Nursing Shortage? Hire Nursing Graduates Who Failed the Board Exam!

New DOH Secretary Teddy Herbosa has sounded the alarm over the mass exodus of Philippine nurses abroad for better pay and working conditions. He says that if this issue is not addressed the number of nurses will be depleted within 3 - 5 years.

https://www.gmanetwork.com/news/topstories/nation/873429/herbosa-sees-ph-nurses-depleted-in-3-5-years-if-exodus-not-addressed/story/

Health Secretary Ted Herbosa said on Tuesday that the number of nurses working in the Philippines may be exhausted in a few years if the problem of them opting for better-paying jobs abroad is not addressed.

This is why, Herbosa said, he is pushing to grant temporary licenses to board-eligible nursing graduates and have them work as nurses in government hospitals.

He reiterated that 4,500 plantilla items for nurses are currently vacant in over 70 hospitals of the Department of Health (DOH) nationwide.

(That's why I'm focusing on it right now because if we don't do anything now, I can see that in a few more years, maybe three or five years, our nurses will run out. So I have to find a way to increase our nurses again.)

His immediate solution is certainly outside of the box, allow nursing grads who failed the board exams to be given temporary licenses. 

https://www.philstar.com/headlines/2023/06/20/2275114/government-hospitals-employ-nursing-grads-who-failed-board-exams

Nursing graduates who failed their board exam with scores between 70-74 percent will be employed in government hospitals, according to the Department of Health (DOH).  

“I will tap them, around 50 percent of those who took the board exam but did not pass – specifically those who achieved a 70-74 percent rating,” Health Secretary Teodoro Herbosa said in an interview at the DOH central office yesterday. 

The measure, supported by Labor Secretary Bienvenido Laguesma, will allow non-board passers to work in state hospitals under supervision and with temporary licenses. 

Non-board passers will be given four years to pass the Philippine Nurse Licensure Examination. 

After passing the board exam, they have to sign a four-year return service agreement and work in government hospitals before they are allowed to work abroad.

“The plan to hire unlicensed nursing graduates is because under the Universal Health Care, the core of any health system are nurses, that is why they are being pirated by other countries... They have the capability to build more hospitals so they would then be needing the services of more nurses,” he said. 

The private sector offered scholarships for the board review classes of unlicensed nursing graduates, Herbosa said. 

Rather than put a stop to foreign nations "pirating" Philippine nurses Herbosa thinks staffing government hospitals with failures will solve the problem. Several nursing groups are opposed to this idea for various reasons. 

https://www.gmanetwork.com/news/topstories/nation/873486/nurses-groups-oppose-plan-to-grant-temporary-licenses/story/

Several nurses organizations on Tuesday expressed disapproval on the proposal to issue temporary licenses to unlicensed nursing graduates to allow them to work in government hospitals.

Philippine Nurses Association (PNA) president Melvin Miranda said that Health Secretary Ted Herbosa should reconsider his plan to hire nursing graduates who scored 70-74% in the board exam even though they flunked, given that they retake and pass the board exam after a certain period of time.

(One of our doubts here is that it seems like those who scored 70-74% in the board exam who will be given a temporary license have a scope of practice that is not yet considered. Since they are not considered by our law to hold professional practice, the burden will fall on our registered nurses who have the accountability.)

Miranda stressed that their priority as nurses is the safety of their patients, thus the Department of Health (DOH) should give the plantilla positions to the professional nurses instead.

(If a nurse is recognized as licensed, his/her level of confidence and his/her competence will be compared to a professional. When we give temporary licenses, there is no definite study to prove that unlicensed nursing graduates have achieved a high level of confidence in performing their tasks.)

(I think this kind of situation is quite risky and should be given more thorough study.)

This was echoed by Filipino Nurses United (FNU) secretary general Jocelyn Andamo, saying that the DOH should focus on hiring registered nurses instead as there are around 120,000 of them who are not currently working in the field of nursing.

“FNU's stand is DOH should prioritize employing registered unemployed nurses or those working in non-nursing jobs. There are around 120,000 nurses categorized by DOH who are working in unspecified field of practice.These may be those unemployed and or those in non nursing jobs,” Andamo said in a message to GMA News Online.

She stressed that issues of nurses, particularly on salary and benefits, should be addressed by the government in order to keep them working in the Philippines.

“The wages should be increased to P50,000 entry salary, give them regular, permanent positions and provide adequate benefits,” she appealed.

So, there are around 120,000 unemployed nurses in the country? Why is that? Have they elected not to work due to the low pay and horrible wiring conditions or have they been unable to find someone willing to hire them? Why wouldn't Teddy tap this prime and ready workforce?

Several Senators have also turned thier thumbs down to this proposal. 

https://newsinfo.inquirer.net/1790966/senators-reject-doh-chiefs-plan-to-hire-nursing-board-flunkers

Several senators on Tuesday rejected Health Secretary Teodoro Herbosa’s plan to temporarily hire nursing board flunkers to address the dwindling number of nurses in government hospitals in the country.

Senate Minority Leader Aquilino Pimentel III said it would be better for the Department of Health (DOH) to institutionalize improvements in the salaries and benefits of state health workers instead of pursuing “Band-Aid solutions.”

“The proposal to allow non-board passers to practice nursing and grant them temporary licenses is a short-term solution,” Pimentel told reporters.

“The root causes of the shortage lie in the significant number of nurses leaving the country to seek higher-paying jobs abroad,” he noted.

It also expressed concern that such a move might compromise the quality of care provided to patients.

Pimentel said the proposal might also impact on the quality of the country’s nursing board exams.

“We have to protect the integrity of our testing system,” he said. “If they passed, that means they are ready (to become nurses). If they failed, then they are not yet ready… (The passing grade of) 75 means 75, not 74.5.”

Senators Nancy Binay and JV Ejercito shared Pimentel’s observations, with the latter pointing out that encouraging Filipino health professionals to stay in the country was one of the goals of the Universal Health Care Act.

“We cannot offer a genuine health care if there’s a shortage in healthcare workers,” Ejercito said. “If we can only give a (salary) raise that would be decent enough to sustain their family, (Filipino health workers) would choose to stay here.”

“The most practical thing to do is to prioritize the hiring of unemployed nurses,” Binay said.

It will compromise the quality of care and does not address the issue of nurses leaving the country. But when has the Senate ever addressed the OFW brain drain? 

One Solon appears to have found a working solution to this mess. A solution that makes Herbosa's plan conform to existing law. 

https://www.pna.gov.ph/articles/1204115

A House leader on Thursday proposed amending the Philippine Nursing Act (Republic Act 9173) with the creation of categories for nurse practitioners and nursing assistants who can lighten the workloads of registered nurses in medical facilities.

House Committee on Civil Service and Professional Regulation chairperson Alexie Tutor said the amendatory bill can be certified as urgent if the Department of Health (DOH) and Professional Regulation Commission (PRC) deem the nursing personnel shortage to be in "urgent crisis mode."

Tutor said DOH Secretary Teodoro Herbosa's plan to provide temporary licenses to nursing graduates who failed the mandatory board exam, but nearly passed with ratings of 70 percent to 74 percent has no basis in either the Philippine Nursing Act or the PRC Modernization Act (Republic Act 8981).

"Republic Act 9173 and RA 8981 do not provide for any circumstance or situation wherein either the Nursing Board or the PRC is authorized or empowered to issue any temporary license to practice the nursing profession. We are aware of no precedents for the issuance of temporary professional practice licenses," she said.

Tutor, however, pointed out that RA 9173 has a provision under Section 15 allowing those examinees to retake the exam for those subjects where they got ratings lower than 60 percent.

"Special examinations can be scheduled for those. This is one way for the DOH and PRC to achieve what they would like to happen: have more passers of the nursing boards," she said.

She also proposed that instead of hiring "near passers", the DOH should hire several unemployed passers of the nursing boards through filling up the vacancies for nurses of the DOH hospitals' plantilla items.

According to this Solon Teddy's plan is illegal as it is but he could adjust it to make it conform to the law. For his part the DOH Secretary says he would shelve his plan if it was found to be illegal. 

https://newsinfo.inquirer.net/1792631/doh-may-shelve-plan-to-hire-unlicensed-nurses

Health Secretary Teodoro Herbosa on Friday said he would consider shelving his plan of allowing unlicensed nursing graduates to work in public hospitals should it fail to hurdle the “legal roadblocks.”

At a press briefing, Herbosa pointed out that he would welcome other possible solutions to the understaffing of nurses in public hospitals, among them hiring board-eligible graduates as “nursing trainees” who would be put in a “training program.”

“I don’t want to do anything illegal … If an agency tells me it’s illegal, then it’s illegal… I can’t force the issue. But they (other agencies) are with me to find solutions,” he told reporters.

Section 21 of the Philippine Nursing Act allows the grant of a special or temporary permit for a limited period only to foreign nurses invited to the country for a program or medical mission.

This has been raised by the Philippine Board of Nursing, said Herbosa, and so he has proposed to some lawmakers that the law be amended to make the issuance of licenses to board flunkers possible.

“They told me, amendment is easy… but they said that the president has to make it urgent,” Herbosa said of his conversation with the Professional Regulation Commission. “That’s the legal side of the problem… I’ll leave it to the lawyers and legislators to help solve the problem,” he added.

Another option is the hiring of nursing assistants under the DOH’s human resources for health program. Under this position, Herbosa noted, unlicensed nursing graduates would be hired under Salary Grade9, equivalent to around P21,000.“It’s being offered as a solution, and that’s going to go forward. It will be open to graduates of college but [are] awaiting to pass exams,” he said. 

The big takeaway here is that DOH Secretary Teddy Herbosa has started a conversation. He has said the quiet part out loud, that the Philippines is bleeding nurses due to the OFW program, and he has offered a solution. It may not be a good or even legal solution but that can always be remedied and adjusted. When will the government stop lauding OFWs and recognize that they represent a massive brain drain which is detrimental to the nation?!

The Refusal of Marcos to Appoint a DOH Secretary is Unconscionable

In a brave and stunning move which highlights his complete ignorance and lack of care for Filipinos President Bongbong Marcos has revealed that he will not be appointing an official DOH Secretary until the COVID situation in the nation normalizes. But the fact that the COVID situation is NOT normalized is exactly why there needs to be an official DOH Secretary and not just an OIC. But it is not only COVID that is plaguing the nation. There is an ongoing health crisis which needs to be addressed immediately. 

Measles and rubella cases are up 153% this year. 

https://newsinfo.inquirer.net/1675842/measles-rubella-cases-up-153-doh

The Department of Health (DOH) has recorded a total of 450 measles and rubella cases so far this year, 153 percent higher than 2021.

The DOH released this data — covering the period Jan. 1 to Sept. 17 — on Wednesday, after earlier warning of an impending measles outbreak by 2023 if the vaccination coverage of children against the said virus does not improve.

Alarmed by the data, Albay Rep. Joey Salceda urged the government to take advantage of the resumption of in-person classes and vaccinate more schoolchildren in order to avert a possible measles outbreak by early 2023.In a statement, Salceda said the resumption of in-person classes is an “opportunity to expand vaccination” among schoolchildren.

He added: “In the long run, we need to build capacity for vaccinating against common diseases. That is one function that an institutionalized Center for Disease Control can boost.”

Salceda made the remarks after DOH officer in charge Maria Rosario Vergeire said the agency needs more funds to hire more vaccinators and improve vaccination coverage because over one million children missed their routine vaccines during the pandemic, including measles shots.

Measles cases alone are up 179%.

https://www.cnnphilippines.com/news/2022/10/13/PH-measles-cases-179--higher.html

The Department of Health (DOH) on Thursday reported a massive increase in measles cases in the country in September this year compared to the same period last year.

Latest DOH data showed there were 11 additional cases from Sept. 11 to 17, bringing the total to 413 as of Sept. 24. This posted a 179% increase compared to the same period last year where there were only 148 cases.

The DOH has warned there will be an outbreak by next year unless vaccination rates improve. 

Dengue cases are up 191%.

https://news.abs-cbn.com/news/10/14/22/doh-dengue-cases-up-191-pct-from-jan-1-oct-1

The Philippines has logged 173,233 dengue cases since the start of the year, which is 191 percent higher from the number of cases recorded in 2021, the Department of Health said Friday.

According to Dr. Alethea De Guzman, director of DOH's epidemiology bureau, dengue cases in the country started increasing in the third week of March.

"We peaked in the second week of July and now, we can see in the epidemic curve that the dengue cases have continued to decrease," she said in a press briefing.

From January 1 to October 1 last year, the Philippines had 59,514 dengue cases.

In the press briefing, De Guzman said dengue cases have also declined in all areas with declared outbreak, except Southern Leyte. These are Zamboanga City, Antique and Zamboanga Sibugay.

While dengue cases are now declining it is alarming that they rose so high in the first place and it is possible they could spike once more. 

Cholera cases are up 282%.

https://www.gmanetwork.com/news/topstories/nation/847670/philippines-cholera-cases-282-higher-this-year-at-3-729-says-doh/story/

A total of 3,729 cholera cases have been recorded in the country since January 2022, which is 282% higher compared to the data during the same period last year, the Department of Health (DOH) said Tuesday.

At a press conference, DOH officer-in-charge Maria Rosario Vergeire said that in 2022, there were only 976 cholera cases.

Vergeire said that the most common age group affected with cholera are children aged 5 to 9, primarily due to unsafe drinking water.

(We know that it is the rainy season now, there is a lot of flooding, a lot of people also go to evacuation centers. Because of calamities, our water systems are always affected, especially in these areas.)

(There are people who die because of cholera. If it is not cured, patients will suffer from severe dehydration, especially if they are immunocompromised or are vulnerable.)

Just as cholera is spread through dirty water so is diarrhea which remains a deadly problem throughout the Philippines.

https://mb.com.ph/2022/10/08/6-die-from-diarrhea-caused-by-bad-water-in-dumagat-tribe-in-quezon/

Six members of the Dumagat tribe here have died from diarrhea reportedly as a result of water contaminated after the onslaught of super typhoon “Karding.”

The Department of Health (DOH)-Calabarzon (Cavite, Laguna, Batangas, Rizal, and Quezon area) and the Integrated Provincial Health Office (IPHO) are investigating the outbreak that has affected a total of 38 individuals from Sept. 26 to Oct. 6 in Barangay Upper Lumutan.

“The DOH is saddened by what happened to our Dumagat natives where many have lost their lives because they were not immediately diagnosed and taken to our primary health care facility,” DOH-Region 4-A Director Ariel I. Valencia said.

“Rest assured that we are working closely with IPHO through our RESU to provide the necessary assistance in the affected barangay,” Valencia added.

Though these deaths may be related to the typhoon it is a fact that deadly diarrhea outbreaks remain a health concern in the Philippines. 

Last but not least infant mortality has increased. 

https://newsinfo.inquirer.net/1683444/psa-logs-higher-infant-mortality-rates-popcom-says-its-due-to-lack-of-healthcare-access

The Philippine Statistics Authority (PSA) logged a slight increase in infant mortality rate this year, which the population commission attributed to a lack of access to healthcare facilities due to the COVID-19 pandemic.

Based on the PSA data, the said number of fatalities classified under “other direct obstetric deaths,” has increased in the first six months of 2022 at 468 compared to 425 in the same period last year.

The said fatality rose in the ranking of causes of death from 44th in 2021 to 39th in 2022, according to PSA.

Commission on Population and Development (Popcom) officer in charge Lolito Tacardon said “this condition indicates an issue in accessing appropriate, quality, and timely services from healthcare facilities.”

“It poses the challenge to improve our local health system for emergency obstetric and newborn care, which was definitely affected during the pandemic.

“Our health system should now be slowly recovering from the deluge of cases caused by the pandemic to ensure adequate services for other health concerns such as those related to maternal, infant, and child health,” Tacardon also said.

That last sentence says it all. After two years the Philippines should be recovering and shifting its focus to ensuring normal, regular healthcare especially for maternal and infant health. An official DOH secretary is necessary to lead the charge and not merely an OIC. 

There is no justifiable excuse for Marcos to refrain from appointing a DOH Secretary until the COVID situation normalizes while the nation is plagued by many and very serious health problems. It is unconscionable and shows Marcos' callous indifference towards the very people who elected him president. 

Davao City Refuses to Enforce Health Ordinances

A recent diarrhea outbreak occurred in Davao killing six people and causing others to be hospitalized. The outbreak was traced to mishandling of food. 

https://www.pna.gov.ph/articles/1180656

The culprit of the diarrhea outbreak in Toril district here was due to food contamination, the City Health Office (CHO) said Friday.

“I announce that the diarrhea outbreak was due to a foodborne microorganism, with Vibrio cholera as the pathogen of concern. The most likely vehicle of transmission is contaminated food,” CHO acting chief Dr. Ashley Lopez said.

At least six infected persons died from the virus outbreak in Toril that began on July 15.

Lopez said a male patient was the latest fatality of the outbreak who died on July 24.

Rectal swabs done on the affected cases showed that 60 percent turned out positive in the bacteriological culture testing, he added.

Based on the CHO investigation, he said diarrhea patient cases have gone down to 217 cases as others that were previously recorded were not related to the outbreak.

Of the figure, 163 or 75 percent of the admitted cases have recovered.

“There are now only 11 individuals remaining, or 5 percent of the total affected cases in the hospitals being treated. Twenty-six cases were treated in the outpatient department of hospitals, while 11 other cases are still for verification,” he said.

Of all those infected, 41 percent had episodes of eating and drinking at food stalls in Rasay Street in Toril, while 21 percent of the cases ate and drank at the district’s public market.

The remaining 38 percent are from multiple sources but are statistically insignificant to be considered as exposure for cases.

“Based on investigations, food may have been contaminated during preparation and handling by infected handlers. It was also found that proper storage, delayed serving, and unsanitary environment may have contributed to the food contamination because of exposure to elements,” Lopez said.

Meanwhile, Toril Police Station Police chief Maj. Carol Jabagat said the city will not file any charges against the street vendors.  

However, a policy will be released that will serve as the guidelines for the food establishments, she said.

Six people are dead and hundreds of others have been incapacitated due to the mishandling of food and the PNP says the city will not filing charges against any of the vendors. However, Mayor Duterte is singing a different tune.

https://www.pna.gov.ph/articles/1180629

Mayor Sebastian “Baste” Duterte vowed to hold accountable the culprits behind the diarrhea outbreak in Toril District here that killed six people, saying the city may pursue charges.

“People have lost their lives just because of mishandling of food. I hope that you have put yourselves in the situation of the victims,” Duterte told reporters Thursday.

However, the mayor said he was disappointed by reports that families of the victims are not keen on pressing charges against the culprits.

“I told them if they decide to press charges, I will accompany them. However, the family said they would rather not,” he said.

“That is what I want,” he added when asked whether the city government will file charges instead.

Following the outbreak, Duterte said the local government will enforce additional policies for street food vendors before they are allowed to operate.

“I have already tasked the barangays and CHO to coordinate. Having a health card is only one of the requirements, there will be more. We cannot allow this to happen again. It is unacceptable,” he said.

Based on investigations, food may have been contaminated during preparation and handling.

It was also found that proper storage, delayed serving, and an unsanitary environment may have contributed to the food contamination because of exposure to elements.

By all means the city should charge these vendors for violating existing health ordinances. That Duterte asked the victims if they wanted to press charges is beside the point. It does not matter what the victims want. These vendors did not follow existing ordinances and six people are dead as a result. Did the Mayor ask the deceased victims if they wanted to press charges? What good is having laws if the city will not punish those who violate them? Once again this situation shows how ultimately the Philippines is a lawless nation. 

Universal Healthcare is a Fake Duterte Accomplishment

In these last few weeks of the Duterte administration the public is being treated to a hagiography of Rodrigo Duterte. Specifically Duterte's men keep repeating a list of his accomplishments. One of these accomplishments is universal health care. 

https://newsinfo.inquirer.net/1604050/2-day-legacy-summit-wraps-up-duterte-admin-achievements

One month before President Rodrigo Duterte steps down from office, members of his Cabinet and other government officials gather on Monday for a two-day summit showcasing his administration’s achievements and accomplishments that changed the lives of Filipinos.

The “Duterte Legacy Summit” at the Philippine International Convention Center (PICC) in Pasay City wraps up a two-year information drive by the Presidential Communications Operations Office (PCOO), through its Office of the Global Media and Public Affairs.

The summit features some of the “realized” key campaign promises of the Duterte administration such as the Universal Health Care Law and Malasakit Center, Universal Access to Quality Tertiary Education, Bangsamoro Organic Law, the anti-illegal drugs campaign and migrant workers’ protection.

But wait a minute. It turns out that universal health care was not actually realized under the Duterte administration.

https://www.philstar.com/headlines/2022/05/10/2180167/next-admin-should-focus-implementation-universal-health-care-doh

The Department of Health said the next administration should focus on the implementation of the Universal Health Care Act, which seeks to expand people’s access to health services.

In a briefing, Health Undersecretary Maria Rosario Vergeire said the agency will brief President Rodrigo Duterte’s successor on its strategies for the implementation of the UHC Act, which was signed into law in 2019.  

(When the pandemic started, what we were doing for UHC was temporarily delayed. But it became an opportunity for all of us. We realized toward the end that what we're doing during the pandemic were all attuned to the implementation strategies of UHC.)

The department will also provide the country’s next leaders with its plans for moving forward from the pandemic which is “to live with the virus.”

Universal health care was signed into law but never implemented? Then how did online cockfighting fund it?

https://www.pna.gov.ph/articles/1170051

President Rodrigo Roa Duterte on Thursday said e-sabong or online cockfighting in the country contributes to revenue that can be used to fund the government’s Universal Health Care (UHC) program.

In a speech in Palo, Leyte, Duterte reiterated that the government has earned over PHP640 million monthly since January from the online gambling activity.

“E-sabong gives the government PHP642 million a month. In one year, it gives the government billions,” he said.

Aside from providing funding for hospitals and medicine, he said revenues generated from e-sabong can also be used for education and infrastructure.

Duterte said temporarily closing down the businesses of operators without any violations would be unfair.

“It's not the fault of the management...it's the fault of evil men doing something wrong,” he added.

It did not. Not only was universal healthcare not implemented but the taxes from online cockfighting were never collected. 

https://mb.com.ph/2022/03/21/bir-pagcor-failed-to-get-taxes-from-e-sabong-operations-tolentino/

Senator Francis Tolentino on Monday, March 21 chided the Bureau of Internal Revenue (BIR) and the Philippine Amusement and Gaming Corporation (PAGCOR) for allegedly failing to withhold the 20 percent tax from the winning profits of online cockfighting (“e-sabong”) operations.

“(It appears that the government doesn’t receive any taxes from the e-sabong industry, unlike, listen BIR, in sweepstakes winnings. In Lotto operations, they get taxes when one wins, right? Even in horse winning. But why is there no tax being taken from e-sabong?)” Tolentino asked during a Senate inquiry on the mysterious disappearances of 34 cockfighting aficionados.

The lawmaker also found that the government earnings from the e-sabong industry, which has been operating for about two years, only came from the regulatory fee being collected by PAGCOR from license operators on every match. A regulatory fee costs only P12,500 per match or “sultada”.

“We are in a state of disarray by letting go of a big amount that should have gone to the coffers of government and used as ‘ayuda’ for drivers, farmers and fisherfolks,” Tolentino said after also finding out that some e-sabong operations only remitted a scant amount of fee from the billions of pesos they would earn monthly.

What more needs to be said? Universal health care was neither implemented nor funded during Duterte's term. He signed the bill on February 20, 2019 which means there was plenty of time between then and now to implement the law. But it was not done. That makes universal healthcare a fake Duterte accomplishment. 

The Philippines' Diarrhea Pandemic

Another village in the Philippines has declared a diarrhea outbreak.

https://www.pna.gov.ph/articles/1147405

Sto. Tomas, Davao del Norte Mayor Ernesto Evangelista declared a diarrhea outbreak in Barangay Tulalian on Friday. 

In a statement on Saturday, the Municipal Information Office (MIO) said the declaration was due to the death of a resident while 47 others were confined in various public and private hospitals. 

As of Saturday, the Municipal Health Office said the fatality is a 58-year-old male resident who experienced loose bowel movement, stomach pain, and vomiting. 

“The 47 residents were rushed to both private and public hospitals; some are still recovering while others were discharged,” the MIO said. 

Charlemagne Fernandez, MHO administrator, said the local government unit (LGU) and the MHO began their investigation to determine the cause of the outbreak. 

“But the Environment Sanitation Report from the MHO revealed that the water system source in the area was possibly contaminated because of the water’s poor quality due to poor chlorine disinfection. Such finding was based on the ocular inspection conducted by the Sanitation Team and random interviews with the Tulalian Water Association (TUWASA) personnel,” the MIO said. 

Lapiña said the Sto. Tomas LGU provided potable water, installed a makeshift treatment facility in Barangay Tulalian covered court, meals, and other medical support to patients complaining of severe diarrhea. 

The town also provided new water containers and water-purification chemicals to the affected areas while residents have been briefed about cleaning their surroundings and maintaining proper sanitation to prevent another outbreak. 

“We will continue to monitor the patients to make sure they were all safe,” Lapiña said. 

To avoid future outbreaks, Lapiña urged the officials of Barangay Tulalian to sit down with TUWASA to discuss how to improve the water supply in the barangay. 

She added that the town is available to guide and improve water services delivery in the area.

How many diarrhea outbreaks is that this year so far? If the government thinks shutting down the entire economy and forcing people to follow burdensome and unscientific health protocols like wearing face shields and face masks because of a virus with an official survival rate of 97% is acceptable then why not do the same for the diarrhea pandemic which has been gripping this nation for decades?

Just how serious is the diarrhea pandemic? To assess that we will have to review the available statistics. Oddly enough the statistics compiled by the DOH and PSA do not agree with one another.

First, let's look at the available stats for 2016, 2017, 2018, and 2019. These statistics are whats available on the DOH's official website. 

2016:

2016

14,487 cases with 52 deaths.

2017:

2017

17,768 cases with 48 deaths.

2018:

2018

17,906 cases with 20 deaths.

2019:

2019

11,594 cases with 14 deaths.

Perhaps you cannot tell but this data is not complete. What is being recorded here is not all diarrhea cases and deaths but only those related to Acute Bloody Diarrhea which is not the same as regular or Acute Watery diarrhea. The DOH has a different publication which gives the details for both types of diarrhea. The stats for 2018 do not match the above stats from 2018.

The total number of Acute bloody diarrhea cases for 2018 is 30,886.

pg. 366

For acute watery diarrhea the number is much higher.

pg.391

The would bring the total number of diarrhea cases in the Philippines for 2018 to 164,446 which is much higher than in the DOH's other official figures. What accounts for this discrepancy?

It is not so easy to find hard data on the diarrhea situation in the Philippines. For instance, in 2008 the WHO and UNICEF released a report noting that 10,000 children in the Philippines die each year from diarrhea.

https://www.gmanetwork.com/news/news/nation/119921/diarrhea-kills-10-000-pinoy-kids-every-year-who/story/

Over 70,000 Filipino children have died of diarrhea in span of seven years, the World Health Organization (WHO) said in a study released Friday. In its study which it co-conducted with the Department of Health and United Nations Children Emergency Fund (UNICEF), WHO said this figure makes diarrhea the fourth leading cause of deaths among children less than five years old and the third leading cause of illness among the children. The study showed that if the trend continues, it is expected to cause 10,000 deaths every year.

Try as I might I cannot find this study. It appears WHO and UNICEF deleted it from the web. Perhaps if this news article had given the name of the study and a link I could manage to find something. The only official reference I can find is on the web archive.

http://web.archive.org/web/20100430085500/https://www.unicef.org/philippines/mediacentre_10168.html

In the country, diarrhea is the 3rd leading cause of child illness and the 4th leading cause of deaths among children less than 5 years. It is estimated to cause 12% or almost 10,000 deaths a year. A 2004 UNICEF assisted study on the prevalence of soil transmitted helminthes, estimates that almost 70% of pre schoolchildren are host to at least one type of intestinal helminth infection and that  7 out of 10 children (aged 3-12) suffer from intestinal worms. 

I had to find this on the web archive because otherwise it is now a dead link. Strangely enough this dead linked article is cited in a textbook about the Philippines.

Diarrhea causes the death of about 10,000 Filipino children every year. It is the third leading came of illness among the children. The ratio of diarrhea cases in the Philippines is almost double the figure for other Southeast Asian countries such as Vietnam, Malaysia, Laos or Cambodia. 10-20%—or 1.5 million children—under the age of five suffer from diarrhea. A 2004 UNICEF study shows that 70% of children aged 3-12 suffer from intestinal worms.

The Philippine Archipelago, Yves Boquet, pg. 141

The source for that paragraph is the UNICEF article quoted above and not the actual studies from 2004 or 2008. It is pretty odd that a text book would quote a press release as an authoritative source rather than an official study because in the context of the book there are many surveys cited to confirm what the author has written.

Let's take another look at official statistics on diarrhea deaths from the PSA. The most current report is from 2017.

pg. 50

4,039 deaths

2016:

pg. 51

4,801 deaths

The statistics from 2006-2015 are all laid out in one convenient table put together by the PSA. Diarrhea is the 18th cause of death in this time period.

pg. 1

We are given separate totals for both male and female deaths but I will only give the totals for each year.

2006: 4,390

2007: 3,989

2008: 4,306

2009: 4,572

2010: 3,708

2011: 4,199

2012: 3,970

2013: 3,273

2014: 3,313

2015: 3,675

That is 39,395 deaths from diarrhea over a ten year period.

Let's go back a little further and see all the statistics since the year 2000.

Going back 21 years to 2000 the annual death rate was not much different.

pg. 212

4,015 dead from diarrhea in the year 2000.

4,200 dead in 2001.  Pg. 116 of the report.

3,684 dead in 2002. Pg. 116 of the report.

3,135 dead in 2003. Pg. 123 of the report.

3,538 dead in 2004. Pg. 132 of the report.

3,982 dead in 2005. Pg. 133 of the report.

According to the PSA from 2000-2017 there were 66,589 deaths which is an average of 3,699 dead every year from diarrhea. 

So, what can be done to fight the diarrhea pandemic? The government has many solutions laid on the table. Making sure everyone has proper toilets is a big goal.

https://www.unicef.org/philippines/press-releases/department-health-100-toilet-coverage-possible-2022

“Our target is 100 percent coverage by 2022. Let us not wait till 2022. Nothing is stopping us to achieve this earlier than planned,” Duque said, citing his agency’s National Sustainable Sanitation Plan. 

According to the Joint Monitoring Programme for Water Supply, Sanitation and Hygiene of the World Health Organization and the United Nations Children’s Fund (UNICEF), approximately six percent of Filipinos, mostly in rural areas, still do not have sanitary toilets, as of 2015. 

“When people living in our communities defecate in the open, in fields and waterways, our children will more likely experience frequent bouts of diarrhea, have worm infections, and grow up stunted and undernourished,” said UNICEF Philippines country representative Lotta Sylwander. 

Eliminating open defecation by 2022 is one of the goals of the Philippine Health Agenda. “But giving away toilets alone will not solve our problem,” said Duque. 

To address this, the Department of Health (DOH) is implementing the Zero Open Defecation Program (ZODP). The ZODP utilizes the approaches and strategies of Community-Led Total Sanitation (CLTS). CLTS is under the umbrella concept of total sanitation that includes a range of behaviours such as stopping open defecation practices; ensuring that everyone uses a sanitary toilet, washes hands properly, handles food and water in a hygienic manner; and disposing animal and domestic waste safely to create a clean and safe environment. 

“Achieving zero open defecation is not easy. Households and communities need to be aware and prepared. We cannot just give toilets for free. All our efforts will be for naught if families are not willing to invest their time and resources in building and maintaining their own toilet facilities,” said Duque. 

According to DOH, eradicating open defecation and setting up the safe management of sanitation requires a shift in the use of approaches. This shift will include collective behavior change, strong supply chains and improved public services. Across these steps is a need for public regulation of behavior compliance, improvement of infrastructure and services of individuals, collectives and corporations.

Stopping open defecation is a major goal of the DOH and an important step in eradicating the scourge of diarrhea. But if families do not use those toilets properly then their efforts are pointless. What the public can do is practice basic hygiene like washing their hands. This has in fact lead to the decrease of diseases since the COVID-19 pandemic began. 

https://www.pna.gov.ph/articles/1130632

In its disease surveillance report, DOH data showed that from Jan. 1-30, influenza-like cases dropped to 69 as compared to the 678 -- a 130 percent decrease -- recorded in the same period last year; typhoid and paratyphoid cases with 29 cases from 266; and dengue with 35 cases from 251. 

The three illnesses logged the highest number of cases last year. 

Other illnesses, including viral hepatitis B and C, bacterial meningitis, non-neonatal tetanus, leptospirosis, and acute bloody diarrhea also logged decreases in cases during the first month of this year. 

Only one measles case was recorded in January as compared to the 106 in the same month last year. 

Dr. Ruby Constantino, DOH regional director, attributed the decrease in the number of illnesses to the observance of health protocols. 

“The practice to prevent getting infected with Covid-19 applies to other diseases. Iwas lamok, paglilinis ng paligid at ng katawan (avoid being bitten by mosquitos, cleaning of the environment and our bodies) is also protecting us from acquiring other diseases,” Constantino said.

Washing ones hands and keeping their environment clean is an obvious way to prevent disease but not everyone knows this. Just as important as proper toilets and sanitation are to preventing diarrhea outbreaks is having clean water. But what can people do when the water supply controlled by the city is tainted? 

https://www.pna.gov.ph/articles/1147931

The Sto. Tomas Municipal Health Office (MHO), in a statement, said they found E. coli bacteria in the village's water system which is run by the Tulalian Water Association (TUWASA), a private water service provider in the said village.

E. coli or coliform is bacteria that can be found in human or animal waste and causes diarrhea/bloody diarrhea, vomiting and stomach pains, and cramps.

“For now, we discouraged the residents from drinking water if it is not purified or boiled for about 20 minutes in order for the bacteria to die,” Lim said. As of July 21, the MHO recorded another 27 diarrhea cases.

In the Philippines it is better to never drink water from the tap.  

There is no single solution to this problem. The eradication of diarrhea as a cause of death in the Philippines will take a multifaceted approach involving both the public and the government. Seeing as the problem has persisted for decades there is likely no ending this pandemic anytime soon.