Harnessing the PCP to Champion Advocacies
In Medicine PRA Annual Conven:on
February 27,2014
Philippine College of Physicians (est. 1954)
• Healer • Execu2ve /Entrepreneur • Advocate • Leader • Teacher • Hero
Flow of the Presenta:on
1. Background on Philippine Healthcare System 2. The HERO program of the PCP in 2007 3. Strengthening the PCP organiza2on through
Focused Strategic Goals 4. Aligning PCP advocacy programs with PH top
causes of mortality 5. Execu2on /Implementa2on of programs 6. Call to Ac2on
Philippine Healthcare Situa:on • Epidemic of
noncommunicable diseases or lifestyle diseases eg. Stroke, heart aVacks, cancers, COPD, diabetes
• Shortage of MDs (primarily due to maldistribu2on)
• Lack of health infrastructures in the countryside
• Cura2ve rather than preven2ve approach
• Low level of health literacy
Why do we fail at what we set out to do ?
1. Ignorance : we may err because science has given us only par2al understanding ; Educa2on is key.
2. Inep:tude : knowledge exists, yet we fail to apply it correctly.
Gorovitz and MacIntyre, 1970
2 reasons why we fail
SPIRIT OF H.E.R.O. Health Education Reform Order- EO 595
Better health outcomes through preventive health education
among Filipino schoolchildren
Better health service delivery for Filipinos thru relevant education of
future healthcare workers (barangay health workers, public )
HERO Launch : PCP Convention - May 2007
H.E.R.O. : Metrics of Success
In the next 5 years : 2008-2013 1. Help reduce Burden of Communicable Disease 2. Help reduce Burden of Non-Communicable Disease 3. Reduction in expenditure for hospital care for the
management of preventable diseases – Out of pocket costs – Reimbursements from PhilHealth – Expenses of Government Hospitals in Inpatient Care
4. Positive change in knowledge, attitudes, and behaviors of teachers, schoolchildren and their families in both elementary and high school on preventive health concepts
– Documented through examinations of students and surveys of parents/ families
– Decrease in the drop rates in the school kids 5. Improvement in Health Policy
2014 STRATEGIC PLANNING WORKSHOP
8 June 2014, SMX Aura
Strategic Ques2ons How Doctors Think
• 1.Where are we now? Diagnosis ? Eg ICU case
• 2. Where do we want to go? Eg pa,ent saved and out of ICU
• 3. How do you get there? Eg Plan of Ac,on
1. Engaging & Enabling Members 2. Empowerment & Capability Building of Chapter 3. Pursuing the Advocacy & Legislation Agenda 4. Building a Culture of Professionalism & Integrity 5. Enabling & Supporting Trainees and Examinees to meet
Standards 6. Strengthening Strategic Linkages & Partnerships with
Allied Organizations 7. Redefining College Governance & Stewardship 8. Branding the PCP Leadership 9. Future Funding strategy for PCP 10. Engaging in Translational Research
STRATEGIC THRUSTS
ST 7: Redefining College Governance & Stewardship
Execom (President, Vice President, Secretary, and Treasurer) agreed to pursue thrusts from 2014-‐2018 for con:nuity
ST 3: Pursuing the Advocacy & Legisla:on Agenda
– NCDs (an:-‐tobacco, healthy diet, non-‐motorized traffic, food labelling, environmental change)
– Primary care – Advocacy for ra:onal use of technology/drugs e.g. stem cell, organ transplanta:on, HB 4477 (compassionate use of medical marijuana)
• Priority Programs
Philippines 93 Million Popula2on (2010,WHO )
Lesson # 1 Silent EPIDEMIC 300,000 deaths in PH, 800 deaths/day,35 deaths/hour !
2.HIGHER NCD RISK
4.HIGHER MORTALITY 1.NO ACCESS TO
PREVENTION
3.NO ACCESS TO TREATMENT
LIMITED RESERVES MORE Expenses & IMPOVERISHMENT
Heart Disease Stroke Cancer Chronic Lung Ds
Biologic Risk factors
Smoking Unhealthy Diet Phys. Inactivity
Behavioral Risk Factors
Blood Sugar Blood Pressure Cholesterol BMI
Chronic NCD Morbidity/Mortality
Lesson #2 NCDs: Diseases of the POOR
Predisposing Environment
Globalization Urbanization Poverty Low Education Stress
NCD deaths per 100 thousand population
0 5 10 20 30 40 50 60 70 80
400
500
600
700
800
900
Myan Camb
Laos
Viet Indo Phil
Thai Mal Sing Brun
Gross National Income (International Dollars x 103)
Dans et al (Lancet 2011)
SOURCE: WHO Report on global tobacco epidemic:Implementing smoke free environment.Geneva,Switzerland.WHO, 2009
17.5% Girls
28.3% Boys
(Philippines: Highest in South East Asia)
Lesson # 3 NCDs: Diseases of the YOUNG
Lesson # 4 Smoking is PH’s
top killer.
Counseling or Education for Risk Factor Modification Ebrahim et al, Cochrane 2011
> 55 Clinical Trials > 163, 471 patients studied
> Did not affect longevity > Did not prevent heart disease > Did not prevent stroke > Did not reduce cholesterol > Did not lower BP > Did not lower smoking rates
Lesson # 5 Education for general population is not effective.
Overcoming Resistance to Change
1. Direct the Rider 2. Motivate the
Elephant 3. Shape the Path
SWITCH, Heath and Heath, 2010
!"# To inform # To influence # To inspire
3 Principles In Communication ( Steve Jobs)
!"
6 Principles of Sticky Ideas (SUCCESs)
# Simplicity # Unexpectedness # Concreteness # Credibility # Emotions # Stories
Why tax sin products ?
Universal Health Care(UHC) Republic Act 10606
• A government mandate aiming to ensure that every Filipino shall receive affordable and quality health benefits and services such as : – Human resources – Health facilities – Health financing
Health is Wealth: Universal Health Care Realiza:on
• DOH annual budget • Excise Tax • Tobacco revenue • Smoking related
expenditures 1. Indirectly, through loss of
produc2vity and income 2. Directly, household spending on
chronic medical care, o^en of catastrophic propor2ons
• Php 54 Billion • Php 60 – now 40 Billion • Php 26 Billion • Php 188 Billion (Dans
2012)
1. Hospitals and other infrastructures 2. Health Informa2on technology 3. Human resources 4. Health promo2ons and research
ini2a2ves
Why Change Hurts ? Ketan Lakhani, South Africa
!"Partnership in Advocacy
Congress Commieee Hearing White Coat Army -‐ Feb 2012
Lower House Plenary Debates : We won !
October 2012
Recto’s Resigna:on: Turning Point 15 October 2012
Turning Point : Recto Morris – Drilon ( TwiVer/FB)
!"
Advocacy and Power of Media
# Facebook # Twitter # Prints # TV # Radio
Sec Ona with Med Org Leading the Way in Sin Tax Lobbying Nov 2012
Sin Tax on tobacco & alcohol Approval at Malacañan Dec 20, 2012
What the Sin Tax Law has already achieved
• Revenue genera2on
16.8
32.9
70.4
12.4 23.9
33.0
0.0 10.0 20.0 30.0 40.0 50.0 60.0 70.0 80.0
Sin Tax Revenues, 1998-‐2013 (in PhP billions)
Tobacco Alcohol
1. Prevalence of smoking among adult Filipinos went down from 31.0% in 2008 to 25.4% in 2013.
2. There are 3.2 million less smokers in the country because of the Sin Tax Law.
4. Approximately 32,000 deaths were averted.
5. Health benefits were greatest in price sensi:ve popula:ons – the poor, rural folk, the very old, and the very young.
Sin Tax Law Benefits (2013) CONCLUSIONS ( Metrics of Success)
3. The drop is partly from people who stopped smoking. It is mostly from people who avoid star:ng to smoke.
A. Dans, etal
Doctors
Nurses
Midwives
Ac2ve in Professional Regula2on Comm.1 66,000
500,000
74,000
Employed in Government Facility2 2,838
4,576
17,000
Ra2o per 10,000 popula2on3 0.2
0.4
1.7
1 PRC database, 2014 2 Philippine Sta2s2cal Yearbook, 2010.
Health Human Resource, Philippines.
3 Total 2.3 HCW’s/10,000 pop; WHO recommends 24/10,000.
New DOH Sec Janeee L Garin : Maximize U2liza2on of Sin tax funds
Advocacy: Working Together
If you want to walk fast, walk alone ; if you want to go far,
walk with others. -‐ African Proverb