Thursday, May 28, 2009

Searching JSTOR through HAIN

Health Action Information Network is currently subscribing to JSTOR, an online digital archive of academic journals, scholarly works and other materials needed for research and teaching. Mainly covering Arts and Sciences, the collection includes core journals in economics, history, political science, and sociology, as well as in other key fields in the humanities and social sciences. This collection also contains titles in ecology, mathematics, and statistics. Overall, there are 119 titles in twenty-one disciplines. Example of titles include-

· Annual Review of Sociology
· Anthropological Review
· Anthropology Today
· Applied Statistics
· Current Anthropology
· Demography
· Family Planning Perspectives
· International Family Planning Digest
· International Family Planning Perspectives
· International Family Planning Perspectives and Digest
· Journal of Health and Human Behavior
· Journal of Health and Social Behavior
· Journal of the History of Ideas
· Man
· Population and Development Review
· Population Index
· Population Literature
· Population Studies
· Population: An English Selection
· Studies in Family Planning
· World Politics

How to Access JSTOR Collection
The collection is available to development partners of HAIN by sending an email request on specific topics or journal articles that you wish to search. Our staff will conduct the research and will deliver the materials to you online at no cost. Charges will apply to those who are requesting for printing and mailing.

For more information, please contact Emie or Tere at 952-6409 or 952-6312
Or email us at,,

Wednesday, May 27, 2009

Influenza A (H1N1) Brief Situation Report for Partners in the Philippines

(Click on image to enlarge)

WHO Philippines
Influenza A (H1N1) Brief Situation Report for Partners in the Philippines
Number 28, 25 May 2009
Updates as of 10 AM, 24 May 2009 (figures may change due to the rapidly evolving situation)
  • Department of Health announces the country’s second confirmed case in a 50-year old female with history of travel to the US
  • People are advised to wash hands thoroughly with soap and water on a regular basis and should seek medical attention if they develop any symptoms of influenza-like illness (fever, cough, runny nose, body aches)
  • Individuals who are ill should delay travel plans and returning travelers who fall ill should seek appropriate medical care.
  • The practice of good health habits including adequate sleep, eating nutritious food, and keeping physically active are some of the general preventive measures for influenza.
  • The Lancet announced the launching of its H1N1 Flu Resource Center at , a microsite for physicians, nurses, pharmacists, and health care professionals.

WHO Actions
Published Clinical Management of Human Infection with new influenza A (H1N1) virus; initial guidance:
The WHO library has shared more scientific information on Influenza A(H1N1) with this link:
The document "WHO technical advice for case management of Influenza A(H1N1) in air transport" has been posted on web site (
Instructions for storage and transport of suspected or confirmed influenza A (H1N1)
human and animal specimens and virus isolates
The latest WHO recommendations and situation updates can be found at and at

Monday, May 25, 2009

HAIN in Ilocos

PhilHealth Update

Here’s a pop quiz to check your knowledge about PhilHealth, our national health insurance system. Give your answers to the following questions, then read on to find out which of them you got right.

Can domestic employees (your yaya, driver) be enrolled? Can a sidewalk vendor enroll herself? What about overseas Filipino workers? Can an illegitimate child be a beneficiary?

I recently had to call a friend, Dr. Madeline Valera at Philippine Health Insurance Corp. (PhilHealth) to ask some of those questions and ended up with a lot of information that I thought I should use two columns to share with readers. Dr. Valera, senior vice president for health finance policy, is proud of what PhilHealth is doing right now, but she is also full of dreams around how PhilHealth could do more.

Social solidarity

For all the cynicism people have about our public health care system, I have to say PhilHealth does make a difference. It’s evolved through the years, expanding the number of medical procedures that are reimbursable and extending PhilHealth to self-employed people and the informal sector.

Before we go into specifics about who and what can be covered, I did want to talk a bit about the principles that guide public health insurance, which will allow me to push readers to explore how they can use PhilHealth to help others.

Government health care systems vary across the world, the strongest ones built on a national health care system financed by government, through contributions of its citizens. Many European countries use such a system, with citizens paying a fixed amount of their income, ranging from 7 percent to 12 percent, going to the national health service. That percentage may seem high but in those countries people do get many benefits—for example, paying a fixed price for each prescription (regardless of the type of medicine), and getting almost all hospital services for free. They even get a transportation allowance!

Our system, unfortunately, is more closely patterned after the United States’, where health care is left largely to the private sector and, supposedly, free-market competition. The assumption here is that competition leads to better health care.

In a way, that assumption is true . . . but only if you can afford the private hospitals. If you can’t, then you better have coverage from health maintenance organizations (which we have as well in the Philippines) but which have many limitations, including the cost of premiums. The last resort you have in such a system would be government health insurance and public institutions but in both the US and the Philippines, even that system is inaccessible.

Health insurance is based on social solidarity, the rich paying more to help the poorer members of society. Not only that, there is solidarity in the sense that young, healthy people pay for the greater health risks of children, the elderly, the chronically ill (e.g., someone with a very serious kidney disease), and the disabled. Social solidarity through health insurance becomes even more important in times of a financial crisis. Just think, for example, of the overseas workers losing their jobs abroad and coming home with some savings that can be wiped out completely with one major illness.

The financial crisis has certainly made Americans rethink their health care, wondering if maybe a bit of “socialistic” health care might not be too bad. Public health insurance does benefit individuals and society. After all, if you don’t do your share to help take care of the elderly or the poor, then you still end up losing because the entire country ends up with too many unhealthy people. That’s actually what’s happening in the Philippines, with the poor having to run to politicians for doles (which actually come from our taxes), or to richer relatives and kinder employers, as many of my readers have experienced. In all these cases, the help is limited and can pay only for substandard care, sometimes leading to even more expenses.

Who can enroll?

Who can enroll in PhilHealth? The answer is simple: anyone can, as long as you pay the premiums, which are based on income and range from P100 to P750 a month. You can be self-employed as a sidewalk vendor, in which case you pay the total premium yourself; or you can be a corporate executive who will pay P375 a month while your company pays another P375. Overseas workers can also enroll, and this is important for the families they leave behind, as well as for themselves, because hospitalization expenses incurred overseas can also be reimbursed, subject to certain limitations.

There is a cap on monthly premiums, meaning the rate is the same for anyone with a monthly income of P30,000 and above. This cap has been criticized by the likes of former health secretary Alberto Romualdez, and rightly so since in a way those earning P30,000 a month are actually subsidizing someone earning P300,000 a month.

What you do need to know is that paying premiums for a quarter, which is the minimum, doesn’t automatically allow you to reimburse medical expenses. Self-employed PhilHealth members need to have paid a year’s premiums while those who are employed by someone else need only to have paid six months. Those sponsored by local governments units (many politicians offer such sponsorship for a few months or a year, especially as elections approach) or who are overseas workers and pay premiums on an annual basis are entitled to benefits right after enrollment.

These differences are important. If you’re self-employed then, you cannot just enroll in PhilHealth when you find yourself pregnant, hoping to have your hospital delivery covered. But if you are working for someone, and have been remitting premiums for at least six months, you are covered.

This takes us to potential beneficiaries. PhilHealth’s enrollment forms emphasize that you can only enroll someone you are married to, described in Tagalog as “tunay na asawa,” as long as he or she is not a PhilHealth member. You can also enroll children below the age of 21, whether they are legitimate (“anak na galing sa tunay na asawa”) or illegitimate, unemployed and single. (Those distinctions are important: that means if you have an 18-year-old child who is married, he or she will have to take out Philhealth individually. ) PhilHealth also allows children over the age of 21, but who have a congenital disability, to be covered as a parent’s beneficiary.

Finally, a PhilHealth member can enroll their parents (as well as step-parents) who are over the age of 60, who are not PhilHealth members and who earn less than P1,000 a month. Note that someone over the age of 60 and made 120 monthly contributions to PhilHealth will now be covered for the rest of his or her life, without paying any more premiums.

By Michael Tan, Pinoy Kasi, Philippine Daily Inquirer, May 20, 2009

PhilHealth coverage and ‘folk illnesses’

Last Wednesday I explained why we need a government health insurance system like PhilHealth, and who can become members and beneficiaries. Today we’ll go into some of the medical expenses that can be covered.

The information I’m using comes mainly from Dr. Mads Valera, the senior vice president for health policy at Philippine Health Insurance Corp. (PhilHealth) , who very kindly gave me three hours to run through some of the more important benefits. We also had some interesting discussions about bangungot [nightmare] possibly being a genetic problem, and which I’ll share in a future column. (If you need some information right away, you can look at my book, “Revisiting Usog, Pasma, Kulam.”)

Last Wednesday I gave a pop quiz eligibility for PhilHealth membership. Let’s do another pop quiz about coverage. Which of these are covered by PhilHealth: natural deliveries, dialysis, cataract operations, liposuction? Let me make it more difficult by asking if usog, pasma, kulam and bangungot are covered.

Usog and other “folk illnesses” are not covered by PhilHealth unless two important conditions are fulfilled. First, your physician must give a diagnosis for a condition that is recognized by Western medicine and by PhilHealth (e.g., bangungot might actually be a heart problem called “long QT syndrome,” but then that syndrome still isn’t recognized by PhilHealth); and second, your expenses for treating the recognized illness must be incurred during hospitalization, and this can include room and board, some diagnostic procedures and medicines.

Maternity packages

Let me give you the answers now to the other questions in the pop quiz.

For a long time, only caesarian deliveries were reimbursable, a policy which was criticized because it seemed to encourage both patients and obstetricians to go for a caesarian even if it was not necessary.

PhilHealth has since modified that policy, offering a “maternity care package” that includes “spontaneous natural deliveries.” The package is for P4,500, with plans to increase this to P6,500. The package can be used both in hospitals as well as in accredited lying-in clinics, but not for home deliveries.

The expansion to include lying-in clinics is a welcome one because many low-income Filipinos prefer going to a lying-in clinic, which is cheaper than a hospital. The P4,500 reimbursement goes a longer way to cover costs incurred in a clinic rather than in a hospital.

In principle, the maternity package can cover pre- and post-natal care as well, but PhilHealth is still fine-tuning how this can happen, and what would be included for pre- and post-natal care.

Let’s move on with the pop quiz. Yes, hemodialysis is covered if it is used for end-stage renal disease. In terms of reimbursement payments made by PhilHealth, hemodialysis was in fact at the top of the list in 2008. (In terms of actual payments though, caesarian deliveries topped the list, PhilHealth paying out P2.6 billion.)

Cataract removal? Again, yes, this is covered, and is an important benefit for the elderly.

Cosmetic vs reconstructive

Finally, liposuction. Even if the liposuction is conducted in a hospital, technically, it would not be covered because cosmetic procedures are not covered. Note though that some “reconstructive” procedures are covered. PhilHealth uses the definitions of the Philippine Association of Plastic, Reconstructive and Aesthetic Surgery to make the distinction: “Cosmetic surgery is surgery performed primarily to improve or change a person’s appearance, which is already normal but may not conform to one’s self image. In contrast, reconstructive surgery is performed primarily to improve or correct body deformities resulting from trauma, disease or birth defects.”

Here’s a concrete example of how this distinction is made: silicone breast implant would not be reimbursable if done only for “cosmetic” purposes, but if it is done after the removal of breasts (e.g., in cancer), it would be considered “reconstructive.”

PhilHealth relies on medical specialists to draw up guidelines to what illnesses and medical procedures can be reimbursed, and it’s almost fascinating to look at how they evaluate the cases.

There are many debates on what procedures should be covered. Cosmetic procedures are not reimbursable because they’re considered too much of an individual concern, without any life-threatening implications. In richer countries though, some cosmetic procedures are allowed—even sex reassignment, for example—because the low self-esteem of the individual might lead to serious depression, or even suicide.

Rare illnesses are also generally excluded in PhilHealth, but one could argue, too, that precisely because they’re so rare, and expensive to treat, society should help the patient and his or her family.

For a country like the Philippines, priorities need to be built around what’s most needed by the majority of the population, and right now that would mean the poor. PhilHealth’s important “if” for reimbursement is hospitalization and this ends up excluding many basic medical procedures that the poor need. For example, I was asked for help recently by an employee whose father was having problems with urination. The urologist had ordered ultrasound to determine if there were stones or not, and a PSA to see if there was prostate cancer. The family could not afford the procedures, but asked around and were told that if they checked into a hospital, the procedures could then be performed and reimbursed through PhilHealth. It’s a roundabout way, and risky in the sense that they could incur more expenses around the hospitalization than PhilHealth will cover, but that’s how health care works (or doesn’t work) in our system.

PhilHealth helps to make it easier to survive in our system, but we need to do our part as well, making sure our employees, including household help, are covered. Meanwhile, expect more voices to be heard from socially-oriented physicians to continue to expand PhilHealth’s coverage. With elections around the corner, we might want to pressure politicians as well to be clear on how they view PhilHealth’s role.

By Michael Tan, Pinoy Kasi, Philippine Daily Inquirer, May 22, 2009

Monday, May 18, 2009

HAIN joined 2009 AIDS Candlelight Memorial

Quezon Memorial Circle, May 15, 2009

Friday, May 15, 2009

Wednesday, May 13, 2009

RGS Level 2

HAIN conducted the Level 2 workshopn on Religion, Gender and Sexuality (RGS) at Hotel Elizabeth in Baguio City last May 2-4. Nineteen RGS fellows from NCR, Visayas and Mindanao joined the workshop together with resource speakers which included Dr. Mike Tan, Fr. Percy Bacani and Dr. Caster Palaganas.

The RGS level 2 workshop was designed to:
* Discuss current updates on issues relating to RGS
* Identify bottlenecks in advocating RH in the communities
* Formulate possible strategies to advance RH advocacy and services in the communities amidst Church objections
* Recognize lessons learned from various groups in advocating RH vis-a-vis religion issues
* Design training modules to educate RH and RGS issues in different community settings or sectors
* Formulate a strategic plan on how they will use the modules in educating their respective communities/sectors on RGS issues and concerns

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