I should start off by greeting you a Happy Halloween; a rather apt greeting since you haven’t heard from me for so long. Rise, delinquent blogger, rise from your slumber. Rise from the grave and type again.
It’s been raining hard since last night, the perfect Halloween weather. My cat has been snuggling with me in bed the past few weeks—the chilly “winter” months in Batanes are coming in soon, which they say get colder than Baguio. In Egyptian lore, cats are said to be the guardians of the underworld, the servants of the goddess Isis, if I’m not mistaken. With my cat around, ghosts and ghouls become the least of my worries—actually, more practical, earthbound concerns come to mind, like:
a) how will my clothes dry in this wet season?
b) What hot meals can I place in my menu during cold days?
c) I’ve to replace the sand in the litter box, or my cat will make a mess inside the house…
Indeed, a lot of things have changed about how I view things, having stayed in Batanes for over two months. Months ago, I never would have thought I would ever spend a weekend tidying up the house, ironing clothes and experimenting with cooking (currently my favorite hobby), and enjoy these activities altogether. Maybe in this respect a freaky Halloween thought comes to mind: the sloppy college graduate who can’t even make his own bed was bodysnatched during the 2 months he was away, his soul replaced by a complete hausfrau.
Which is why I purposefully leave a couple of things untidy around the house: an unmade bed on Monday, a deskfull of unsorted clutter on Tuesday, the bathroom tiles unscrubbed on Wednesday; token reassurance that the old me hadn’t fully slipped away. (I know Cuads will sleep a little better because of this.)
With all the chores done and two free days indoors (it’s still raining outside) and my hands itching to write (to Gail: yes, I do miss writing after all), I’ll try to update you with the events spanning between my last post and now. Which accounts for a lot: Batanes sightseeing, my 22nd birthday spent away from home, the Arbeiterwohlfart German evaluation, the Inter-Local Health Zone study tour in Capiz (plus, the Boracay sojourn), seeing dear friends and a loved one in Manila, then a couple of fiestas here and there. Now, where to start? I recall an old philo term, abstractio, which means I will have to mince and dice this bulk of experience in digestible bite-sized pieces—not an easy task, but I hope to tell you as much as I can in a couple of posts during this long weekend.
The wind and rain is raging outside. The cat is on my lap, dozing. A music CD turns in the DVD drive of the laptop, and steam swirls from a hot cup of coffee. Time to write.
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The most popular (and the most basic) FAQ when I get in touch with people is: what exactly do you do there anyway? If you had asked me this a few months ago, I’d probably quip: “Bakasyon,” in an effort to hide how clueless I was in this area. My officemates mention that I was extremely quiet during my first few weeks in Batanes; at the time, I was admittedly a Socrates (translation: walang alam) in my position as a Communication & Information Officer of HealthDev Institute. Imagine the irony: the communication & information officer who was clueless and didn’t talk much.
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HealthDev Institute is a non-government organization focused with aiding poverty stricken groups, particularly the workers sector, by making quality health services accessible to them. For the Ateneans, you’ve probably seen our main office which is located in the CCS complex opposite the ISO. Feel free to drop by and ask about our NGO. This very office started out with outpatient services for labor groups (Ateneo employees too, if I’m not mistaken), charging socialized fees, of course. HealthDev celebrated it’s 15th anniversary last October 5, having grown through an expansion of projects funded by the German NGO, Arbeiterwohlfart (AWO), which translates to “Worker’s Welfare Association” (this was a tongue-twister for me during the first weeks, with the “w” read as “v”, to boot). One of the projects is a water sanitation system in Rizal, and the other is the social health insurance (SHI) project in Batanes. The SHI is the one I’m currently part of, and the feature presentation of this thread.
As a backgrounder, provincial health systems used to be organized under the national government, under the Department of Health. Back then everything used to be free; meaning if you got sick, your medical fees, from hospitalization, medicines and consultation fees were covered by the government. This all changed when the devolution in the set-up of health services occurred, with the coming of the Local Government Code of 1991, where, as our college PolSci units would remind us, the systems of governance will be localized under the LGUs, which also includes the health .
Under this set-up, LGUs with limited budgets can no longer provide completely free health services for its constituents. It devised a system of income classification where the A & B classes will be paying for most if not all of their health expenditures, while C, D and E will be aided by the LGUs, the percentage of coverage depending on the income and capability of the individual to pay for his own medical costs. To further help constituents shoulder these costs, a national health insurance program (NHIP) was also implemented through the Philippine Health Insurance Corporation (PhilHealth), with the goals of universal coverage (for the employed readers, you will notice that apart from taxes deducted from our salaries, employees like you and I are mandated by law to pay for PhilHealth policies ourselves). The principle of insurance is that you get a certain protection from unforeseen risks(it can be fire, car or life insurance, depending on what kind you get; in our case it is health insurance) by paying a certain premium to save up an emergency event. Your house burns down, you have fire insurance to rebuild your home. Nabangga ka, may pang ayos ka ng kotse. You get sick, you’ll have money for the hospital; this is what our Medicard does for us.
Even with these laws, many Filipinos still cannot afford health services. With the hot-air balloon of inflation, the cost of services and medicines are going up, and with the crisis, it’s obvious we don’t have much funds to go around the LGUs. Masalimuot pag-usapan to, dahil maraming aspeto ang pinanggagalingan ng suliranin; you have issues like overpopulation, imperialism, and not to mention a questionable system of governance to point fingers at. However, I did say I was going to go into this in abstractio so I will try to move into the subject matter(at this point I’ve been hearing a lot of yawns from what I expect to be a bored audience. I will have to apologize for the lengthy preamble to the topic of “what exactly does Mark do in Batanes” because a) I can’t explain what I do without getting into this; and b) I like explaining this, so sit through this lecture whether you like it or not hmph! In any case you can always scroll down and pretend you read it. Try to stay with me though. Don’t worry, we’ll get there soon.)
For another, despite its goal of universal coverage, PhilHealth covers only the formal sector—the formally employed. Because it uses employment as a means of implementation, it can’t reach the informal sector which are the self-employed workers, those with their own businesses, those who run stores and shops, the farmers and the fishermen, and the contractual or casual workers who rarely get health benefits in their compensation package. Furthermore, this informal sector who rely on seasonal harvests, catches and jobs have unstable incomes which cannot sustain the regular premiums (payments) of health insurance policies. In the province of Batanes, over 40% are in the informal sector. It is ironic that those in the more hazardous of occupations are the ones who are unprotected by health insurance.
This is where HealthDev comes in. Funded by AWO and in partnership with the Provincial Government of Batanes, a social health insurance project was launched in 2003, dubbed Kapanidungan sa Kalusugan, or KsK. KsK didn’t pop up out of nowhere, of course. Ordinances and Memorandums of Agreement had to be created between the LGUs and the health units to form a cooperation to be able to start an SHI program. The target market of this product, which is the informal sector, should be able to afford KsK premiums, hence the term ‘socialized’. Also, you’d have to imagine the resistance people will have towards the concept of paying for ones health when health services used to be given for free, much less, pay for health insurance. Eventually, in June 2003 though, KsK was launched and for the past 2 years, has enjoyed support from the local government and a stable membership of 1,500 households.
How does KsK work? In the event of a family member falling ill, a typical family would shell out P1,000-P3,000 for hospitalization. Which is why most of them seek cheaper, but less reliable sources of treatments. The chilling fact is that during the cold “winter” Batanes months, some children still die of cold.
Insurance uses the idea of risk pooling, which means members pool together contributions; whenever one of them gets sick, money will be available. This idea may seem like a difficult concept to introduce, but it isn’t so with Ivatan culture. They have what they call kapanidungan, which is the Batanes term for community solidarity, or our version of bayanihan. Activities like cogon roof thatching and setting(something I haven’t helped out in yet but look forward to experiencing), funerals and fishing in Batanes are events where the whole community participate and share in the work.
Members contribute an amount of P92 a month, or P1,080 a year, and get inpatient benefits of (pertains to hospitalization costs) P5,000 and outpatient benefits (dental, x-ray, consultation and medicines) of P500. In this way, they’re protected from unexpected out-of-pocket expenses brought about by illnesses.
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Nyarky, heavy. I hope you’re still with me. I finally get to the meat of the meal: what exactly do I do here?
Answer: Wala. Bakasyon.
Joke lang. Read on, mehn.
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HealthDev doesn’t run the KsK program; in fact, we’re just here to help set it up, and to ensure its sustainability through administrative, financial and operations monitoring, quality assurance, and marketing support and human resource training and capacitation.
KsK runs on its own, managed and run by the Provincial Health Office (PHO), which is situated in Agan Building, a ten-minute walk from my house in Diptan. Downstairs, we have the Provincial Health Clinic run by Dr. Nicolas, the Provincial Health Officer I in Batanes, and upstairs we have the KsK Office, which is shared by Healthdev Institute.
There are 5 of us in the Healthdev SHI Project Team:
Gary is Project Coordinator, who is my semblance of a boss here in Batanes. I say semblance since he’s hardly a boss to me. Off work we’re both tenors in the Dominican Youth Choir in the Basco Cathedral, and like me he lives alone in a house near the beach. He’s very passionate about work and rather OC around the office. Sometimes we discuss books (I borrow his when my own stock has run out), Tostoy’s work, or Kundera’s, or Ivatan cuture, though most of the time our conversations fall into an academic dissection of plots and character development of GMA-7’s Encantadia, something we’re both into. He’s the only other ipula or non-Ivatan in the project team besides me. He’s a UP Nursing grad, with credits in post-grad Community Building (something I think of getting into myself in the near future).
Rory is our Quality Assurance and Liaison Officer. She studies quality health systems and helps create measures to ensure that quality healthcare is being delivered in the provincial health units. After all, it isn’t enough that we are able to give Ivatan households access to healthcare through a socialized financing mechanism like KsK; it must be ensured that the services their getting are up to DOH standards. She’s a UPLB graduate and a mother of one hyperactive kid named Timon. I consider her a source of emotional support in the office (she complements Gary, who is more technical in nature), and quite a source of gossip as well. She and her husband Chico have a very interesting and practical methodology of bringing up Timon, which I try to pick up on, although marriage and kids isn’t something I plan to get into in the near future *shudder*. Bata pa ako…
There’s Jhona (yep, there’s an ‘H’ there) and Mao, both administrative assistants. Jhona handles financial disbursements and minutes of the meetings while Mao pretty much handles everything else: from repairs in the minicab to a killer encoding job (I’ll get to that later).
Mao is a father of two, and has a knack for entrepreneurship. He’s got a part time job with HealthDev, and millions of tiny businesses: raising pigs, roasting pigs, running a bakeshop (I’ve always wanted to sit in and learn a bit of baking myself, but never had the time) among many other things. I get practical information from him, easy recipes to cook, Ivatan terms (sometimes the profane ones, too), drinking tips, drinking songs and snatches of stories involving the shady side of Ivatan life.
And then there’s me. I’m the Communications and Information Officer of the HealthDev SHI Project, tasked with a chopsuey of a job, which falls into 3 categories:
a) Knowledge Management
Under this tab, I’m tasked with the design and editing of the KsK quarterly newsletter, the Kapanidungan, as well as the maintenance of the website (which I plan to renovate this November). Though I’m the last person any of my friends and family would consider to be OC and systematic (astrological sources say that Virgos are obsessively neat and orderly though) I had to assume that role when I tackled the office library, categorizing, alphabetizing, encoding it in a database and tabbing them with ID tags, since my job scope includes that, as well.
I’ve also given you a taste of my position as process documentor of the project—I have to capture the project methodologies of the SHI system and write them into a coherent thesis, so it can be replicated by other institutions. This requires me to understand the project workings as a whole and in their distinctive parts, or else magiging chopsuey ang isusulat ko. Which is where a skill of abstractio becomes rather useful.
b) Social Marketing Support
I work with the KsK Marketing Officer in this area, Auntie Fely. Together we conduct trainings to capacitate our partners, the Baranggay Health Workers (BHWs) in Marketing and Customer Sensitivity through our Rejuvenation Trainings. This, perhaps is the most exciting part of my job scope since it’ll squeeze your people skills out of you. You also have no idea what kind of things turn up during GD’s and games, which facilitate.
Every Friday, from 10-11am, Auntie Fel and I drive up to the Radyo ng Bayan Station (government owned, and the only station in Batanes you can pick up a coherent station from, unless you’re into Taiwanese, Korean, Australian, Japanese, or even German AM channels) up in the hills to run a radio show, the “KsK Hour”. I write the weekly script and run the controls (I swear I’d nearly collapsed during my first day out of nervousness), and arbitrarily play the songs I like during breaks in our discussions. Listeners are used to sappy (Bryan Adams) or novelty (the usual sexbomb deal) songs played over the radio, but during our show I try to bring them back to the classic Beatles and decent 90’s OPM, and here and there I try to insert a bit of Norah Jones and Alanis Morisette. Pretty soon, I’ll be able to soften their tastes up to tolerate my Cynthia Alexander, Sarah Mclachlan and Aimee Mann CDs, you’ll see.
c) Research
Probably my toughest work so far, since I had to learn Microsoft Access and my rudimentary database design to create an encoding system for our household surveys, which numbers to about 1500. We have to have a grasp of our membership demographic to come up with stats that can help us with our financial and marketing operations. At first it was tough, since I was locked into doing the work on my own (some nights found me sleeping in the office), but things became a bit better now that Mao has taken over. As of last Friday our total has reached 1,000 surveys (“Isanlibog!” he screams), which means we only have 500 to go. An actuarial firm is coming mid-November to assess our data and our encoding program, and we’ll see how our work in this area will measure up.
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You can see I’m pretty happy where I am right now. I’ve found myself quite attached to the project and the people running it, and the people who are benefiting from it. I even dream about KsK, sometimes.
Two months in Batanes and running three. Not bad. There’s still more things to learn, people to meet, places to see, and stories to tell. Try to hang with me a bit more, and I’ll take you along for the ride.
Final Halloween thought: If this is the kind of experience you get when somebody snatches your body and brings you to a strange, faraway place, then try getting bodysnatched yourself. You’ll lose a bit of your old self, but gain much, much more.
(Even with a socialized fee, however, a lot of households still can’t afford their KsK insurance. As I’ve mentioned earlier, the income of the informal sector here isn’t very stable. If you guys are committed to sponsor a family or two, your help will be most welcome. With less than a hundred pesos a month, you can give a family a year’s worth of protection. Tell me if you’re interested and I’ll hook you up with KsK, or log on to the KsK website at http://committed.to/kapanidungan for more details)
