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Philippine Institute for Development Studies

DEVELOPMENTRESEARCH NEWS

Editor’s Notes

October – December 2013 ISSN 0115-9097Vol. XXXI No. 4

Surian sa mga Pag-aaral Pangkaunlaran ng Pilipinas

Economic growthmust translate to better

health outcomes

DESPITE rapid economic growth in recent quarters, the Philippines faces myriad challenges in providing adequate health care, and inequality in access to health services is in fact high. It is high time for the government to focus on health as an important subject matter in policy research to directly confront the “conundrum” of undeniable economic progress with stubborn social deprivation.

In this context, the theme “Making Health More Inclusive in a Growing Economy” was adopted for this year’s nationwide celebration of the 11th Development Policy Research Month (DPRM) spearheaded by the Philippine Institute for Development Studies (PIDS).

Health expenditures must be brought to at least 5 percent of gross domestic product as recommended by the World Health Organization, from the current 3 to 3.5 percent, said Oscar Picazo, PIDS senior health research consultant. Picazo presented data on worsening health conditions in the country as he laid the case for crafting a policy that will make health care more “inclusive” in the DPRM press conference last Sept. 4 at the NEDA sa Makati Building.

Maternal health alone—which serves as a good indicator of the health system as it covers the entire spectrum of the referral scheme—is not improving as shown by a spike in the maternal mortality ratio to 221 maternal deaths per 1,000 live births in

4 Effective impact evaluation: Knowing what works and what does not

5 Health department aiming for universal coverage

6 11th DPRM showcases health innovations

8 Study calls on gov’t to go into public-private investment partnerships in health

9 Inequalities in maternal, child care cited

10 Fill gaps in coverage, PhilHealth urged11 Senate forum emphasizes need to

enhance conditional cash transfer program

12 ‘Broad reform coalition’ needed to deal with enormous jobs challenge

14 ‘Inclusive growth must be asserted in AEC’

15 PIDS, DFA tie up for APEC 2015 research project

15 PH ‘behind’ ASEAN neighbors in infra quality

WE PRESENT to you, our readers, the final issue of the revamped Development Research News (DRN) for 2013. Looking back, it was an interesting year that saw the Institute become engaged in a number of pressing socioeconomic issues, many of which were tackled in the pages of the DRN. We started the year with the usual review of the economy in 2012 and prospects for 2013. The second quarter issue examined the effects of trade liberalization in developing countries. For the third quarter, the focus was Manila’s hosting of the 14th Global Development Conference, in which social protection policies were put on spotlight.

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What’s Inside

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Development Research News October – December 2013

2011. Before that, the ratio had declined steadily to 161 in 2006 from 209 in 1990, based on government statistics. The infant mortality ratio, meanwhile, is decreasing but not as fast as neighbors in the region, Picazo told members of the press.

“Reproductive health has something to do with this,” he said. “There’s still a high number of children per woman … Unwanted pregnancies are high among the poor.”

Picazo also pointed to the high variation of health outcomes across socioeconomic classes and regions. For instance, there is a huge discrepancy in PhilHealth coverage between the rich and the poor—52.8 percent of the richest have coverage while only 21 percent of the poorest are covered, he said. “Rich people are being subsidized by PhilHealth,” he added.

There are three sets of underlying causes for large disparities in health, Picazo said. The first is the interplay between poverty, income inequality, and the burgeoning population.

Hospitals are unable to accommodate the growing number of clients, and the number of health workers per population is declining. Frequent disasters and environmental risks are also worsening inequality, Picazo said.

The second challenge pertains to the effects of demographic and epidemiological transitions as well as population mobility. The country’s population is starting to age, which will lead to a shift in disease burden to noncommunicable diseases from infectious diseases. PhilHealth is also unable to keep up as more Filipinos seek work overseas, which leaves dependent families without health coverage.

The third set of factors is systemic in nature, Picazo said. Doctors, nurses, and midwives are concentrated in Metro Manila and nearby regions. While the government has a program to upgrade health facilities, equitable distribution remains an issue, and the Department of Health has limited absorptive capacity despite increasing fiscal space for health expenditures.

The Philippines could do well to make use of information technology to improve health outcomes, such as by using laptop computers to connect patients with their doctors. “I don’t understand why we’re the outsourcing capital of the world and we can’t do that,” Picazo said.

Discussing the DPRM theme, Dr. Rafaelita Aldaba, acting PIDS vice-president, said facing this challenge could be the key to the country’s development.

“We cannot wait for growth effects to trickle down, we need the government to interfere by formulating policies and programs to improve the state of health,” she said.

The DPRM has been celebrated every September since 2002, under Presidential Proclamation No. 247. PIDS has been actively promoting and instilling national awareness and appreciation of the importance of policy research and information in national development, by focusing on various socioeconomic themes such as climate change, poverty, and education.

The DPRM aims to cultivate a “culture of research and research use” among decisionmakers and the general public, as well as elicit support of the public for activities that advance the standard of policy research in the Philippines. The

Oscar Picazo (right), PIDS research consultant, and Dr. Irma Asuncion of the DOH (center) discuss the health challenges in the Philippines, the reasons behind them, and the steps the government must take to achieve better health outcomes. With them is Dr. Aniceto Orbeta, Jr. of PIDS. (Photo: Gizelle Manuel)

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PIDS partners for this year’s DPRM are the National Economic Development Authority, Philippine Information Agency, Civil Service Commission, Presidential Management Staff, Asia Pacific Observatory on Health Systems and Policies, World Health Organization, and Center for Health Market Innovations.

Focus on poor families

Aldaba noted that Brazil, China, and other emerging economies have gone as far as investing at least 7–8 percent of their gross domestic product in education, training, and health.

Economic growth makes it possible for the health budget to increase, especially with the recent passage of the Sin Tax Law on cigarettes and alcohol, which can provide estimated incremental revenue of PHP 84.3 billion in 2013, rising to PHP139 billion in 2016.

“The sin taxes have already been committed, and the question then is how could we absorb or spend this money equitably so that the poor will benefit from health services,” Picazo said.

The Aquino administration’s Universal Health Care program or Kalusugan Pangkalahatan is deliberately designed to focus on the poorest two quintiles of the population, but expansion of benefits has not reduced the out-of-pocket spending on medical care that has remained very high, Picazo said.

Dr. Irma Asuncion, director of the National Center for Disease Prevention and Control of the Department of Health, revealed there are 1,819 hospitals in the country, which has a total bed capacity of 101,914. This is equivalent, she said, to a population-to-bed ratio of one bed for every 960 persons. Picazo

said: “Our population is growing at 1.8 million a year, but our hospitals clearly cannot accommodate this burgeoning population.”

Another important issue is human resource. Health workers are overburdened at different levels of care and in different locations, leading to inequality in health care service delivery in the country.

“They are tasked to provide counselling, education, and information as well as recording and reporting, which may be attributed to the fast turnover of staff and volunteers,” Asuncion explained.

Citing 2011 data from the National Statistical Coordination Board, she pointed out that the lack of sufficient health care workers is aggravated by the increase in the country’s population.

Filipinos are living longer, with females having a longer life expectancy at 71.64 years than males at 66.1 years. Moreover, data from the National Statistics Office showed that the proportion of older persons is growing—from 3.83 percent of the population in 2000 to 4.19 percent in 2007.

The good news is that there is now a working Maternal and Neonatal Death Reporting System in the Philippines. The Unified Non-Communicable Disease Registry System or Oneiss will also be operational in the first quarter of 2014. Noncommunicable diseases are the top causes of death worldwide. In the Philippines, diseases of the heart, the vascular system, and malignant neoplasm are the top three leading causes of death.

At the national level, the DOH is addressing the lack of health human resources through a rationalization plan

requesting a 16–17 percent increase in approved positions from the Department of Budget and Management.

Communication strategy needed

Coordination among government agencies is needed particularly in fighting HIV-AIDS, which infects one Filipino every 1.5 hours. There is also a lot of work to do in meeting the Millennium Development Goals for health, Asuncion said.

The Philippines has the third highest total fertility rate in Southeast Asia, and ranks fourth in infant and under-5 mortality rate and fifth in neonatal and maternal mortality as well as underweight children under five years old, the health department official noted during the DPRM press conference.

The country needs to upgrade health facilities, recruit and deploy health human resources, ensure competency, and ensure the availability of drugs, medicines, and vaccines, she said.

According to Asuncion, the government must also come up with adequate and effective communication strategies to reach target populations, specifically the poor.

“We have to really track them to see if they are utilizing the resources available to them,” she said.

Aldaba, for her part, summed up her presentation with a quote from Amartya Sen, the Indian economist and Nobel economics laureate: “Growth must be accompanied by social capabilities like health, education, gender rights; healthy and educated population serves as foundation for economic growth.” FFS, CSM, PMGV, KCOO

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Effective impact evaluation:Knowing what works and what does not

FOR DEVELOPMENT practitioners, it is important to find out what programs work and what do not. Doing impact evaluation is crucial to assessing the effectiveness of antipoverty or development interventions and determining whether such efforts should be scaled up or expanded.

Effective ways of evaluating impact were discussed in a seminar hosted by PIDS and international nonprofit organization, Innovations for Poverty Action (IPA) – Philippines, last Sept. 10 at the Romulo Hall of NEDA sa Makati Building, as part of the observance of the 11th Development Policy Research Month.

Nassreena Sampaco-Baddiri, IPA country director, said impact evaluation has gained new importance amid questions over the government’s use of development funds.

Jessica Kiessel, IPA director for country programs, said impact evaluations “tell us if we are on the right track and how we can improve.” Impact evaluation is also necessary for accountability and for taking stock of lessons learned.

“Instead of asking ‘Do development programs work?’ we should be asking ‘Which works best?’ and ‘How we can scale up what works?’” said Kiessel.

Kiessel stressed two important things. Impact evaluation should involve a comparison between a treatment group and a “counterfactual” or control group to determine if there has been an impact. Also, randomized experiments are more effective in conducting evaluations. “We need to make comparisons. If the counterfactual group can’t be observed, we need to ‘mimic’ it…randomization is

needed to make sure the counterfactual group matches what the treatment group would look like without the program,” she explained.

Kiessel noted that in Ghana, three randomized evaluations found low-cost, remedial education programs to have quick, positive impacts on literacy and numeracy.

Moreover, randomization helps ease tension between treatment and control groups. “If properly designed and conducted, randomized experiments are the most credible method to estimate impact of a program,” Kiessel said. “The bottom line here is that the math that we use does matter.”

There are two interesting case studies in the Philippines: microcredit and savings programs. There is conflicting evidence on the impact of microfinance in the developing world, and the results are also mixed when it comes to the Philippines, said Mark Miller, deputy country director at IPA–Philippines.

In 2010, IPA partnered with First Macro Bank of Pateros for an evaluation of the latter’s credit program, using experimental credit scoring. One of the main findings was that after loan takeout, profits increased but only for male entrepreneurs, Miller said. “The effects of the loan were also stronger for higher-income entrepreneurs. These entrepreneurs had already started their business well, and they benefit more. But the loans did not serve well for starting businesses,” he added.

Jessica Kiessel, director for country programs of Innovations for Poverty Action.(Photo: Jose Ignacio Tenorio)

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Miller noted that businesses that had obtained loans subsequently laid off employees. This meant these businesses had to shed workers to be able to grow.

Miller also discussed IPA’s study on commitment savings, a program that requires depositors not to withdraw money from their accounts until their saving goals are met. Results showed that the total amount saved by depositors increased by 82 percent. Female clients also purchased 20 percent more durable items, such as refrigerators, from their savings. “More impatient clients are more likely to commit to save. They realize their weaknesses and know they need help in order to save,” Miller noted.

Meanwhile, monthly text messages sent to program participants as reminders of their savings commitments increased savings by six percent.

PIDS President Gilberto Llanto said impact evaluation is becoming important with researches needing more rigor. Impact evaluation is also needed now that the government has decided to incorporate performance measures in the budget process, he said in his closing remarks. PIDS and IPA have agreed to a partnership to disseminate the results of impact evaluations to policymakers and the public, Llanto said.

IPA, established in 2002, ties up with researchers and organizations around the world to study which social and economic programs work and which don’t. IPA has 14 country programs, including IPA Philippines, and more than 350 research projects completed or ongoing in over 40 countries across Africa, Latin America, and Asia.

IPA has been conducting research in the Philippines since 2003. FFS, CSM

Health department aimingfor universal coverage

THE DEPARTMENT of Health (DoH) is working to expand enrollment in the state-owned Philippine Health Insurance Corp. (PhilHealth) as part of efforts to achieve universal health care.

The government aims to enroll 14.7 million families or around 58.8 million Filipinos with Philhealth by the end of the year to cover the so-called “near-poor” aside from the poorest layers of society, as part of the Aquino administration’s Kalusugan Pangkalahatan initiative, Health Secretary Enrique Ona said in the seminar-forum titled “Sustainable and Inclusive Health Market Innovations: Challenges and Opportunities for the Philippines”, held last Sept. 17 in observance of the 11th Development Policy Research Month (DPRM). Ona’s keynote address was delivered by Health Undersecretary Madeleine Valera.

This year’s theme, “Making Health More Inclusive in a Growing Economy”, puts health in the spotlight, to highlight the pressing need to address inequality in health service delivery.

The Universal Health Care Program is anchored on three areas: (a) financial risk protection through expansion in enrollment and benefit delivery of the National Health Insurance Program; (2) improved access to quality hospitals and health care facilities; and (3) attainment of health–related Millennium Development Goals.

Because of the uneven enrollment of the “near poor”, only around 70 percent of families are able to access hospitals, Ona said. At present, the DoH is cleaning up its data to ensure that the number of enrolled and the number of people covered by PhilHealth do match.

To address inequity in health service delivery, the DoH has deployed human health resources to “geographically disadvantaged areas” that often do not have doctors. Around 21,400 nurses have been deployed across poor areas of the Philippines. “I’d like to say that the rural health care units are the backbone of our primary health care system. We estimate to have birthing facilities at around 70 percent of rural health units by next year, from 57.79 percent in 2010,” Ona bared.

The budget of the Health Facility Enhancement Program that seeks to upgrade rural health units has also significantly increased, he added.

For his part, Dale Huntington, director of the Asia Pacific Observatory on Health Systems and Policies, said the health market is beset with imperfections, perverse incentives, and market failure. “It is indeed a broken market. The solution to these problems is finding solutions through innovations,” he said.

Delivering the opening remarks on behalf of PIDS president Gilberto Llanto, PIDS Senior Research Fellow Aniceto Orbeta said this year’s DPRM theme underscores that recent economic growth has not translated to achieving inclusiveness and equity in growth.

“Moreover, rising population growth continues to put pressures on existing resources. This is why the role of market innovation in addressing inequality specifically in finding new technology will help us deliver health care better. Health market innovations are critical in improving the supply-side response to the large-scale demand for adequate health financing and service delivery,” he said. CSM

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Energy Secretary Jericho Petilla (standing), former Leyte governor, highlights how Leyte was able to improve the province’s health delivery through proven business models. (Photo: Jose Ignacio Tenorio)

PROVIDING health care to poor Filipinos is an area fraught with problems, in particular huge costs. But there are local success stories with proven business models that can serve as good examples of health market innovation for the rest of the country.

The experiences of Leyte province in efficiently financing its hospitals and a government-owned medical center in Davao in maximizing resources and improving its facilities were showcased in the Sept. 17 seminar-forum titled “Sustainable and Inclusive Health Market Innovations: Challenges and Opportunities for the Philippines”, organized by the Philippine Institute for Development Studies, the WHO-Asia Pacific Observatory on Health Systems and Policies, and the Center for Health Market Innovations as part of the 11th Development Policy Research Month.

Carlos Jericho Petilla, the former Leyte governor who is now energy secretary, was able to improve the province’s health care delivery by incentivizing doctors and health workers, maximizing collections from the state-owned Philippine Health Insurance Corp. or PhilHealth, and raising revenues by charging fees to patients who are willing to pay.

Petilla said his province’s hospital incentive scheme provided for maintenance and other operating expenses, capital outlay, and employees’ share. This way, hospitals retained money to improve facilities and government doctors earned around PHP 250,000 monthly. The plantilla was filled up and government hospitals reduced the need to hire private doctors as consultants,

11th DPRM showcases health innovations

he said. “The bottomline is that sustainable programs depend on medical practitioners,” the Cabinet official said.

Another strategy was to partner with Mother Bles Birthing Clinics founded by a religious sister to improve maternal care. This exerted a positive effect on erstwhile underutilized rural health units, which “declogged” the hospitals of normal deliveries.

The solution lies on allowing patients to maximize PhilHealth benefits by linking hospitals to an electronic database that eliminated the need for membership cards. Local governments should focus on the supply-side of health care delivery, and let PhilHealth take over the demand side, Petilla argued.

Dr. Leopoldo Vega, chief of the Southern Philippines Medical Center (SPMC), a

training hospital under the Department of Health, said improving process flows resulted in the maximization of PhilHealth benefits.

A drastic improvement in PhilHealth reimbursements allowed SPMC to increase PhilHealth admissions to more than 27,000 patients in 2012 from around 22,000 the previous year. This also allowed the hospital to improve its facilities and embark on public-private partnership arrangements such as the consignment of modern hospital equipment.

One of the discussants, Alex Raoul Villano, assistant secretary-general of the League of Provinces of the Philippines, said the presentations of Petilla and Vega were similar in that they employed working business models. “Hospitals should be economic enterprises without sacrificing social responsibility,” he said.

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Health Undersecretary Madeleine Valera, who was also a discussant, noted that these innovations worked to attain the best care at a lower cost, but pointed out that these ultimately depended on PhilHealth resources. “Innovation can really distinguish between a true leader and a follower,” she said.

Health experts from India presented best practices and technological innovations that the Philippines can emulate to bridge wide gaps in its health care system.

Dipika Bedi, head of operations of Teleradiology Solutions, shared her firm’s success story in teleradiology, an online system where diagnostic images are sent electronically for remote interpretation. This system was founded on the rationale of providing poor communities with easy access to health care. “Delayed diagnostics means delayed treatment,” Bedi pointed out.

Teleradiology uses advancements in technology to fill the lack of radiologists worldwide. Results of X-ray scans and other medical examinations are available within 30 minutes to one hour. The system has been widely successful in the United States and has been adopted by Singapore. Teleradiology is now available in 20 countries around the globe, and the Indian firm seeks to make the service widely available in Africa.

Meanwhile, Vijaybhasker Mudiganti, head for process control of LifeSpring Hospitals, presented through videoconferencing a model for providing efficient maternal health and infant care. The hospital chain offers a viable, affordable, and accessible maternal health care scheme to poor communities without compromising quality. This was made possible by capitalizing on low-cost or “no-frills” strategies.

LifeSpring has 12 hospitals in India operating 24/7 for in-patient services and 360 days for outpatient services. It has facilitated the delivery of 20,000 infants, and provides examinations to 35,000 pregnant women annually.

These best practices from India were lauded by the session discussants composed of Dr. Teodoro Herbosa, undersecretary of the Department of Health; Josef Yap, former president of the Philippine Institute for Development Studies; and Dr. Elmer Soriano, director of ACCESS Health Philippines.

Herbosa presented some innovations in the Philippines through the Kalusugan Pangkalahatan program of the government, noting that approximately 25 million people from the poorest communities have been given social protection under this project. Funding will no longer be an issue with the health budget increased to PHP 87.5 billion next

year, he said. He added that through the additional revenues from the sin taxes, the government will be able to strengthen current programs or introduce new ones to make health more inclusive.

Soriano noted that the Philippines has world-class human capital plus financial resources, but what is hindering the country to foster a culture of innovation is the lack of “legitimacy capital” to encourage innovators to come up with more creative ideas for the health market. Yap, meanwhile, reiterated the importance of replication and scaling up to make innovation successful.

Former health secretary Manuel Dayrit, who attended the forum, agreed and noted that thousands of health professionals are only waiting to be tapped. “We’re No. 1 in exporting nurses, No. 4 in exporting doctors. The next innovation should be HR (human resources) innovation.” FFS, KCOO

Undersecretary Ted Herbosa of the Department of Health presents the innovations the government is now implementing through the Kalusugan Pangkalahatan program. (Photo: Gizelle Manuel)

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THE GOVERNMENT should deepen Public-Private Partnership (PPP) arrangements in the health sector if it wants to achieve universal health coverage.

Dr. Josephine Anne Lucero, research consultant at the Philippine Institute for Development Studies (PIDS), drew a distinction between the relatively short-term “Public-Private Interaction” (PPI) and a “Public-Private Investment Partnership” (PPIP) that lasts at least 10 years and yields system-wide efficiency gains. Nearly all local PPP deals are PPIs, Lucero said in her presentation during the forum titled “Health Care For All: Issues and Challenges in Financing and Service Delivery in the Philippines” at the Romulo Hall of the NEDA sa Makati Building last Sept. 24.

“Health outcomes are the measure of health system’s performance, thus there is a need to strengthen our health systems,” Lucero said during the forum, held as part of activities of the 11th Development Policy Research Month.

The country should focus more on PPIPs as these types of arrangements address the public policy objective of universal health care, which seeks to ensure quality services, equity of access, and efficiency gains at a neutral cost to patients.

Six overseas case studies of PPIP options in three settings—primary care, hospital, and integrated health care settings, were presented in the seminar. It was found that the more effective models of PPIPs were those that were “contracted out”.

In the hospital setting, it was found that it would be possible to maintain the quality of hospitals while improving the efficiency and productivity of providers. Information systems were deemed vital in the success of health systems integration.

If the government is keen on pursuing PPIPs as a way to achieve universal health care, it must lay down a framework that will guide and provide direction to health PPPs. “There is a need for explicit government direction on the role of PPIPs,” said Lucero.

Moreover, policymakers should not lose sight of the fact that PPIPs are means and not ends. “PPIPs are tools for achieving universal health coverage objectives and these must be harmonized with the general health sector objectives. They are not plans by themselves but actually part of an integrated, long-term health plan

with detailed action steps of accountable institutions and agencies,” Lucero said.

PPP Center Executive Director Cosette Canilao, who served as a discussant, agreed that most health PPPs were only service agreements. The decision tree formulated by Lucero’s research team will be useful for decisionmakers in determining whether to push for a PPIP or not, she said.

The Department of Health has been capitalizing on PPPs, she added, citing the proposed modernization of Philippine Orthopedic Center. The project involves the construction of a 700-bed hospital with state-of-the-art infrastructure, modern medical diagnostics and clinical equipment, and information technology facilities, to be operated and maintained by the private sector proponent within a period of 25 years. KCOO

Study calls on gov’t to go into public-privateinvestment partnerships in health

Speakers underscore the importance of public-private partnerships as one of the key measures in strengthening the country’s health systems. (Photo: Jose Ignacio Tenorio)

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IN THE PHILIPPINES, maternal and child health services remain inequitable. This was the gist of the seminar on Health Care for All last Sept. 24 at the Romulo Hall of NEDA sa Makati Building, in celebration of the 11th Development Policy Research Month.

“Trends with very high level of inequity are seen in access to skilled birth attendants and facility-based delivery, said Valerie Gilbert Ulep, research associate at the Philippine Institute for Development Studies (PIDS) in his presentation “Are there improvements in the Delivery of Maternal and Child Health Programs for the Poorest in the Philippines?”

The Autonomous Region in Muslim Mindanao (ARMM) has the highest level of inequity in maternal and child health services. In the 2003-2008 National Demographic and Health Survey, the ARMM recorded significant increases in the level of inequality in access to and utilization of prenatal care, tetanus toxoid administration, Vitamin A supplies, skilled birth attendants, and full immunization.

Dr. Vicente Belizario, vice chancellor for research at University of the Philippines-Manila and executive director at the National Institutes of Health, highlighted the “not-so-popular” and neglected tropical diseases in the country. In particular, he cited soil-transmitted helminthiasis infections or worm infection and schistosomiasis as the predominant diseases of the poor in underdeveloped countries such as the Philippines. Ascaris is the major source of infection and causes the greatest morbidity. A worm produces 10 million

Inequalities in maternal, child care citedeggs daily that can stay alive in soil for up to two years, he noted.

In the Philippines, 66 percent of pre-school age children (PSAC) and 67 percent of school-age children (SAC) are suffering from worm infection. Because they have worms, many children experience growth stunting, weakness, as well as poor physical and cognitive development. Their school performance and productivity are also impaired. “We should not let worms win over people. It is not acceptable. We should win over them for our children,” Belizario emphasized.

Unlike before, the supply of deworming tablets is no longer a problem. The tablets are safe, effective, candy-flavored, and chewable in one single dose. However, massive drug administration efforts have little support and publicity. Parents have not been fully cooperative.

Many Filipino children are suffering from schistosomiasis. In Agusan del Sur, for example, 5.2 percent of PSAC in day care centers are affected. The figure is 32 percent among elementary and high school students.

The Philippines has failed to meet the 2010 target and deadline set by the World Health Organization, which is 75 to 100 percent administration of chemotherapy to SAC with risk of morbidity because of worm infection. The Philippines reached only 11 percent coverage in 2011.The same target and deadlines were also set for schistosomiasis, which the country was likewise unable to meet.

“In the end, these are developmental issues. Infectious diseases are diseases of poverty and the marginalized. Healthy individuals are what the country needs for growth and national development,” Belizario stressed. CSM

Dr. Vicente Belizario, vice chancellor for research at UP Manila and executive director of the NIH. (Photo: Jose Ignacio Tenorio)

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THE GOVERNMENT has achieved universal coverage of the poor through the Philippine Health Insurance Corp. (PhilHealth), but this may be uneven and there are wide disparities at the regional and provincial levels. The same is true for PhilHealth’s “mandatory” program.

These were the findings of separate studies conducted by the mother-and-daughter tandem of Raymunda and Denise Valerie Silfverberg, research consultants of the Philippine Institute for Development Studies (PIDS), which were presented in a forum last Sept. 24 as part of activities for the 11th Development Policy Research Month (DPRM).

This year’s DPRM celebration zeroes in on inequalities in health service delivery, with the theme “Making Health More Inclusive in a Growing Economy”.

PhilHealth’s Sponsored Program (SP), said Dr. Raymunda Silfverberg, had attained universal coverage in 2011. Intended beneficiaries of the program for indigents are those in the “poorest of the poor” or the lowest 25 percent of the population, but this was later expanded to cover the “near poor”.

Benefits include hospitalization, special packages, and outpatient benefit packages. Premiums are covered by the national government through PhilHealth, local governments, nongovernment organizations, private individuals and corporations, and Priority Development Assistance Funds of lawmakers.

Dr. Silfverberg described as “disconcerting” the uneven coverage and wide disparities in coverage rates at the regional and provincial levels, noting that

Fill gaps in coverage, PhilHealth urged

distribution was skewed toward mild to extreme “leakage”.

Data showed less than 50 percent or severe undercoverage in Siquijor, Zambales, Tarlac, and parts of Quezon City; and “outlying leakage” in places like Guimaras, Isabela City, Sulu, Maguindanao, and Zamboanga Sibugay, which had coverage rates of 430.69 percent to 4,508.92 percent.

Dr. Silfverberg also found indicators of a “substitution effect” in which members shift to the indigent scheme from the regular scheme and vice versa, which could be due to the practice of politicians handing out PhilHealth cards during election years.

“Analyses underscore the important role of local government units as partner implementers of SP – as provider of health services (primary and lower-level hospital care) and financier of [PhilHealth] premiums and health services rendered,”

she said. This can be done by earmarking a special health fund, both from the national and local governments.

Dr. Silfverberg’s daughter, Denise Valerie, said problems in the mandatory PhilHealth program covering private sector and government workers needed to be addressed before expanding it. The coverage rate in the private sector is better than in the government sector, while the individual paying program is lagging behind. Still, there are disparities in regional data, and one reason could be the prevalence of contractual employment contracts that do not have health benefits, Ms. Silfverberg said.

Discussant Dr. Joseph Capuno of the UP School of Economics said the government could be over-enrolling in some areas to make up for under-enrollment in other areas.

For her part, Dr. Maria Eufemia Yap of the Ateneo School of Medicine and Public Health said health maintenance organizations, for which PhilHealth is the “first peso payer”, might want to rethink the way they do business with given the goal of universal health coverage.

But while health insurance is a “numbers game”, there will still be people in the informal sector who will require some form of safety net, she said.

PIDS President Gilberto Llanto said all this underscored the importance of policy research in decisionmaking. “Policy research gives the biggest bang out of a small buck,” he told participants. Llanto also pointed out that “Development is human development, and if it is to matter at all, it should be inclusive.” FFS

Dr. Raymunda Silfverberg, PIDS research consultant. (Photo: Jose Ignacio Tenorio)

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EXPANDING the Pantawid Pamilyang Pilipino Program or 4Ps—the government’s conditional cash transfer (CCT) program—should be accompanied by modifications in its design and implementation to make it more effective and efficient.

Poverty specialist and PIDS Senior Research Fellow Celia Reyes emphasized this again in a seminar-forum titled “Pantawid Pamilyang Pilipino Program: Why “deepening” matters in achieving its human capital objectives” held on Sept. 19 at the Senate of the Philippines. Organized by the Philippine Institute for Development Studies (PIDS) and the Senate Economic Planning Office (SEPO), the forum was intended to apprise Senate technical staff of the major findings of PIDS’ initial evaluation of the CCT program to assist them in providing effective technical support to legislators. The forum was part of the celebration of the 11th Development Policy Research Month which is also spearheaded by state think tank PIDS.

The Aquino II administration picked up the recommendation of Reyes and her research team at PIDS to extend the period of assistance being given to CCT beneficiaries to enable their children to finish high school. The original design of the 4Ps, when it started implementation in 2008, was to provide assistance to identified poor households to enable their 6- to 14-year-old children to finish elementary. The assistance is for a maximum of five years and amounts each year to PHP 3,000 per child for the education component and PHP 6,000 for the health component for each family

Senate forum emphasizes need to enhanceconditional cash transfer program

beneficiary. Only a maximum of three children per family shall receive the education grant.

The President cited in his State of the Nation Address what Reyes took note in many of her presentations that the average daily wage of high school graduates is 45 percent higher than those who only had some elementary education. The PIDS team also showed results that the school attendance of children of 4Ps families steadily declines among older children. This has not been the case with younger children. School attendance falls below 90 percent after age 13 based on their analysis. More boys than girls also attend school, and even among older children, boys have lower school participation than girls.

“There is a public elementary school in almost every barangay so access is not a problem among younger children. High schools are typically located in the poblacion, which means higher cost of education for families given higher transportation cost and school fees. As to the gender disparity in school participation, we can attribute this to the fact that older male children would often drop out of school to help their families. The cash grant for male CCT children should thus be higher to encourage them to stay in school,” Reyes explained.

Most 4Ps families cited “lack of personal interest” as the reason for the inability of their 6- to 14-year-old children to sustain school attendance. Reyes said this requires more probing. If the reasons behind are clear, better intervention can be developed to address it, she said.

In an earlier CCT forum organized by PIDS in July, Secretary Corazon “Dinky” Soliman of the Department of Social Welfare and Development (DSWD) confirmed the extension of the program’s coverage to children up to 18 years old to give them the chance to finish high school. Each 4Ps high school student, she said, will receive PHP 500. Whether or not DWSD will follow Reyes’ recommendation of differentiating the amount of the cash grant by gender still remains to be seen.

There is a need for a clear exit strategy, Reyes also noted. The program should be concerned with what will happen to the beneficiaries after they ceased being part of the 4Ps. For the beneficiary children, the goal should be to ensure that they can continue up to college or earn a vocational degree. Some technical staff in the audience commented that the 4Ps should be harmonized with other programs—such as the tertiary scholarships and vocational programs—being implemented by other government agencies.

The significance of clear objective-setting was emphasized by PIDS President Gilberto Llanto. “The program has a strong potential to make economic growth more inclusive in the Philippines, but we have to be clear about our objective and pair it with a good intervention…sustain it over time, and correct the flaws, otherwise, it will be reduced to a very costly and ineffective instrument. Government is saying we have to converge, coordinate our efforts. Maybe it is not about inventing new programs but deepening, improving present ones,” Llanto said. SVS

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THE PHILIPPINES needs to create 14.6 million jobs in the next four years, and the way to do this is by keeping the country on a sustained path of economic growth. This will be possible through a “broad reform coalition” that will work to make growth inclusive and support policies that will generate more and better jobs.

This was stressed by experts from the World Bank (WB) and the Philippine Institute for Development Studies (PIDS) as they dialogued with stakeholders in the labor and business sectors as well as the academe last Sept. 13.

“People want to earn a living, they don’t want handouts,” said Axel von Trotsenburg, WB vice-president for East Asia and Pacific Region, as he opened the “Dialogue on Creating More and Better Jobs” at One Global Place in Bonifacio Global City. The forum was organized by World Bank Philippines and PIDS as part of the activities for the 11th Development Policy Research Month.

Job creation is a real concern as it has a direct link to poverty, and considering that four billion people around the world live on less than USD4.00 a day, he said.

Karl Kendrick Chua, WB senior country economist, said transforming the Philippine economy to yield more and better jobs would be the challenge for everyone. “More and better jobs should be created for 10 million Filipinos who were either unemployed or underemployed as of 2012,” said Chua as he presented highlights of a draft report titled “Philippine Development Report (PDR):

‘Broad reform coalition’ neededto deal with enormous jobs challenge

Creating More and Better Jobs”, which provides an in-depth discussion of the country’s jobs challenge.

With an estimated 1.15 million Filipinos entering the labor force every year in the next four years, a total of 14.6 million jobs would be needed, he said.

The problem is that the Philippine economy has failed to undergo a structural transformation, and its inability to produce a massive number of jobs is due to a long history of “policy distortions”. Chua pointed to the country’s historically weak economic growth record, which, at an average of just 4.1 percent in the last three decades, was considerably slower than the average 6.5 percent of its more dynamic East Asian peers over the same period. Moreover, the share of manufacturing to gross domestic product has stagnated at around

25 percent since the 1960s, while other countries steadily increased theirs before moving on to growth driven by high-skill services.

PIDS Acting Vice-President Rafaelita Aldaba called for a comprehensive industry roadmap that will link all sectors, including agriculture and services. “We need to improve the competitiveness of industries,” she said, adding that effective government policies and complementary actions such as competitive exchange rates would also be needed. Structural transformation would require rebuilding capacity, a shift to high value-added activities, and deeper participation in regional production networks.

Needed reforms include secure property ownership; fair competition; more investments in health, education, and infrastructure; and simple business regulations to decrease the cost of doing business in the Philippines. Businesses need to embrace the principle of a level playing field and recognize freedom of association, while labor needs to recognize valid flexible contracts and reduce calls for minimum wage hike as food prices fall to facilitate job creation, Chua said.

A broad coalition would be needed to tackle these issues, the WB economist said. “Instead of tackling policy reforms one by one, the government, business, and labor, with the support of civil society, need to work together to come up with a package of reforms in creating more and better jobs in the Philippines,” Chua said. FFS, PMGV

World Bank Senior Country Economist Karl Kendrick Chua. (Photo: Gizelle Manuel)

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Research DigestsDiscussion Paper No. 2013-51Regional Comprehensive Economic Partnership: Reform Challenges and Key Tasks for the Philippinesby Gilberto M. Llanto and Ma. Kristina P. OrtizThe ASEAN+6 countries are currently engaged in negotiation for a Regional Comprehensive Economic Partnership (RCEP). The paper discusses some of the challenges facing the Philippines during the difficult period of negotiation and the necessary structural and institutional reforms that it has to take to ensure that it will benefit from RCEP.

Discussion Paper No. 2013-50Energy Market Integration and Energy Poverty in ASEANby Adoracion M. Navarro, Maxensius Tri Sambodo, and Jessie L. TodocThis study maps the energy poverty situation in the region, and reviews the links between energy access and economic and human development. It also draws a connection between ASEAN Energy Market Integration (AEMI) and the eradication of energy poverty, or attaining universal energy access, in terms of benefits and strategies, particularly with regard to mapping investment requirements and taking inventory of financing options. The study concludes with some recommendations for near-term actions.

Discussion Paper No. 2013-49The Pathway to ASEAN Energy Market Integrationby Adoracion M. Navarro and Maxensius Tri SambodoGlobal experience in regional energy market integration presents broad elements of integration, i.e., binding agreements, physical infrastructure, standardized or harmonized rules of operation, and governing or coordinating institutions. The pathway to AEMI will also involve creating these elements; however, this activity must be preceded by trust-building activities among ASEAN members. Trust should be built by candidly disclosing mutual gains from, and shared costs and externalities in energy resource development, trading

energy products, market adjustments, and regulatory reforms.

Discussion Paper No. 2013-48Customs Brokerage Services and Trade Facilitation: A Review of Regulatory Coherenceby Gilberto M. Llanto, Adoracion M. Navarro, Keith C. Detros, and Ma. Kristina P. OrtizThe study looks at the rarely studied customs brokerage activity in the Philippines and its role in facilitating trade given the ongoing push to modernize customs administration. It analyzes how the customs brokerage profession is being regulated and synthesizes insights on opposing views on the importance of customs brokers in trade facilitation.

Policy Notes No. 2013-15Export Processing Zones, Special Economic Zones: Do We Really Need to Have More of Them?by Rosario G. ManasanExport processing zones (EPZs) are considered an important economic strategy to boost export promotion, attract foreign direct investments, and create employment opportunities for the domestic workforce. With our more than 40 years of experience in managing ecozones, it is but fitting to know if these ecozones have been successful in facilitating economic development for the Philippines. This Policy Note briefly reviews the performance of EPZs and special economic zones (SEZs). It also provides some guidance in evaluating ecozone proposals by drawing on the lessons learned from our experience in SEZs and that of other countries to ensure the success of future ecozones.

Policy Notes No. 2013-14The Impact of Natural Disasters on Income and Poverty: Framework and some Evidence from Philippine Householdsby Danilo C. Israel and Roehlano M. BrionesThis Policy Note provides a framework for analyzing the impact of natural disasters on household income and household poverty and empirically estimates the effects of

natural disasters on household income using 2011 CBMS data for Pasay City, Metro Manila. It summarizes some of the results and findings of a recent study conducted by PIDS and funded by the Economic Research Institute for ASEAN and East Asia.

Policy Notes No. 2013-13Border and Behind-the-Border Restrictions in Logistics and Trade Facilitation in the Philippines: Some Results of Regulatory Dialoguesby Gilberto M. Llanto, Adoracion M. Navarro, Keith C. Detros, and Ma. Kristina P. OrtizThe Philippines’ potential to capitalize on the gains of regional economic integration depends on its resolve to address the reform gaps and challenges that undermine the efficient and effective regulation and management of trade facilitation at the border and behind the border. This Policy Note summarizes the findings of the Philippine research team in a study funded by the Economic Research Institute for ASEAN and East Asia that probed the regulatory environment and the remaining border and behind-the-border restrictions in logistics and trade facilitation in the region.

Policy Notes No. 2013-12Key Reforms for an Effective Regional Comprehensive Economic Partnershipby Gilberto M. Llanto and Ma. Kristina P. OrtizThe Association of Southeast Asian Nations (ASEAN) is looking at Regional Comprehensive Economic Partnership (RCEP), a region-wide free trade agreement, as an important step toward a deeper and integrated production base in the region that is also open to the rest of the world. If successfully negotiated, RCEP can be the world’s biggest trading bloc covering at least 40 percent of world trade and offering significant benefits to participating countries. This Policy Note points out key reform challenges facing the Philippines during the difficult period of negotiation and the necessary structural and institutional reforms that must be taken to ensure that the country will benefit from the RCEP.

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‘Inclusive growth must be asserted in AEC’THE INCLUSIVE growth mantra has to be further asserted in the ASEAN Economic Community (AEC), said Cielito Habito, former director-general of the National Economic and Development Authority (NEDA) and chief of party of the USAID Trade Related Assistance for Development, during the Final Workshop of “ASEAN Beyond 2015”, a project of the Economic Research Institute for ASEAN and East Asia (ERIA). State think tank Philippine Institute for Development Studies (PIDS) co-organized the event held at the Carlos P. Romulo Hall, NEDA sa Makati Building last November 26.

According to Habito, ASEAN trade relations must be competitive rather than complementary. “The Philippines has a predominantly intra-industry trade with the rest of the ASEAN countries, especially with its major trading partners in the region, meaning we trade in products within the same industries. The Philippines’ top exports to its major ASEAN trading partners are petroleum products, electronics, and chemicals, the same products that we import in the region,” Habito said.

Habito also noted the budget misallocation in the agricultural sector, where 70 percent of the commodity budget goes to rice yet it is responsible for only about 16 percent of the value adding in agriculture.

He pointed to the growth potentials of the services sector. “The Philippines has much more growth in the services sector because there are lots of value adding within this sector, such as in design and software.”

Meanwhile, UP professor emeritus and the first NEDA director-general, Gerardo Sicat, highlighted the negative impacts

of governance and political issues on the country’s investment performance. Changes of government have caused reversals of economic policies and the effects of these reversals have been very costly, Sicat said.

Sicat said the Philippines was the only country in the ASEAN with complex constitutional provisions on economic issues. “We have restrictions on capital, land ownership, public utilities, and operation of land mineral resources, which not all foreign investors could deal with,” he said.

PIDS Senior Research Fellow and Acting Vice-President Rafaelita Aldaba stressed that the Philippines should not rely on the services sector alone if it wants economic growth to be inclusive. Aldaba noted the urgent need for the revival of the manufacturing sector to increase the country’s competitiveness in the region. A more vibrant manufacturing sector also means more jobs available for Filipinos. “There has been very little movement of

resources in the Philippine manufacturing sector. Its share of value added to gross domestic product declined to 23.7 percent in the 2000s from 26.3 percent in the 1980s,” she said.

ERIA Senior Researcher Ponciano Intal said ASEAN competitiveness must be strengthened to sustain high and equitable growth beyond 2015. The Philippines needs an enabling policy and regulatory environment to meet the desired targets of eliminating dire poverty, reducing poverty rates by at least two-thirds, and reducing the youth illiteracy rate and malnutrition. “There should be greater focus on food security as it remains to be a significant concern in the ASEAN,” Intal, a former PIDS president, said.

PIDS President Gilberto Llanto stressed the need for ASEAN countries to focus on border and beyond-the-border issues. “We also need to cascade the implications of AEC 2015 to our policymakers, especially to those who still are not aware of what AEC 2015 is.” PMGV

Cielito Habito (left), former NEDA director-general, and UP Professor Emeritus Gerardo Sicat (right). (Photo: Gizelle Manuel)

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QUALITY of infrastructure in the Philippines is second to the last in ASEAN. This was disclosed by Adoracion Navarro, senior research fellow of the Philippine Institute for Development Studies (PIDS), during the forum “Financing Infrastructure in the Philippines” last Oct. 24.

In the Global Competitiveness Report 2012-2013 of the World Economic Forum, the Philippines ranked 98th among 144 countries in terms of quality of overall infrastructure. Philippine infrastructure is worse than Cambodia’s, Navarro said. In the ASEAN region, the only country the Philippines overtook was Viet Nam

PH ‘behind’ ASEAN neighbors in infra qualitythat placed 119th, the ASEAN nation with the poorest quality of infrastructure. Ranked first in the region was Singapore, which placed second overall among 144 countries. Malaysia was ranked 29th; Brunei Darussalam, 43th; Thailand, 49th; Cambodia, 72th; and Indonesia; 92th. The Philippines got the lowest rank in quality of port infrastructure (120th) and air transport infrastructure (112th). This was worse than Cambodia’s 69th and 75th ranking in port and air transport infrastructure, respectively.

Navarro attributed this poor showing to underinvestment in infrastructure. In 2012, only 11 percent of the budget for

infrastructure was spent, a scenario that has not changed since 2010. The decreasing reliance on official development assistance (ODA) loans also contributed to the low quality of infrastructure, she said. In 2012, ODA loans for infrastructure stood at around US$5 million, smaller than the 2008 figure of more than US$6 million.

Navarro challenged stakeholders in the financial sector to take advantage of the liquid financial market given huge project costs. The government should also organize a group of experts to formulate clear mechanisms and an institutional setup to mobilize bank resources for infrastructure financing, she said. PMGV

PIDS, DFA tie up for APEC 2015 research projectTHE PHILIPPINE Institute for Development Studies (PIDS) signed a memorandum of agreement with the Department of Foreign Affairs (DFA) for the APEC 2015 Research Project last Nov. 14 at the Carlos P. Romulo Hall, NEDA sa Makati.

PIDS President Gilberto Llanto and DFA Undersecretary for Administration Rafael Seguis signed for PIDS and DFA, respectively.

Under the agreement, DFA will lead in the conduct of the project that will provide the requisite analytical framework for determining the substantive priorities the Philippines will push for as APEC Host Economy in 2015. Meanwhile, PIDS will provide technical expertise in the conduct of the project.

The 2015 APEC Conference in the Philippines is the second time that the

country will chair the conference since its first hosting in 1996. The DFA-PIDS research project will serve APEC’s purpose of maximizing the benefits of

regional cooperation with other APEC member-economies, and provide inputs to development planning of the Philippine government.

PIDS President Gilberto Llanto and DFA Undersecretary Rafael Seguis seals the agreement for the APEC 2015 Research Project. (Photo: Gizelle Manuel)

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DEVELOPMENT RESEARCH NEWS is a quarterly publication of

the PHILIPPINE INSTITUTE FOR DEVELOPMENT STUDIES (PIDS). It

highlights the findings and recommendations of PIDS research

projects and important policy issues discussed during PIDS seminars.

PIDS is a nonstock, nonprofit government research institution

engaged in long-term, policy-oriented research. This publication is part of the Institute's program to

disseminate information to promote the use of research findings. The views and opinions expressed here

are those of the authors and do not necessarily reflect those of the Institute. Inquiries regarding any of

the studies contained in this publication, or any of the PIDS papers, as well as suggestions or comments

are welcome. Please address all correspondence and inquiries to:

Research Information Staff Philippine Institute for Development Studies

Fifth floor, NEDA sa Makati Bldg., 106 Amorsolo Street, Legaspi Village1229 Makati City, Philippines

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This edition of the DRN chronicles the proceedings of the nationwide commemoration of the 11th Development Policy Research Month (DPRM) last September. With the theme “Making health more inclusive in a growing economy”, the DPRM events highlighted for policies that will make health more inclusive. The Philippines needs to hike its health expenditures to the minimum five percent recommended by the World Health Organization, from the current 3 to 3.5 percent.

Other DPRM-related articles feature effective tools for evaluation of the impact of antipoverty and development projects, best practices in health financing and innovations, the government’s Universal Health Care program being implemented under the Philippine Health Insurance Corp., inequalities in maternal health and

child care, and public-private partnership arrangements in health.

As part of the 11th DPRM, the Institute and the World Bank Philippine office held the “Dialogue on Creating More and Better Jobs” in a bid to assemble a “broad reform coalition” that will work to make growth inclusive and support policies that will generate more and better jobs. Another forum at the Senate highlighted the need for improvements in the Pantawid Pamilyang Pilipino Program to make it more effective and efficient. The DPRM was officially concluded by the forum titled “Towards Universal SHI Coverage in the Philippines: Setting the Subsidies Right for the Informal Sector” at the UP School of Economics last Sept. 27.

This issue also features PIDS events in the fourth quarter, such as the Pulong

DEVELOPMENTRESEARCH NEWS

Vol. XXXI No. 4

Oct - Dec 2013

ISSN 0115-9097

Editorial Board: Dr. Gilberto M. Llanto, President; Dr. Rafaelita M. Aldaba, Vice-President; Renee Ann Jolina C. Ajayi, Officer-in-Charge for Project Services & Development; Dr. Sheila V. Siar, Director for Research Information; Ms. Andrea S. Agcaoili, Director for Operations & Finance; Atty. Roque A. Sorioso, Legal Consultant.

Staff: Sheila V. Siar, Editor-in-Chief; Felipe F. Salvosa II, Issue Editor; Claudette S. Malana, Jose Ignacio O. Tenorio, Jane C. Alcantara, Writers; Felipe F. Salvosa II, Layout; Romero F. Lopez, Ma. Gizelle G. Manuel, and Phidel Marion G. Vineles, Contributors; Valentina V. Tolentino and Rossana P. Cleofas, Exchange; Delia S. Romero, Gerald Jay S. Libiran, Necita Z. Aquino, and Michael A. Caturan, Circulation and Subscription.

The Staff

Editor’s. . . from p. 1

Saliksikan on Financing Infrastructure in the Philippines, the fourth and final workshop of the ASEAN Beyond 2015 Project, and the signing of a memorandum of agreement between the Institute and the Department of Foreign Affairs for a research project on the country’s APEC 2015 hosting.

The year 2013 was marked by successive tragedies in the Visayas—a massive earthquake and the onslaught of super-typhoon “Yolanda”. These natural disasters also serve to remind policymakers and researchers of the need for evidence-based policy that are relevant to the poor and vulnerable, especially in terms of health, education, and jobs. Social protection policies have an important role to play as the country embarks on a recovery and rebuilding process.

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