Learning from Batanes’ public health systems
Long before the Universal Health Care Act (Republic Act 11223) was signed into law in 2019, the province of Batanes had already internalized the concept of universal healthcare.
Batanes, despite its geographic isolation and limited resources, serves as a good case study for the effectiveness of primary healthcare. Primary healthcare is a wholeof-society approach to health, which shifts the focus from systems designed around diseases to systems designed for people. It has a strong focus on equity and interventions that encompass a person’s entire lifespan. It emphasizes one’s needs as early as possible, from health promotion up to treatment.
Several factors can explain Batanes’ success: the development-oriented approach of local chief executives who consistently make health a priority, the innate health consciousness and collective action of Ivatans, and the presence of healthcare workers who advocate primary healthcare.
Successful partnerships with nongovernment organizations also explain Batanes’ exemplary local healthcare financing system. The province’s voluntary social health insurance scheme, Kapanidungan sa Kalusugan (KsK) dates back more than two decades. Under KsK, families are classified into income brackets, which determine their monthly premium for outpatient and inpatient services. Initiated by the non-government organization HealthDev Institute, the fund survives to this day even if most members are also covered by PhilHealth. Thanks to KsK and financial programs from politicians for hospitalization, most Ivatans need not shell out money for their healthcare within the province.
Dr. Roel Nicolas, Batanes’ former Provincial Health Officer, notes that Ivatans are generally health conscious and usually immediately report any sign of illness to their community health workers, partially because out-of-pocket expenditure is minimal.
Barangay health workers (BHWs) are the main providers of primary healthcare and the first points of contact in Batanes’ health system. As the province with the smallest population size in the Philippines (18,831 as of 2021), Batanes is one of the provinces with the least BHWs, with 137 BHWs distributed among the six municipalities. But the small BHW population in Batanes is dynamic and motivated to work. They are given importance by the local government, reflected in their relatively high level of honorarium which they receive from the provincial government, municipal government, and barangay.
The Batanes local government unit (LGU) understands the pillars of primary healthcare, internalizing the notion that prevention is better than cure. The LGU focuses on health promotion and disease prevention within the community precisely because they are cognizant of the difficulties of their location. Complex cases need to be airlifted to hospitals with specialists and more sophisticated equipment in Cagayan Valley or Metro Manila. Medicines and supplies are limited. And insufficient Information and Communications Technology (ICT) infrastructure hinders connectivity and coordination.
The COVID-19 pandemic tested the strength of Batanes’ health systems. The LGU knew that although their health system was functioning well, due to their location, an outbreak would overwhelm them. The lack of testing facilities meant that swab samples needed to be sent to the mainland and would delay results. Supplies and equipment came sporadically, and few ventilators are available on the island for critical cases.
The local government believed that prioritizing health would eventually result in less economic scarring. The province remained the only COVID-free province for almost the entire first year of the pandemic, and cases remain low to this day. The LGU acted fast, activating the barangay health teams and implementing border control measures even before the National Government announced community quarantine in Metro Manila.
Although Batanes was completely closed to tourists, the government provided support to those who lost their livelihoods. “Ang pera ay kikitain pero ’pag nawalan ng buhay, hindi mo na ’yan maibabalik (Money can be earned but losing a life, you cannot get that back),” Batanes Governor Marilou Cayco told GMA News in an interview in 2020.
Batanes’ number one problem within its healthcare system is also arguably the biggest problem in the Philippine healthcare system: the lack of human resources for health). Although there are many Ivatan doctors, they only usually return to the islands for limited periods of time. While the beauty of Batanes attracts many visiting doctors, the lack of financial reward is the reason why only around five doctors are permanently stationed there. The World Health Organization’s “SDG index threshold,” or the estimated number of skilled health workers needed to reach the minimum proportion of the population for achievement of high coverage, is 4.45 healthcare workers for every 1,000 people. That means Batanes would need 80 doctors to reach this target.
Batanes’ health system is one to marvel at: It proves to us that a small, geographically isolated set of islands can very well become a leader and innovator in good governance for health, with the right focus on inclusivity, and with leaders who possess the political will to make sure that their constituents live healthy and comfortable lives. ■