Wednesday, October 12, 2011

Purple is the Color of Other Peoples Money: RH Bill is all about money


What's wrong with 

Find out what Pro-RH people

> Inadequate safeguards against corruption. Ensuring what little funds for RH are eaten up by greedy Lolongs everywhere.

> Non-specified source of funding.
Ensuring either under-funding or encouraging untrammeled government borrowing.

> No provision stating how hospitals/health centers will determine stocking levels for 
Family Planning products and supplies.
Ensuring hospitals will either stock too little or too much Family Planning products and supplies.

Eggplants are purple and among vegetables, probably have
the lowest nutritional value. These ones in the picture
probably best depict the hollowness of some arguments
thrown out to anyone who opposes the passage of a bill
that will probably open a gaping chasm of corruption.
I get the impression that some of the more active Reproductive Health Bill advocates on Twitter, Facebook, the blogosphere and elsewhere are wearing purple blinders as they try to rush its passage into law despite its glaring potential for corruption.

Looks pretty much like a RH Bill advocate.
After raising this point against the Reproductive Health Bill or House Bill 4244 on Twitter, I was confronted by a lot of replies which had the definite feel of being somewhat scripted in a call center kind of way.

Instead of being told that HB4244 actually had some safeguards against corruption, I was told  that I lacked faith in the system and that I was merely being pessimistic.


Corruption is a real issue

In an article on ABS-CBN's news website, Senator Vicente Sotto III pointed out a couple of irregularities which tend to bolster the idea that one implementing government agency cited in the RH bill may be riddled with corruption.
Sotto said in an interview before Tuesday's session that billions of these funds were unaccounted for in the past three years: P600 million in 2008, P800 million in 2009, and P1.2 billion in 2010. 
In his speech, Sotto cited the case of Ilocos Norte, where a total of P3.7 million of supposed funds for MNCHN from 2008 to 2010 were not received. 
He said 15 other provinces claimed to have not received any fund. He is now waiting for the reply of other provinces on the issue. 
"If this is really the case, can we afford that this continue to happen? The House of Representatives version of the RH bill enhances these expenditures. Can we be assured that taxpayers' money will no longer be wasted?" he said.
Of course, it may be pointed out that the instances that Sotto has cited still needs to be verified and explained.  After all, some times what appears to be "money that was not received" may be dispelled later by neat official paper work proving the opposite.  Moreover, I am not sure at all if Sotto had submitted actual paperwork proving his claims.

But till Sotto's "revelations" are looked into, this should give people enough reason to doubt the Department of Health's bureaucracy's capability to function without graft and corruption greasing its cogs.  And common sense will probably tell you that if you are doubtful about something, it is always best to investigate and see if the claims are true.

It would be highly IRRESPONSIBLE and STUPID to quickly brand something that runs counter to one's view as mere counter propaganda without examining the claims.

After all, we've seen a number of social media consultants and experts opine about how corruption is endemic to the Philippines.  In fact, I think it's almost cliche to say that corruption is  pretty well established that corruption is an integral part of how Philippine government works.

What bugs me is the somewhat naive assertion that the RH Bill, by whatever virtue is conjured up for it, will not be tainted with corruption unlike so many other laws and government programs.

The thing is, even the best conceived anti-corruption provisions in almost every Philippine law has been circumvented at least once.

Section 10 of HB4244 and how it can go wrong

Anyway, let's look at a couple of sections in HB4244:
Section 10 Family Planning Supplies as Essential Medicines 
Products and supplies for modern family planning methods shall be part of the National Drug Formulary and the same shall be included in the regular purchase of essential medicines and supplies of all national and local hospitals and other government health units.
See also Section 3 Guiding Principles where:  
Item 4 states: "The provision of medically safe, legal, accessible, affordable and effective reproductive health care services and supplies is essential in the promotion of people’s right to health, especially of the poor and marginalized;"
 Item 7 states: "The provision of reproductive health information, care and supplies shall be the joint responsibility of the National Government and the Local Government Units (LGUs);"

A lot of Pro-RH people on Twitter and Facebook bawl out "RH is not just about contraception."

Well, perhaps, one glaring reason which people with purple blinders conveniently overlook is that when you talk about Reproductive Health you talk about family planning and when you talk about family planning, you talk about contraception.

A lot of them do the run-around when you confront them on this issue.  First they say that what's more important is that the country has an RH policy.  But when when you tell them that an RH policy doesn't necessarily mean you should give away free pills/contraceptives, they turn around and say "What's wrong with giving away free pills/condoms?"

Anyway, what I take Section 10 to mean is that all hospitals will be required to stock up on "Products and supplies for modern family planning methods..."

Thing is, I put this section out on the table with a small group of fellow bloggers and Ben Kritz weighed in:
I actually don't see anything wrong with this. The problem with this part of the bill is in the ambiguity in how what constitutes an appropriate supply of 'products' is to be determined. Obviously, Congress can't write what should be a determination by medical professionals into the law, as in "A hospital should stock such-and-so many of item X, etc." But Congress can designate the responsibility for making that decision rather specifically, and set clear guidelines for it. They haven't done that, and the counter-argument "We're not doctors, all we can do is tell the DOH to figure it out" is not valid. Congress *would be* able to write clear provisions, if they had done their homework and consulted with the people who know what's what before drafting the bill.
So, what's wrong with giving away free condoms/pills?

So, basically, all national government hospitals and provincial hospitals will be required to stock up on products and supplies for family planning methods.

Just by rough figuring, that could actually be around 2,000 or more hospitals.  Of this number, 64 are directly under the Department of Health.  That's a lot of hospitals being automatically required to stock up on products and supplies for family planning methods.

Assuming, just for the sake of illustration, just how much money that would involve, here's a rough figuring just for condoms...
Price of condom = 20 pesos 
Quantity to be bought = 1 pack of 3 condoms for every male Filipino multiplied (X) by the number of Filipino males (let's figure it at 30 Million). 
That gives us 20 x 30 Million or P 600 Million just to supply all males of reproductive age with 1 pack of condoms each. 
Imagine if you figured that every male has sex just 3 times a week, every week of the year... That's P 600 million multiplied by 52 or Php 31 billion.
Well, maybe the figure I ended up with may be a bit big, just for condoms and I suppose the Department of Health may be in a better position to determine its stocking requirements.

So given that corruption usually eats up 30 percent to 70 percent of government supply contracts, can you imagine just how few condoms will be delivered in a year?

Where will the government get the money to fund the RH Bill?

So far, we haven't even factored in that government budget requests sometimes only get partially funded.

You have to realize that just because a law or program says it requested X amount of money as budget, it doesn't mean that X amount of money will be approved and even if it is approved, funding will depend largely on available revenue.

And in instances where revenue cannot support spending, the government then has to borrow money or delay payments to contractors.

I'd figure that using borrowed money to fund a government program or projects within a government program will cost more than getting the money from revenue.

The other option, which is to delay payment (which happens fairly easily and regularly) has the tendency to create more graft and corruption.  With suppliers wanting to collect as soon as possible, the usual practice is to bribe people within the bureaucracy to speed payment up.

So, with corruption eating away at whatever budget is allocated, we're also looking at a situation where the RH program may not be fully funded (because no funding source was contemplated) and if it IS fully funded, we'll be saddled with more government debt.

For the poorest of the poor, I guess they're looking at PhilHealth.
SEC. 25. Implementing Mechanisms 
(d) Take active steps to expand the coverage of the National Health Insurance Program (NHIP), especially among poor and marginalized women, to include the full range of reproductive health services and supplies as health insurance benefits;

LAST Nov. 22, an inspection team from the Philippine Health Insurance Corp. (PhilHealth) made an unannounced visit to the Januaria Marcial Memorial Hospital in Banga town, in South Cotabato province in southern Philippines.  
In the 50-bed hospital, the team found more than a hundred pages of fabricated claim forms and other documents with false entries. "The team made the surprise inspection on Nov. 22 but some of the dates on the forms were already Nov. 25. The same forms were filled up by persons who (had) yet to be confined in the hospital," said lawyer Jay Villegas, head of PhilHealth's Fraud Prevention and Detection Unit (FPDU). When the team tried to confiscate the documents, however, hospital officials refused. "Instead, they set the forms on fire," Villegas said. "We have video and photos of the incident." Januaria Marcial is one of many health care 
providers on the "watchlist" of PhilHealth, a state-run insurance firm administering the National Health Insurance Program for both private- and  public-sector employees. On Dec. 23, PhilHealth suspended the hospital's  accreditation. (The INQUIRER tried but failed to reach Dr. Elizabeth Bayuga, the hospital's medical director, for comment.) 
Here's another case of PhilHealth being scammed:
MANILA, Philippines -- Some doctors and hospitals have defrauded the government’s Philippine Health Insurance Corp. (PhilHealth) by P4 billion in unnecessary or overpriced medical procedures since 1995, an official has disclosed to the Senate. 
Dr. Madeleine Valera, PhilHealth vice president for health finance policy, said fraudulent claims included one doctor who conducted more than 2,000 cataract surgeries worth P17 million in one year. She said among the cases being investigated by PhilHealth were those involving circumcisions and toenail extractions. 
“It would appear [from medical records submitted to PhilHealth] that a lot of Filipinos are supot [uncircumcised] and have infection on their toenails,” she told a hearing Tuesday. 
“May mga raket din ang mga doctor [Doctors also have their rackets], more as individuals than as syndicates. Some doctors are in on the scam. Many have earned millions from PhilHealth,” Valera said. 
She said the scam involved some “scalawag” doctors treating “ghost patients,” and making “dubious claims.” Others “harvest” these patients by enrolling them in PhilHealth before they are treated.
How will hospitals balance RH products and supplies with essential, life saving medicines and supplies?

Looking over HB4244 again, I can't seem to find a section or provision that explicitly states how the DOH and its 64 hospitals will balance the purchase of "Products and supplies for modern family planning methods..." with other medicines, supplies, and equipment.

It looks like a carte blanche or a blank check giving hospitals almost free reign to determine how much "products and supplies for modern family planning methods" they need to buy.

I think this somewhat springs from Section 3, Item 10:
There shall be no demographic or population targets and the mitigation of the population growth rate is incidental to the promotion of reproductive health and sustainable human development;
Which makes me wonder if Section 3, Item 6, Sub-item 4 has set two rules in opposition or at the very least makes one or the other moot :
conduct studies to analyze demographic trends towards sustainable human development 
Without targets, there seems little basis for conducting studies.  It fails to articulate where those studies will be used for.

My older brother, who is a doctor and actually ran a hospital in the boondocks of Palawan years ago tells me that he had to consider very carefully what medical products and supplies to stock up on.

He had to base it on whatever data he could gather that showed which supplies were needed more than others.

The thing is this, there is no limit to the amount of sex people can have or want to have.  But there is a limit to how long a person will live if he is stricken by malaria, dengue, cholera, typhoid fever, or what have you.

What little it has in guiding the DOH in determining stocking levels for Family planning products and supplies is  
Section 11:

The DOH shall spearhead the efficient procurement, distribution to LGUs and usage-monitoring of family planning supplies for the whole country. The DOH shall coordinate with all appropriate LGUs to plan and implement this procurement and distribution program. The supply and budget allotment shall be based on, among others, the current levels and projections of the following: 
(a) number of women of reproductive age and couples who want to space or limit their children; 
(b) contraceptive prevalence rate, by type of method used; and 
(c) cost of family planning supplies.

(More aggravation to follow)

1 comment:

ici said...

agree. thank you and keep enlightening the people. :)

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