In the year 2000: Health for all still a dream

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By Gina Mission

IN 1977, the World Health Organization (WHO) launched a worldwide movement called HFA 2000 or Health for All by the New Millenium. Two decades and two years after, the Philippines, a member-country, is far from the goal of ensuring equal health status for all Filipinos, irrespective of socio-economic status and place of birth.

___Figures presented recently by the Community Medicine Foundation (Commed), an NGO of community-based physicians and other health professionals who advocate for community health, were sobering. Citing case studies during the National Colloquium on Primary Health Care held in UP Manila early this week, Commed revealed that:

  • poverty and malnutrition are worsening

  • maternal mortality rate (MMR) and infant mortality rate (IMR) remain high at 171 per 100,000 births and at 50 per 1,000 live
    births, respectively
    infectious diseases, such as tuberculosis and malaria, are re-emerging

  • around 15,000 persons get measles every year despite the supposed 100-percent attainment of immunization targets

  • one out of five persons dies of complications from pneumonia and diarrhea

  • most people still do not have access to potable water

  • occupational diseases are on the rise

___For all this, Commed says, the government is largely to be blamed, having failed to deliver basic health services to the residents of far-flung areas. According to Commed, Section V of the Declaration of Alma Alta, signed by WHO member-countries at the International Conference on Primary Health Care in 1978, says: "Governments have a responsibility for the health of their people which can be fulfilled only by the provision of adequate health and social measures."

___Now, Dr. Reynaldo Lesaca of the Health Alliance for Democracy suggests, it is time that the sorry state of the Filipino’s health is examined in the context of the system that has bred the debacle or, at the very least, the stagnation of such basic services in the country.

___Judging from the cases presented at the UP Manila conference, the Philippine government has a long way to go to bringing every Filipino to "a state of complete physical, mental and social well-being… without distinction of race, religion, political belief, economic and social condition."

Malnutrition in Misamis

___In 1998, a deworming and nutritional assessment program of children aged 2-8 was conducted in the barangays of Mamalad, Siloy and Singalat, Misamis Oriental in Northern Mindanao, under the supervision of Dr. Jo-Anne Marie Salangsang, head of the services desk of the Zamboanga Peninsula Health Extension Program. All these areas are mixed Visayan and Subanen farming communities.

___The program revealed several stories of malnutrition, hunger and general unhealth. For instance, in all three barangays, most children were found to be underweight. In Mamalad, only 7 per cent of children are of normal weight, while 47 per cent are malnourished to the first-degree. In Siloy, only 13 per cent of the children have normal weights, while 62 per cent have first-degree malnutrition. In Singalat, only 9 per cent are of normal weight, while 29 per cent are suffering from first-degree malnutrition, 41 per cent second-degree, and 20 per cent third-degree malnutrition.

___Height is also a problem in all three barangays. In Mamalad, 41 per cent of the total child population have normal heights and 45 per cent suffer from mild stunting, and 14 per cent have moderate stunting. In Siloy, 54 per cent of the children have normal heights, while 40 per cent have mild stunting and 16 per cent have moderate stunting. In Singalat, only 16 per cent are normal in height, 37 per cent are mildly stunted and another 37 per cent are moderately stunted. Nine per cent are severely stunted.

___In her conclusion, Dr. Salangsang said that the state of children in Barangay Singalat "can be correlated with the fact that it is the farthest and most economically deprived among the three."

The lepers of Tag-anghin

___Barangay Tag-anghin is one of the 58 barangays in the municipality of Tapaz, Capiz. The community is very isolated and is not accessible by modern transportation. There are roughly 90 families, each having five or more children. The residents live on slash-and-burn farming.

___The fact-finding mission of COMMED to the place in 1997 found that the barangay is "deprived of basic social services." A midwife, the report said, visits once every two months, and only to provide immunization. The last time a doctor visited was in 1991. The nearest health center is located in Barangay Roxas, which is about a day’s walk away.

___Out of the 186 patients treated during the mission, six were found to be suffering from leprosy, with active lesions. Some have never been treated while others were provided with multi-drug therapy against leprosy, but treatment was not completed or was erratic. At least nine more suspected cases of leprosy were reported by barrio folk but did not show up during the mission.

___Discrimination and ill treatment of leprosy patients is rampant in Tag-anghin because of lack of health education among the people. Many leprosy patients are secluded in the forest, far away from the barrio proper. An old woman with severe deformity, according to Fe Mamon, executive director of HELP-Panay, (Health Education for the Less-Privileged-Panay), was reportedly burned alive by the military with the
consent of her family.

___Mamon shared data from the Western Visayas Regional Health Office for the year 1997 showing that the incidence of leprosy is on the downward trend, but anecdotes gathered from rural health workers and barrio folk tell of many undiagnosed and isolated cases in their areas. Case-finding, Mamon continued, remains difficult due to the social stigma, and treatment remains erratic due to inadequacy of supplies and "low compliance secondary to lack of knowledge of what is actually happening in many rural remote areas."

___The government set the goal of eliminating leprosy as a public health problem by the year 1998, and started to phasing out and converting its leprosariums nationwide. But it is clear that the menace of leprosy has not left us.

Wanted: water in Nueva Ecija

___"The municipal water systems were partially or totally destroyed or rendered ineffective due to lack of maintenance. The barrios were, for the most part, without clean water in sufficient quantities; there was lack of proper excreta and body waste disposal facilities. In fact, all the necessities for a minimum state of physical, mental and social well-being were lacking.

___"In addition, poverty, lack of understanding of the causal relationship between disease and insanitation, and the existing socio-economic conditions were largely responsible for the high disease index in the Republic of the Philippines."

___This was how the 1955 Annual Report of the Philippine-American Public Health Program described in part the health situation of the country after World War II. COMMED asserts that it remains true even today, as it does in Nueva Ecija.

___A 1998 survey by the Community-Based Halth Program-Nueva Ecija (CBHP-NE) covering four barrios each in the towns of Guimba, Cuyapo, Nampicuan and Talugtog, shows that an average of 180 persons (or 30 households with six family members each) share a single source of water, usually a shallow well or poso of "questionable potability." The survey says that "Many of them are positive for coliform organisms." Coliform is a cancer-causing substance.

___Toilet facilities are no better. Official 1991 statistics show that in Nueva Ecija, only 65 per cent of households have sanitary toilets; 19 per cent have unsanitary toilets; and 15 per cent have no toilets at all.

___But then, who else is not in this pit? According to COMMED, only 68 per cent of the total Philippine population have access to public potable water supply systems. Of the 42 million covered by water services, 57 per cent get their water from wells -- developed springs of rainwater collectors; 28 per cent are serviced with communal faucets; and only 14 per cent get their water from distribution systems and communal faucets. The remaining 32 per cent of the population get their water from rivers, rain ponds, and open dug wells.

___In 1990, only 3.9 million out of the 11 million households had private, water-sealed, septic-tank toilets. Some 942,000 households shared toilets with other households, one million used closed pits and 1.6 million used open pits. Still, some 1.8 million households had no toilets at all.

Dental decay in Tandag

___HFA 2000 set specific oral health goals for signatory countries. These are: 50 per cent caries-free for ages five and six; less than three decayed, missing or filled teeth for the age-12 group; 85 per cent retention of all their teeth at age 18. For ages 35 to 44, the WHO envisioned a 50 per cent reduction in the number of persons with no teeth (in the case of the Philippines, this means that 75 per cent of this age group should have at least 20 teeth). And for the age group 65 and above, there should be a 25 per cent reduction in number of persons with no teeth – that is, half of the age group should have 20 teeth.

___Today, however, the WHO cites the Philippines as one of the countries in Southeast Asia where oral cancer is a common occurrence. Oral cancer is the 6th most frequent cancer in the world but in developing countries, they rank third for males and fourth for females. According to COMMED, 98 per cent of Filipinos suffer from dental caries and 50 per cent suffer from various gum diseases. At the age of 12, most Filipino children have six decayed, missing or filled teeth due to caries. COMMED remarked on the irony that like any other diseases on top of the morbidity list of the country, oral diseases are enormously preventable.

___What contributed further to the problem, according to a COMMED paper, The People’s Struggle for Dental Health Care in Tandag, is the inadequacy of the public dental health system. As of 1997, the dentist-to-population ratio is 36,000 Filipinos for every government dentist.

___The paper pointed out that Tandag, capital of the Surigao del Sur in Northern Mindanao, has a high incidence of dental patients in need of tooth extraction and dentures.

___"Like the national government, the local government does not prioritize the health budget for the province. Efforts in providing dental health education as a preventive measure of dental problems are negligible. Dentists can hardly go farther than their health station because of the lack of budget for transportation," the paper said.

CyberDyaryo | 2000.01.26

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