A rapid appraisal of the health situation in Palawan: access to medicine issues and perspectives
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1 A rapid appraisal of the health situation in Palawan: access to medicine issues and perspectives UP-NIH Project Team Team Leader: Cecilia S. Acuin, MD, PhD Co-Team Leader: Mary Ann J. Ladia, PhD Field Supervisors: Gerald S. Jandusay, RN, Catherine S. Jovinal, RND, Dianne Aiza Barone, RN November 2012
2 This rapid appraisal, conducted in AugustSeptember 2011, will provide: a situational analysis of the provincial health situation & identify social, economic, political and other factors that will assist the development and implementation of a proposed intervention on improving access to medicines
3 Methods 1. document & records review 2. interviews & group discussions 3. site visits & observations
4 4
5 N a t io n a l LG U F a c ilit y M e d ic in e S o u r c e In d iv id u a l/ H o u s e h o ld B nb s u ppo rt p o lic y ( B n B ) P h y s ic a l F a c to rs F ra g m e n te d p u b lic s e c t o r s u p p ly c h a in t r a n s p o r t a t io n go vt or p r iv a t e o r N GO b o t ik a lo c a t io n L o c a t io n o f r e s id e n c e p o p u la t io n s iz e / d e n s it y D O H & LG U s up po rt c o m p e t it o r? m e d s s to re d a t hom e w e a th e r u rb a n o r rura l lin k w it h f a c ilit y ( R x, v o u c h e r, fre e c o n s u lt ) in p a t ie n t o r o u t p a t ie n t t e r r a in p r im a r y o r s e c o nda ry o r t e rt ia r y p h y s ic a l d is a b ilit ie s roa ds d is a s t e r s 5
6 Palawan Province The Philippines' largest province 1 city & 23 towns >1700 islands ~2000 km (1200 mi) coastline Palawan Island 80% of province's land area 450 km long & 50 km wide Mountainous spine Transportation Road network~1000 km (2011) with <15% paved Travel ex. PPC to Dumaran distance = 131 nautical miles cost ~P600/way (bus + boat) or P2500 (boat) travel time = 4 to 8 hrs Communication Cellphones reach all towns But not all bgys, not even in 6
7 7
8 Botika ng Barangay, Inogbong, Bataraza 8
9 Taytay Sofronio Espanola San Vicente Roxas Rizal Quezon Puerto Princesa City Narra Magsaysay Linapacan Kalayaan El Nido 30 Dumaran 35 Cuyo 40 Culion Coron Cagayancillo Busuanga Brooke's Point Bataraza Balabac Araceli Agutaya Aborlan Drug outlet: BnB ratio = 74: # of Drug Outlets # of BnBs*
10 % availability of medicines, Palawan August
11 % availability of meds by facility private hosp ave public hosp ave RHU ave all public ave Adventist Hospital MMG/COOP Hospital ONP SPPH Quezon Medicare Coron District Hospital Magsaysay RHU Rizal RHU Balabac RHU Brooke's Point RHU Dumaran RHU Roxas RHU San Vicente RHU Taytay RHU El Nido RHU
12 National Financial Factors Fragmented public sector supply chain LGU health/ medicine budget GF meds: TB & malaria (vertical program) PhilHealth packages: inpatient vs outpatient govt or private or NGO Medicine Source Individual/Household free/ user retail price fees/ (mark-up, capacity to discounted procurement buy (income or cost, generic quintile) subsidized/ vs branded) insured urban or rural? competitor? ILHZ or other bulk procurement mechanism primary or secondary or tertiary procurement process (bulk or retail) disasters DOH & LGU support wholesale or retail? P100 Pharma 50 Facility capacity to access Co-op, local Sponsor? health Access to insurance or social worker PhilHealth or other liaison sponsored member use of meds (episodic, employment chronic, status (emp/ maintenance, unemp/ ret) emergency) 12
13 LGU Budgets for Health Nutrition and Population Source: BLGF 2008 P r o v in c e a v e T a y ta y S o f r o n io E s p a ñ o la S a n V ic e n t e Roxas R iz a l ( M a r c o s ) Quezon N a rra Magsaysay L in a c a p a n P u e r t o P r in c e s a E l N id o D u m a ra n Cuyo C u lio n C o ro n C a g a y a n c illo Busuanga B r o o k e 's P o in t B a ta r a z a B a la b a c A r a c e li A g u ta y a A b o r la n % o f to ta l in c o m e spent on HNP Regional average
14 PhilHealth Coverage* Palawan + PPC Palawan Province PPC National Government Private Overseas workers Individually Paying Lifetime Sponsored Coverage % *Coverage=Beneficiaries/ Population x 100, PhilHealth April
15 PhilHealth Reimbursements to Hospitals/ Doctors Source: PhilHealth
16 PhilHealth Reimbursements to members, Palawan 2010 Palawan Total amount OOP Meds amount OOP meds as %total OOP Indigent total OOP Indigent OOP amount for meds meds as %of total indigent OOP ave OOP/ indigent ave meds OOP/ indigent Puerto Princesa Total amount OOP Meds amount OOP meds as %total OOP Indigent total OOP Indigent OOP amount for meds meds as %of total indigent OOP ave OOP/ indigent ave meds OOP/ indigent public hospitals 7,971, ,255, ,914, private hospitals 5,925, ,835, , ,338, , , ,712, ,559, ,229, ,408, ,229, , , , , , , ,
17 PhilHealth Average Values per Claim Based on PhilHealth 2010 claims 17
18 National Acceptability Factors LGU Facility Medicine Source Individual/Household policy on info/ counseling on meds info on meds program govt or private or NGO generic vs branded IP / social status packaging of services (FP commodities) presence of health NGOs urban or rural? traditional vs biomedical education primary or secondary or tertiary OTC vs Rx age DOH & LGU support link w diagnosis/ Rx provider social networks previous access to info experience w re meds/ meds/health health system system 18
19 Governor's Campaign Slogan The HEAT is ON in Palawan. Health For All in 2015! 19
20 Injectables in sari-sari store, rural bgy in PPC 20
21 Source: WHO 2009, Batangan & Juban 21
22 When a person needs medicines Non-emergency Urgent/ emergency No home supply/ cannot self-treat Home supply/ self treat Outside PPC/ Palawan Hospital Private clinic Urban/ accessible Rural/ remote w funds: Hospital pharmacy (PhilHealth) or outside Botika w/o funds: Hospital pharmacy (PhilHealth) &/or sponsor 1.Private botika 1.Satellite/ NGO clinic 2.RHU 2.Botika ng barangay 3.MD clinic 3.Sari-sari store 4.BnB 5.Sari-sari store CHO/ RHU Program drugs Non-program drugs Prescription out of pocket 22
23 Medicine Supply Chain Philippine Distribution Channels Government Private PITC BNB National, Regional LGUs Private Drugstores and Clinics Provincial Provincial hospitals RHUs Satellite clinics Hospitals Co-op Government emergency procurement NonCo-op
24 Recommendations 1. In improving access to medicines, there is a need to address the hierarchy from physical availability, to acceptability and affordability 2. Government medicine provision is just one part of the equation, but because it is crucial for the poor, it needs to be more reliable 3. Private sector medicine provision is more reliable but needs to be made more physically accessible and financially affordable 4. Access needs to be assessed regularly to determine whether interventions are 24
25 PhilHealth OOP Payments, Palawan public hospitals private hospitals Total amount OOP P P meds as % total OOP meds as % of total indigent OOP ave OOP/ indigent P 1,352 P
26 26
27 % availability of meds, Puerto Princesa Satellite clinics, based on 2010 inventories 27
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