Cheaper medicines law hasn’t served the poor

By Satur C. Ocampo

The Philippine Star, Opinion Page

June 9, 2012

Four years ago last June 6, the Cheaper Medicines Law  (Republic Act 9502, the Universally Accessible Cheaper and Quality Medicines Act of 2008) passed after contentious debates in the 14^th Congress, was signed into law by President Gloria M. Arroyo.

            R.A. 9502 was intended to achieve two correlated goals:

1.      Reduce the cost of medicines – especially those that are commonly bought by the poor – to 50% of their 2001 prices and make these available nationwide, and

2.     Require and ensure the production of adequate supply, distribution, use and acceptance of medicines identified by their generic names, which are priced much lower than patented drugs mainly produced by multinational corporations.

This second goal was supposed to have been realized through the Generics Act of 1998.  But that law was proven inadequate, thus  R.A. 9502 was enacted to complement it.

Through amendments to the Intellectual Property Code, the 2008 law allows generics-producing firms to test, produce, and register their own versions of patented drugs, and prohibits the grant of new patents based only on newly-discovered uses of a known drug substance.

However, a “rider” provision says that “when the public interest is at stake” – which can be interpreted in varied ways – the government can resort to procuring patented drugs.

When R.A. 9502 was passed, medicine prices in the Philippines were among the highest in Asia:  per an ASEAN survey, 5 out of 9 medicines here cost 40 – 70% higher than those in Indonesia, Malaysia, and Thailand.

As one solution to the problem, R.A. 9052 gives the President the power to set price ceilings on various drugs, upon the recommendation of the Secretary of Health, including medicines for chronic illnesses, for prevention of diseases, and those found in the Philippine National Drug Formulary Essential Drug List.

Moreover, it allows the parallel importation of patented medicines from abroad when these are more affordable than those available domestically.  And to ensure the availability of affordable medicines, the law requires drug outlets to carry a variety of brands for each type, including imported ones, to give the consumers more choices.

After four years of implementation, how far has the Cheaper Medicines Act gone towards attaining the twin goals?

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CBHP project with DSWD

The VPHCS continues its health capability-building project funded by the Bayan Muna Party-List and supported by the Department of Social Welfare and Development (DSWD) in five barangays in Cebu.

The two-year project which started last June 2011, “Building community-based health programs (CBHP) in Cebu through training, education and services,” is implemented in Barangay T. Padilla, Sitio Ermita Proper in Barangay Ermita, and Sitio Lawis in Barangay Pasil in Cebu City, Sitio Back of Matimco, Barangay Subangdaku in Mandaue City, and Barangay Canjulao in Lapu-lapu City. Beneficiaries in the barangays include 310 households in Barangay T. Padilla, 240 households in Sitio Ermita Proper, 220 households in Sitio Lawis, 160 households in Sitio Back of Matimco, and 500 households in Barangay Canjulao.

Members of the Ermita Fisherfolks Association pick lagundi leaves before boiling them into a decoction and a syrup as a cough medicine.

A community health worker in Ermita takes the blood pressure during a regular community clinic.

Health services including operation blood pressure are conducted in the people’s organization’s health center in Sitio Back of Matimco.

The project works with people’s organizations in the communities, including the Pundok sa Sitio Para sa Kauswagan (PSPK) in T. Padilla, Ermita Fisherfolks Association in Ermita, Pasil Women’s Association in Pasil, KALUWASAN in Sitio Back of Matimco, and the Nagkahisang Kabus sa Lapu-lapu in Canjulao. They have health committees with community health workers (CHWs). 

VPHCS staff Jessica Pejo conducts a health education class for mothers in Canjulao.

Health skills trainings were conducted for 75 CHWs last year in order to equip them with basic knowledge and skills to render preventive, promotive and selective curative care to the residents. Health education classes were also conducted among residents in the areas to promote health awareness with the aim to empower them in terms of health care delivery on common health problems that can be prevented in the community level. The VPHCS staff also guide, monitor and upgrade the knowledge and skills of the trained CHWs in between trainings as they deliver their health services to the residents. More trainings and health education activities are expected to continue this year. 

VPHCS staff Irish Ramirez talks to mothers in Canjulao on nutrition.

The project is highly significant today with the prevalence of common health problems that can be addressed in the community level. It has been observed that people seek tertiary care in the hospitals when they are already affected with serious illnesses that could have been prevented in their early stage in their homes. With increased health awareness and capacity in knowing, preventing and taking care of their own health needs through home remedies and indigenous resources in their communities, the incidence of serious illnesses and preventable ailments can be lessened. Eventually, the high cost of hospital care which unfortunately is now generally shouldered from out-of-the pockets can also be lessened. In the long term, quality of life can be enhanced. 

VPHCS Dr. Erlinda Posadas conducts blood sugar screening for diabetes mellitus in T. Padilla.

ACT continues support for Bohol project

The VPHCS project with the Asian Community Trust (ACT) of Japan, “Sustaining community-based health programs to promote health and prevent disease in Bohol” is on its third year.

The project is implemented in Barangay Sto. Nino, San Miguel and Barangay Caluasan, Dagohoy, in partnership with the people’s organizations, Hugpong Mag-uuma sa San Miguel (HUMASA) or the Farmers Association in San Miguel and the Mga Mag-uuma sa Lakalsanda Apektado sa Land Levelling (Farmers in Lakalsanda affected by Land Levelling) in Caluasan.

There are 125 households (679 population) in Sto. Nino and 402 households (2,132 population) in Caluasan.

Since the project started in April 2010, it has greatly benefitted the residents who are mostly poor farmers in dire need of health services in their rural areas. Through various programs developed and sustained by the people’s organizations through their trained CHWs and health committees, the project has reaped increased health awareness and improved health practices and rendered basic health services to the people.

A community health worker weighs a child as part of the growth monitoring and nutrition program in Sto. Nino and Caluasan. 

 

A community health worker renders ventusa or cupping therapy, a form of traditional Chinese medicine.

The project witnessed widespread health information dissemination on disease prevention and health promotion, covering topics including home remedies for common ailments, nutrition, basic first aid, family planning and contraception, control of acute respiratory tract infections, and control of diarrheal diseases, among others.

Health services by trained CHWs addressed common illnesses such as upper respiratory tract infections or common colds, diarrhea, fever, gastritis, muscle and joint pains, tension headaches, and skin diseases with the use of herbal medicines, water therapy, ventusa, and over-the-counter medications such as paracetamol, antacids, oral rehydration salts, and common antibiotics. Cases that they cannot handle were quickly referred to the project health services officer and to the health centers or government hospitals for more specialized care. 

A community health worker takes blood pressure. Hypertensive patients are advised on healthy lifestyle and referred to health professionals for proper treatment.

Hypertensive patients were screened by trained CHWs in the series of operation blood pressuring monitoring and were referred to the project health services officer and to the health centers for further work-up for possible complications and associated illnesses such as heart diseases and diabetes mellitus.

A nutrition program was started in the second year in both barangays which did not only have mass feeding of malnourished children identified in operation weighing and growth monitoring but also maintenance of proper nutrition through health information on nutrition, proper food preparation, cheap and easily available food sources and feeding practices to the mothers provided by trained CHWs.

Nutrition program in Sto. Nino and Caluasan fed malnourished children, monitored their growth and taught mothers regarding good nutritional practices.

A family planning program was launched in Caluasan, Dagohoy which included community education classes on reproductive health and contraception and referral by the CHWs of women desiring birth control to the health centers to avail of contraceptives such as pills and condoms.

The third year that started in April 2012 shall sustain the gains of the two years in terms of making the CHWs more capable of addressing the health problems in the communities. Advanced health skills trainings shall be conducted to enable them to manage more difficult medical cases. Special skills trainings shall enable them to effectively launch and sustain their ongoing health campaigns, the nutritional rehabilitation of malnourished children, promotion of proper nutrition, family planning, control of hypertension, and provision of essential herbal and rational Western medicines.

Furthermore, a small community health center shall be constructed in each of the two barangays, which shall serve as venues for the meetings of the CHWs, health education classes, clinics for regular check-ups and services, and the botica sa barangay (village pharmacy). Herbal medicines to be processed by the residents, medical supplies and materials, leaflets on common health problems and essential Western medicines aside from the patients’ medical records will be stocked safely in the health centers.

To strengthen the sustainability of their health programs, the leaders of the people’s organizations shall continue to network with their barangay councils, municipal governments, health centers and civic organizations in order to generate financial and material resources.

These prospects have been planned together with the leaders of the two people’s organizations.