We, the Coalition for Health Budget Increase (CHBI), composed of unions, chapters and individual health workers in the public and private sectors, community-based health organizations, health professionals and students nationwide are deeply concerned on the proposed 2024 health budget. We are requesting your good office and committee to review and increase the minuscule allocation of the 2024 Proposed Department of Health (DOH) budget, government-owned and controlled corporations (GOCC) hospitals and the Philippine General Hospital (PGH) budget.

We were hoping that the pronouncement of President Ferdinand Marcos Jr. during his budget message that, “following the lessons from the COVID-19 pandemic, health has become a top priority of this administration” will reflect on the proposed 2024 health budget.

At closer scrutiny, the meager 2023 health budget was cut further for 2024 thereby, the condition of health workers, patients and the general population concerning the delivery of public health services will further suffer as shown in the following data:

1. Cuts on direct services for the people

• The P1.7 billion cutbacks on budget of the MOOE of the four specialty hospitals will deprive many indigent patients their much needed specialized health services. Specialty hospitals are vital in providing specialized medical care to patients with lung, kidney, heart, and pediatric conditions.

• Philippine Heart Center (PHC) a premier cardiovascular institute is facing a budget cut of P316 million. This reduction in funding could have a detrimental impact on the hospital’s ability to provide high-quality cardiac care including surgeries interventions and specialized treatments. Meaning, at least 785 patients will be deprived of coronary heart bypass surgeries.  In fact, according to the 2023 data of Philippine Statistics Authority (PSA), heart disease is the leading cause of mortality in the Philippines. Thus, it can be considered as public health emergency.

• The National Kidney and Transplant Institute (NKTI) a leading center for kidney and transplant procedures is facing a substantial budget cut of P442 million. This reduction of budget could affect the efficiency and accessibility of services for patients who are in need of kidney transplants or dialysis treatment.  Meaning, there are at least 295 patients who will be deprived of kidney transplant and other initial medication.  And as per the data of NKTI, chronic kidney disease is the seventh leading cause of death in the Philippines. 

• The Philippine Children’s Medical Center (PCMC) a specialized hospital for pediatric care is also facing a significant budget cut of P720 million. This decrease in funding could severely impact the hospital’s ability to provide specialized care to children including treatment for complex medical conditions and surgeries.

• The Lung Center of the Philippines (LCP) a specialized hospital for lung and other chest diseases face a budget cut of P274 million. This reduction in funding could lead to serious impact on the hospital’s ability to provide adequate medical services and interventions to patients with respiratory conditions. Based on the latest WHO data published in 2020, lung disease deaths in PH reached 32,559 or 4.83% of total deaths and the age adjusted death rate is 51.31 per 100,000 of population that ranks the Philippines #14 in the world.

• The P842.4 million cut on the MOOE and MAIP of UP-PGH will only make the long line of patients at the emergency and outpatient department longer and will eventually lead to more deaths.

• P10.37 billion cut on the MAIP under DOH
• P1.03 billion cut on the Prevention and Control of Communicable Diseases
• P1.18 billion cut on the Prevention and Control of Non-Communicable diseases
• P78.19 million cut on the National Referral Laboratories and Operations of Blood Centers
• P35,233,000 billion cut on Family Health, Immunization, Nutrition, and Responsible Parenting
• P173,743,000 billion cut on Operations of National and Sub-National Reference Laboratories
• Inadequate budget increase for Rehabilitative Health Care Sub-Program. Except for NCR, Regions I, III, IV-A, V, VII, X, and XIII, the rest of the regions have only 1 regional public rehabilitation center. The meager budget of P1,581,127,000 for 2024 is only P14 per Filipino.

• Understaffing of health workers leading to long hours of work, migration and promoting contractualization will be aggravated thereby the delivery of quality services will greatly have affected.

• 19,850 remain unfilled positions under Office of the Secretary – DOH
• 685 unfilled positions at the Lung Center, 385 unfilled positions at PCMC
• 22,674 doctors, nurses, and other health professionals under the National Human Resources for Health Workforce Support Program deployed to underprivileged areas where there are no Municipal Health Offices are cut by 3,361 and they are also called contractual health workers.
• Personnel Services (PS) category of the 14 DOH hospitals were cut while a slight increase in the MOOE of the 69 DOH hospitals means that plantilla positions are being cut down and contractualization will be increased.

• There is no provision for the year 2024 budget for the salary increase of the health workers ‘modern-day heroes’ who serve wholeheartedly during the pandemic and until now. While commodities and utilities are continuously increasing.

• The purchase of drugs, medicines and vaccines which is centralized at the DOH amounting to P27.907 billion for 2024 is yearly being flagged by Commission on Audit for medicines, drugs and vaccines being expired which amounts to over P7 billion while a large population at the regions remain unvaccinated and no drugs and medicines available at the public hospitals’ pharmacies.

We stand firm that the budget for the year 2024 for Purchase and Allocation of Drugs, Medicines and Vaccines amounting to P27.907 billion must be directly allocated to the Maintenance and Other Operating Expenses (MOOE) of the 69 DOH hospitals, so as not to lead to misuse and corruption of people’s money and the people themselves can avail the free medicines in public hospital.

• While Philhealth is increased by P1.2 billion from 2023 budget of 100 billion to 101.5 billion on the proposed 2024 health budget. According to the 2022 Philippine National Health Accounts (PNHA), Philhealth which is touted as a purchaser of health services, only covered 13.6% share in the Total Health Expenditure.

The data mentioned above only shows that there is a miniscule and misprioritized health budget and not grounded on the needs of the people and care for health workers wellbeing.

Our Stand:

The proposed 2024 health budget does not reflect what President Marcos Jr. said. It only deprives the people of the much-needed public health services. Inadequate hospital allotment – are killing our poor patients and making our health workers further overworked and underpaid. While, giving premium on Philhealth and cutting allotment on direct services on preventive health to tertiary hospitals will only lead to the privatization of health services amidst extreme economic crisis.

In addition, not addressing understaffing and promoting contractualization instead of mass hiring of regular health workers in public hospitals will lead to the massive migration of our health workers and leads to the closure of the public hospitals.

Hence, we reiterate our appeal to legislators:

1. Restore the P13,993,972,000 budget cut from the DOH- Office of the Secretary (P10.169 billion, P1.7 billion MOOE fund of the GOCC hospitals and UP-PGH (2.071 billion).
2. Restore the budget cut of the Personnel Services of the 14 DOH hospitals.
3. Allot P10 billion budget increase for Philippine General Hospital. Double the proposed MOOE for the 69 DOH hospitals to P38,914,986,000.
4. Double the MOOE of the GOCC hospitals for these are the subsidy of the indigent patients to P13,489,116,000.
5. Restore the cut budget for communicable diseases amounting to P1.03 billion and for non-communicable diseases amounting to P1.18 billion.
6. Hire regular personnel. Stop contractualization at the health department. Health workers are vital and essential to health services. This is a violation of the constitution.  Fill up the 19,850 vacant positions at the DOH or convert them to doctor, nurse and other health workers’ positions in direct patient care.
7. Regularize the 22,674 doctors, nurses and other health workers who are serving at the underserved areas.
8. Increase to P33,000 entry salary of Salary Grade 1 health workers.
9. Increase entry salary of nurses to P50,000. Fully implement SG 15 for Nurse 1 to include nurses at Local Government Units.
10. Hire additional 42,066 permanent nurses and 42,066 midwives for 42,066 barangays. Hire additional 100,000 permanent nurses for 100 hospitals nationwide.
11. Philhealth budget amounting to P101.5 billion should be re-allocated to the 69 DOH hospitals for direct services to ensure free, accessible and quality health services to the general public.
12. The budget for Purchase and Allocation of Drugs, Medicines and Vaccines amounting to P27.907 billion must be directly allocated to the Maintenance and Other Operating Expenses (MOOE) of the 69 DOH hospitals. 
13. Other benefits such as Collective Negotiations Agreement Incentive for public health workers amounting to P25,000 should be appropriated in the General Appropriations Act and its provision should not be subject to hospital or agency’s savings.
14. Release promptly the Health Emergency Allowance of health workers in public, private and local government units from 2021-2023.
15. Restore cuts and double the budget for Family Health, Immunization, Nutrition, and Responsible Parenting, Operations of National and Sub-National Reference Laboratories, Rehabilitative Health Care Sub-Program and other items
16. Realign the budget of confidential and intelligence fund to public health services that would have a more significant and better serve the interests of the Filipino people.
17. Defund NTF-ELCAC. Realign its budget to public hospitals.
18. Enact House Bill 208 or the “Free National Public Health System Act”.

We hope that our honorable legislators will provide careful review and attention to these matters and we look forward for your favorable stand for the good of the majority of the Filipino people and your constituents.

CHBI | 25 September 2023

The Council for Health and Development and the Coalition for People’s Right to Health are members of CHBI.