A Human Rights-Based Approach to

Universal Health Coverage in the

Philippines
Commissioner Karen Gomez Dumpit
Commission on Human Rights of the Philippines
Universal Health Coverage: Perspectives
ADB-HQ Auditorium
Disclaimer: The views expressed in this paper/presentation are the views of the
2 March 2016
author and do not necessarily reflect the views or policies of the Asian Development
Bank (ADB), or its Board of Governors, or the governments they represent. ADB
does not guarantee the accuracy of the data included in this paper and accepts no
responsibility for any consequence of their use. Terminology used may not
necessarily be consistent with ADB official terms.

Health and human rights are interdependent,

indivisible and interrelated

UHC is one aspect of health and

human rights (reducing vulnerability
to ill-health through human rights)

Universal health coverage (UHC), is

defined as ensuring that all people
can use the promotive, preventive,
curative, rehabilitative and palliative
health services they need, of
sufficient quality to be effective,
while also ensuring that the use of
these services does not expose the
user to financial hardship. (WHO,
2015)

Right to health: Definitions under international

human rights norms
UDHR, 1948: Everyone has the right to a standard of living adequate for the health of himself and of his family,
including food, clothing, housing and medical care and necessary social services. (Art. 25.1)

WHO, 1948 and Alma Ata Declaration, 1978: Health is a state of complete physical, mental, and social wellbeing, and not merely the absence of disease or infirmity, is a fundamental human right and that the
attainment of the highest possible level of health is a most important world-wide social goal whose realization
requires the action of many other social and economic sectors in addition to the health sector.

ICESCR, 1966: The States Parties to the present Covenant recognize the right of everyone to the enjoyment
of the highest attainable standard of physical and mental health. (Art. 12.1) ; General Comment on Article 12
of ICESCR, 2000 (General Comment 14)

Relevant international human rights treaties: CERD, 1965 (Art. 5 (e) (iv) ; CEDAW, 1979 (Articles 11.1(f), 12 and
14) ; CRC, 1989 (Art. 24) ; CMW, 1990 (Art. 28) ; CRPD, 2006 (Art. 25)

Millennium Development Goals: right to health mainstreamed into all 8 goals.

Third parties do not infringe

upon the enjoyment of the
right to health

FULFILL

Ensuring that equal access to

health care is not denied or
limited for any population
group but also recognizes
that particular groups are
vulnerable (women,
children, older persons,
persons with disabilities,
indigenous groups and
migrants)

PROTECT

RESPECT

Key aspects of UHC linked to human rights and States

obligations

Availability

Underlying
determinants

Accountability

Accessibility

Human
rights
and UHC

Participation

Acceptability

Good quality

Nondiscrimination

Taking positive steps to

realize the right to health

Right to health and UHC in the Philippines:

relevant laws and policies
Philippine
Constitution, 1987

International
human rights
treaties

The State shall adopt an integrated and comprehensive approach to health development which shall endeavor to make essential goods,
health and other social services available to all the people at affordable cost. There shall be priority for the needs of the underprivileged,
sick, elderly, disabled, women, and children. The State shall endeavor to provide free medical care to paupers (Art. XIII, Sec.11)

Philippines ratified the following UN Conventions: ICESCR, CERD, CEDAW, CRC, CMW, and CRPD
The country was a signatory to the 1978 Alma Ata Declaration on Primary Health Care

RA 7875, 1995

Established the countrys social health insurance program, the National Health Insurance Program (NHIP), and Philhealth, the corporation
which manages the social health insurance program. Covers those who can pay monthly premiums or those groups subsidized by the
government. Philhealth assumed administration of health funds of OWWA in 2005.

RA 10606, 2013

National Health Care Act, amends the laws on Philhealth (RA 7875 and RA 9241): Health care insurance is compulsory at all levels in the
country and coverage extends to the poorest of the poor, persons with disabilities, women, children and provide health care services to
indigents.

Other laws

RA 10361 (Domestic Workers Act: Art. IV, Sec. 30) ; RA 10354, 2012 (Responsible Parenthood and Reproductive Health Act: Sec. 12
PhilHealth benefits for serious and life-threatening reproductive health conditions) ; RA 10645, 2014 (Expanded Senior Citizen Act,
amending RA 7432 stipulates mandatory Philhealth coverage for older persons) / meeting the Millennium Development Goals (2,3,4 and 7)

Implementation and coordination of UHC

Decentralized, privatized and / or subsidized by
governments and private sectors
Private sector
(hospitals, medical
centers, clinics) : inpatient and outpatient services
through private
healthcard (HMO),
Philhealth

Non-government
organizations,
charitable
institutions and
individuals,

Philhealth: usually in-patient

benefits (contributions from
formally employed (govt or
private) informally employed,
individuals through sponsored
programs, retirees, OFWs

Development aid,
funds from
international
financial institutions
(WB, IMF, ADB)

Poorest of
the poor

Social safety nets

(GSIS, SSS, DSWD
programs
(Conditional Cash
Transfers / PPP)

Local government units

(primary health care,
implementation of DOH
programs such as TBDOTS,
vaccinations, etc)

Department of Health (DOH): lead governing agency,

provides national policy direction, develops national
health plans, technical standards, and guidelines.
Manages tertiary hospitals (specialized, regional and
Metropolitan Manila hospitals)

Part of the
informal
sector

PEOPLE
Vulnerable
groups

Part of the
formal
sector

Challenges in the current UHC in the

Philippines
Access
Not everyone has or can access social health insurance. Existing barriers to coverage, particularly
for the vulnerable and informal sectors

Data
Difficulty in identifying the real poor. Identification rely on proxy indicators for family income

Political patronage
Issue of political poor, where individuals are covered by the sponsored program of the social
health insurance through incumbent politicians

Financing
Philhealth depends on premium payments (members contributions and reserve funds) and tax
subsidies (Sin Tax) that are still unsustainable. Out of pocket expenses of Filipino households are
56.3% (P296.5 billion) of the P526.3 billion in overall health expenditures (2013 data from PSA
National Statistical Coordination Board (NSCB).
Corruption, tax evasion and avoidance

Challenges in the current UHC in the

Philippines
Healthcare alone is inadequate unless socio-economic and political factors in
influencing health outcomes are given the same importance, i.e. social
determinants to health

WHO conceptual framework on social determinants to health

Promising practices in relation to

universal health coverage

The Universal Coverage Scheme of Thailand as an example depend on only 12

percent of payroll contributions of the countrys population and the rest is
financed using general government revenues.

Moldova has enhanced equity and reduced the burden of out-of-pocket

payments for all income groups through the pooled health budget (one third
from payroll contributions and two thirds from general tax revenue).

Recommendations
Compliance and implementation of recommendations of UN Treaty
Bodies (e.g. CESCR)
Among others: Increase national spending on social services such as housing, health, and education so as to progressively realize ESC
rights. ; Regularize the situation of persons working in the informal economy by ensuring adequate protection through existing labor
and welfare legislation. (2008 Concluding Observations of CESCR)
Consideration of the State party report on September 2016 at the 59th Session of the CESCR
Meeting the Sustainable
Development Goals
An opportunity to address social determinants of health

UHC should go beyond insurance

coverage
Breaking from the old model of social health insurance and learning from countries making progress in universal health coverage.

Revisit the Alma Ata Declaration

Strengthen primary health care that should be available, accessible, acceptable and of good quality.

References

___. Briefer on Philhealth. July 2014.

Committee on Economic, Social and Cultural Rights (CESCR). Concluding observations. E/C.12/PHL/CO/4. 02 Dec 2008.

National Economic and Development Authority (NEDA) and United Nations Development Programme (UNDP). The Philippines:
Fifth Progress Report Millennium Development Goals. http://www.neda.gov.ph/wp-content/uploads/2014/08/MDG-ProgressReport-5-Final.pdf Accessed 26 February 2016.

Office of the United Nations High Commissioner for Human Rights (OHCHR). Toolkit on the Right to Health.
http://www.ohchr.org/EN/Issues/ESCR/Pages/Health.aspx Accessed 24 February 2016.

Oxfam. Universal health coverage: Why health insurance schemes are leaving the poor behind. 176 Oxfam Briefing Paper. 9
October 2013. https://www.oxfam.org/sites/www.oxfam.org/files/bp176-universal-health-coverage-091013-en_.pdf Accessed
23 February 2016

Ordinario, Cai. Out-of-pocket health expenses of Filipino households reached P296.5 billion in 2013PSA. Business Mirror, 5
August 2015. http://www.businessmirror.com.ph/out-of-pocket-health-expenses-of-filipino-households-reached-p296-5-billionin-2013-psa/ Accessed 24 February 2016

Paterno, Ramon Pedro P. The Future of Universal Health Coverage: A Philippine Perspective. Global Health Governance,
Volume V1, No. 2 Summer 2013. http://blogs.shu.edu/ghg/files/2014/02/GHGJ_62_32-52_PATERNO.pdf Accessed 23 February
2016.

World Health Organization (WHO). Health and Human Rights Fact Sheet.
http://www.who.int/mediacentre/factsheets/fs323/en/. December 2015. Accessed 24 February 2016

World Health Organization (WHO). Anchoring universal health coverage in the right to health: What difference would it
make? Policy brief. 2015. http://apps.who.int/iris/bitstream/10665/199548/1/9789241509770_eng.pdf Accessed 23 February
2016

Thank you!

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