Primary Health Care in the Philippines
DAVID R. PHILLIPS
The Philippines has in the past displayed many of the indices typical of Third World countries: poverty, imbalances in income distribution, urban primacy, dependence on primary products, dependence on overseas aid and multinationals, militarism and, above all, poor health and low life expectancy ( 1, 2, 3, 4). The health situation probably improved in the 1980s, although the general economic situation, if anything, worsened ( 5, 6). International confidence in the Marcos government and economy was low, although it improved somewhat after the Aquino takeover in February 1986. The Philippines, to a far greater extent than any other economy in this part of Asia, experienced sluggish performance and even negative growth in gross national product (GNP) in 1984-1985 ( 7). However, because of ideological and organizational changes in the delivery of health care, and particularly the emphasis on primary health care (PHC), health is perhaps one of the few sectors showing much dynamism in the country, even if the practical results to date may not be fully evident.
Traditionally, the country's economy has been heavily dependent on agriculture, especially rice, corn, copra, sugar, bananas and pineapples ( 8, 9). Other primary products include mineral exports such as copper and manganese, while an effort has been made to develop food processing and manufacturing. The effort in manufacturing has been particularly through the medium of export-processing zones, though with relatively little success ( 10). Average incomes are low, and the distribution of incomes is markedly skewed. Estimates suggest that, in 1979,