President Duterte (left) and DOH Sec. Francisco Duque

So, it is now the front-liners who want us to return to Enhanced Community Quarantine or lockdown?

President Duterte still doesn’t get it.

Here is the breaking news: “Medical front-liners recently banded together to call on the government to place Mega Manila again under a period of enhanced community quarantine from August 1 to 15 as coronavirus disease cases in the country continue to surge.

“We proposed that this ECQ be used as a ‘time out’ to refine our pandemic control strategies, addressing the following urgent conditions — hospital workforce efficiency, failure of case finding and isolation, failure of contact tracing and quarantine, transportation safety, workplace safety, public compliance with self-protection, social amelioration,”  Philippine Medical Association (PMA) president Dr. Jose Santiago said.

The “distressed call was made” as the country’s healthcare system is “overwhelmed”, he added.

The Department of Health, meanwhile, has reported that there are 4,063 new Covid-19 infections, bringing the country’s case total to 93,354.

Aha! the issues have come to roost, Mr. President. Ang bagal mo kasi.

Last June, I have asked for the firing of Secretary Francisco Duque III not because of how some quarters said he stepped on the brakes on the Dengvaxia investigations or incompetently he led the Covid pandemic management.

I purposely sidetracked that debate, because even before those issues, he should have been fired.

Arguando, nobody else but nobody is better prepared to run the Department of Health, as Duque.

Look at his curriculum vitae – it is all over the place.

Bachelor’s degree in zoology, University of Santo Tomas, 1978.

Doctor of Medicine, UST Faculty of Medicine and Surgery, 1982.

Master of Science degree in pathology Georgetown University, 1987.It was at Scientific training in immunology from Georgetown University, 1985 to 1988.

Post-graduate course on executive education on Health Program Management at the Harvard University School of Public Health and Graduate School of Management in Boston, 1992.

Dean of the College of Medicine of Lyceum-Northwestern University, 1989-95.

Director of the University of Pangasinan (1989–1999).

Concurrent Administrator and Executive Vice President of the Lyceum-Northwestern University General Hospital up to 2000.

President & CEO of the Philippine Health Insurance Corporation (PhilHealth), 2001-2005.

Secretary of Health, 2005 to 2010.

Concurrent Anti-Hunger Czar as Chair of the National Nutrition Council (NNC), overseeing 27 government agencies.

Concurrent Oversight Chair of the Philippine Charity Sweepstakes Office (PCSO).

Chairman of the Civil Service Commission (CSC), 2010.

Chairman of the Career Executive Service Board (CESB), 2010.

Chairman of the Government Service Insurance System (GSIS), 2016 to 2017.

Secretary of Health, 2017 to the present.

Upon his assumption of office as DOH Secretary on November 6, 2017, he became the first returning health chief of the agency since the reappointment of Health Secretary Paulino Garcia in the 1960s.

Let’s do a take two on my June 29, 2020 column:

My strongest issue against Health Secretary Francisco Duque III is that the man has hit his Peter principle.

The Peter principle is a concept in management developed by Laurence J. Peter, which observes that people in a hierarchy tend to rise to their “level of incompetence.”

Hence, employees are promoted based on their success in previous jobs until they reach a level at which they are no longer competent, as skills in one job do not necessarily translate to another.

The concept was elucidated in the book The Peter Principle (William Morrow and Company, 1969) by Dr. Peter and Raymond Hull.

Wikipedia offers an example: “A competent school teacher may make a competent assistant principal, but then go on to be an incompetent principal. The teacher was competent at educating children, and as assistant principal he was good at dealing with parents and other teachers, but as principal he was poor at maintaining good relations with the school board and the superintendent.”

Satirically, it may also be said that Duque lost his “peter”!

In 1978, I was one of those first trained by San Miguel Corporation in the transition of personnel management to human resource development.

The first lesson is never judge a person by his cover.

So we were introduced to a series of psychometrics so that we don’t end up putting square people in round holes and vice versa.

I was then vice-president for corporate development of a Toyota franchised dealer and I noticed that my counterpart in sales kept failing to achieve the quota because he precisely judged his people by their cover.

The key problem, I discovered after taking the SMC seminar was, he always promoted his best salesmen to become sales manager. He did not only lose a spectacularly-performing salesman but also created a poor manager. The job requirements for the two positions were almost always diametrically opposed.

For providing the solution, the Board of Directors transferred me to head sales, precisely to change managing salesmen as mere personnel to developing them to more productive associates of the Company.

The Secretary has been to the department twice. The second time around, and with increased experience in government career development at the Civil Service Commission and in a related discipline such as PhilHealth, he should have already made miracles at the Department of Health.

I will repeat, nobody else but nobody is better prepared to run the Department of Health, as Duque.

But unfortunately, I will also repeat he has hit his Peter principle.

There is, thus no one else to blame for the decrepit profile of healthcare system of the country today but he.

While Duterte and Duque enjoys mutual patronage for some yet undetermined affinity, data from the DOH shows that there are 1,236 hospitals in the country as of 2017, and of these, 2/3 are private hospitals.

Despite the WHO standard is 20 beds per 10,000 population, the Philippines has never reached the recommended ratio.

This indicator even worsened from 14.4 beds per 10,000 population in 1990 to only 9.9 beds per population in 2014, according to the Philippine Statistics Authority (PSA).  

Of the 1/3 that are government hospitals, most are in despicable state ever since they were devolved to the local governments who could hardly sustain enough funding for them to meet basic operational standards.

I have a grandchild who despite being born normal at a Pontevedra Municipal Hospital in Capiz last month, died within 36 hours from birth due to the negligence and carelessness of its nursing staff.

These government hospitals are under the supervision of the Department of Health.

And when it comes to community health services, only 47% of barangays had barangay health stations in 2018.

There is also a significant shortage of health personnel in the country.

The PSA reported a ratio of one government physician to 33,000 Filipinos, which is far from the WHO recommended 1:1,000 doctor to population ratio.

When President Duterte assumed office, the DOH said that the country is in need of 15,000 doctors to meet the healthcare needs of Filipinos each year.

The number of public health nurses is also dismal at a ratio of 1 to 50,000 Filipinos.

Philippine Overseas Employment Administration (POEA) data show that despite the scarcity of government health workers, the country has been exporting nurses for decades, which is worsening the brain drain of the health sector.  

The Philippines deployed 19,551 nurses in 2016 or 53 nurses per day. In 2013, the Department of Labor and Employment (DOLE) advised nurses to find work in business process outsourcing (BPO) as medical transcriptionists, billers, and health care secretaries since they can no longer be accommodated in government hospitals.

These shortages in medical facilities and personnel are due to government’s low prioritization of the health sector as seen in the national budget.

While it seems good that the health sector budget has increased from Php177.7 billion in 2019 to Php185.5 billion in 2020, its overall share in the national budget has fallen from 4.9% to 4.5 percent.

The Php7.8 billion or 4.4% increase in the health sector budget is even eaten up by inflation.  

Situation Zero

The cuts to much-needed health programs that could help the country better cope with the ongoing pandemic already reeked of serious lack of vision and gross mismanagement.

For instance, the budget for Health Systems Strengthening Program was cut by P6 billion in 2020. The program is used for ensuring a wide range of human health resources such as doctors, nurses, midwives, community health workers, and other health care providers.

The budget for the Epidemiology and Surveillance Program which monitors, investigates, and analyzes disease outbreaks was cut by more than half. It was reduced from Php263 million in 2019 to Php116 million in 2020.

This is the Situation Zero, when Covid-19 entered the picture this year.

Only God’s grace saves our country from the contagion and its curse of death.

So now that Secretary Duque has gone even lower than losing his “peter,” what is in-store for him?

I recommend retirement from government service, but helping improve the healthcare facilities of the country by putting up his own provincial hospital.

Or he may choose another track. One former health secretary went to the serious promotion of traditional and alternative healthcare system. Or do something he also failed to do during his two stints as secretary: go into the development of indigenous herbal medicines and nutri-ceuticals.

On the third, however, he might lose friends in the big pharma industry that he has been rumored to patronize.

 The Filipino, Mr. President, deserves justice that stops today at one level still below yours.

The patience of the industry in asking for ECQ for Mega-Manila, has already run out. (ia/SPH)