RH debate highlights: Jan.31

RH debate highlights: Jan.31
Plenary Discussion
Senate Bill 2865, the Reproductive Health (RH) Bill
31 January 2012

Note: This post summarizes the questions raised and points clarified on Tuesday’s floor debates, but is not an exact transcript of the proceedings.

Senator Pia S. Cayetano (PSC): [Starts the discussion by clarifying points from the last question asked from the previous interpellation.] What provisions in the RH Bill (RHB) are important vis-à-vis the Magna Carta of Women (MCW)? The MCW mentions maternal care to include pre- and post-natal services. The RHB expands the definition to include the responsibilities of different sectors. These include Sec. 5, on the hiring of skilled professionals with specific ideal number to hire; Sec.6, LGUs’ on appropriate facilities such as BEmONCs/CEmONCs*; Sec.8, on maternal death review due to lack of data or underreporting of women suffering from maternal or childbirth complications; Sec.7, on access to family planning; Sec. 9, on family planning supplies as essential medicines; and Sec.10, on procurement and distribution of family planning supplies.

On services provided by Magna Carta of Women and RH Bill

Senator Loren Legarda (LL): Is the provision on employment of skilled health professionals, as proposed in the RHB, not covered or funded in the MCW?

PSC: MCW being a special law for women does contain provisions for RH care. But the provisions in the MCW are very simple one-liners that do not really give teeth to the program and services that should be offered. They are just one-liners as opposed to whole specific sections in the RH bill.

In the IRR [of the MCW], it says the LGU shall ensure that there shall be sufficient number [of health workers]. But RHB proposes specific actions, e.g., 1 midwife per 150 deliveries in a year.

LL: I support this measure and I hope that this could be highlighted as a main feature of the bill because the focus has so far been on population and contraception. But it is important to focus on complications of childbirth and pregnancy and infant mortality.

PSC: There is also a provision for population living in geographically neglected areas. This is a product of experience and difficulties of many service providers from NGOs (Non Government Organizations) and DOH (Department of Health). RHB will ensure that a minimum number of health workers are available and that there will be health facilities available.

LL: Will the skilled health professional provision address the training of Barangay Health Workers (BHW)?

PSC: Yes. Because we rely, and we will rely on BHWs for a lot of things; including provision of services under the bill.

LL: Will the sponsor accept amendments on provision on training of BHWs?

PSC: Yes. Sec. 14 (“Capacity-building of health workers”) may be improved.

LL: I support Sec. 6 (BEmONC/CEmONC). But I wonder why the DOH would need the enactment of RHB to perform this program?

PSC: DOH does not require to have the law passed before performing [Sec.6 on BEmONC/CEmONC] because this program is already being implemented, but this has been very limited by funding and budget. DOH is implementing MNCHN (Maternal, Neonatal and Child. Health and Nutrition strategy), which seeks to improve maternal and newborn care. Some of their funding have already been used for related services, but the program needs to be strengthened. Another difficulty that the DOH faces is the lukewarm support from LGUs because DOH requires the participation of LGUs in the RH programs.

On family planning supplies as essential medicines

LL: What is the basis of Sec. 9 (on family planning/FP supplies as essential medicines)? Does the bill classify FP supplies such as condoms and pills as medicines? Are FP supplies included in the core list of essential medicines?

PSC: The inclusion of FP supplies as essential medicines is a practice of WHO (World Health Organization), which has provided standards for us for so many decades. We shall follow this practice. This provision will allow the LGUs to purchase FP supplies. If these are not listed as essential medicines, LGUs will have difficulty to procure these supplies.

LL: For the record, what are the differences between core list and complementary list of essential medicines?

PSC: The core difference is that the core list is the required medicines that shall be carried by the government, but the complementary is not required [government may or may not carry these medicines]. Complementary list includes medicines that may be replaced if these are not really needed.

LL: FP supplies will be part of the core list under the category ‘contraceptives.’ Given that we follow the criteria of WHO, what standards were used to make such classification?

PSC: Yes, we went with WHO standards. We trust that the WHO’s standards are based on scientific studies on efficiency and efficacy, and also cost-effective.

LL: Which Asian countries have complied with this WHO standard list?

PSC: We have China, Malaysia, Thailand. But in previous interpellations, we know that almost all countries have RH programs and have very wide access to FP supplies. Most, if not all, countries adhere to WHO recommendations so we would be one of the few that will not classify contraceptives as essential medicines. But I will verify this.

LL: May we have a matrix of Asian countries that have FP supplies as part of the core list of essential medicines, perhaps, a list from WHO? We would want to understand the process of selection of core and complementary, and which Asian countries comply with WHO standards. In Bangladesh, the essential drugs list includes only condoms and oral contraceptives. In Nepal, only injectibles and condoms. In India, only condoms, oral contraceptives and copper IUDs. We need a clearer understanding of the nuances of the list in other countries.

PSC: In other countries where there are differences in their list of essential medicines, the reason for that is that the countries have made a decision on how they will approach their FP needs. This is a cost-efficient approach. In our case, because of the difficulty of making all these available, we have taken a more liberal approach and provided more choices. Our list will cover a wider variety of choices because it will really depend on who will use these supplies, depending on their choice. That is the reason for the differences in what is in our formulary and what is in other countries’ formulary.

LL: Are all FP supplies already classified as essential medicines? I understand that hormonal contraceptives are part, but other FP supplies are not. I wonder why some FP supplies are essential medicines and why some are not? RHB classifies all FP supplies as essential medicines.

PSC: The policy we have in the country is for the government to allow the users to choose which FP supply or method to use. In the Philippines, we have the progestins and hormonal contraceptives included in the drug formulary. IUDs and condoms are devices, which is why they are not included in the list of essential medicines.

LL: So the bill will not include IUDs and condoms as essential medicines?

PSC: They are included in the bill as ‘essential FP supplies.’ Currently, they are not essential medicines because they are supplies and not medicines. In the bill, there may be a need to make an amendment to emphasize that these are really ‘essential supplies.’

LL: Who comes up with the list? Delists medicines, reviews the list, updates the list? The National Drug Information Center reviews and recommends. Is this part of the DOH? Is the process participative?

PSC: The FDA (Food and Drugs Administration). They also review this annually. What we have is the National Formulary Committee. The committee exists and it does the updating and review.

LL: Is the National Formulary Committee’s process participative? It must be receiving inputs from academe, experts and companies? Did the present list of essential medicines undergo this process?

PSC: Yes. Some FP supplies are already part of the essential medicines list.

LL: How will the bill, which proposes to include FP supplies as essential medicines, overtake the process of the National Formulary Committee?

PSC: This is not the intention of the bill. Sec. 9 aims that FP supplies be part of the drug formulary, but we leave it up to them to determine which medicines will be classified as essential medicines.

LL: I am glad that we discussed this because it is my belief that whichever medicines we provide as part of the program should undergo the scientific process and let the experts, and not lawmakers, to say whether they are appropriate to be part of the program. May I amend Sec. 9 at a proper time?

PSC: Yes, it will respect the process of the National Formulary Committee. Yes, we will welcome amendments. Thank you.

On procurement of family planning supplies

LL: Are some services to be provided under the bill over and above the IRA (Internal revenue Allotment)and PDAF (Priority Development Assistance Fund)? So will this be part of GAA (General Appropriations Act)?

PSC: The objective is to procure more supplies and to supplement the budget of the local governments. It is the responsibility of LGUs to provide for the health care of their constituents. But we can have a support system for the poorest of the poor and supplement their budget. The DOH now has a list of which areas need help the most. It is only a matter of coordination with DOH. This is not additional IRA of LGUs or PDAF of legislators. It will be part of GAA for DOH.

On government budget and spending for health

LL: May we know the current level of health expenditure in the Philippines as opposed to the WHO standard?

PSC: The recommendation of WHO is that 5% of our GNP should be spent on health care. We spend only 2-3% annually. #

*acronyms:
BEmONC – Basic Emergency Obstetric and Newborn Care
CEmONC – Comprehensive Emergency Obstetric and Newborn Care

Photo: RH Bill sponsor Sen. Pia Cayetano answers questions from Sen. Loren Legarda (inset) on Tuesday’s session.

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