Executive summary

  • When the strongest hurricane in the Philippines’ recorded history, Typhoon Haiyan/Yolanda, struck in November 2013, the health system’s pre-existing vulnerabilities and lack of adequate disaster preparedness contributed to thousands of deaths. 4 5 6
  • This large-scale disaster was a motivating factor for reforms to increase disaster planning and preparedness work in health facilities and across the health system. Between 2018 and 2020, a number of policies and laws were established with a focus on increasing health system resilience through health emergency and disaster management.
    • The Philippine Department of Health established the National Policy on Disaster Risk Reduction and Management in Health, which provided strategies for institutionalising disaster risk reduction and management across all levels of the health system. 
    • The country passed its Universal Health Care (UHC) law. It included a requirement that the country “ensure resiliency in health care systems that can adapt to both standard scenarios (i.e. health care system requirements relative to population, demographics, and level of economic development) and emergency circumstances such as outbreaks and pandemics,” to be achieved by policy reforms and investment in health facilities and services. 7
    • The Department of Health issued National Objectives for Health, which include a focus on resilient health systems; released the Guidelines on the Institutionalisation of Disaster Risk Reduction and Management in Health (DRRM-H) in Province-wide and City-wide Health Systems, which provide further guidance to local government units working to institutionalise the disaster risk reduction and resilience work; and partnered in a multisectoral collaboration to produce the National Disaster Risk Reduction and Management Plan in 2020.
  • While the changes enacted by these reforms are still relatively recent–and interrupted by the COVID-19 pandemic–some important outcomes from these policies include increased alignment with global disaster risk reduction and management, an increased role by the Philippines’ health sector in national multisectoral work towards risk reduction and resilience, and preparations for a disaster management conference at which Filipino policy leaders will share some of the experiences and best practices coming out of this work.
  • Every July, the country celebrates its now-annual National Disaster Resilience Month during which time the National Risk Reduction and Disaster Management Council calls on stakeholders to support government programs oriented to improving disaster resilience through prevention and mitigation, preparedness, response, and rehabilitation and recovery work. 8 9

Learnings from in-country experts

Dr. Ronald Law is the Chief of Preparedness of the Philippine Department of Health and responsible for policies, plans, and programs on health emergency and disaster risk management at the national level. In this role, Dr. Law has played a major role in the response to major emergencies and disasters affecting the Philippines. Dr. Law provided more detailed information about the Philippines’ work to increase health system resilience to emergencies and natural disasters. Responses have been edited for length and clarity.

Q1: What was the impetus for reforms to increase disaster resilience in the Philippines?

Answer: There were several reasons, but the major one is disaster occurrence–the actual events–in terms of increasing frequency and intensity and all the societal consequences. This was exemplified by Haiyan. Other factors include international agreements. In 2019, I went to Geneva to attend a global platform on disaster risk reduction. That year I was helping WHO come out with the Health Emergency and Disaster Risk Management framework. That year was also important in terms of the convergence of all these international agreements, focusing on climate change and sustainable development goals. Locally, at the national level, we have to align with policy priorities. I think that’s a strong basis for reforms. That was facilitated by the passage of our UHC law, passed in 2019 as well, just before the pandemic happened. It has always been disaster occurrences that have paved the way for reforms, even before Haiyan.

Q2: What were the major goals and priorities of these reforms? 

Answer: Because we have a decentralised health system, the major priority has been improving local government capacity to prepare for and respond to disasters. For the longest time we’ve had this vision of seeing all these highly vulnerable local government units be self-sufficient. Other than that, we would like the local governments to increase their investments in PHC, secure and invest more money for these programs, and also invest in human resources. In the Philippines, it’s a classic issue for local government–to not have enough money or human resources. Sometimes it’s the training that is lacking. We really want to make this an important component of our program. 

As in the global efforts [to increase resilience], the biggest gap is the prevention side. We think there has to be more efforts in terms of the development of PHC efforts, land reforms, urban development, water, sanitation, and hygiene, nutrition–all of this important stuff that goes into our prevention work. This work will relate to our efforts related to climate change adaptation and mitigation. Health has to be part of the multi-sectoral working group–tackling the environment and climate change. 
 
We have elections coming this next month, and I’m sure these will be continuing as priorities as well. These are the major areas we’ve been prioritising. Policy-wise, for the past five to six years, we were able to develop a lot of policies already–to integrate disaster management in health into our PHC strategy, to define some indicators; we have defined some packages of assistance already. Our role is to support local government units in terms of policies and, when disasters come, support them in terms of assistance. This is not sustainable–it really comes down to local government units being able to stand on their own in terms of preparedness and response. 

Q3: What factors contributed to the success of reforms? What were the major challenges? 

Answer: In terms of contributing factors, number one is political will. These [shocks] happen, but our officials, government agencies, and president were able to push several policy reforms including moves to institute a department for disaster resilience and the UHC law. Two, the way people have worked together towards this end, through a multisectoral and whole-of-society approach, with a lot of support from the private sector, civil-society organisations, local and international non-governmental organisations, all there to help the government. We also started to involve communities in this approach. It started with all of these experiences–what we call the policy window opened up, policymakers made this a top priority, instructing all government departments to come up with policies. We had a significant increase in our budget because of these developments, but it’s still not enough. And then COVID-19 happened. So now we’re almost back to square one, but we’re looking at this as a good opportunity to push for more funding.
 
In terms of challenges, beyond the shortage of financing and human resources, it’s about the use of data. I think we need to do more data-driven decision-making. For response, it should influence operations; for preparedness, it should influence our programs and policies. We saw this acutely with COVID-19. Additionally, although the multisectoral, whole-of-society work is there, we need to do more with communities. Filipinos are all about communities, and I think this can be key. We need to do better in community involvement and engaging better, especially in high-risk and vulnerable communities. Our government has been described as very top-down, and with COVID, of course, all the autocratic types of decision-making have prevailed. I think as a country, we need to investigate more bottom-up approaches that can provide solutions especially at the local level. So that’s an area that still remains a challenge.

Q4: Are there any other lessons or policy implications to be learned from these reforms that you’d like to share? e.g. What is something you wish you or other decision-makers in your country had known, or that you think policymakers in other countries should employ?

Answer: My colleagues, policymakers in government, should do better in terms of the use of science, the role of science, from prevention, preparedness, even response. We should be guided by data, but our system is not yet as robust as it should be. We need to invest more, and for people to become more skilled at this, we need to work more with people at universities. The use of science needs to catch up with what else we have done. In terms of policy implications, we need to consider the role of local populations at frontlines of resilience and build more community-level approaches. We need to know more about what makes people more resilient on the ground. We need more monitoring and evaluation for the periods to come, and we need to write more case studies. We are so poor in documentation in the Philippines, not publishing a lot about what we are doing, but I can say that we have a lot of good practices that others in the world can benefit from. Even after Hurricane Yolanda there were a lot of articles written that were not by Filipinos. This needs to change, including through partnership with institutions, to allow us to be supported here, so we’re not just victims.

Q5: Now that the UHC law with the inclusion of requirements to ensure resilience in health systems has been implemented, what do you think is the next priority area for PHC in resilient facilities and services going forward?

Answer: Disaster work is as much about responding as about transforming our health system to be resilient. But we also need to go back to the root cause of the problem:  much of this won’t be improved if we don’t address climate change. We have to do climate change mitigation and other kinds of adaptation work, globally as well as in the Philippines. 

Responding, preparing, we’ve been doing–but the prevention we need to address. This is related to our extreme weather events, causing problems year in and year out. The pandemic will end–but not extreme weather events. The health sector will lead, but this is also really complicated and entails working with many sectors. Doing so is complicated, and the focus can be lost. But the health sector, pushing for resilient health systems, can lead the way. Decarbonization, in light of the latest IPCC report, is very urgent. We have to start coming up with solutions ourselves and can’t just be the poster child. We have to operationalize. If you ask me, in terms of climate change, people still talk about this in terms of abstractions. Good guidance documents from WHO, need to make sure people know how this is carried out in the work that we do. Capacity building, communications, strategic planning–this work will be revisited in May with the new leadership. 

With resilient health systems, we need to relate it to COVID recovery. This is connected to UHC; we need this to achieve health security for our people. Put this into a package that we and the MOH will implement, that the people on the ground will implement. Our country is faced with a lot of climate change-related issues, and reality is really the main driving force. Leaders must face that with policies. Always with the constraint of resources, and also political priority. But disasters, when they come, the policymakers will go there. This is closely related to the Philippine psyche: we have a short-term memory sometimes, but the next disaster is a reminder.

Relevant tools and resources

References:

  1. Nuevo CE, Yap ME, Boxshall M, Ravishankar N. IMPLEMENTING UHC IN THE PHILIPPINES: IS THE GLASS HALF FULL OR HALF EMPTY? [Internet]. P4H Social Health Protection Network. 2021 [cited 2022 Feb 13]. Available from: https://p4h.world/en/blog/IMPLEMENTING-UHC-IN-THE-PHILIPPINES/IS-THE-GLASS-HALF-FULL-OR-HALF-EMPTY%3F
  2. Yap MEC, Carpio LPD, Ong MM, Aposto VC. Development of a Competency Certification Framework for Primary Care Providers in the Context of Universal Health Care in the Philippines. ThinkWell Global; 2019 Dec.
  3. Liwanag HJ, Wyss K. What conditions enable decentralization to improve the health system? Qualitative analysis of perspectives on decision space after 25 years of devolution in the Philippines. PLoS ONE. 2018 Nov 5;13(11):e0206809.
  4. Casamina C, Lee C, Reyes R. Medical school hotline: tropical cyclone Haiyan/Yolanda medical relief mission: perspectives of John A. Burns School of Medicine 2nd year medical students. Hawaii J Med Public Health. 2015 May;74(5):176–8.
  5.  Salazar MA, Pesigan A, Law R, Winkler V. Post-disaster health impact of natural hazards in the Philippines in 2013. Glob Health Action. 2016 May 17;9:31320.
  6. Salazar MA, Law R, Pesigan A, Winkler V. Health consequences of typhoon haiyan in the eastern visayas region using a syndromic surveillance database. PLoS Curr Influenza. 2017 Feb 6;9.
  7. Sebastian MMG. INVESTING IN PPPS FOR HEALTH [Internet]. Republic of the Philippines Public-Private Partnership Center. [cited 2022 Feb 13]. Available from: https://ppp.gov.ph/ppp-sectors/