Healthier Ps and Ds

As a health professional, I wanted to take a crack at pro-Duterte blogger Sass Sasot’s ridiculous defense of the nowviral “Pepedederalismo” video on Assistant Communications Secretary Mocha Uson’s page. Like a hapless high school student with a deadline and no idea about the topic to write about, Sasot took to social media with a far-reaching defense of the songand-dance: “Ang FEDERALISM ay may kinalaman sa PEPE at DEDE,” she wrote. “Dahil sa mas may kontrol na ang bawat sa region na kanilang kinikita, mas mabilis na magkakagawa sila ng mga programa pang reprodutive [sic] health. Federalism will lead to healthier pepe and dede. Healthier pepe and dede will lead to healthier communities.”

I tried to make sense of that, but was just as confounded as the next Twitter user. How does one deal with this level of discourse? The mind reels. How do you deal with a President-appointed communications officer whose pronouncements consistently defy truth, logic and good taste? Howdo you deal with her defender, who has stretched the limits of logic to associate “pepedederalismo” with something even remotely relevant to the political landscape?

No one seems to know the answer. Mocha Uson and company have many critics, but more importantly, they also have impunity. No amount of lewdness, misinformation, poor fact-checking and illogical commentary will get them thrown out, as long as they’re useful. Their monkeying around on social media is just one aspect of the farcical, dystopian environment this administration has cultivated.

We plough on ahead with facts, and the facts are these: Do we know if federa- lism—the shift to regional governments and a central “federal” government of equal sovereignty—will result in better health service delivery all around? In reality, it could go either way. Those familiar with the Philippine healthcare system can make good guesses.

The Philippine health system has for decades operated on a “devolved” setup: The delivery of health services is the concern of local government units or LGUs. Primary and secondary healthcare are the purview of city, municipal and provincial governments. The national government supervises tertiary and speciality care, and is responsible for accreditation of hospitals; food and drug regulation; and health research and insurance.

Thus, the current devolved system affords our local governments a measure of autonomy in assessing and addressing local health concerns. This is good in theory, although the setup has given rise to concerns by healthcare workers that their budget, programs and resources are at the mercy of local governments which may have other priorities.

Professor Maria Ela Atienza, PhD, speaking on federalism to the Philippine College of Physicians in May 2017, mentioned that a number of low-income LGUs are unable to cope and cannot provide basic health services due to lack of resources or poor technical knowledge. As a result, in the devolved system, the services provided across LGUs tend to be unequal. Thus, the aim of primary healthcare—universal accessibility to sound health services—remains unmet.

Under a federal government, the mobilization of resources will be at the discretion of each state or province, without being held back significantly by the central government. As mentioned by former health secretary Dr. Paulyn Jean Ubial in 2017, under federalism, devolution would be done at regional levels, thus hopefully addressing the concerns faced by health advocates and workers at the LGU levels.

However, according to Professor Atienza, federalism might also magnify present challenges. The key is for the government to first address present concerns—the need for good governance at multiple levels of government. One fears what the upheaval arising from the shift in government may do to our already fractured health system.

In short, will federalism lead to healthier Ps and Ds and healthier communities? In terms simple enough for the pepe-dede squad to understand: maybe. Success would depend on accountability and good governance across all levels of government—some things that certain members of the PCOO may start considering for themselves.