Dengue, doctors, hospital beds: Ne'er the twain shall meet?

BY THE PCIJ DATA TEAM September 11, 2019






A NATIONAL Dengue epidemic has been declared last August. In the first six months this year alone, or from Jan. 1 to July 20, 2019, the Department of Health (DOH) has monitored a total of 146,062 cases and 622 deaths from dengue hemorrhagic fever.

Day by day by day, these numbers continue to rise. As of Aug. 17, 2019, the number of dengue cases has grown to a total of 229,736. Within a week’s time alone from Aug. 11 to 17, at least 13,327 new cases have been reported.

Region VI (Western Visayas) has topped the list of regions by number of dengue cases at 39,892 or 17 percent, followed by Region IV-A (CALABARZON) with 30,889 cases, and Region X (Northern Mindanao) with 17,674 cases.

Even worse, at least 958 patients had died since the start of the year. Region VI (Western Visayas) ranks first in terms of case fatalities with 179 deaths due to dengue, followed by Region IV-A (CALABARZON) with 98 deaths, and Region VII (Central Luzon) with 90 deaths.

In the face of a public-health epidemic that exacts a most tragic toll on lives, should we not ask ourselves now: How prepared are we, or, could we have prepared better, for dengue?

The National Health Facility Registry of the Department of Health (DOH) currently lists a total of 1,456 hospitals across the nation. Only 463 or 32 percent of these hospitals are government-owned. Of the total, 270 or 58 percent of these government hospitals are in Luzon, 80 or 17 percent are in the Visayas, and 89 or 19 percent are in Mindanao.

With a projected national population of 106,168,803 for 2018, the ratio of government-owned hospitals to the Philippine population is a horrible 1: 229,306.

Cavite and Cebu, two provinces with high cases of dengue, are also among the highest in terms of government-owned hospitals to population ratio: Cavite ranks sixth, with a ratio of 1: 450,115, while Cebu ranks 10th, at 1: 377,865.

Filipinos in provinces with smaller ratios of government-owned hospitals to population might be presumed to have better access to public healthcare services.

But this is not the case for Iloilo, the province that has the largest number of dengue cases and deaths this year. Iloilo has a ratio of government-owned hospitals to population that is lower than the national average at 1:164,966. In fact, Iloilo ranks 60th among the 81 provinces in the Philippines with the highest ratio of government-owned hospitals to population.

In truth, responsive healthcare systems are more than just about hospitals.

Other than the facilities, are there enough government physicians in government-run hospitals? How about hospital beds? For citizens who live far away from where hospitals are located, are there any Rural Health Units or Urban Health Centers in the town or city?

PCIJ prepared a visual narrative of the current state of public healthcare services in the Philippines.

Check out other indicators by selecting these from the dropdown list above the choropleth map.

Government hospitals singly and together are not at all capable to support the ideal hospital bed to population ratio.

As of 2018, the ratio of government-owned hospital beds to population stands at 1:2,320. This is many numbers away from the hospital bed to population ratio that the Philippine Health Facility Development Plan 2017-2022 of the Department of Health (DOH)has set as target -- one hospital bed for every 800 citizens or 1:800.

The DOH’s National Health Facility Registry lists a total of 89,700 hospital beds. Of this number, government-owned hospitals account for 47,645 or only 53 percent of the beds, including 33,008 (69 percent) in Luzon; 6,767 or 14 percent in the Visayas; and 7,870 or 17 percent in Mindanao.

Of the country’s 81 provinces, the top five with the highest ratio of government hospital beds to population are all in Mindanao.

In these provinces, the severe lack of hospital beds seems totally outrageous at more than five to 10 times worse than the national ratio -- Basilan at 1:100,686; Zamboanga Sibugay at 1:26,468; Davao Occidental at 1:18,311; Sarangani at 1:11423; and Compostela Valley at 1:10,925.

There are only two government-owned hospitals -- one in Lamitan City and another in Isabela City – in Basilan. Their combined hospital beds come up to only 50, quite a puny number for a population of more than half a million.

The better ratios are to be found in Luzon island, though. Three of the five provinces with the lowest ratio of government hospital beds to population are in Luzon: Batanes has the lowest ratio at 1:235; Mountain Province comes in second at 1:688; and Apayao fourth at 1:984. Camiguin, a province in Mindanao, ranks third at 1:912, while Siquijor, a province in the Visayas, ranks fifth.

Metro Manila is the only region that has scored better than the national ratio of government hospital bed to population ratio. With 17,221 government hospital beds available to support a population of more than 13 million, its 1:783 ratio is much better than the DOH target for 2022.

Almost every city and municipality in the Philippines has at least one Rural Health Unit (RHU) or Urban Health Center (UHC).

According to the 2017 National Demographic and Health Survey of the Philippine Statistics Authority (PSA), these RHUs and UHCs are the second most-utilized public health facilities, next to Barangay Health Stations, in the country.

RHUs and UHCs provide primary care services like health advice and immediate treatment for residents. These facilities are not capable, however, of providing hospital services for more serious medical cases.

There are currently 2,597 RHUs and UHCs across the Philippines, or less than half the DOH’s target of 5,250 RHUs and UHCs (Philippine Health Facility Development Plan 2017-2022). The current RHU/UHC to population ratio stands at 1: 40,881, almost double the DOH’s target of 1:20,000.

Only 12 of the country’s 81 provinces have met the DOH target: seven are in Luzon (Batanes, Abra, Mountain Province, Kalinga, Romblon, Apayao, and Ifugao); two in the Visayas (Siquijor and Eastern Samar); and three are in Mindanao (Dinagat Islands, Camiguin, and Surigao del Norte).

As of 2018, a total of 14,107 physicians are in the public service sector, or working in government-owned health facilities. Of the total, 10,447 or 74 percent are in government-owned hospitals, while 3,660 or 26 percent are fielded in Rural Health Units (RHUs) or Urban Health Centers (UHCs).

Of the physicians employed with RHUs and UHCs, 3,204 were directly hired by Local Government Units, and 456 were deployed by the Department of Health.

About two-thirds or 9,277 of government physicians are working or have been deployed in Luzon (65 percent), including 4,552 (32 percent) in Metro Manila alone.

Only 2,589 (18 percent) of government physicians are in the Visayas, and an even smaller number, 2,234 (16 percent), in Mindanao.

Of the Philippines’ 81 provinces in the country, five with the lowest ratio of government physicians to population – or with more doctors serving numbers of citizens -- are in Luzon: Batanes has the lowest government physicians to population ratio, at 1:1,355; Apayao ranks second at 1:2,460; Mountain Province third at 1:2,962; Benguet fourth at 1:3,469; and Ilocos Norte fifth at 1:3,511.

Metro Manila also has one of the lowest ratio of government physician to population, at 1:2,962.

Meanwhile, the five provinces with even fewer doctors against numbers of citizens, or with worse ratios of government physicians to population, are Cavite at 1:38,217; Basilan at 1:29,541; Davao del Sur at 1:25,931; Rizal at 1:21,605; and Batangas at 1:21,235.



From the Health Human Resource Development Bureau: As of June 2018, there were 1710 hospitals in the NDHRHIS matched 60% of the list of 2014 HFSRB DOH Licensed Government and Private Levels 1 to Level 3 hospitals, 1370 rural health units/health center, municipal/city health offices and other health facilities.



National Database of Selected Human Resources for Health. Health Human Resource Development Bureau, Department of Health.

National Demographic and Health Survey 2017. Philippine Statistics Authority.

National Health Facility Registry. Knowledge Management and Information Technology Service, Department of Health.

National Objectives for Health 2017-2022. Department of Health.

Philippine Health Facility Development Plan 2017-2022. Department of Health.

Population Projections by Region, Province, Cities and Municipalities, 2018-2022. Epidemiology Bureau, Department of Health.