PIDS study provides health system-specific solutions to address chronic malnutrition in PH
BUTUAN CITY -- The economic and health consequences of chronic malnutrition in the country are “too enormous and extreme” and need critical and urgent attention.
This
was highlighted in a recent study of state think tank Philippine Institute for
Development Studies (PIDS) authored by PIDS Research Fellow Valerie Gilbert
Ulep.
Citing
the 2021 Joint Child Malnutrition Estimates, Ulep said “about a third or 3.5
million of Filipino children under five years old are stunted,” which is a
marker of chronic malnutrition.
“Stunting
is a result of chronic and recurrent stresses that the child encounters during
a critical period, which starts at pregnancy until the first 1000 days of
life,” he explained.
Undernutrition
during pregnancy, child nutritional deficiency, and repeated infection or
disease are some of the stresses that increase the risk of stunting.
Compared
to countries with similar income levels, the rate of decline of stunting in the
Philippines was “relatively slow” at 0 to 1 percent annually, according to
Ulep. Well-performing countries, such as Viet Nam, had a 5- to 6-percent annual
decline.
To
help address this, Ulep emphasized the need to look at chronic malnutrition
using a health system lens. The study identified issues and challenges in three
health system components: health financing, health service delivery, and health
governance.
On
health financing, the government should “cover a comprehensive package of
cost-effective health and nutrition interventions”.
However,
the study revealed that nutrition-related expenditures from 2017 to 2019 were
approximately PHP 1,504.06 per capita only or 0.92 percent of gross domestic
product and 7.70-percent of total government expenditures. These figures show
that the country’s public spending for nutrition is “low compared to other
countries”.
Moreover,
Ulep noted the importance of a health facility network for health service
delivery. In the Philippines, primary care facilities, such as barangay
health stations (BHS) and rural health units, and hospitals are not integrated.
Hence, referral systems are not institutionalized.
About
10 percent of primary care facilities do not have medical doctors. There is
also a limited number of community health workers.
On
health governance, the roles and capacities of agencies should be clearly
identified. However, agencies tasked to finance and deliver health and
nutrition services in local government units (LGUs), such as the Department of
Health (DOH), National Nutrition Council (NNC), and Commission on Population
and Development (POPCOM), have “limited” capacity to perform these functions.
Similarly,
LGUs have varying capacities to deliver health services, while the Philippine
Health Insurance Corporation (PhilHealth) has limited capacity to finance
comprehensive packages.
Ulep
recommended long-term solutions to address chronic malnutrition in the country.
One is
for the government to accelerate the implementation of the Universal Health
Care Act, particularly the expansion of a well-costed outpatient benefit
package.
Another
recommendation is for PhilHealth to pay for a network of facilities instead of
reimbursing individual hospitals or facilities to facilitate the continuous
delivery of health and nutrition interventions. Using PhilHealth to pay and
incentivize quality and uptake of nutrition and services could also be
explored.
There
is also a need to accelerate the rationalization of DOH, NNC, POPCOM, and
PhilHealth functions.
Given
the urgency of chronic malnutrition, the author also provided short-term
solutions.
Ulep
said the government should rationalize the use of its resources by classifying
provinces and highly urbanized cities based on capacity and burden of chronic
malnutrition.
“Given
the variability of performance and capacity of LGUs, the national government
must provide the type of grants depending on [their classification],” he
pointed out.
In low capacity or fragile areas, the government should “explore tapping private nonprofit entities to deliver the entire package of health and nutrition interventions for a given period”. (PIDS/PIA-Caraga)
