Challenges to Proper Hygiene and Sanitation
THE World Health Organization (WHO) and Department of Health (DOH) strongly recommend handwashing with soap and water for at least 20 seconds as a basic precautionary measure against the spread of infectious diseases. However, available data from the 2018 FHSIS reveal precarious coverage of safe water supply and basic sanitation facilities among some households in the region. While 9 in 10 homes have access to improved safe water supply, there are about 22,573 (17 percent) and 29,266 (12 percent) households in Bukidnon and Lanao del Norte, respectively, who do not have any access to safe water supply.
Households which lack proper sanitation facilities (i.e. toilet or latrine) are also vulnerable should an outbreak occur. Proper sanitation promotes proper waste disposal, the absence of which, may contaminate the environment and, hence, increase the risk of spreading infectious diseases in the community. Based on the 2018 FHSIS report, 34 percent of households in Northern Mindanao lack complete basic sanitation facilities, amounting to 334,877 households at risk of contracting various diseases.
The provinces with the poorest coverage of basic sanitation facilities are also among those with the highest poverty incidence in the region. For instance, the Philippine Statistics Authority estimates about 730,000 (28 percent) individuals in Bukidnon who have a per capita income that is not sufficient in meeting their basic food and non-food needs. According to the 2018 FHSIS, there is a dearth in basic sanitation facilities in nearly half of total households in the entire province. In Lanao del Norte wherein an estimated 276,000 (26 percent ) Filipinos are poor, 83 percent of 133,670 households lack the resources for proper sanitation. This amounts to 110,889 households with no facilities for proper waste disposal and may be at greater risk of infection.
Table 1. Percentage distribution of households with access to improved safe water supply and complete basic sanitation facilities, by province/highly urbanized city: Region X, 2018 FHSIS.
Population Change amid a Fragile Healthcare System
The previous decades have witnessed significant changes in the size and density of Northern Mindanao. Although its population growth rate (PGR) since the 1980s have been steadily declining, Cagayan de Oro (CDO) City-a first-class highly urbanized city-remains Northern Mindanao's fastest growing administrative region. Its household population grew from 461,877 in 2000 to 675,950 in 2015, corresponding to a 2.5 percent increase during this period. This growth is considerably more rapid than the rest of the province of Misamis Oriental, whose household population grew by only 1.9 percent during the same period.
Aside from its high population growth rate, CDO is also the most densely populated area in the region. It has a population density of 1,637 persons per square kilometer, which is 12 percent higher than its population density of 1,459 persons per square kilometer in 2010. This figure is more than five times higher than the population density of 220 persons per square kilometer at the regional level.
Excluding its capital Iligan City, the province of Lanao del Norte closely follows CDO in terms of size and density. Based on the latest census, its household population grew from 473,062 people in 2000 to 676,395 people in 2015. While Iligan City remains more densely populated with 421 persons per square kilometer than the rest of Lanao del Norte, whose population density grew to 202 persons per square kilometer in 2015, the percent change during this 5-year period is larger for the province at 12 percent compared to the six percent change in the population density of its capital city.
A region that is growing both in size and density also poses a challenge to our shortage of doctors in public hospitals. Based on the 2018 FHSIS report, the doctor-population ratio in the country stands at 1:33,909, which is a far cry from the WHO standard of 1:20,000.
Based on this indicator, the National Capital Region (NCR) appears to experience the least shortfall of government physicians across the country, with a doctor-population ratio of 1:20,519. In 2018, Northern Mindanao's ratio of government physicians to the population was 1:40,346. This figure is still higher than the ratio at the national level, although better than the 1:61,387 of Barmm in the same year.
The 2018 FHSIS also reveals that while the larger province of Lanao del Norte is growing in size and density at relatively the same rate as CDO and Misamis Oriental, its healthcare system is a far cry from its neighbors. Apart from being one of the poorest in the region in terms of poverty incidence, improved safe water supply, and basic sanitation facilities, it also has the greatest shortfall of doctors in public hospitals. The ratio of government physicians to its population ballooned from 1:38,339 in 2015 to 1:142,250 in 2018.
Our healthcare system both at regional level and provincial level is not prepared for an outbreak of this scale. According to a review of the Philippine Health System published by the WHO and written by public health experts including former secretary of Health Manuel Dayrit, there have been disproportionate investments in additional hospital beds by ownership and by region in the country. Investments in hospital beds are more evident in the private sector, whereas there have hardly been any significant improvements in hospital bed capacity among public hospitals all over the country. Furthermore, only 20 percent of the total number of beds in 2016 are in Mindanao while a great majority (65 percent) were found in NCR and the greater parts of Luzon.
Given the fragility of our healthcare system, remaining complacent with being "Covid-free" and doing little to validate this claim will bring us no closer to flattening the curve. Local governments must take immediate action and conduct mass testing and identify those who are infected even without symptoms. Otherwise, we risk making drastic decisions with a blindfold.
However, even conducting mass testing is barred by our fragile system. Of the accredited Covid-19 facilities in the country, the Southern Philippines Medical Center in Davao City is the only one in Mindanao. This means that SPMC is expected to cater to six regions inhabited by 24,036,406 people (figure is based on 2015 census). Not only will this significantly overwhelm SPMC, but will keep the curve on which our safety depends largely imaginary.
And in so doing, how can we ensure that in this fight against a global pandemic, no one is left behind?
***
Maria Karlene Shawn I. Cabaraban is currently completing her Master of Arts in Demography at the Population Institute, University of the Philippines Diliman. She obtained her Bachelor's degree in Sociology, magna cum laude, from Xavier University - Ateneo de Cagayan in 2017. Apart from writing her thesis on older Filipinos, she works as a Research Assistant for the 2018 Longitudinal Study of Aging and Health in the Philippines, a project implemented by the Demographic Research and Development Foundation and funded by the Economic Research Institute for Asean and East Asia.