‘Filipinos belong to either the “unwell” or the “worried well.”’
By Juan Antonio A. Perez III, MD, MPH
DR. Alfredo R. A. “Alran” Bengzon, who was President Corazon Aquino’s health secretary, knew he had inherited a corrupted and underfunded health system from the older Ferdinand Marcos in 1986.
Alran would have to start by literally cleaning out the Aegean stables that was the Department of Health (DOH) as he found it. Regional directors were most affected, as he fired seven, retained three, and promoted one before he even started to pay attention to the people’s health.
The former secretary recognized health as a human right, but he had his priorities. He viewed the Filipino population as being divided among the “well;” “worried, but well;” and the “unwell.” His policies and programs were focused on keeping people well (preventive health programs on immunization, for one) and taking care of the unwell (the Generics Law was meant to make medicines more affordable, since it constitutes 60 percent to 80 percent of the cost of health care).
As one of the first doctors with a Master of Business Administration degree, Alran set his priorities for the meager budget of the DOH by setting up a management structure that reduced his supervisory load from 40 to seven. His pragmatic position on the decentralization of health services under the Local Government Code would be his undoing when he ran for a Senate seat in 1992.
Today, with the coronavirus disease sweeping the country, it is important to get our priorities right and dig in with the basics of health-resource management as Sec. Alran did.
Taking care of the unwell
At near 50 percent positivity with COVID-19, health managers at all levels can presume that everyone with flu-like symptoms has been infected with COVID-19 (most likely), or with influenza (less likely). Nine out of 10 patients do not need hospital care and need symptomatic relief.
It would also be senseless to have them all tested, since the National Capital Region-Plus (or NCR-Plus, with the provinces of Bulacan, Rizal, Cavite and Laguna) is now a COVID-19-transmission hotspot (areas with high effective transmission), so why overload laboratories with tests that are costly, while the money could go to symptomatic treatment? Is it so we can know the numbers, which can only lead to the “worried well” being more worried?
Most regions in the country may well be in NCR-Plus’ current hotspot situation within the next month. The DOH no longer has direct supervision over local health systems, but it can set a treatment policy that any health provider can follow with any COVID patient that all health professionals and workers, including the barangay health workers (BHWs), need to pay attention to:
One Influenza-Like Illness Station in every barangay – led by a midwife or nurse to assess everyone with symptoms, triage to the health center the moderate and severely ill, and isolate all “symptomatics” at home or isolation facilities for 10 to 14 days, dependent on their vaccine status (longer if “unvaccinated;” or, lock in all those who are unwell). Those over 55 years of age can be prioritized for testing, as well as those with comorbidities.
BHWs conducting daily health visits – to check on symptoms of those in isolation, and report adverse events
LGU health centers as COVID triage facilities, and overall health-care providers – health centers led by health officers to set up areas accepting referred patients from barangays to higher-level facilities for appropriate care, and a regular area for other types of health care.
Caring for the unwell
TRIAGING patients through the health system for necessary care means sending patients to hospitals only when they need it. The One Hospital System needs to decentralize to the provinces and cities with hospitals. Private hospitals should also respond to referrals from the decentralized system (as was intended under the Universal Health Care Law).
Mayors and governors need to support their local health systems so that hospitals do not get overwhelmed.
COVID 19 patients with the now-dominant Omicron variant who are critical do not all need the higher-end care that was seen with the Delta variant, so the lower-level hospitals can take on more of the load, leaving the most severe cases for the higher-end hospitals.
Assure and vaccinate all
THE message on minimum-health protocols needs to be continuously promoted by all agencies and organizations, public and private. As people go about on their necessary tasks, the proper role for enforcers is to provide assistance—not enforce compliance.
The vaccination program needs to be stepped up and continued, eventually as part of the regular service of health facilities. It cannot be sustained as a national program.
Going after the unvaccinated is a complete waste of health resources, and cannot be imposed on a health system that is already overburdened. The messages need to be:
“Stay in if you are unwell.”
“Sit tight with protocols in place if you are among the ‘worried well.’”
Undersecretary Juan Antonio “Doc Jeepy” Perez III is the executive director of the Commission on Population and Development, or POPCOM. For comments and reactions, e-mail juan.perez@popcom.gov.ph