how we worked out nursing therapy public health because there are many lessons to learn as we move forward and make it successful but I would like to think that the return service agreement is a very successful program of the University of the Philippines Manila I think you also have another program that's worth mentioning in this episode there is a regionalization program as well could you explain that a bit? This has been going on for decades now yes even you're my time when Dr. Ted and I were students but it's unheard of people don't know it a certain percentage of students that get into the college of medicine actually come from the provinces there is a commitment to go back to the province so it's a when you come into the college of medicine there are many other you get the regular program one become an MDPHD you become a PhD after your medicine we'll talk about PhD next and the thing is for the regionalization there is a number of slots we're in I have committed to actually go back to a distant island after I get this so it's a different track that you're getting into once again that's a very good model and I think we should really increase the number of slots because that means you've got a doctor that's coming back to that province or to that community and all we need to do as a university is coordinate with the Department of Health and the DILG and maybe it's really and ask them where are the doctorless areas that you need a young graduate to go to so very interesting so how about this MDPHD you mentioned MDPHD so I'll have to grab you on that one we just graduated last year right yes we started graduating I was there in graduation you had four graduates of the MDPHD program so the MDPHD program is another track for a doctor you become a physician and a scientist at the same time which means you extend another three years to finish your dissertation so that you become a PhD so in other words if you look at the field of health it's not only doctors or nurses or midwives that you need or therapies we need public health people we need people who should stay in the academic teach we need people who will go into deep research deep research basic research basic research to come up with new ideas innovative changes so that we can actually produce products that will be useful to our people so I think when you look at health you cannot just look at you cannot just look at this clinician not only services not only services you need to create the PhD scientist that will change the way we care for diseases that we have in the Philippines and I just want to mention that the Philippines is very unique whatever you say you cannot say you can copy what dex or country is doing we have to generate our own data so that we can come up with a diagnostic kit that is aligned to the Filipino people our genes are different so I guess my message is that when I talk about you want doctors we have many kinds of doctors doctors will become public health people who will teach who will become clinicians and then you can be scientists and we have more tracks that are available for the students right now I just want to mention Dr. Ted the current dean actually recently did a survey of medical students about 800 about 600 actually responded and he just want to mention that quite a big number of medical students want to go to policy and I am really happy about this I notice that because it's very important that our medical students understand the importance of policy to change the quality of health that we will give our people so can you can you answer that is the college of public health ready to accept more than how many students half of the students wanting to go into health policy actually the college of public health is not ready the college of public health is already doing it so actually the college of public health is already to talk with Dean Sherlock Chung not just the PhD part but we're talking about masters in hospital administration masters in occupational health masters in public health as well as the health policy so Dr. Ted what we're saying now is that we want a doctor instead of graduating from an MDPHD might graduate from an MDMS in health policy yes what question you seeing all the programs being done at the academe are you seeing this on the ground well we've observed that with the graduates of UP really going into the Dr. Sudabarya's program and then eventually becoming policy makers as well they think what's critical there is also them doing research but what's more important is that this research is translated into policies and are implemented correctly by our government so you think we need to deliver the experience to government so that it can be really implemented in a true policy and with that I think we already have a cadre of good doctors that are researchers that are policy makers and implementers young doctors at that would really make a difference in terms of improving and again outcomes of our country so the future looks bright I have a few more minutes and I'll give one to two minutes for each of you to give your final message about your field of expertise I think the future looks bright for the Philippines as you said the enabling there should be an enabler you might have a noble idea but there should be enablers and policy plays a big part there policy and of course the capacitation the academy plays a big part there and the cooperation with the private sector everything will fall into place only if we work on it together everything in harmony just like an orchestra there's percussion there's wind but there must be a coordination between all to at least see that whole of government approach working to achieve the common goal so amen to that but the academy is definitely going to work with government we will give what the government needs and what is important is that I think for UP Manila we will provide models and examples that can be used by government so we're behind every step of the way wonderful wonderful for the non-government organization and specifically for this Wheeling Family Foundation we really support the initiatives of the government and in so doing we support them improving their health outcomes capacitating the leaders and the implementers as well so as really leaders a whole of government and a whole of society approach in this whole scheme of things so we hope that the universal healthcare law would really revolutionize the healthcare system and eventually improve the health outcomes thank you Tony Boy well technically we're seeing that there's a lot of change and reform happening in our health system and what I've heard is we want harmony we want health and we want harmony and the system will work if everyone contributes their own share in terms of achieving better health outcomes this is Dr. Teddy Herbosa thank you very much to our guests Dr. Emmer Farahon Chancellor Menchit Padilya and Tony Boy Farahon for enlightening us on all the issues the health systems and health reform of our country