Women's Challenges in Universal Health Care

About halfway through the establishment of Kalusugang Pangkalahatan (Universal Health Care or UHC) as the Aquino Health Agenda, we have seen massive efforts to increase PhilHealth enrollments and enhance benefits for Filipinos belonging in the lowest income quintiles.

Private sector participation seeks to help address the remaining gaps and inequities in health care access by looking at unreached disadvantaged sectors such as the workers in informal sector who cannot be classified as poorest of the poor yet, are disempowered from accessing basic health services.

In my work at a foundation that helps said disadvantaged segment obtain sustainable access to quality health care through PhilHealth memberships, I came to realize that economically-disadvantaged women have yet to hurdle some challenges to a more inclusive health care system.

A Disconnect between Case Rates and Access

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In 2011, the PhilHealth released Special Benefits Packages, including case rates payments covering several cases for women such as maternity packages, mastectomy, dilatation and curettage, among others, and no balance billing (NBB). Under NBB, "no other fees shall be charged or paid for by PhilHealth patients beyond the identified case rates." (PhilHealth)

While these enhancements in member benefits are beneficial for women, the problem is they are not accessible to some, if not many. This situation prevents PhilHealth from fully realizing its intentions.

"Complicated Relationships"

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So what makes access still an issue for women?

Due to gender roles, men are often the ones who register as PhilHealth members -- especially when they sign up as paying members. In many cases, men in marginalized communities grapple with PhilHealth's documentary requirements. The only way they can include their partners as qualified dependents is if they can produce photocopies of marriage contracts. Sad to say that often, there are none.

It is true that among the poor, common marriages are rampant. Local government units seek to address this through kasalang bayans (mass weddings) but even so, "complicated relationships" where men live with a new partner or support more than just one family put women at a disadvantage.

PhilHealth should find a way to ease their documentary requirements or open opportunities for women to be part of its inclusive health agenda.

Windows of Opportunity

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PhilHealth and partners should find inspiration in pursuing initiatives to bring in women not only as qualified dependents of the working men, but also as registered members.

Studies show that women as homemakers are efficient domestic financial planners, indicating their ability to save for their own PhilHealth premium payments. Aside from this, they can take active roles in increasing awareness on PhilHealth benefits and availment procedures within their respective communities while their husbands are working and when their children are at school.

There is still plenty of time to make women count in UHC if we can already start now.

Random Thought # 1: Disposable Relationships

Romantic relationships are disposable these days, I told a friend over chat this evening. There's annulment, divorce, legal/physical separation, and clean break ups, and dirty ones. Sometimes, people just drop one another like hot potatoes.



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A Malala in All of Us

"Because education is a powerful thing," answered Angelina Jolie when asked by her children why Taliban men attempted to kill Malala Yousafzai, a 14 year-old schoolgirl who started a movement for girls' education in Pakistan.

The story of Malala is both shocking and inspiring even for Filipinos who face immense challenges in achieving quality education for all. On the surface, Taliban restrictions on girls' education that usually resort to violence seem totally alien. However, there are other forms of gender-based oppression that set aside girls in many family decisions regarding education. These forms of oppression need not be inflicted by the usual suspects - men; there are far bigger causes such as culture, economics, and environment, which men alone cannot be blamed for.

In the absence of statistical information, we can refer to commonly shared stories of poor families where the male children are given priority in education out of the notion that they will be the ones to take their families out of poverty while the girls are destined to become mere homemakers anyway. Hence, girls are made to stay at home to take care of younger siblings, do household chores, and fetch water from distant springs or wells. Girls' vulnerability to violence and lack of access to clean, working toilets also contribute to high dropout and low enrollment rates. (Many may not realize how important toilets are for girls in their puberty!)

News of Malala's recovery certainly mean more opportunities to further her advocacy as she lives to tell her tale. We look forward to the day when men and women play equitable roles in all societies across the globe because they both have equal access to education.



Worth reading:

1. We All Are Malala by Angelina Jolie in The Daily Beast.
2. Malala and the Women of Malolos by Prof. Ambeth Ocampo in The Philippine Daily Inquirer.
3. Malala Yousafzai: Portrait of the girl blogger in BBC News