COA 2008 report shows PGH is severly underequipped and lacks essential personnel

By Chanda Shahani

The University of the Philippines (U.P.) Philippine General Hospital's (PGH) inadequate government budgetary allocation for human resources and state of the art equipment may adversely affect its goal of becoming one of the best national university hospitals in Asia, and achieving International Organization for Standardization (ISO) 9001:2000 Certification, a 2008 report of the Commission on Audit (COA) shows.

With an annual budget of PhP 1.3 billion, which is PhP 1.7 billion short of the PhP 3 billion COA says PGH needs to attain ISO certification, and to operate effectively as a world-class government hospital, both PGH and the U.P. Administration may need to raise revenues through effective profit-making schemes and also addressing issues of financial mismanagement that only serve to take away badly-needed pesos that should go, by law, to the medical personnel of PGH.

The 2008 CAAR quotes the PGH service mandate which says that:

“PGH exists because, in health, we are our brother’s keepers. With a “Tatak PGH” manner of treating our patients, we ensure that all patients understand their conditions and are able to participate in their own treatments. We have 19 clinical departments, which with their attached units, offer excellent facilities for the delivery of comprehensive care for both healthy and sick Filipinos, especially the poor and marginalized, seeking specialty and subspecialty care.”

But while acknowledging this vision, the 2008 CAAR also scores the U.P. Administration for tis failure to observe Section 2 of the Magna Carta of Public Health Workers (Republic Act No. 7305) which says that:

“The State shall instil health consciousness among our people to effectively carry out the health programs and projects of the government essential for the growth and health of the nation. Towards this end, this Act aims: (a) to promote and improve the social and economic well-being of the health workers, their living and working conditions and terms of employment; (b) to develop their skills and capabilities in order that they will be more responsive and better equipped to deliver health projects and programs; and (c) to encourage those with proper qualifications and excellent abilities to join and remain in government service.”

“Among the benefits/allowances granted to public health workers under Section 20 of this Act are hazard allowance which is equivalent to at least 25 percent of the monthly basic salary of health workers receiving salary grade 19 and below, and 5 percent for those with salary grade 20 and above, subsistence allowance, longevity pay, laundry allowance and remote assignment allowance. Under Section 38 thereof, the DBM shall provide the funding requirements.”

“The Hospital is equipped with human resources of the best minds and talents of the land as most of these are graduates of the University of the Philippines. However, it needs adequate financial resources for procurement of the state of the art medical equipment and improvement of facilities to attain its goal of becoming one of the best national university hospitals in Asia and achieve the ISO 9001:2000 Certification. As well as, for PGH Management to be able to pay fully lawful incentives/compensation to its working force.”

In 2008, the PGH served a total of 560,218 patients. Of this total, 49,340 were admitted in Charity Wards, 14,274 in Pay Wards and the remaining 496,604 were outpatients.

However, PGH could not fully maximize its potentials in delivering the state of the art service as it faced inadequacies in order to achieve its mandate such as:

• Lack of some 69 units of Medical, Laboratory and Dental Equipment worth P274.55 million.
• The nurse to patient ratio in Charity Wards and Operating Rooms is 200 percent lower than the Department of Health (DOH) Standards.
• As per computation made by the Nursing Services, the Hospital needs 244 additional Nurse II positions for various wards/units.
• 844 Nurses are still under salary grade 15, despite the fact that Section 32 of Republic Act No. 9173 otherwise known as “The Philippine Nursing Act of 1991” provides that: “In order to enhance the general welfare, commitment to service and professionalism of nurses, the minimum base pay of nurses working in the public health institutions shall not be lower than salary grade 15 prescribed under Republic Act No. 6758, otherwise known as the “Compensation and Classification Act of 1989.”

However, the PGH administration said that it made attempts to address the issues by engaging in the following:

• To augment its Medical Staff, the Hospital conducted Fellowship Training for 176 Fellows in 2008. The Fellows will conduct clinical research, clinical trials and experiments without compensation or allowance for a period ranging from one year to three years as these fellows render services “Pro-Bono.”
• Though, there were attempts of management to secure funds for these Fellows since 2004, it was only in that stipends were provided for the incoming post – residency fellowship (subspecialty) program trainees/service providers across clinical departments who lack extramural support. The UP Board of Regents granted the request of PGH to borrow from the PGH – SEF the amount of P8 million, which shall be incorporated in the 2009 Internal Operating Budget of the Hospital. The subspecialty trainees are needed by PGH to sustain and advance its leadership, research and manpower resource development role in highly specialized cutting edge medical fields as the country’s National University Hospital.
• The P8 Million additional expense for Fellows stipend plus the accumulated unbooked and unpaid obligations of the Hospital for MERALCO of P119 million for CYs 2007-2008, and Maynilad of P36 million for 2008 will already require additional appropriation of at least P163 million for MOOE.
• The incomplete payment of Hazard Allowances of the Medical Staff existed since the budgetary allocation for the full implementation of the Magna Carta for Health Workers was not enough. According to the Deputy Director for Fiscal Services, the Hospital requires additional P70 million annually to fully implement the Magna Carta of Public Health Workers. Presently, a portion of the amount utilized came from the savings from personal services due to the delay in the filling – up of 176 vacant positions in the Health Operations.
• The Management thru the UP System consistently requested the DBM to provide enough funds for the Hospital’s operations by submitting realistic Budget Proposals and for the release of the 20 percent Discounts given to Senior Citizens as mandated under Republic Act No. 9257 totaling P 94,093,335.70 from CY 2005 to 2008, but to no avail.
• The U.P. PGH Executive Director Dr. carmelo Alfiler issued Memorandum Order No. 2009 - 02 a Call for Intensified “Iwas Waldas”,“Dagdag Kita” and “Magmalasakit, PGH Muna” with the donations received thru the efforts of the PGH Medical Foundation as one of the comprehensive measures which requires the Offices of Administration, Fiscal Services, Health Operations and Nursing to rationalize manpower resources with particular emphasis on multi-skilling and multi-tasking.
• Releases of funds by the DBM and the Hospitals income were not enough to sustain operations and to implement fully the payment of mandatory allowances for its personnel. Its income from Hospital operations is not even enough to pay the expenses of the University such as the janitorial, security, waste disposals, emergency medications and dietary allocations of the charity patients.
• There was also a minimal increase in its appropriations despite the factors, such as inflation and rising prices of commodities as shown below:

To augment its meager resources and shortfalls of income, the UP-PGH embarked on strategies such as engagement of a supplier to be an Exclusive Distributor of laboratory equipment provided that reagents and consumables are procured from them, resulting in increased of Hospital and Laboratory Fees ranging from three percent to as much as 47 percent for the last five years and Tie –up or Profit Sharing Agreement with suppliers for the rental of Laboratory and Medical Equipment.

As part of the U.P. Administration's desperate gambit to increase revenue for PGH, it entered into a contract with DMMC

COA, However recommended that the U.P. Administration make a strong and persistent representation with the Department of Budget and Management for the approval of the proposed Budget and the Actual Personnel Requirements of the Hospital including the release of the 20 percent senior citizens discounts totaling P94,093,335.70 and raise more funds to augment government subsidy by intensifying collections of accounts receivables; and creating more income in generating projects in line with the Hospital’s mandate.

The U.P. PGH replied to COA that PGH is requesting for the approval of the budget that will adequately provide for the needs of the hospital for its predominantly charity clientele. Despite representations with the Congress and DBM at various levels of budget approval, the budget that is approved is still inadequate.

They also replied that the Budget and the Human Resources Divisions will prepare the updated Detailed Comparative Statement of Budgetary Allocation and the present personnel requirement of the Hospital. The collection of account receivables is a regular thrust of the Hospital. The UP BOR approved the hiring of the services of a collection agency to help the hospital collect from the defaulting payors/patients with long outstanding accounts.

The COA report said that UP System officials commented that, “in its annual budget request to the DBM, UP Management always includes the budgetary amount requested by UPM-PGH as submitted by the unit. However, DBM does not grant the budget request of UP in full, including the line budget for PGH. At present, UPM-PGH already receives roughly one-fourth of the total budget granted to UP. This allotment is bigger than the budget allocation that other UP campuses receive, with the exception of UP Diliman. The budget of the UP System already constitutes 30 percent of the total budget of the SUCs. For this, it will be difficult for PGH to have an increase in budget without affecting the budget of other State Universities and Colleges.”

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Editor's note:

To readers who would like to make a financial contribution or otherwise volunteer to help PGH's official foundation; which would help close PGH's budget gap which is necessary to acquire state-of-the-art and basic equipment and address compensation needs for their understaffed medical personnel, please click
on this link: http://www.pghmedfoundation.com/