SRH and HIV/AIDS Linkages at Policies, Programmes and Service ...

life-threatening reproductive healthconditions such as HIV and AIDS,breast and reproductive tract cancersand obstetric complications shall begiven the maximum benefits as providedby Philhealth programmes.”A nascent initiative by Philhealthwill soon provide coverage for thepurchase of ARVs. Essential sexual andreproductive health commodities thatare related to HIV and family planning,such as contraceptives like condoms,are proposed to be included in theNational Drug Formulary and in theregular purchase of essential medicinesand supplies of all national and localhospitals and other government healthunits. However, publicly fundedcontraceptives and supplies haveexperienced cutbacks since 2004.Provision of budgetary support toRH and family planning has largelycome from Congress through the socalledbudgetary insertions. ’Budgetaryinsertions’ are largely done throughthe initiative of certain supportivelegislators who manage to add a specificamount to a particular budget itembeing proposed by a department duringappropriations hearings to approvethe budget proposed by the ExecutiveBranch. In 2008, 150 million pesos (~US$ 3.5M) was ’inserted’ by Congressfor family planning and was releasedby the Department of Budget andManagement (DBM). In 2008, 1.2billion pesos (~US$28M) was again’inserted’ for family planning but it wasnever released by the administrationof President Arroyo. In 2009, 410million pesos (~ US$9.5M) wasadded by Congress and its statusof implementation in 2010 is stillunknown.Philhealth is mandated to providefinancing for universal healthcare,including reproductive health, familyplanning and HIV.It is supposed to provide coverage toall Filipinos and augment coverage toinclude the poor through the sponsoredprogramme.This programme subsidises socialinsurance payments by the poorthrough co-financing by the NationalGovernment and local governmentunits (LGUs). But through the years,Philhealth has been hobbled byseveral problems, including a) unstablesponsorship financing for the poor, b)setting of financing limits especially forserious and catastrophic cases, and c)disease or case exclusion.Firstly, flaws were noted in theenrollment of the poor and indigentsbecause of patronage politics. Politicians’favorites were being enrolled instead ofthe real poor. Secondly, there is an upperlimit on all case types being coveredby Philhealth giving rise to huge outof-pocketexpenses for poor patients.Thirdly, it is only recently that certainSRH and HIV-related cases havebegun to be covered and the processis very slow. In relation to the equityissue pertaining to future coverage ofthe poor for SRH, family planningand HIV needs, only 4.5 billion pesos(~ US$105M) was proposed by thenational government for the SponsoredProgram in the 2011 budget, whereasin the 2010 budget was 5.5 billionpesos (~ US$ 128M). In all of these,107