Keynote speech at UERMMMC Graduate School's 10th Foundation Day

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Keynote speech delivered by Senator Edgardo J. Angara during the Pearl (10th) Foundation Day of the University of the East Ramon Magsaysay Memorial Medical Center (UERMMMC) Graduate School

Angara Keynotes 10th Anniversary of UERM Grad School (August 12, 2011)Senator Edgardo J. Angara delivers the keynote address at the Convocation Programme for the 10th Anniversary of the University of the East-Ramon Magsaysay Memorial Medical Center’s (UERMMMC) graduate school.

Allow me to congratulate the deans, faculty, staff and students of the University of the East Ramon Magsaysay Memorial Medical Center Graduate School on your 10th founding anniversary.

Quality healthcare is a fundamental need of all societies. Unfortunately, in our society, those most in need of health services are denied of it. The Department of Health itself admits that poor Filipino families largely do not have access to critical health services.

Only 53 percent of Filipinos are covered by the National Health Insurance Program – and a considerable portion of them do not even belong to the poorest of the poor who need this coverage the most.

Furthermore, 892 rural health units and 99 government hospitals have yet to be accredited by PhilHealth, when majority of poor Filipinos turn to government facilities for medical attention.

Many of our rural health facilities are terribly understaffed, fueling more social inequities. To illustrate, only 41 percent of births in rural areas are attended by skilled health personnel against 79 percent in urban areas, according to the World Health Organization.

This situation leaves millions of Filipinos disenfranchised from quality, life-saving medical services. In fact, this puts the lives of millions of mothers and children in peril every year. We lose 162 mothers for every 100,000 who give birth. Furthermore, our infant mortality rate is 25 per 1,000 live births while the under-five mortality rate is 34. We will not likely meet our Millennium Development Goals targets in these areas.

A fundamental reason for this is inadequate investment. In 2007, the Philippines' total health expenditure relative to gross domestic product was 3.9 percent while the government's per capita expenditure on health during the same year was $45 (in purchasing power parity terms).

On the other hand these are the rates of investment in healthcare across Southeast Asia. Ours is among the lowest. [Refer to Table 1]

Clearly, we have to immense work to do to improve access to and delivery of health services – very basic elements of quality healthcare.

But while we repair the foundations of our healthcare system, we also have to start foraying into more advanced and cutting-edge areas of medical and health services that have the potential to dramatically improve the quality and span of life.

Our country's demographic statistics shows that the average lifespan has considerably lengthened over the last 50 years, without a doubt due to advancements in nutrition, public health and medicine.

While our population is relatively young, with a median age of 22.9 , we cannot overlook the fact that our population will continue to age though not at an alarming rate as in developed countries – at least not yet.

We do not have to wait for a crisis before we act. Now is the best time to capitalize on the so-called “demographic dividend ”. Changing age distribution results in having majority of a population in the productive labor force.

As of 2009, the segment of our population aged 15 to 64 has been at its highest ever. Trends show that this will continue, as probably will falling fertility and birth rates.

But these trends will not continue forever. This demographic transition provides a limited window of opportunity to maximize the benefits of a maturing population.

Advanced education

I believe health education – especially graduate health education anchored on research and development – will play a vital part in how the country will make the most out of this limited opportunity.

On the more basic needs, we would first have to increase access to quality healthcare. This means having more doctors and nurses serving the population, especially in the rural areas.

Of the estimated 2.77 million students enrolled in the tertiary and postgraduate levels in 2009-2010, only an estimated 395,000 went into medical and allied health services.

On average, the Philippines produces 10,000 nurses, 2,000 doctors and 1,500 midwives. Yet, our health workforce ratio to population still needs to be raised to be on par with the best in the region.

The country needs to address a number of challenges on planning human resource to ensure that the needs of society in terms of actual numbers, distribution and areas of specialization are satisfied.

First, enrollment in some programs, such as medicine, is decreasing while nursing programs are practically bursting at the seams. Currently, we have an oversupply of registered nurses, physical therapists, optometrists and occupational therapy. Meanwhile, we lack medical doctors, doctors of dental medicine, medical technologists and pharmacists.

One result is 287,000 unemployed nurses at present, scores of who troop to business process outsourcing centers where their skills are underutilized.

Second, schools' curricula are more instruction-oriented than research-oriented, more content-based than situation-based. Research, extension and postgraduate programs are not given enough priority.

Master of Science degrees emphasize research as the cornerstone of the program, but there are only a handful offered in the country.

UERMMMC Graduate School is one of the few institutions that do, with your MS in Internal Medicine, Nursing, Public Health, Health Science Education, and the notable MS in Asian Health Practices and in Tropical Medicine.

The University of the Philippines is another outstanding institution, having the only graduate school that offers MS in Surgery and Pediatrics. We need more institutions like UERMMMC and UP Manila to uphold both quality of instruction and research, especially in the top causes of morbidity and mortality in the country including tuberculosis, malaria, influenza, pneumonia, dengue, diabetes and diarrhea.

Third, is the pervasive brain drain. Many of our brightest medical professionals leave the country not only for greater compensation abroad, but better opportunities for higher learning and actual practice.

To illustrate, total graduate enrollment in the United States of temporary residents grew by 4.2 percent on average from 1999 to 2009 . Majority of these admissions come from China, India, South Korea and the Middle East. In 2009 alone, 7.4 percent – or about 10,500 – of total graduate enrollment in Health Sciences comprised of temporary residents.

We need to create more challenging and exciting opportunities for advanced learning, research and application to keep our health professionals here at home.

New frontiers

Many countries are pioneering in specialized areas of advanced learning and research.

Determined to be the biotechnology leader in Asia, if not the world, Singapore built Biopolis, an international R&D center in biomedical sciences, at a cost of SG$500 million.

The Taipei Medical University is now known as a leader in several specialized fields: neural injury and neuroregeneration, telehealth and stem cell imaging.

The United States is leading in nanomedicine through the Harvard University, as well as in neurosciences, embryonic stem cell lines and stem cell biology through the University of California.

The University of London excels in epidemiology, immunology, infectious diseases and vaccine research. Peru's Cayetano Heredia University is one of the world's top research institutions on tropical medicine.

Some countries are also going at it collaboratively. An example is Universitas 21, an international network of 23 leading research-intensive universities in fifteen countries . Collectively, the network has over 830,000 students and an annual research grant income of over US$4 billion. This is a great model of leveraging limited resources.


In one way or another, these specialized areas of health research will contribute to enhancing our quality of life, especially toward the future as our population matures.

The country's health curricula and R&D should pay special attention to continuous demographic transition. How do we ensure that health services will enable all segments of the population to be as productive as possible?

Aging is a multidimensional phenomenon that pertains to the body's accumulation of damage over time . It does not happen only to the elderly as we usually readily assume, only manifests among them most visibly.

We must not regard aging as inevitable and incapacitating. It is a biological process which we can cope with through intervention, treatment and therapy. Biotechnology, stem cell therapy and genomics will provide key solutions to enhance the body's ability self-repair and make the period of peak health longer – hence must be among the focus areas of graduate education.

Going toward the future, we must ensure that our strategies for quality healthcare cover both curative and preventive aspects. The goal should be to continuously find means to boost the well-being of all members of society, regardless of age. Health education, and its applications, must not only help uphold the right to live, but most importantly the right to live well.

Mabuhay ang UERMMMC Graduate School!

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