Philippines to follow health care model of Cuba

The Cuban health system has become one of the most advanced in the world. | Photo: EFE

In a country where little more than a quarter of the population still live below the poverty line, universal healthcare – or, at the least, giving people access to cheap medicines – should be right there at the top of government's priority programs. Fortunately, this was among the priority concerns that President Rodrigo "Rody" Duterte first took up with his Cabinet members on day one of the new administration.

When he convened his maiden Cabinet meeting a few hours after his inaugural last June 30, President Rody lost no time to identify the priority thrusts of his administration, at least on its first 100 days in office.

In the Cabinet meeting at Malacañang Palace, President Rody made this off-the-cuff pronouncement that he is sending newly appointed Health Secretary Paulyn Ubial to Cuba to study that country's highly successful healthcare program.

I had no idea what President Rody was talking about. The first thing that came to my mind was the campaign attacks against the alleged communist links of the former Davao City mayor. I have fairly little knowledge about Cuba other than it has long been under communist rule by a dictator named Fidel Castro. It is a large Caribbean island nation located close to the United States.

Fascinated by this revelation of President Rody of the Cuban model of public health care, I browsed through Google.com. Cubans call their system medicina general integral (MGI, comprehensive general medicine). Its programs focus on preventing people from getting diseases and treating them as rapidly as possible.

Even the director-general of the World Health Organization, Margaret Chan, was all praises for Cuba's healthcare system. She commented after her visit to Havana in July, 2014: "Cuba is the only country that has a healthcare system closely linked to research and development. This is the way to go, because human health can only improve through innovation… We sincerely hope that all of the world's inhabitants will have access to quality medical services, as they do in Cuba."

According to the WHO, over 100 countries are looking to the example of Cuba, which has the same 78-year life expectancy of the US while spending 4 percent per person annually of what the US does. The most revolutionary idea of the Cuban system is doctors living in the neighborhood they serve. "A doctor-nurse team is part of the community and know their patients well because they live at (or near) the consultorio (doctors' office) where they work. Consultorios are backed up by policlínicos which provide services during off-hours and offer a wide variety of specialists. Policlínicos coordinate community health delivery and link nationally designed health initiatives with their local implementation."

Budget Secretary Benjamin Diokno noted President Rody's plan to replicate Cuba's healthcare model is doable in the Philippine context.

Aside from Davao City, the DBM chief noted the province of Albay, under the leadership of its former governor and now Congressman Joey Salceda, has achieved a high level of efficiency from primary to tertiary hospital care.

Now as the country's Chief Executive, President Rody showed how his unorthodox and revolutionary manner of doing things made him one of the most successful mayors in the Philippines. During his years serving as Davao City mayor, he had effectively addressed local health concerns of his constituents.

The President announced his plan to funnel the ₱35-billion annual earnings of the state-owned Philippine Amusement and Gaming Corp. to the Department of Health. It will fund essential healthcare and the pharmaceutical needs of Filipinos, particularly the poor. Because as President Rody succinctly put it, "people who cannot buy medicines will die."

And this brings us back to the Cheaper Medicines Act, now spanning three administrations. I remember that in 2009, then president and now Pampanga Rep. Gloria Macapagal Arroyo used her favorite "moral suasion" to call on pharmaceutical firms to slash the prices of their essential medicines by 50 percent.

Actually, even those who earn more than the poverty threshold of ₱9,140/per month would see their capacity to spend for basic things greatly diminished when they are on maintenance drugs. This is based on personal experience, as I am also on maintenance medicine.

Being close to my heart, I also wrote opinion columns about this topic in the past, particularly because it became apparent that this appeal of Mrs. Arroyo was being met with strong resistance from giant multinational companies (MNCs). One big MNC on pharmaceutical products even faced Senate probe for the release of its so-called discount cards which was seen as a mere marketing strategy that provide calibrated discounts to their medicine products dispensed only by doctors being served by their company's medical representatives.

As consumers of maintenance drugs who must take these medication on life-time basis, we count on the Cheaper Medicines Law to cushion us from inflation. The government needs to review the marketing campaign of MNCs at the level of the doctors, who are closest to the patients. Maybe this is one of the missing links to the successful implementation of the Cheaper Medicines Act.

This is despite the greater efforts by the previous Aquino administration, which focused on Universal Healthcare and even strengthened PhilHealth services with the support of the funds coming from the Sin Tax law.

Filipinos getting full access to cheaper medicines will not happen without the cooperation of everyone. Despite the Generics Law that has given patients cheaper priced medicines that they can afford but with same efficacy, multinational brands continue to dominate the market, particularly for essential medicines. However, these profit-motivated MNCs don't see the need to really bring down their prices to the affordable level of lower income patients.

I remember asking former Secretary Janette Garin when she was our Kapihan sa Manila Bay guest in January this year about the sudden rise of price of a MNC branded medicine that I was taking. Believe me, I know and feel the frustration of Filipinos who are on maintenance drugs.

But I see hope in President Rody's forward-looking directive to look into the Cuban model. We can only conclude that change is indeed coming – and it's coming fast. – philSTAR

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Philippines v. China: Q. and A. on South China Sea Court Case

The Chinese Coast Guard confronted Filipino fishermen near Scarborough Shoal in the South China Sea last year. Credit Renato Etac/Associated Press

An international court in The Hague is scheduled to release a landmark ruling on Tuesday in a dispute between China and the Philippines over the South China Sea. Here are answers to six questions about the case.

What is this case about?

The Philippines filed a complaint in 2013 after China took control of a reef about 140 miles from the Philippine coast. It accused China of violating international law by interfering with fishing, endangering ships and failing to protect the marine environment at the reef, known as Scarborough Shoal.

But the Philippines also went further, asking an international tribunal to reject China’s claim to sovereignty over waters within a “nine-dash line” that appears on official Chinese maps. The dashes encircle as much as 90 percent of the South China Sea, an area the size of Mexico that is vital to global trade and rich in natural resources, including potential oil deposits.

The Philippines also accused China of violating international law by dredging sand to build artificial islands out of several reefs in the South China Sea, including one it says is in its waters.

What does international law say?

The Philippines filed its complaint under the United Nations Convention on the Law of the Sea, which lays out rules for the use of the world’s oceans. The treaty came into force in 1994 and has been ratified by both China and the Philippines, as well as 165 other states and the European Union.

Islands are colored by occupying country: China, the Philippines, Malaysia, Vietnam or Taiwan. Lines in the same colors show the extent of territorial claims. Photo: New York times

The treaty says a country has sovereignty over waters extending 12 nautical miles from its coast, and control over economic activities in waters on its continental shelf and up to 200 nautical miles from its coast, including fishing, mining, oil exploration and the construction of artificial islands.

The treaty sets out detailed rules for defining these zones, what to do when two nations’ zones overlap and how to resolve disputes.

China’s nine-dash line includes waters beyond these zones, and Beijing has cited what it calls historical evidence to support it.

The treaty does include exceptions for historic rights, but the Philippines says China’s claims in the South China Sea do not qualify.

The Obama administration has backed the Philippines on this question, saying historic rights can apply only to bays or other coastal waters, not the high seas. But the United States has not ratified the treaty.

China’s reclamation of Mischief Reef in the South China Sea. China has conducted enormous dredging operations to transform reefs into artificial islands with military runways. Credit Pool photo by Ritchie B. Tongo

What does China say?

China has boycotted the international tribunal that was set up to hear the case.

It says the panel of five judges and legal experts has no jurisdiction because the sovereignty of reefs, rocks and islands in the South China Sea is disputed.

The argument goes like this: If you don’t know what countries these specks of land belong to, you can’t use the treaty to draw territorial and economic zones in the waters around them. And the judges can’t decide whom the specks of land belong to because the Law of the Sea deals only with maritime disputes, not land disputes.

China also says it reached a deal with the Philippines years ago to settle disputes in the South China Sea through negotiations. That agreement, it says, prohibited the Philippines from taking the case to the tribunal.

Why is this case important?

In addition to China and the Philippines, five states — Brunei, Indonesia, Malaysia, Taiwan and Vietnam — claim parts of the South China Sea. Their differences sometimes escalate into skirmishes, and people are worried that an incident could erupt into a broader conflict.

United States Navy sailors monitoring radar and other instruments aboard the guided-missile cruiser Chancellorsville in the South China Sea. Credit Bryan Denton for The New York Times

Tuesday’s ruling will be the first time an international tribunal has ruled on any of these disputes. It could set a precedent or establish principles for easing tensions. It could also alter the political dynamic in the region, restraining some countries while emboldening others.

China probably has the most at stake. Since the case was filed, it has conducted enormous dredging operations to transform reefs into artificial islands with military runways and naval harbors, over the objections of countries with competing claims as well as those of the United States. The tribunal could declare some of this construction illegal, or it could leave the question unresolved.

Either way, China’s response to the ruling will be seen as a test of what kind of country it is becoming — a global leader committed to international law and institutions, or a superpower willing to take unilateral action against its neighbors.

Why does the Chinese government care so much about the South China Sea?

Chinese military strategists say China needs to control the sea to defend itself, to push the United States out of the Western Pacific and to become a naval power.

China also depends on the shipping routes that go through the sea, and is eager to lay claim to oil and other resources to fuel its voracious economy.

There are domestic political factors, too. Chinese schoolchildren are taught that the sea has belonged to China since ancient times, and President Xi Jinping has used the construction of artificial islands in the sea to fan nationalist sentiment and strengthen his authority over the Chinese military.

What happens if the tribunal rules against China?

The Chinese government has said it will not “accept, recognize or execute” the decision.

While the ruling will be binding, the tribunal has no power to enforce it, and no one expects that China will volunteer to dismantle its artificial islands and return the sand to the ocean floor.

But the United States, the region’s dominant military power, could use the decision to justify more naval patrols in the area, to recruit new allies and give more support to old ones, and to rally world opinion against Beijing’s behavior.

While it will denounce the ruling in public, the Chinese leadership may decide to back off and begin easing tensions with neighboring countries. It could start with the new Philippine president, Rodrigo Duterte, who says he wants to improve relations with China and has proposed talks on maritime cooperation.

But some analysts are worried that President Xi will respond instead with defiance.

Chinese diplomats have already suggested China might withdraw from the Convention on the Law of the Sea.

It could also begin transforming the reef at the center of the dispute, Scarborough Shoal, into a military outpost, risking a clash with the Philippines, an American ally.

And it might try to impose a new “air defense identification zone” over part of the South China Sea, asserting the right to identify, monitor and take military action against planes in the area.

Bryant Rousseau contributed research. A version of this article appears in print on July 11, 2016, on page A8 of the New York edition with the headline: Philippines v. China: Ruling Will Be a First on South China Sea.

The New York Times

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