Republic of the Philippines - Secretary of Health

1 1 Republic of the Philippines Located in south-eastern Asia, the Philippine archipelago (projected population million in 2008)1 lies between the Philippine Sea and the South China Sea and encompasses 300,000 square kilometres of land and water. Although the 7,107 islands are favourably placed in relation to south-eastern Asia's main water bodies, they are located in the typhoon belt and affected by cyclonic storms each year. The Republic of the Philippines is divided into 81 provinces with 136 cities. Manila (population million)2 is the capital and the surrounding National Capital Region of Metropolitan Manila (population at least 11 million)3 is the country s political, economic and social centre.

2 The United Nations Human Development Index ranks Philippines 90 out of 177 countries worldwide (value ). This places the Philippines in the group of countries with medium human According to the 4-part typology developed by the International Observatory on End of Life Care, the Philippines is categorised as a country in Group 3: that is, with localised palliative care 2 Palliative care service provision Current services In the Philippines , 34 organisations provide 108 hospice and palliative care services (Table 1).

3 Alongside these providers, a wide range of groups give compassionate care to the dying. Table 1 Palliative care provision in the Philippines The Philippines : Hospice-palliative care organisations Freestanding unit Hospital unit Hospital Inpatient support Consultancy Home care Day care Clinic Counselling Psychosocial support Total AKBAY Inc, Cagayan de Oro 1 1 Buena Vista Verde Caring Centre, Cebu 1 1 1 3 Alay Kapwa Kilusang Pankalusugan (AKAP) 1 1 Aruga, Jose Reyes Memorial Medical Centre, Manila 1 1 Ayala Alabang Hospice Care Foundation 1 1 2 Bigkis ng Tayabas Inc, Quezon 1 1 Central Luzon Pain Management and Hospice Care Centre 1 1 1 1 1 5 Children s Hospice of the Philippines Foundation, Manila 1 1 Cradle of Hope: James L Gordon Memorial Hospital 1 1 De La Salle Hospice Care Programme 1 1 2 Disciples of Hope, Naga 1 1 2 Far Eastern University.

4 Nicanor Reyes Medical Foundation 1 1 1 1 1 1 6 Francis Regis Clet House and Pain Clinic, Mother Seton Hospital 1 1 1 3 Iloilo Mission Hospital: Pain and Palliative Care Clinic 1 1 1 3 Madre de Amor Hospice Foundation, Laguna 1 1 1 3 Kythe Inc 9 9 PALCARE Volunteer Group, Manila 1 1 1 1 4 PALCARE/ JIREH 1 1 1 1 4 Palliative Care Centre, Cebu Cancer Institute, perpetual Succour Hospital 1 1 1 1 1 1 6 Philippine Cancer Society 1 1 Philippine Children s Medical Centre.

5 Hospice Care Programme 1 1 1 1 4 Quezon-Lucena Cancer Society Hospice HCP 1 1 Remedios AIDS Foundation 1 1 1 1 1 1 1 7 Ramon Aboitz Cancer Foundation, Cebu 1 1 1 3 Rizal Medical Centre, Pasig 1 1 San Lazaro Hospital for Infectious Diseases: Starfish Programme 1 1 1 3 SM Foundation Inc Quezon City General Hospital 1 1 St Ignatius Hospice Foundation, Cagayan de Oro 1 1 Smiles Support Ng May K, Davao 1 1 3 The movement towards palliative and hospice services in the Philippines began in the 1980s and took a significant step forward when pain relief became incorporated into the government s Cancer Control Programme in 1990.

6 The following year, the Philippine Cancer Society founded the first home care programme and offered support to other interested groups. Seventeen years later, 34 hospice-palliative care organisations provide end of life care to needy members of the Philippine population. Two features figure prominently. First, is the range of settings under which palliative care is given. In the Philippines , less than 40% of hospitals belong to the government and many of the private hospitals achieve a level of investment which the government cannot match.

7 As a result, patients with money are attracted to private care; those who are poor gravitate towards government facilities. Some public hospitals provide whatever they can free of charge; others have pay wards alongside charity wards. As both public and private hospitals offer palliative and hospice care, a range of services inpatient, outpatient and home care may be accessed by patients on a pay or charity status. Alternatively, the community-based hospice organisations usually make free-of-charge provision for patients who are admitted to their programmes.

8 Second, is the perception of hospice and palliative care . Although these expressions are sometimes thought to be coterminous, palliative care in the Philippines has a sharp focus on pain control - reflecting its historical links with the Pain Society of the Philippines - whereas hospice care has a strong association with dying and support for the bereaved. So hospice care may be offered as a discrete element of a hospital-based palliative care service (as found at The Medical City) or as a dedicated programme offered by a community-based NGO.

9 Yet the message is clear. Madre de Amor Hospice Foundation is dedicated to the care and comfort of the dying 6 and the Manila-based Palcare Volunteer Group receives patients where death is foreseeable in 28 to 48 hours .7 Caring for patients who are close to death, particularly over long periods or where two or more people are dying simultaneously, places special demands on the people involved. Nurse Nancy Legaspi is a member of the Starfish Project at San Lazaro Hospital for Infectious Diseases and comments: Sometimes there are two or three dying patients; but I remember the starfish [story]8 and have checked for one patient at a time.

10 I know that my time is The Medical City Cancer Centre, Pasig: Palliative Care Service 1 1 1 1 1 1 6 University of Santo Tomas Hospital Hospice, Manila 1 1 1 1 4 University of the Philippines -Philippine General Hospital: Supportive, Palliative and Hospice Care Programme 1 1 1 1 1 1 6 University of the Philippines -Philippine General Hospital: Munting Paraiso 1 1 1 1 4 Vineyard Medical Foundation, Cagayan de Oro 1 1 2 Western Visayas Medical Centre, Iloilo.