Historical Overview

I have chosen the Philippines as my country of focus for my Core Assessment.  My reasons for choosing this country are personal, as I lived and volunteered there in 1992-1993.  I very much loved the country and still keep in touch with many of the people I became friends with there.          

Historical Overview

            The Philippines is an interesting and unique country in many ways.  Part of southeastern Asia, it is an archipelago consisting of over 7,107 islands between the Philippine Sea and the South China Sea.  It is a chain of volcanic islands with mountainous interiors and coastal lowlands that vary in size depending on the island. The history of the Philippines is believed to have begun with the arrival of Negrito & Austronesian peoples by boat from nearby islands in the Polynesian chains. While Negritos were believed to live a more isolated culture, the Austronesian peoples were travelers and traders. They brought cultural influences and practices from various Asian nations such as India, China and Japan (Bisht, 2004).  Later, as part of Spanish world exploration, the Philippines came under Spanish rule and were part of the Spanish empire from about 1524 to 1898 (Riley, 2013).  In 1898, the United States purchased the Philippines from Spain and annexed it, finally granting it independence on July 4, 1946 after the end of World War II.  However, it should be noted that during the war, the Japanese occupied much of the nation for a period of time (Philippine Historical Society, 2014) and was a particularly difficult and brutal time for Filipino people. 

Ethnic Groups and Languages

Ethnic Groups and Language

            The peoples and cultures of the present day Philippines arise from this unique historical background and have combined to create a wonderfully layered and welcoming culture with a large array of subcultures throughout the country. 

            Today, the people of the Philippines generally fall into one of seven different ethnic groups which are (in order of prevalence): Tagalog 28.1%, Cebuano 13.1%, Ilocano 9%, Bisaya 7.6%, Hiligaynon Ilonggo 7.5%, Bikol 6%, Waray 3.4%, and other 25.3% (Philippine Statistics Authority, 2015).

            The same influences that contributed to the creation of these various ethnic groups have also had an impact upon language within the country as well.  The Philippines has eight major dialects closely tied to these varying ethnic groups.  Tagalog, Cebuano, Ilocano, Hiligaynon or Ilonggo, Bicol, Waray, Pampango, and Pangasinan are listed as official languages of the country.  Additionally, there are over 175 regional and local dialects in regular use within the country (Philippine Statistic Authority, 2015).  This diversity of languages - while fascinating - can also be a barrier to communication between peoples.  While the majority of the people have been taught Tagalog, which is the national language, its use varies widely.  In some rural areas it is spoken so infrequently that people have a hard time remembering it.  
     I had a personal experience of nodding off for a few minutes on a jeepney ride one day.  When I awoke, I could tell by my watch that I had perhaps only gone a few kilometers past my stop.  Still it was an unfamiliar area.  I got off the jeepney at the next stop in order to catch one in the opposite direction and was suprised to find that no one at that stop spoke Tagalog OR Ilonggo (the dialect in the town where I was living).  It was a little unnerving and also surprising that so much could change so quickly.  Sometimes this issue is less about understanding and more about local identity.  There is a strong sense of local identity and sometimes people simply refuse to use the national language. 

Modern Day Culture

Modern Day Filipino Culture

While identification with one’s particular ethnic group and region are important, there are certainly some overarching cultural practices that help to create a general sense of unity and national identity. 

            Filipino people are generally family oriented; religiously, politically and morally conservative.  Certainly this is largely due to the influence of Catholicism within the country but these are also shared values among the more Muslim dominated areas of the south as well as within some of the indigenous groups that remain in pockets  - particularly in mountainous interior regions (Aquino & Alegado, 1992).

            Cultural life in the Philippines generally revolves around extended family and it is not unusual for multiple generations to live together.  Members of extended families frequently gather together for things such as weddings, baptisms, and holidays. Families are generally close-knit and supportive. Neighborhoods, known as barangays, serve as something of a familial extension.  Much of daily life occurs right within a Filipino's neighborhood – with each barangay generally having a mix of homes and schools as well as certain areas where daily work (such as clothes washing or cleaning of fish) occurs. Most neighborhoods also contain several small little storefronts, often attached to people’s homes.  Called sari-saris in Tagalog, this is where many Filipinos purchase basic necessities. 
     This type of localization serves a practical purpose in that it reduces the amount of time and money spent traveling to larger towns - or even to the main commercial area of the town they live in.  It also serves to unite and connect members of various neighborhoods, as well as provide an informal means of passing along news and other information - including tsismis (gossip) which is jokingly referred to as the national pastime (Aquino & Alegado, 1992).  This stands in contrast to much of present day United States with areas of industry, commerce and housing separated. Furthermore, even within many U.S. neighborhoods, there is limited interaction between people.  

            Celebrations are frequent in Filipino culture and held for almost any reason under the sun.  Hospitality is an important value and it is considered an honor to host a guest.  While many Filipinos live below the poverty level, sharing of ones means is common regardless of how meager their resources.  These celebrations typically revolve around music, games, talking and food. The majority of celebratory or entertainment occasions are also multi-generational, with fewer "adult only" or children-specific occasions (personal experiences).

Education and Religion

Education and religion

            Most children are able to attend at least primary and some secondary school.  Although public school is the most common, it is often influenced by the Catholic Church in terms of curricula. In areas of higher Muslim concentration, children may attend private Muslim schools (Riley, 2013).  An increasing emphasis on education has translated to greater numbers of Filipinos going on to college in the last twenty years. 
     Because the overwhelming majority of Filipinos are Catholic, the church and its religious tenets also play a huge role in daily life and culture.  However, interestingly enough, each region also mixes its own superstitions and traditions into the Catholic culture so beliefs and customs are not necessarily uniform even among those who consider themselves Catholic (Aquino & Alegado, 1992).  However, the influence of Catholicism is felt in more major ways and even plays a role in Filipino national laws.  Perhaps the most prominent legal influence is that outside of  the Vatican City, the Philippines is the only country in the world without divorce laws (Lichauco de Leon, 2014).

Geographical, Climate and Environmental Aspects

Geographical, Climate and Environmental Aspects

            The Philippines are classified as a tropical marine climate and have traditionally been an agricultural & fishing based economy. While historically rich in fishing grounds and blessed with an abundance of vegetation, there are major environmental issues within the country that threaten this diversity.  Additionally, because of its geographical location it is also affected by monsoon seasons, volcanic and earthquake activity. 

           According to papers associated with the United Nations 2013 Human Development Report, the Philippines continues to have multiple environmental concerns.  The report categorizes the environment into three zones:

            1.  Green Zone – includes forest ecosystems, critical habitats and biodiversity and the      agricultural ecosystem.

            2.  Blue Zone - water resources such as watersheds, water supply, coastal and marine        ecosystems.

            3.  Brown Zone - urban ecosystems with focus on water and air quality, solid wastes,       toxic and hazardous wastes and industrial activity (Naz, 2013).

    Green Zone Issues - Degradation of forestland leading to a dramatic decline in native forests.  It is estimated that currently a mere 3% of original forest remains.  This sustained forest loss is also cited as a significant factor in loss of biodiversity. This is particularly concerning as many of the Philippines’ animal species are endemic (they cannot be found anywhere else in the world). For example, of 180 native terrestrial mammal species in the country, about 61% are endemic (World Wildlife Fund, 2014). Other “green zone” issues include overuse of chemicals, fertilizers, and pesticides in unsustainable agricultural practices.  This has also led to significant watershed degradation (Naz, 2013). 

            Blue Zone Issues – Due to increased population growth and unregulated building, many coastal areas have been compromised.  This has led to a severe loss of mangroves, coral reefs, and natural fish hatcheries.  Additionally saltwater intrusion into improperly located freshwater wells has contaminated many fresh water sources (Naz, 2013).  Due to overfishing issues, there has been a drop of 90% in the quantity of marine organisms in some fishing areas of the Philippines (Asian Development Bank, 2015).

            Brown Zone Issues - Improper waste management policies are a major health concern because only about 10% of sewage in the Philippines is treated or disposed of in an environmentally sound manner. The rest usually right back into the ocean (World Wildlife Fund, 2014). One of the greatest difficulties in getting these issues under control is that the country is desperate for the economy of business and industry and the immediate needs of jobs and production trump long term environmental goals.  Furthermore, implementation of existing regulations is difficult due to overlapping jurisdictions and conflicting rules.  There is also a severe lack of financing to implement programs designed to clean up the environment (Naz, 2013).

Economic & Governmental Factors

Economic Factors

            In the last 15 years the Philippine economy has been transitioning towards an increasingly manufacturing and information-technology based economy.  However as of 2011, 41% of land was still used for agricultural purposes (Central Intelligence Agency, 2015).  This transitional economy has elevated the Philippines beyond third world status, although large numbers of people remain self-employed or under-employed with low incomes.  The cultural differences between agricultural based poorer economies and first world economies are evident, and contribute to the difficulties in transitioning.  For example, it is not what you would consider a “time clock society”.  Mid-day breaks (which make perfect sense in a hot, humid agricultural industry) are common.  Set hours for appointments, work, and meetings are loosely adhered to.  Preferential treatment, favors and legal latitude are often extended to family and friends by those in positions of authority (Cullinane, 2015).  These factors create mixed results in terms of daily life there .  A positive thing I noticed about these cultural influences on government and economy were that people tended to be quite patient with one another and understanding of delays and changes in plans. However, the downside is that world culture and economy tends to be less forgiving. In order for the Philippines to grow and compete in the world market, they will have to adapt to a more time pressed society.

Governmental Factors

The Philippine is a republic with a presidential form of government wherein power is equally divided among its three branches: executive, legislative and judicial. It closely mirrors the governmental system of the United states upon which it was modeled when the U.S. granted the Philippines their independence in 1946. The Philippines also has four main classes of elected administrative division, grouped as local governmental units (LGU's). They are, from the highest to the lowest division: autonomous regions, provinces and independent cities, municipalities and barangays (Philippine Government, 2015). However, according to a World Bank study in 2006, corruption in the Philippines is considered to be the worst among East Asia's leading economies.  Corruption exists in all levels of the government, especially among high-level civil servants. Compounding this problem of corruption are incompetence, poor infrastructure and poor inter-governmental communication (World Bank, 2006).

Health indicator map

       The following photos illustrate some of the gaps within government programs. These photos were taken from the Philippines Department of Health website http://www.doh.gov.ph/node/1983.html and are designed to show data regarding health information.  However, as the next photo shows when a spot on the map is chosen there is little data available. It is not uncommon for programs to be initiated such as this health indicator data, and then abandoned part way through.  Yet this data remains on the Philippine Department of Health website, despite the fact that it has not been updated in several years.

Data available for Antique region

Health Systems

Health System of the Philippines

            In 1995, the Philippines instituted a national health insurance agency called PhilHealth for the large number of citizens who lack access to employer provided health care.  The provision of national healthcare did not eliminate private healthcare coverage - which remains available through some employers or to individuals affluent enough to purchase individual policies. The government run health care system went through an additional large reform in 2010 with goals of increasing availability to the very poor, providing better overall benefits and reducing co-payments. Some headway has been made; an April 2011 World Health Organization report noted almost 4.4 million new poor families had been enrolled In PhilHealth, equivalent to a 100 percent increase in enrollment for the "real poor".  That same year PhilHealth introduced a no-balance billing policy for households who met poverty requirements (World Health Organization, 2011).  However major issues continue to plague the system.  Some of the major obstacles are: 

1.  Attracting and retaining staff in rural areas. Because the Philippines consists of over 7,000  islands and areas of difficult terrain, most available health resources are in major cities - leaving large numbers of rural areas with little to no health care.

2.  The system is partially nationally run and partly decentralized to allow for control at the provincial and village levels. This has led to fragmented delivery, care and policy being subject to multiple interpretations, a lack of checks and balances within the system and cost variation depending on location.

3.  Overall poor economic strength and stability for the country as a whole remains a challenge which limits available funds for the system. Out of pocket payments still account for almost half of total health care payments.

4.  Provider regulation is inconsistent at best and many provider charge additional fees beyond those covered by government insurance.  The majority of hospitals are also privately owned and can set their own fees, choosing whether or not to require additional payment.

5.  Public perception is often that private healthcare offers better services and more competent care, causing many health consumers to by-pass government clinics and hospitals in favor of private care.  This often causes people to seek care only when critically necessary and makes them less inclined to continue with follow up care.

6. Inconsistent focus on preventative health, vaccination and mental health services.

(World Health Organization, 2011).  

       Within the private sector, there is greater access to providers and specialists but the majority are confined to large urban areas. Because private healthcare is more expensive, those who have it tend to be more educated and have better paying jobs.  This also translates into better understanding of preventative health and increased patient compliance (Santos, 2014).  Consequently these providers bring in more money and are able to recruit more experienced health care workers. They often have more coordinated systems of care, resulting in better patient outcomes. Furthermore, many of the private hospital and insurance systems are based outside the Philippines and have greater access to capital and technology (Aquino, 2013).  However, the private system is not without obstacles as well.  Some key issues are:

1. Lack of regulation within private sector often results in "over-service", difficulty checking the records and credentials of providers and inconsistent practice and labor rules for their employees.

2.  Hospitals, clinics and insurance providers may be based outside the country which can result difficulties resolving patient issues.

3.  Private providers may close doors without notice or provision of referrals for their patients

4.  Lack of information coordination between competing private providers can cause treatment mistakes and delays for patients as well as increased costs to both parties (World Health Organization, 2011).

       Charitable health organizations from outside the country also remain an important source of healthcare for many Filipinos, especially in small towns, slums and outlying regions. Unfortunately, these clinics may only be staffed at certain times of the year, may be specialized to specific members of the population and usually lack access to laboratories and technology (World Health Organization, 2011).

       Like much of the items discussed within this overview, the healthcare system is one of transition. While great strides have been made, it is also subject to complex and many layered issues of difficulty.