The second Aquino presidency has spread a virus of hope that finds sole parallel in the tide of goodwill that Filipinos bestowed on his late mother and democracy icon Corazon ‘Cory’ C. Aquino after the 1986 EDSA People Power revolt.

Indeed, Aquino’s campaign equation of “no corruption = no poverty” has animated Filipinos so much that the expectations are great that he will deliver results soon.

But while his first two months in office marked vigorous efforts to address the first part – filing suit against alleged tax evaders nearly weekly, creating a “Truth Commission” to hound crooks of the old regime, and firing midnight appointees of his predecessor Gloria Macapagal Arroyo – he has announced only tentative and inchoate initiatives to address the second part.

Thus far, Aquino’s economic team has launched an “inclusive growth framework” for tackling poverty. It is a framework lifted – up to the level of many specific recommendations – from the World Bank Country Assistance Strategy for the Philippines titled “Fostering More Inclusive Growth,” which was released last August 19.

The concept was first enrolled in the Bank’s Country Assistance Strategy for 2010-2012 titled “Making Growth Work for the Poor” and dated April 2009.

And yet it was only last Monday, September 6,  that Aquino issued a directive for the National Economic and Development Authority (NEDA) to formally start the crafting of the new Medium-Term Philippine Development Program (MTPDP) for 2011-2016. It is a document that should serve as his program of action but which officials say may take until yearend to finish.

On slow mode?

It’s a slow-motion executive performance that has political and economic observers alike taking a second, hard look at Aquino, who was a trailblazer in the last elections.

In fact, he is the first presidential candidate to beat a former president, Joseph ‘Erap’ Estrada, who until then held the record of securing the largest margin of victory in Philippine elections.

The country’s first bachelor president is also the first to be thrust to power via a national automated elections, the nation’s first. Those polls turned out to be the first fiercely contested in both old and online media as well; Aquino won a crowded nine-candidate race in a balloting that saw a fourth ‘G’ defining RP-style elections – gigabytes – aside from the guns, goons, and gold of old.

By most accounts, however, Aquino has remained true to his roots. It is in the image and likeness – and the same starting premises – of the mother’s presidency that the son has advanced to Malacañang.

Like Cory, Noynoy Aquino ran and won on the same franchise of integrity, or campaigning against both “material corruption” and “moral/spiritual corruption,” according to University of the Philippines political science professor Felipe ‘Pepe’ Miranda.

This was captured in his campaign slogan. Yet, in reality, the catchphrase might be too simplistic.

Miranda, for one, does not think that by curbing corruption, a president could also automatically stomp out poverty, or that with corruption put in check, poverty will, on its own, work its way out of the system.

“The probability is that without corruption, you may not do away completely with poverty but you will do away with it, significantly,” Miranda says.

Lofty visions but…

The battery of economic technocrats in government knows this full well. The problem is that what they have spewed out so far seems to be long on lofty visions but short on concrete goals.

Last August 18, at a midyear economic briefing, Socioeconomic Planning Secretary Cayetano Paderanga Jr., said, “The Aquino Administration aims to create adequate employment opportunities for many more Filipinos in order to significantly reduce poverty.”

Among the “strategies for inclusive growth,” Paderanga said the Aquino administration will launch the following programs: “better education, primary health care and nutrition, and other basic social services; equal access to infrastructure, credit, land, technology, and other productive inputs; improve governance and strengthen institutions to promote competition.”

In addition, he said, “we will equalize access to development opportunities across geographic areas and across different income and social spectra” and “among others, we will try to better education, primary health care and nutrition, and other basic social services.”

Finally, according to Paderanga who is also NEDA director general, “we need to formulate and implement effective and responsive social safety nets to catch those who are left behind by the character of a high sustained growth.”

“Likewise,” he said, “in recognizing the devastating effects of climate change in the future, social safety nets that support and capacitate vulnerable sectors are necessary to address poverty.”

Critical gaps

The “Reform Budget” for 2011 that the administration submitted to Congress last August 25 does not really help much in making its targets on poverty alleviation clearer to discern.

Aquino’s accompanying message to the “Reform Budget” says only that it “mirrors our commitment to lift the nation from poverty through honest and effective governance” and reflects the Cabinet’s consensus on “priorities to address critical gaps in social services for the poorest.”

The message adds that these “basic governance principles” drive the 2011 budget – transparency and accountability to make government productive; bias in allocating resources for the poor and the vulnerable; fiscal responsibility to reduce debt; public-private partnerships to spur growth despite lack of funds; and zero-based budgeting to prioritize activities with impact.”

“Through the zero-based budgeting system, we were able to focus allocations on programs that are really intended to lift the lives and empower the poor,” explains Budget Secretary Florencio ‘Butch’ Abad. “We are trimming the fat by phasing down programs where we think government has no business in doing or is bad at doing, including subsidy programs which apparently benefited the rich instead of the poor.”

But while some subsidy programs will go, a few others will continue on, and with bigger scope and budgets yet, in the Aquino administration. Abad cites the budget items that he says demonstrate the administration’s zeal to quell poverty:

• “The budget of the Department of Education, which continues to receive the highest budgetary allocation among all agencies, increases by 18.4 percent or P32.3 billion to P207.3 billion (12.6 percent of total budget), the largest in over a decade. This is attributed to the construction of 13,147 classrooms and the creation of 10,000 teaching positions, among others.”
• “The budget of the Department of Social Welfare and Development increases by 122.7 percent to P34.3 billion, primarily due to the increased provision for Conditional Cash Transfer (CCT) to benefit 2.3 million households by the end of 2011.”
• “Reforms in other subsidies were made: the DepEd’s food-for-school program was transferred to DSWD as it can better target beneficiaries; the Department of Agriculture’s input subsidies was reduced as it was found to have benefited the rich; and the Kalayaan Barangay Program was eliminated as it is no longer effective. Savings were instead directed to the CCT, the DepEd scholarship program and the National Health Insurance Program.”

Not clear, not out

University of the Philippines professor Karina Constantino-David, who had served as housing czar under then President Estrada and later Civil Service Commission chairperson, acknowledges that the poverty alleviation platform of the Aquino administration needs better, fuller articulation.

“We also talked about it, it’s not coming out, and it’s not being conveyed clearly by the Communications Group,” she remarks.

The president has named three secretaries and an undersecretary to share artificially divided roles in press and media relations. They have been precisely invited to meetings on these anti-poverty initiatives, says David, who has helped review nominees to government positions for the Aquino administration.

“The conceptualization of how to put things together, that’s supposed to be their job, pinaupo na sila (they’re already there),” she points out.

Much like Cory, Noynoy Aquino came to power backed by a company of similarly reform-minded if variously motivated political allies with consensus on general policy themes but not on concrete programs or policies.

But while Cory’s presidency was described as being given to “Kamag-Anak Incorporated,” Noynoy Aquino’s is said to be evolving into a “Ka-Vibes” or “Kabarkada Incorporated.”

His multiple-head Communications Group is evidence of Aquino’s dangerous tendency to accommodate all the factions that fathered his presidency, prompting a media analyst to ask, “If he cannot manage his friends, how can he manage his enemies?”

It is clear the Filipinos did not get “an Aquino solo presidency,” says public-relations consultant Aurelio German, a long-time personal friend of the president.

German, who had worked for defeated candidate and Aquino cousin Gilberto C. Teodoro Jr., adds, “The way I see it, this looks like an oido presidency, one driven by gut-feel. But that won’t suffice. You have to put science into it.”

He says Aquino’s advisers and Cabinet appointees would do well to give him more substantial advice and staff work.

Miranda shares the observation. Aquino might be better assisted, he says, by “Cabinet members cutting their teeth on the job exercising a lot more restraint in the way they make public pronouncements.”

To be fair, German says, “There is no question about his honesty but what is coming to the fore right now is his ability. The determination is there but apparently not enough to push through campaign line, to craft a master plan beyond the sloganeering.”

Big burden

Fortunately, the government’s old-hand economists are around to spell out what the Aquino administration has to do for the Philippines to meet its commitment to reduce poverty incidence by half, within the deadline of the United Nations’ Millennium Development Goals.

That would be a poverty incidence of 23 percent by 2015, from the base figure of 45.3 percent as of 1991. Right now the figure stands at 33 percent.

According to Ramon Paul Falcon of the NEDA’s Social Development Staff (NEDA-SDS), that translates to a “medium probability” of attaining the poverty MDG. In other words, reaching the goal isn’t all that impossible; all the Philippines needs to do, says Falcon, is to increase its pace of reducing poverty by more than two percent annually – and to sustain this until 2015.

And if he so intends to do right by the MDGs, the big burden on Aquino is this: In absolute numbers, rescue from poverty at least 278,852 Filipino families every year in the next five years.  These are the families who survive on less than one dollar or P45 a day – the poverty threshold income that the United Nations says should be increased by now to $1.50 at least.

Yet Falcon says the NEDA’s “inclusive growth framework” highlights recommendations based on a comprehensive analysis of the poverty situation in the country, which economists say has been worsening in recent years. This is despite former President Arroyo’s pronouncement that her administration achieved a 7.3-percent growth in the first quarter of 2010, which was even supposedly the highest posted by the country in the last three decades.

Falcon does not refute this, but explains it was a “jobless growth…buoyed up by the services sector” – mainly business process outsourcing (BPO), retail trade, real estate, as well as remittances from overseas Filipino workers.

This, he says, is a “very narrow source of growth” as it “doesn’t translate to the greater population who are mostly engaged in agriculture, in manufacturing, and in industry.” He says that growth should be “inclusive” so that workers in agriculture and manufacturing, as well as the downright impoverished, would also feel its positive effects.

Still, the strategic framework prepared by NEDA recommends that the Aquino government continue certain programs of the previous administration. These include the Basic Education Sector Reform Agenda (BESRA), which is anchored on the education-for-all goal and improvement in the quality of education. For health, NEDA sees nothing wrong in maintaining the Arroyo administration’s “Fourmula One” program, which focuses on improving health regulation, health financing, and delivery of health services.

The framework also recommends the strengthening of conditional cash transfers that used to be under Arroyo’s “Pantawid Pamilyang Pilipino Program.”

Supply-demand issue

But the verdict is not yet out on how far these cash transfers could go in rescuing the poor. For one, the sums will come from a $400-million loan from the Asian Development Bank that in time will be booked on the budget and paid from taxpayers’ money. For another, the cash transfers may unduly perk up demand for education and health services that remain in short, short supply in low-income towns and cities populated by the poor.

Another flagship poverty-alleviation project of the Arroyo administration called “Kapit-Bisig Laban sa Kahirapan (KALAHI)” should also be continued, says NEDA-SDS assistant director Cleofe Pastrana.

KALAHI provides community grants to support the building of “low-cost, productive infrastructure such as roads, water systems, clinics, and schools” in poor areas. Residents and local governments provide a cash or in-kind counterpart to the project.

For housing, the framework deems it wise for the focus on slums upgrading to continue.

Falcon, meanwhile, says that several recommendations from the strategic framework plan are actually “in line” with Aquino’s agenda, based on what he said at his inaugural and in his campaign platform. The NEDA-SDS supervising economic development specialist cites Aquino’s goal of universal Philhealth coverage and the strengthening of key institutions like the National Anti-Poverty Commission to better coordinate anti-poverty efforts as among these. But Aquino’s proposal to have a 12-year basic education cycle remains “under study,” says Falcon.

Pastrana, though, stresses asset reforms as the central “intervention” for the Aquino government’s poverty-reduction efforts. She points in particular to the continued implementation of the Comprehensive Agrarian Reform Program Extension with Reforms (CARPER), and the strengthening of livelihood and microfinance programs. She stresses a need to have more rationalized social protection and safety-net programs “to cushion the impact of shocks and disasters that affect most the poor and the vulnerable,” which government data say are the fishers, farmers, children, and disadvantaged women.

Bad, good money

One important concern, of course, is where the money for all these reforms will come from. Aquino, after all, had made a big to-do over the budget deficit he said his predecessor had left.

Former National Treasurer Leonor Briones, however, says that the budget just needs to be “restructured” for the Aquino administration’s anti-poverty plan to fly. “(President Aquino) has a lot of leeway in restructuring the budget,” she says. “That is, if he wants to, if his advisors want him to.”

The convenor of the advocacy group Alternative Budget Initiative, Briones points out that the country’s budget laws concentrate the power of the purse not on the legislature, but on the president. For instance, she says, more than half of the 2010 budget – or about P800 billion – is directly under the president’s control as special purpose funds.

All Philippine presidents from the time of Ferdinand Marcos had enjoyed an intense concentration of budgetary powers, says Briones. While Congress is supposed to pass the Appropriations Law, it is the president who either signs it into law or vetoes it. In case of conflicting versions between the House of Representatives and the Senate, the president can also decide to reenact the budget.

But what really “makes a mockery” of Congress’s supposed grip on the state purse strings, says Briones, is how the president can transfer funds at whim while the enacted budget is already being implemented. She says this was what happened in 2008, when then President Arroyo transferred no less than P140 billion from different agencies to “overall savings,” which were recorded as “unreleased appropriations.” This included an allocation of P1.2 billion meant for the purchase of contraceptives; the money was never released.

“Congress has not been able to rein in the excessive abuse of the budget by the president,” observes Briones. “As a matter of fact, they were part of the activity itself.”

“They say money is the root of all evil,” she adds. “But it can also be the root of all good if you instill value, if you account for it, and if you participate in all the decisions.” – PCIJ, September 2010

Yet if one were to compare health’s share of the budget for this year and what the corresponding figure could be in the next, the difference isn’t much.

For 2010, the health allocation is 1.8 percent of the P1.54-trillion national purse. For 2011, the Aquino administration is proposing P32.62 billion for health –as indicated in the proposed National Expenditure Program — which is 1.9 percent of the P1.64-trillion national budget. The increase in terms of share in the total budget then would amount to just a tenth of a percentage point.

But that isn’t all. When he was still on the presidential campaign trail, Aquino had promised that health would take a five-percent share of the national budget. It would seem now that he is off by at least 3.1 percentage points from what he had pledged, and short by almost P50 billion in peso terms.

Aquino, however, appears to have an ally in Dr. Esperanza Cabral, who was the last secretary of the Department of Health (DOH) in the previous administration.

According to Cabral, the promised increase should not all happen in one year. “Because if you throw P80 billion to the department, but the department is not ready to spend it, sayang naman (it would just be a waste),” she says. The increase, she says, should be incremental according to the “absorptive capacity” of the DOH.

“The spending should be programmed because the accomplishments are also programmed,” Cabral says. “Hindi naman matatapos lahat ng health care problems natin sa isang taon (Our health care problems won’t be solved in just one year anyway).”

That’s putting it mildly. As it is, the Philippines is already unlikely to attain the Millennium Development Goal (MDG) No. 5 by the 2015 deadline – to reduce by three-fourths the number of mothers dying from child-birth complications, and to assure greater access to contraceptives.

Feeble, infirm

The National Economic and Development Authority (NEDA), which put together the latest Philippine Progress Report on the MDGs that will be out this week, does say that the country may have a medium to high probability of meeting other health-related MDG targets. But development and health experts would probably agree that “feeble and infirm” are apt descriptions for the delivery of health services in this country, especially to the poor.

And yet the Aquino administration is poised to maintain several key health programs of its predecessor, even though these had been plagued by inefficiency and political interference, among other things. These include health subsidies under the conditional cash transfer program and Philhealth’s sponsored program, which is co-financed by national and local government agencies.

One major point of divergence it has with the previous government regarding public health, though, is in the area of reproductive health.

Aquino had some quarters worried that he was about to renege on another campaign promise when he reportedly said he needed to review the reproductive health bill and rename it the “responsible parenthood bill.”

But statements made just last week by Health Secretary Enrique Ona assured most of the Aquino government’s support for artificial contraceptives, which would be among the range of choices to be offered to couples.

The support would include funds for the availability of contraceptives in government health centers. Ona also said that the government would support sex education, which had been strongly opposed by the local Roman Catholic Church hierarchy and lay groups.

Arroyo’s failure

Aquino’s immediate predecessor, Gloria Macapagal Arroyo, was known to frown on government programs that incorporated artificial contraceptives, including initiatives promoting maternal health, as well as those aimed at preventing HIV/AIDS or the human immunodeficiency virus and acquired immune deficiency syndrome.

In large part, say development and health experts – and even Cabral – this is why the Philippines will be unable to achieve MDG No. 5.

In 1990, the Philippine maternal mortality rate (the number of women dying from pregnancy or childbirth-related complications for every 100,000 live births) stood at 290. This figure was supposed to be reduced to 52 by 2015.

But the current maternal mortality rate is 162, which translates to about 12 women dying each day while giving birth.

Most of these women are poor. After all, according to the 2008 National Demographic and Health Survey (NDHS), a woman in the lowest wealth quintile will bear an average of 5.2 children in her lifetime, compared to an average of 1.9 children for a woman in the highest wealth quintile.

In general, this is because the poor have less access to more family planning methods, even though they may want to space or limit their childbearing.

Income divide

For sure, proper medical attention and hygienic conditions during delivery are crucial in lowering the risks of women dying during childbirth. But in this area, there appears to be a huge divide between rich and poor women, between the educated and uneducated, and between urban and rural residents, says the United Nations Population Fund (UNFPA).

In the National Capital Region (NCR), for instance, almost nine in 10 deliveries are attended by skilled health professionals, versus only two out of 10 in the Autonomous Region in Muslim Mindanao (ARMM), 2008 NDHS data show.

Indeed, the fact that she lives in Metro Manila may be why Claire Briones has yet to encounter any real problem while giving birth. Still, she says she dreads having any other medical emergency. At 35, Briones has four children; she is a single parent.

In theory, Briones’s family may qualify as one of the beneficiaries of the Conditional Cash Transfer (CCT) scheme that was the flagship anti-poverty program of the Arroyo administration and which is being continued by Aquino.

Known previously as the ‘4Ps’ or the ‘Pantawid Pamilyang Pilipino Program,’ the CCT’s health component includes maternal health care for pregnant women, responsible parenthood seminars, and regular health check-ups and vaccinations for children below five years old.

But because the program is built on providing cash subsidies to indigent families, the question of sustainability has been raised against it.

Target: 4.7M families

For this year, the scheme’s target coverage is one million families. That translates to a monthly funding requirement of P500 million in health subsidies alone. Aquino, however, plans to expand coverage to all poor families – a figure that reached 4.7 million at last count. CCT health subsidies would thus come to about P2.35 billion a month.

The specter of ever-rising subsidies becomes all the more acute given the program’s apparent lack of any timeline (save for the maximum of five years that each beneficiary family can avail itself of the scheme’s benefits).

Interior and Local Government Secretary Jesse Robredo says that the CCT program had improved “health and education outcomes” in Naga City when he was mayor there. But he says that subsidies provided to the poor should be time-bound. “If not,” he says, “then (the program) is clearly not working.”

Briones does not seem to have heard of the CCT. But she says she was once a member of Philhealth, the national health insurance program that began in 1995.

Aquino has promised Philhealth coverage for all Filipinos within three years. He may not have to do all that much to achieve that if one were to go by Philhealth’s claim of having 85 percent of the population as its members. Yet even assuming that Philhealth’s figure is accurate, ensuring universal access to health care is obviously more than handing out Philhealth cards.

Even current Philhealth members think twice before seeking treatment, considering that the insurance covers only a small portion of the fees in accredited facilities – about 20 to 35 percent, according to Cabral.

Leverage, palakasan

Briones says that even when she was still a Philhealth member, she would bring her children to the barangay health center instead of a Philhealth-affiliated facility. With the earnings of her tiny neighborhood sari-sari store barely enough to feed all her children and keep them clothed and clean, Briones simply has no budget for medical expenses. She says she was able to use her Philhealth card just once, when she gave birth to her youngest child two years ago.

Briones was actually a beneficiary of Philhealth’s indigent program, in which a local government splits the premium payments with the national government. According to Philhealth’s 2010 first quarter report, the indigent program has 4.98 million beneficiaries or about 25 percent of the entire Philhealth membership.

But even Cabral concedes that the program has been used for less than altruistic purposes. “Local government officials will actually use this as leverage for political favors, for votes, etcetera,” she says.

Briones herself says that she would not have gotten a Philhealth card had she not known the barangay coordinator assigned to her neighborhood. And now that the coordinator had passed away, Briones says she has been unable to renew her membership. She says the new coordinator lives elsewhere and tends to favor her own neighbors.

“Palakasan kasi (It depends on who you know),” Briones says.

Last year, NEDA also reported in its Updated Medium-Term Philippine Development Plan 2004-2010 that Philhealth’s sponsored program has been largely dependent on “the willingness of (local governments) to enroll their constituents.”

NEDA Social Development Staff assistant director Cleofe Pastrana says as well that in the past, many local governments were unable to sustain their part of the premium payments for Philhealth’s indigent program.

“That’s why the money at (the budget department) cannot move,” says Pastrana, “because without the (local government) counterpart, the money for health insurance wouldn’t be provided.”

The recalcitrance – and sometimes sheer unwillingness – of local governments to support national health programs or follow suggestions by the health department has left the likes of Cabral exasperated.

Devolve health service?

The way Cabral sees it, the most important reform that the health system needs is in the area of devolution. “We need to make up our minds whether the devolution of health services is good or not,” she says.

To which Robredo retorts: “It’s not a question of devolution, it’s getting the right people for (the task).”

He admits, however, that local governments seem to be out of the loop regarding national health priorities. He cites the case of the MDGs, among which the health-related ones focus on prevention.

“It’s not sexy at the local level,” says Robredo of the MDG thrust. “The issue there is ‘how many have I provided health assistance to’.”

But he argues that local governments would be encouraged to prioritize MDG-related programs if achieving the targets resulted in tangible rewards for the towns and cities, such as more funds.

Yet additional monies may not be enough to encourage local government executives to, say, allocate the necessary budget to keep their health centers stocked with contraceptives. That would, after all, mean, going head to head with religious leaders who wield great influence especially over rural communities.

Wanted: Direction

In 2004, then Health Secretary Manuel Dayrit issued Administrative Order 158 or the Contraceptive Reliance Strategy that gave local governments the task of providing contraceptives to their constituents – either for free or at cost.

The strategy’s failure can be seen in the lack of free contraceptives in public health facilities, which NEDA’s Pastrana says caused the very slow progress in contraceptive use rate. In 2003, the rate was 49 percent. Today the comparative figure is 51 percent – quite a long way still from the MDG target of 80 percent.

Some observers are optimistic that with the Aquino administration’s stance on reproductive health, local governments may give AO 158 a chance.

But there are those like Donato Macasaet, executive director of CODE NGO or the Caucus of Development NGO Networks, who say they would be surprised if Aquino would be able to achieve the health targets – particularly the one on maternal health – that the Arroyo administration had missed miserably.

Macasaet, though, says that he would be content if the Aquino government provides even just the direction so that the MDGs would be attained “if not in 2015, at least soon after.” – PCIJ, September 2010

CONTROVERSIAL FAMILY. The Arroyo couple hears mass with their children (from extreme left) Dato, Mikey, and Luli. [photos courtesy of Malaya]

FROM overpriced highways to secret bank accounts, to gambling lords and thoroughbred horses, controversies have hounded the Arroyo administration long before wiretapped conversations implying election fraud hogged the headlines. And it is not only the president who has more than once been asked to account for charges of improper behavior; so too have husband Mike, eldest child Mikey, and brother-in-law Ignacio Arroyo.

IMPSA

Four days after it assumed office, the Arroyo administration approved the awarding of a controversial $470-million contract to the Argentine firm IMPSA (Industrias Metalurgicas Pescarmona Sociedad Anonima) to rehabilitate a hydroelectric plant in Laguna. Justice Secretary Hernando Perez was later accused of demanding and receiving $2 million dollars from ex-Rep. Mark Jimenez, who brokered the deal. Jimenez said he wired the amount to the account of Ernest Escaler in Hong Kong on Feb. 23, 2001 from his bank in Uruguay. The former congressman was later extradited to the United States, where he had to serve a two-year jail term for federal election fraud and tax evasion.

San Francisco

From the time she was first elected senator in 1992 up to 2004, Gloria Macapagal Arroyo had failed to declare in her sworn Statements of Assets, Liabilities and Net Worth the properties her husband, Jose Miguel ‘Mike’ Arroyo, bought in San Francisco through his California-based LTA Realty Corp. In 2003, Newsbreak reported that Mr. Arroyo acquired, resold, and managed at least five properties with a total value of at least $7.1 million in the Bay City from 1992 to 2000. The First Couple said they bought the properties in trust for Mike Arroyo’s younger brother, Ignacio or Iggy, now a congressman.

Bong Pineda

President Arroyo has been questioned about her personal connection with alleged jueteng boss Bong Pineda: She is godmother to one of Pineda’s sons. She has denied any impropriety, saying she doesn’t associate with Pineda or his crowd. In an interview with Time magazine in 2001, she said that when she was asked to be ninang, she sought and received counsel from Manila Archbishop Jaime Cardinal Sin. Recalled Arroyo: “Cardinal Sin said, as a Christian, if I am asked to be a godmother, it is my Christian duty, because the sins of the father are not the sins of the son.”

Macapagal Boulevard

In the middle of 2002, Sulpicio Tagud Jr., then board director of the Public Estates Authority (PEA), blew the whistle on what he said was the overpricing by over P600 million of the construction of the 5.1-kilometer President Diosdado Macapagal Boulevard at the Manila Bay reclamation area. First approved during the Estrada administration, contracts for constructing the highway were allocated to three companies: Shoemart Inc. (one portion), DM Wenceslao (one portion), and Jesusito D. Legaspi Construction (JDLC for the remaining three portions). A series of supplemental contracts with JDLC were later approved by the PEA board under the Arroyo administration, increasing the original approved cost of their section of the highway. Tagud did his investigations and found that while the SM group of companies constructed its part of the boulevard at a cost of P54,000 per lineal meter, JDLC built its section at P302,000 per lineal meter.

Piatco

The construction of the 1.1-km-long, four-storey Terminal 3 of the Ninoy Aquino International Airport (NAIA) by the Philippine International Air Terminals Co. (Piatco) has been riddled with controversies. Some of these were inherited by the Arroyo administration, while others were allegedly of its own doing. In May 2003 opposition Sen. Edgardo Angara accused Malacañang of trying to extort, through the Villaraza law office, some $20 million from Fraport, the German firm with a 30-percent stake in Piatco, in exchange for legal favor.

But the Piatco scandal is a long running one. It figured prominently during the confirmation hearings for Arroyo-appointed Transportation Secretary Pantaleon Alvarez in 2002. Alvarez was alleged to have obtained an overpriced subcontract for one of the public works projects related to the airport terminal. In exchange, Alvarez, while transportation secretary, was reported to have given the firm “onerous” advantages. Piatco was also accused of paying since June 2001 huge sums of money to a public relations consultant, Alfonso S. Liongson, an associate of the First Gentleman, for getting signatures of officials for either permits or supplementary agreements to its contract with the government. Liongson reportedly used part of the money to bribe officials for their signatures. The terminal was finally mothballed in 2003 when President Arroyo revoked Piatco’s build-operate-transfer contract. In December 2004 the government took over the airport, after the Supreme Court affirmed the contract’s revocation. It remains unopened.

Mikey’s horses

Newsbreak in August 2003 broke the news on a plan of presidential son Juan Miguel “Mikey” Arroyo to import 32 thoroughbred horses from Melbourne, Australia. The then Pampanga vice governor, now a congressman, denied the allegation. He admitted, though, that he was in the horse-trade business. The young Arroyo owns Franchino Farms along with cousin Franchino Pamintuan and friend Ralph Mondragon.

Jose Pidal

On Aug. 18, 2003, opposition senator Panfilo Lacson accused First Gentleman Jose Miguel Arroyo of money laundering for supposedly siphoning off at least P321 million in campaign funds and contributions and putting these in a secret bank account under the fictitious name Jose Pidal and in three other accounts using the names of his aides. Among the “donors,” Lacson said, was then Rep. Mark Jimenez who contributed a total of P8 million. Lacson also accused Mr. Arroyo of having an affair with his accountant, Victoria Toh. Following Lacson’s allegations, Mr. Arroyo’s younger brother, now congressman Ignacio or Iggy, came forward to say he is Jose Pidal.

Agri fund

The First Gentleman was linked in May 2004 to the alleged diversion of P728 million from the Ginintuang Masaganang Ani program to President Arroyo’s campaign war chest in the form of development assistance funds to local government units. Then Agriculture Undersecretary Jocelyn I. Bolante, Mr. Arroyo’s classmate at the Ateneo de Manila University and a colleague at the Rotary Club District 3830, cleared the First Gentleman of involvement. Bolante was tasked to oversee the implementation of the Ginintuang Masaganang Ani program at the time.

Philhealth cards

Six weeks before the May 2004 elections, two lawyers from PRO-CON(stitution) filed a disqualification case against President Arroyo before the Comelec, saying she was behind the enhanced Philippine Charity Sweepstakes Office’s Greater Medicare Access or GMA program, which they claimed was meant to prop up her candidacy. Earlier, another PRO-CON lawyer filed a criminal suit, also before the Comelec, against then PCSO chief Maria Livia “Honeygirl” de Leon and PhilHealth president (now Health Secretary) Francisco T. Duque III for vote buying, intervention of a public officer, using public funds for election purposes and using banned election propaganda. Public funds were allegedly spent to enroll families in PhilHealth for one year to induce the enrollees to vote for President Arroyo. The premium cost of P1,200 for each family member was chargeable to PhilHealth and the PCSO.?The PhilHealth identification cards bore the President’s picture and the name. Their distribution coincided with the start of the election campaign.

Las Vegas suite

The First Gentleman was the subject of another controversy over his alleged use of a $20,000-a-night suite at the MGM Grand Hotel in Las Vegas, Nevada during the boxing match between Manny Pacquiao and Mexico’s Erick Morales last March 19. The story first appeared as a blind item in the March 23 column of Inquirer sports columnist Recah Trinidad, who wrote that a “heavyweight backer” of Pacquiao had stayed in a $20,000-suite at the MGM Grand. Mr. Arroyo would later say he did not see anything corrupt about accepting the generous offer of a free luxury suite from the hotel, arguing that his stature as the husband of a head of state entitled him to such perks.

Jueteng (again)

In Senate hearings on the illegal numbers game that began in May 2005, jueteng operators and bagmen said the President’s husband Mike, her son Mikey, and her brother-in-law Ignacio or Iggy were among those who received monthly payoffs from gambling lords. The payoffs supposedly ranged from P500,000 to P1 million. One of the witnesses, businesswoman Sandra Cam, testified that in December 2004, she personally delivered the cash to Mikey (in a gift-wrapped package) and Iggy (in an envelope) at the House of Representatives. The deliveries were supposedly made on the instructions of retired Chief Supt. Restituto Mosqueda, former police director for Bicol and alleged protector of jueteng operations in Luzon. On June 8, the President ordered the Department of Justice to investigate her son and brother-in-law, saying, “Nobody in my family or kin are above the law and no investigator or prosecutor could fear to uphold the law against them. I will stand for justice no matter who gets hurt.” The Office of the Ombudsman has since taken over the DOJ investigation. Both Mikey and Iggy, meanwhile, have sued Cam for libel.

LAST SATURDAY, members of the Philippine Veterans’ Legion (PVL) broke tradition when they spent “Araw ng Kagitingan,” or the Fall of Bataan in Fort Bonifacio. For years, these old men, easily recognizable by boat-shaped military caps, had traveled all the way to Mount Samat to hear the president speak of war and the veterans’ forgotten exploits. But they are growing weaker, and physically and financially incapable of making the trip to the place that marked Filipino surrender to the Japanese. Besides, says PVL chairman Frank Cedula, the veterans feel “the government isn’t doing anything to help” them, especially now that they are facing a different kind of enemy.

Sixty years ago, a grateful nation honored Filipino soldiers and guerillas for defending the country against Japanese invaders. Cedula himself says his personal story is the stuff war movies are made of, having been a 17-year-old reservist who endured seven stabs from a Japanese bayonet in the Sierra Madre mountains in 1941. For their heroism, the Philippine and U.S. governments promised them, their widows and orphans financial compensation and other rewards.

It took ages before many of those promises came true; some remain unfulfilled. What did materialize early on was the creation of a trust fund for World War II veterans and their heirs that would come from the $20 million payment by Japan for the losses and damage it inflicted on the Philippines. Known as the reparations fund, the money was given in 1956. It eventually went into the creation of the Philippine Veterans Bank (PVB), whose stockholders were supposed to be the veterans and their heirs.

To the veterans, the bank is the most tangible tribute of the nation’s gratitude, a financial monument to their service during the war, an edifice of honor built in their name. For all that, though, the veterans and their heirs remain mere titular stockholders of PVB, with little say in the running of the bank. In truth, they also know little about the bank’s operations, as well as that of its affiliates, largely because these suffer from a lack of accountability and transparency.

This has made it possible for politicians, their cronies and bank directors to treat the PVB as their personal piggy bank, dipping their fingers into its coffers without much fear of getting caught. Worse, veterans say that one of their own, who eventually became bank chairman, seems to have failed to watch out for them. At the very least, they fear he let others abuse the bank’s considerable holdings — as well as those of related institutions.

The PVB had been designated as a depository of government funds. Thus, the bank has been holding money belonging to government agencies and local governments; the Philippine Health Insurance Corporation (Philhealth) is one of those currently with huge deposits at the PVB. In addition, the bank holds some P2 billion in trust for the pre-need company College Assurance Plan (CAP).

Such holdings help justify the generous P650,000 that PVB Chairman Emmanuel de Ocampo gets each month in compensation for running the bank, an amount de Ocampo admitted to receiving in a Senate hearing in 2002. De Ocampo also described the work he was doing to merit such a salary: “I had to do some marketing, I have to do some management, I have to help, Your Honor. And besides, the P650,000 includes expenses in the board which I have to sign as chairman.”

But veterans say that for the huge salary he gets, de Ocampo has failed to protect their interests at the PVB. They cite the fact that de Ocampo — himself a war veteran who retired a colonel — was already a bank director prior to its closure in 1985, when cronies of then President Ferdinand Marcos, like Herminio Disini, were running away with the bank’s money. Behest loans to such Marcos friends led to the bank’s closure.

Nothing much changed when the bank was rehabilitated and then reopened in 1992. The plunder continued, even after the Bangko Sentral repeatedly warned bank officials to stop abusing their powers and privileges. In a February 16, 2000 letter to then President Joseph Estrada, then PVB President B. Teodoro Eusebio wrote, “Many…violations of BSP (Bangko Sentral ng Pilipinas) regulations, diversion of bank’s income to personal accounts, dishonesty and inefficiency have been discovered.” Eusebio pledged to “clean the bank” but found himself out of the PVB presidency not long after. At that time, the directors of the bank included Estrada’s sister, Pilarica Ejercito.

Veterans say that among those who are currently taking advantage of the bank’s assets is a director who allegedly falsified his credentials as a veteran’s son to get himself into the PVB and to secure huge loans for his companies. Last year the bank hastily granted a P550-million loan to a company owned by a Filipino-Chinese businessman with close ties to presidents past and present, even if the firm failed to comply with the requirements. The loan remains unpaid a year after it fell due.

Veterans trace part of the problem to de Ocampo and his all-encompassing financial and political power over the bank, as well as over related organizations that control it. Aside from being PVB chairman, de Ocampo also heads the Veterans Federation of the Philippines (VFP) and the Board of Trustees of the Veterans of World War II. A founding member of the Hunters’ ROTC, de Ocampo took part in daring guerilla actions during the war. One of these was the raid on the Bilibid prisons in Muntinlupa in 1943 to free Filipino prisoners of war. De Ocampo was then head of the 47th Regiment.

His fellow veterans now fear he has looked the other way as other raids have gone on, this time at PVB and its affiliates. De Ocampo was unavailable for interview, but Miguel Villa-Real, the bank’s assistant vice president for corporate communications, says that contrary to his fellow veterans’ belief, de Ocampo has been active in pursuing the cause of veterans at the bank. De Ocampo helped press for the increase in the veterans’ monthly pension from P1,000 to the present P5,000, says Villa-Real. He also says de Ocampo’s being a key figure in the bank’s reopening in 1985 is a major contribution to the veterans’ cause.

Yet it has certainly not helped de Ocampo any that the PVB, the VFP and the Board of Trustees all suffer from the lack of transparency even as all three sit on a huge amount of cash. For instance, the PVB, which was initially meant to be a public corporation under the defense secretary’s supervision and control, is a private bank accepting government deposits and exempt from transparency and scrutiny.

Veterans say they also have no idea how money given to it is handled by the Board of Trustees, an entity established by Republic Act 3518, the law that created the PVB. The Board was designated as custodian of 20 percent of the PVB’s earnings, an amount that was supposed to be made “available for ‘grants-in-aid’ to veterans, their widows, orphans or compulsory heirs, for educational, social, charitable and rehabilitation purposes, to organizations doing service for the veterans.” The composition of the Board, the law said, was to be determined by the Supreme Council of the VFP.

Created by another law in 1956, the VFP is an umbrella group of various veterans’ organizations. These include not only World War II groups but also those made up of former soldiers who took part in the Korean War in 1950. Its cash income is collected from the veterans’ pension, automatically deducted by the PVAO. In the past few years, the VFP has been getting one percent from each veteran’s annual pension, or P500 per veteran a year, supposedly for its operations. Many say they were not consulted when the VFP and the PVAO agreed upon these deductions. This is why Philippine Veterans’ Legion national adjutant Manuel Reyes has argued that veterans could get back that P500 collected from them yearly, provided they formally request the PVAO in writing to stop the deductions.

The VFP is estimated to be collecting a total of about P50 million annually, including the veterans’ pension deductions. But its books have never been scrutinized by the Commission on Audit (COA).

Here actually lies a problem, and a divergence of attitude among government agencies toward the PVB and the VFP: The Supreme Court, in a labor case involving former PVB employees, maintained that the PVB is a private entity because it is owned by World War II veterans and not by the government. The Department of National Defense (DND), meanwhile, cites the original law that put the bank and the VFP under the supervision and control of the defense secretary. In fact, when Charlie Beloso, chairman of the Crusade to Reform Veterans’ Organizations (CREVO) and a wartime soldier who fought under war hero Macario Peralta, filed plunder charges against the PVB officials in 2002, the DND legal department endorsed the suit to the Ombudsman for the military, because it considered the bank’s officers public officials.

The COA, for its part, maintains that there is no government money in the VFP, hence it cannot be audited. Yet the law that created it clearly called it a public corporation. Besides, says a DND official, there are several pieces of property belonging to veterans and under the control of the Foundation, for which the VFP refuses to pay taxes because it has cited its being a government entity.

And then there is the VFP’s disqualification from the party-list election because it was an “adjunct of the government.” In 2001, the VFP fielded two candidates in the House of Representatives who won. Beloso had also run in the same race, under a party called the Veteran Care Organization. But the VFP sought his disqualification, because it said the VFP was the “only veterans’ organization in the Philippines.” Beloso countersued, seeking the VFP candidates’ disqualification. He argued that the VFP is a government corporation and cited the law saying the “VFP shall be non-sectarian and non-political.” The Commission on Elections sided with him, disqualifying VFP’s candidates.

More than its affiliates, though, it is the Philippine Veterans’ Bank that preoccupies the minds of those who fought in World War II, because of the meaning it has for them. The bank is often the subject of discussion among members of Cedula’s Philippine Veterans’ Legion, which is composed of soldiers and guerillas that signed up with the USAFFE (United States Armed Forces in the Far East).

The Legion meets regularly at the old Philippine Veterans’ Affairs Office (PVAO) compound in Arroceros, Manila. But its meetings are now fewer and far between, because the members are getting too old or are too ill to make the trip to the old PVAO. They fear there might be one member less every meeting, either because of death or illness. Earlier this year, Legion members put up a sign on a wall at the PVL office that reads: “This is our last hurrah (probably).”

Indeed, moving about is a taxing and tiring activity for many veterans. Mostly in their 80s, Legion officials are just ghosts of the young men they were in the 1940s, when their able bodies could still take a stab from a bayonet. Cedula, who endured five days of pain, thirst and starvation before fellow Filipinos found him bleeding from his stab wounds more than half a century ago, is an exception, and is still quite sprightly at age 82.

Most veterans are like Miguel Marcos, who signed up as a USAFFE volunteer in 1941 and saw action as a guerilla in 1942, along with Cedula. Marcos was a tall high school student when the war broke out. Now he is thin, gaunt and walks slowly, with a stoop. But he still takes public transportation to his home in Valenzuela City.

There is also Manuel Reyes, another former guerilla and now the Legion’s director for Luzon. Reyes’s eyesight is failing, and he needs a magnifying glass to read the papers and readings that other veterans share with him.

Medical assistance is what these veterans need most now. In fact, the PVL has been trying to scrape up funds to build the Angel Suarez Convalescent Home, where they hope members can take refuge in their old age. Angel Suarez was a guerilla and former PVL leader. A notice at the PVL office in Makati says that the convalescent home will rise on that site, but there is hardly any indication of that happening anytime soon. By the time it does, the veterans may no longer be around to use it.

Beloso says World War II veterans are an endangered species. Based on PVAO statistics, they are dying at the rate of 20 a day. If only 5,000 members of the USAFFE and 17,000 recognized guerillas remain, Cedula says, that makes some 22,000 World War II veterans still living. But at the rate they are dying, they might all be gone in four years.

De Ocampo himself is in his 80s. But unlike him, many of his fellow veterans live in poverty, says Braulio Bumanglag whose own father fought as a guerilla in Isabela during the war, and who counts himself among the veterans’ sons and daughters supporting their cause. That is why he, Beloso, Cedula and the rest of those in various veterans’ groups are fuming over how they say bank officials have been enriching themselves.

For sure, the niggardly P80 cash dividend check each veteran gets annually as a PVB stockholder barely covers transportation when they claim pension checks, or apply for medical assistance, which at their age is their most pressing concern.

Villa-Real says, however, that the veterans can avail of free medical and dental care at the VFP Outpatient Center in Taguig that gets support from the bank. Also among the bank’s “substantial assistance to World War II veterans,” says Villa-Real, are pension loans of P24,000, payable in 12 months, or P40,000, payable in nine months, at interest rates ranging from nine to 12 percent. In addition, veterans can maintain a passbook account with only P100, and a minimum balance of P500 to earn interest.

Whenever it is time for the veterans to collect their pension checks, Villa-Real says, “Oplan Beterano” kicks into gear. This is when bank provides tents for shade, brings out chairs and serves water and biscuits to the former soldiers. Portable toilets are set up and an ambulance is put on standby. Villa-Real says “Oplan Beterano” was named the joint winner in the customer service category in the 2004 International Asian Banking Awards.

But perhaps the bank and the VFP should not expect any award from the veterans, who have grown disillusioned over what they had perceived as the reward for their bravery in war. CREVO’s Beloso has even been writing members of Congress and the media to express his outrage that the Federation has somehow managed to skirt election laws.

In the last elections, another party using similar initials and affiliated with the Federation fielded a candidate and won. The Veterans Freedom Party is now represented in Congress by Ernesto Gidaya, former chairman of the PVAO. Said Beloso in a statement: “The Veterans Freedom Party was organized only sixteen days and not one full year before the date set to apply for accreditation under the Party List System. This act of the Veterans Federation Party is a gross and flagrant violation of the Party List Law.”

Many of the men like Beloso who once defended the country against the Japanese feel that no one seems to be listening to them anymore, however hard they scream. Although they are willing to fight against what could be their last adversary, they say they are fast being sapped of the little strength they have left — and running out of time.

Because government resources for health are dwindling, self-care and self-treatment of health conditions will be much more common in the next decade. [photos courtesy of Jose Enrique Soriano]

FILIPINOS HAVE long been prone to self-diagnosis and self-medication, but in the years to come, D.I.Y. health care may become even more pronounced. After all, when society does not assume enough of the burden of health care, individual responsibility and self-preservation become the norm.

Compared to its counterparts in neighboring countries, the Philippine government has not been spending enough for the health needs of its people. According to official reports, our government allocates only 0.9 percent of total spending on health. This is lower than Thailand (11.6 percent), Malaysia (6.5 percent), and Vietnam (6.1 percent), and even less than what the economically distressed nations of Indonesia (3.0 percent), Cambodia (16 percent), and Bangladesh (8.7 percent) allocate for the health of their peoples.

It is not clear whether our government has no money because it is spending on the wrong things or cannot raise more revenues. What is certain is this: because the national government scrimps on health care while local government resources for health are limited and health insurance, inadequate, households end up bearing the bulk of the burden of health spending. Because public spending is deficient, more private resources have to pay for health expenditures.

In the coming years, we can only expect more self-spending activity where families make more out-of-pocket payments for services. And while self-sustaining and self-financing of health care are already becoming extensive, more people will rely on their immediate circle of contacts for remedial measures. Self-care and self-treatment of health conditions will be much more common. In this do-it-yourself setting, we would not even have to go to hospitals or diagnostic laboratories. It would be more convenient and much faster to call on family and get test kits from the neighborhood pharmacies. In this information age, it is also much easier to surf the Internet and access medical-information websites.

For the wealthy, D.I.Y. health care would work. Health is wealth, and the wealthy will be even healthier in the next 10 years and even beyond because of more self-education and self-diagnosis, better self-care and self-treatment, and increasing self-sustenance and self-financing. For the poor, however, even the simplest health problem could deteriorate into a matter of life and death because of their lack of access to health information and services, which in turn could lead to improper self-diagnosis and medication.

Health is a luxury for the needy. For them, thinking about what they can expect 10 years from now may even be difficult, when all they can hope for is just another day. It is an arduous challenge to improve the well-being of the ailing because of the divide among social classes, the gap between the rich and poor, and the disparity among first-class and lower-class communities.

GOVERNMENT HEALTH indices suggest that over the last 15 years our overall health status has improved. Tuberculosis and other infectious diseases are no longer the top causes of death and illness in our country. Diarrhea and other problems associated with environmental sanitation have decreased with improved water distribution and supply. The family planning program has provided a wide range of family planning services to many women of reproductive age, around 47 percent of whom were reported to be using contraceptives in 2000.

Yet while major health improvements have been evident in the last few decades, their pace and scope are now at risk of being overwhelmed by a growing population, a constrained economy, and a major challenge in health and development-the yawning gap between the few people who have so much and the many who have so little.

The “improvement in the economy” reported at the macro level excludes the fact that the Philippines has one of the most unequal income distributions in the world. Although reduced in many parts of the world, inequity is becoming worse in this country. In 1994, the family income of the richest ten percent of our people was 19 times higher than that of the poorest ten percent. Since then, that same affluent group has continued to increase its share of family income while the family income share of the majority of Filipinos has decreased. Economic improvement without equity cannot contribute substantially to human health and development, but there is no indication the trend will change anytime soon.

The differences dividing social classes have rarely been minimal. There is not only an information divide where the rich have the best computers and the best sources of knowledge-the poor are not even provided enough teachers, classrooms, and school books for basic elementary and high school education. It is not only harder for the poor to receive health education, it has also become much harder for them to understand the scant health information that is available.

When it comes to the national government’s approach to health, lack of money is only half the problem. Of the little that is set aside for health, just a pinch is allocated for public health and preventive-care services like family planning or reproductive health or even for diseases like malaria.

Even today, lower-income households see more abortions, unwanted pregnancies, and maternal deaths compared to those in the upper classes. Yet family planning and health information are focused in health centers and in messages placed in magazines that are not always accessible to the poor.

It is true that there is almost equal access across income classes for free family planning commodities like pills, condoms, and injectables. But only those who have money can avail themselves of the more reliable family planning services that have to be paid for, such as longer-term contraceptive methods like the intra-uterine device (IUD) or voluntary surgical contraception for males and females.

The poor are still ravaged by tuberculosis or TB and pneumonia. Although these diseases are no longer among the top three causes of death in our country, they are still in the top 10. The World Health Organization estimates that the Philippines has around 250,000 new cases of TB each year and the second highest number of tuberculosis cases in this region of Asia.

And while water supplies have improved, diarrhea is still the top cause of illness here, with one out of every 100 persons affected each year. It’s easy enough to figure out who are likely to have it. The more expensive housing in upper-class villages and communities can boast of so much water that golf courses are always green and swimming pools are kept full of clean water. On the other side of the fence are rural villages and teeming slums with dirty water and pitiful environmental sanitation.

SUCH DISPARITY is also evident among central cities and peripheral provinces, or first-class and lower-class municipalities. To make matters worse for the poor, more government services and accredited health-care facilities are in the affluent areas. These disparities are unlikely to even out in the coming years Among members of the Philippine Health Insurance Corporation (PhilHealth), for example, the wealthy and healthy are currently more likely to avail themselves of the insurance benefits than the ill but impoverished, who cannot afford to lose a day’s pay or the bus fare to consult a doctor. This trend will likely continue in the next decade.

When family planning and health-care providers do not reach out to the poor and those living in more peripheral areas, it is unlikely that the underserved would spare the extra cost of transportation and access to information and services. Not surprisingly, the number of infant deaths and maternal mortality in our country continues to be high. Apart from a disturbing picture of dying babies and dying mothers, the University of the Philippines Population Institute estimates abortion rates as ranging between 320,400 to 480,600 annually. These figures translate to one abortion for every five to six pregnancies.

The number of women hospitalized for high-risk deliveries and some even dying because of abortion and complications in our country is huge. Based on reimbursements records, these account for over 30 percent of PhilHealth’s spending and amounts to around P1.15 billion each year.

Women from households with higher income have greater use of, and possibly better access to, family planning services. Several studies already show that the number of children that each woman has is related to household-income levels. Richer couples have on average two children, which is the number that most women want. But while married women in poor households say they had wanted around three children at most, majority of them end up with at least one or two more, with many even having more than five children. These figures may or may not include the young children who have died. The rate of deaths of infants and under-five-years-old among the poor in the Philippines is double those among affluent Filipino households.

It has been suggested that it is not only the absolute amount of income that is important for health but also the relative disparity with which the income is distributed. One possible explanation for this is that the social stress associated with such inequity can lead to more smoking, alcohol abuse, and other unhealthy behaviors. It is also conceivable that when too much of the total income is in the hands of the rich who can afford private education and medical care, there is less money for the poor. There is simply less interest among those with money to contribute to funding for public education, public health, and social services. (Blame that partly on growing cynicism, which can kill philanthropic instincts. But plain greed and selfishness play a part, too.)

The correlation between the distribution of disease and the disproportionate allocation of resources is supported by another observation: there are fewer deaths when there was less inequity. This reflection is based on what has taken place in countries with increasing incomes but constant class differentials, and compared with poorer but more egalitarian societies. Hidden behind the health situation reported by our statistics, for example, is the marked inequity and the wide disparity in the health status among Filipinos. According to the Department of Health and our health administrators, there are persistent, large variations in health status across population groups and geographic areas. Again, while there are pockets of excellent health among the rich, the burden of disease is heaviest on the majority who are poor.

THE IRONY is that as the health and health care divide widens between the haves and the have-nots, we are seeing an exodus of health professionals headed for work overseas. This trend is likely to continue in the coming decade. Would that we could count on steady support from the countries that benefit from our countrymen’s labors and who have drawn our resources. Yet it is difficult to beg for aid and assistance from foreign donors and multinational corporations. It is more difficult to find solace in the infusion of dollar remittances from overseas workers, including those who should be looking after our own people’s health, when these come at the expense of families separated by seas and continents and of health institutions in dire need of trained and skilled personnel.

Still, for every 3,000 physicians who yearn for the chance to work abroad, many do choose to stay. For every 300 medical graduates pining for positions in expensive medical centers there are those who would work among the poor. For every 30 successful health professionals who have left our country there is someone who will come back home.

It is, however, distressing to realize that choosing to stay means a harder life for a physician’s family. It is depressing to witness a young nurse or midwife walking in mud as the latest car models roar by. It is disheartening to have barangay doctors reading torn medical books under the flickering light of a kerosene lamp while many other people enjoy a sparkling nightlife. It is demoralizing to be in a country that chooses to break up families and offer our health workers to the uncertainties of foreign employment rather than spending for the means to maintain the human resources that are vital to the health of our people.

Fifteen years ago, I worked as a rural health physician in Kabugao, in Apayao province. My wife was the chief of the district hospital. We lived there for two years with our daughter, who was just 11-months old when we first arrived. Our next child, my son was conceived in that part of the Cordillera mountains. The number of doctors in Kabugao has barely increased since we left, and it may stay that way (or even see a decline) in 2015. With the continuing lure of better pay and better opportunities in the city hospitals of our country and the health centers in other countries, how can there be more health workers in places like Kabugao? Can I myself even care enough to go back to work in the municipal health office I left so many years ago?

I may hesitate, but fortunately there are hardier souls out there. Even now thousands of rural health workers continue to labor in the most difficult and trying circumstances, while there are still doctors who can barely make both ends meet but are sticking it out in the hinterlands. Thousands more nurses have surrendered to a lonely life away from home-not in some foreign land, but in areas in the Philippines they know need them most. These are the heroes who may yet bridge the health gap between the rich and the poor and help heal the wounds of our society.

Jonathan David ‘Jondi’ A. Flavier is a medical doctor who specializes in health policy, planning, and management. He currently provides part-time technical assistance for health and development programs of the Department of Health, the Philippine Health Insurance Corporation, the Philippine Congress, as well as international and other private organizations.