Revival of the cooperative movement

BANTAY GOBYERNO

Ike Seneres

I was a victim of the inefficiency of two cooperatives, and that is why I lost interest in the cooperative movement for so many years. In one case, a coop forfeited my shares for the simple reason that I was no longer connected with the government agency that I used to work for.

           It gave me a bad feeling, because I was instrumental in giving them a profit center that enabled them to earn millions even after I left. In another case, the coop has not given me my shares of stock for so many years until now, citing the reason that they could not locate my records.

            Had it not been for Dr. Virginia Teodosio of the University of the Philippines School of Labor and Industrial Relations (UP-SOLAIR), I would not have restored my faith in the cooperative movement. She showed me the true picture that many cooperatives are now successful, and are now being run efficiently. Thereafter, it was Mr. Orly Peña of Asian Business Consultants (ABC) who convinced me that the cooperative movement is actually our last chance now to democratize the fair distribution of wealth in this country.

            In a manner of speaking, it could be said that the failed or failing cooperatives in this country reflect a microcosm of the bigger reality in the Philippines. Their leaders are probably corrupt, and their members are seemingly indifferent.

            In the same manner that the new leadership is showing a determination to move away from the path of corruption, there is now a chance within the cooperative movement to reform, and move towards a righteous direction.

             Since the apparent problem is not just corruption but also the mismanagement of the cooperatives, the logical solution is the training of their managers so that they could be professionalized and be properly equipped to lead their members towards a more orderly and a more profitable conduct of business. Before that however, they should comply with the basic requirement of the cooperatives law that tells them to engage the services of professional managers, and not to appoint managers from among themselves.

              Just like any modern enterprise, it is now time for the cooperatives to adopt new technologies in order to improve the conduct of their businesses, and that should start in the computerization of their business processes. This should of course include the adoption of new information and communications technologies (ICT).

              For so many years now, I have been thinking about ways that would make it possible to make use of ICT to benefit agriculture in this country. I have thought of many ways, but recently I had the chance to come across some new ways of using programmable logic controllers (PLCs) to control the quality of fruits and vegetables, so that this would conform exactly to the specifications of the buyers. To some extent, it could be said that PLCs are the heavy duty versions of personal computers (PCs).

                In theory, PLCs could be used to control any outcome in any process, and that is why this technology is very useful in manufacturing, and happily now in farming or agriculture too. This would include controls in color, shape, size, temperature, humidity and even in the pattern of looks or appearances. In some ways, optical mark reader (OMR) and optical character recognition (OCR) technologies could also be used for this purpose.

                As PCs and laptops have become smaller, so have point of sale (POS) machines, thus making it now possible for small and medium enterprises, of course including the cooperatives to use these devices since these are now affordable. As an extra benefit, these gadgets now come in handheld versions that are equipped with transmission and communications features, thus making them ideal for use in electronic commerce transactions.

In the same way that big corporations are now making money and saving money by using ICT, small enterprises and cooperatives could do that too now, and there are no more limitations for them to do that.      The best way for them to start however is to plan their systems very well, and they should know that we are not lacking in local talents who could help them to do it right.

               As additional good news to the cooperatives, ICT technologies have now moved towards “cloud computing” sometimes called “software as a service”. What this means is that small businesses could now computerize their operations without having to buy their own servers or without putting up their own data centers.

               In this approach, they would just pay per transaction or per service provided. As usual, I would say that machines are just tools for people to use, and having said that, I would now emphasize that what is more important is for the leaders of cooperatives to modernize their thinking first, for the good of their businesses. 

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Cooking fuels

BANTAY GOBYERNO

Ike Señeres

Do not be alarmed, but the barbecued chicken that you are ordering from your favorite fast food restaurant may be causing the water shortage that we are now experiencing. Not only that, it may also be causing the worsening of global warming that is also killing many plants and animals in our planet.

This is now a different world. Who would have thought that the plastic bag that you used to take home your barbecued chicken might be the same plastic that ended up in the stomach of the whale that died due to too much ingestion of garbage?

The correlation might be remote, and that is why it would really be difficult to imagine what your barbecued chicken has to do with the water shortage and global warming.

 To go direct to the point, the demand for barbecued food has in turn created a demand for wooden charcoal, and that is where my story begins. For so long a time now, perhaps even going back before the Spanish period, forest dwellers have been slashing and burning trees in the forest, for the purpose of converting these into wooden charcoal.

For so many years now, these people have been called “slash and burn farmers” but I disagree with that because I would rather call them “illegal loggers”, simply because they are not even “farmers”, so to speak. By some stretch of my imagination, I would agree to call them “farmers” if they go into actual “tree farming”, but that is just about as vague as requiring logging concessionaires to do their own reforestation.

 Aside from the commercial demand for wooden charcoal, there is also a huge residential demand, because for the most part, the price of liquefied petroleum gas (LPG) has now gone beyond the budget of many people, perhaps including even the middle class.

This is a problem that has caused yet another problem, and that is the problem of substituting LPG with wood or wooden charcoal. This is a situation that has somehow put us between the devil and the deep blue sea, because we do not seem to have a way out now, not unless the price of LPG will go lower.

Actually, the use of LPG is also a problem, because the production of LPG causes carbon emissions that in turn accelerate global warming. So what is the way out?

It may sound simplistic to you, but to me, the only way to meet the demand for charcoal is to increase the supply of wood and similar materials and there is no other way to do that except reforestation or tree farming, in other words.

If you ask me, I will tell you that trees that could produce food or food by-products should be given the priority in choosing the species to be planted, and because of that, bamboos would qualify, because it produces edible bamboo shoots.

Strictly speaking, a bamboo is not a tree because it is actually a grass, but never mind that because its trunk could be processed into charcoal and that is really the main point of our discussion here. By the way, sugar cane is also a grass, but it produces food, and the stalks could be processed into charcoal briquettes.

Just as the demand for food could not be stopped, the demand for cooking fuels could also not be stopped. Either the government subsidizes the price of LPG, or it orders the production of more charcoal. If it does the latter, there should be a prior condition, and that is the planting of more trees in the forests that could be turned into charcoal, and that should include bamboos.

I know that I might sound like I am going around the bush, but what I am really trying to say here is that instead of going after the small scale “illegal loggers” who are continuing to deplete our standing inventory of trees, we should turn charcoal manufacturing into an industry, since it already has a global demand.

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My theory of connectivity

BANTAY GOBYERNO 

Ike Señeres

I used to say that for as long as there is a signal, I could deliver all online services to any point in the Philippines, regardless of height or distance. That would mean delivering online services even to the highest mountain or the farthest island, again for as long as there is a signal. Nowadays however, I do not say that anymore because one way or the other, I could find the means to deliver a signal to anywhere meaning everywhere within the territory of the Philippines. Going back to my basic premise; it would also mean that we could deliver any and all online services to anywhere, for as long as there is something to deliver, meaning that for as long as there is a service provider at the backend.

Pardon me if it might sound as if I am bragging, but please understand where I am coming from, the fact that I am coming from an era of dial-up modems, when the fastest means of connectivity was copper phone lines. Perhaps it was just a play of words, but we accepted the legal fiction at that time that Digital Service Line (DSL) was a high speed broadband connection, but it was only later on when we understood that despite the hype, DSL was still running on copper and it was only considered as high speed because it was the highest possible speed at that time, but it was really nothing compared to the real high speed fiber optic connectivity that we have today.

As the saying goes: if there is a will, there is a way, and that saying applies as well to installing connectivity! In other words, if there is a desire, there is always a way to install a connection, one way or the other. In some cases, the cost of connectivity might become an issue, but in response to that, the costs should be evaluated in relation to how much value it would create. For example, how much value could you assign to a means of connectivity that could not only save human lives, but also improve human lives, among others that it would be capable of doing? From my perspective, I would even say that no matter how much the cost of connectivity is, the value that it would create would always be higher or greater.

I would not be surprised if DSL is still available in many parts of our country, still good for connecting to the internet. In practically all of these locations, Global System for Mobile (GSM) communications is still available, ready to connect your mobile phones to the internet. And in many locations in our country, Long Term Evolution (LTE) is already available, providing better and faster connectivity. Aside from these three, fiber optic connections are now available from third party providers or from cable television operators. And if that is not enough, there is always the Very Small Aperture Terminal (VSAT) option that provides satellite connectivity. On top of all these, there is always a microwave option that could connect distant locations via line of sight.

In theory, any form of two-way communications between two people for medical purposes could already be considered as telemedicine, even if the person at the other end is not necessarily a doctor or a medical professional. In a recent visit to the Southern Philippines Medical Center (SPMC) in Davao City, I was excited to find out that they already have a Department of Telemedicine, and they are already making great progress in the fields of tele-radiology and tele-psychiatry. What is good about this development is that the SPMC is more than willing to reach out to all the other hospitals in Mindanao, thus forming a massive network of hubs and spokes, SPMC being one of the hubs.

In recent memory, we could recall that it was a huge challenge how to transmit large files such as X-Ray files from one point to another. That problem was partially solved when Dropbox and Google Drive came along. The better solution came when cloud hosting became cheaper, and that is the solution that SPMC is using now. Instead of transmitting large files from one point to another, these files are now uploaded to the cloud, and from there, these could already be read from the internet, using a browser or viewer. One good thing about this technology is that most hospitals are using the same Digital Imaging and Communications in Medicine (DICOM) standard. Note that DICOM is not a brand, it is a standard, perhaps a shining example of how technology could be used to benefit all of mankind, and not just their greedy proprietary brand owners.

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‘One government’

 BANTAY GOBYERNO

Ike Señeres

“Anti-corruption”, “anti-red tape”, “integrity monitoring” and “Ease of doing business” are buzz words that are apparently separate from each other, but are actually closely intertwined, either directly or indirectly. From one perspective, it could be said that corruption is completely different from red tape, but then again we could not deny that corruption could also cause red tape, and vice versa as a matter of fact, red tape or the slow processing of government transaction could also breed corruption.

As a matter of fact, it could be said that there are many government agencies that are not corrupt, but are in effect inefficient because of red tape. Same goes for so many government employees who are not corrupt, but are inefficient. As for me, I would rather not choose the lesser evil, because I would rather choose what is not corrupt, or what is not evil,

In so many words, it could be explained that if there is integrity, there is no corruption and therefore it would make sense to monitor integrity because by doing so, we could also monitor the easing up of corruption, it that is at all possible.

Much as I would like to be optimistic about the desirable triumph of integrity over corruption, I would rather say that we should not “tempt the mortals”, because integrity could give way to temptation. I am saying that because from a strictly technical point of view, very little corruption could happen if there is very little discretion. I have seen that over and over again, that discretion is the “friend” of corruption and conversely, strict implementation of rules without discretion is the “enemy” of corrupt people, the same people who could not care less about integrity.

By the way it sounds, “Ease of doing business” seems to have nothing to do with corruption and red tape, but in reality, these two evil forces are really the ones that are making it difficult to do business in this country. On one hand, it could be said that the too many requirements that are being required by the government offices are the ones that are slowing down the conduct of business. On the other hand however, it could also be said that some corrupt government officials are purposely adding more requirements, so that the applicants who would have a hard time submitting them would now fall victim to extortion and bribery, as the case may be. Perhaps that is the reason why President Rodrigo Roa Duterte has issued orders not only to reduce the number of requirements, but also to make the lines of applicants shorter.

Creating a “one stop shop” for government services is not a new idea. I have done it before, although it was difficult to sustain. A few years ago, the government tried to put up an online version of the “one stop shop” concept, but the idea was overtaken by some changes in government priorities, so to speak.

Recently, the “whole government” approach seems to have acquired some traction, basically promoting the idea that two or more government agencies should coordinate to work together, to deliver similar or related services to a citizen.

Basically, “whole of government” is the same as the “one stop shop” idea, except that the latter is a physical, actual brick and mortar site. In a manner of speaking, it could be said that the online version of the “one stop shop” in the form of a web portal is the most up to date solution so far.

Making two or more government agencies work together is easier said than done, but what could possibly make it easier is a unified platform that would enable any citizen to transact online with any government agency from anywhere at any time by using any available device.

That would mean transacting with any and all government agencies that would have any product or service to offer to the citizens in general. Take note that the key word here is “transact” meaning to engage the government in any way, in whatever form it takes.

To be specific, these could range from complaints to requests to reports to questions all the way to compliments, including of course the purchase of tangible products and the payment of taxes, fees and contributions. Come to think of it, that could even include the purchase of subsidized rice and discounted medicines.

For all intents and purposes, the government is really just one giant conglomerate with so many holding companies and subsidiary units. Despite all the names and legal charters that its parts would brandish, the government really has one “owner” and that is the “State”.

And despite its wide range of target sectors and audiences, the government really has one “market” and these are the citizens, including of course its resident aliens and foreign tourists.

At the risk of stating the obvious, any citizen could transact with “one government” to get anything, again using any available means. To be more specific, that could mean buying from a physical store, from a mobile app or an online web portal.

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Cooperation in public services

BANTAY GOBYERNO

Ike Señeres

Public schools and public hospitals are the best known public services; because we see these and we physically go to them as a matter of fact. The same could be said about public markets and public works, but that is not so in the case of public attorneys and public housing.

Common sense would tell us that public works would usually mean roads and bridges, but that should be broadly interpreted now to mean anything that would construct any infrastructure or any physical project that would assist in the delivery of public services and thus improve the quality of life.

It is good to note that the Department of Public Works and Highways (DPWH) has already started building public schools, but what could also be good is if they could start building public hospitals as well.

At first I thought that courtrooms could be the places where the people could go to seek justice, but that is not really the case in the real world. Seeking justice would usually mean filing suit in a court of law, but in reality, a lawyer is always needed to do just that.

That is the reason why I now say that the people who seek justice should now go to the Public Attorney’s Office (PAO), on the assumption of course that they could not afford a private lawyer. In a manner of speaking, it could be said that PAO offices are just like private law offices, except that they could not be found in more places as they should be.

As I see it, there is a need to re-invent the whole process of providing free legal assistance, and one way to do that perhaps is to outsource it to non-profit organizations, possibly including cooperatives as well.

Perhaps unknown to many, there is a law granting cooperatives to own and operate public markets, in partnership with, or under the authority of Local Government Units (LGUs). I think that this provision has a double advantage, somewhat like having two sides to a coin.

On one side, it will free the LGUs from the expense of building and maintaining the public markets. On the other side, it will give the cooperatives a default business to invest in, aside from the fact that it will automatically create a market for the goods and services produced by their members.

Needless to say, the LGUs could still generate incomes from local taxes, a function that they could also delegate to the cooperatives. Looking at this from the positive side, it may even reduce the incidents of corruption, because of the reduced involvement of public officials.

In theory but with so much legal basis, it could generally be said that all of the public services mentioned here could already be owned and operated by cooperatives, including public housing as a matter of fact. Apparently and for some reason, there seems to be no concept of “public housing” in this country, in much the same way that there appears to be no concept of “homeless persons” here also.

So far, what is generally understood here is the concept of “socialized housing”, which is now defined to mean low quality homes with short amortization periods. My wish however that the term could be interpreted to mean high quality homes with longer amortization periods, possibly even on a rent-to-own basis. By comparison, rental housing would be a better offer for those who could not afford expensive mortgages.

Imagine what would happen if the public services mentioned here could already be owned and operated by cooperatives? Among other things but most of all, we would have a very big chance to reduce poverty in this country. How do we do that?

All that we have to do really is to eat our way out of poverty, going into prosperity. That might sound that simple to you, but it is really that simple. And what do I mean by that? I do not have the figures right now, but I do know that we are importing billions of pesos worth of food items and petroleum products. Can you imagine that?

               We are not only importing so much of what we eat, but we are also importing so much of the fuel that we cook our food with. Again I say that I do not have the figures with me right now, but can you imagine what would happen if we import in the substitution of these imported items?

Goods and services that are purchased from cooperatives are generally cheaper, and for that reason alone, co-operators could already save a lot of money. On top of the savings however, they could also earn money not only from rebates, but also from dividends.

Seriously, one does not have to be a math genius to understand that with the combination of discounts, rebates and dividends, co-operators would not only become richer, they might also become healthier because they will be consuming organic and natural foods that are also produced by their own members.

I have searched far and wide, high and low, but up to now I have not found any other movement that has the full potential of liberating the people from poverty and bringing them forward to prosperity.

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Organizing human organ donations

BANTAY GOBYERNO

Ike Seneres

Generally speaking, it is good to talk but in order to have a sense of balance; it is also good to listen. I thank the Lord that as much as He has given me the talent to talk, He has also given me the talent to listen, and that is how I gain new knowledge that enables me to talk more, about many more subject matters.

After patiently listening to some professional people who are very conversant about the subject of organ donations, I finally understood how the system (or the lack of it) works (or does not work). To go directly to my point, there appears to be no working database of organ donors and donees and much less, there also appears to be no system for ordering and delivering these resources.

Quite clearly, you can rule out billing and collection, because the law prohibits the buying and selling of human organs. It does not mean however that hospitals and other providers could not bill for the processing and storage of these resources.

Although the technology for electronic commerce could technically be used for “ordering” and “delivering” human organs, there are limitations in doing so, because these resources are “beyond the commerce of man”, so to speak. Challenging as it may be however, there is a “supply” and “demand” for human organs and it is very important to have a working system for such, in order to improve the lives of many people at the very least, or even to save their lives, when it comes to life and death situations.

Of course, I will not say that the existing manual and analog solutions will not work, but no one can argue against the logic that automated and electronic solutions are not only better, these are also faster. What that means is that more lives could be improved or more lives could be saved, as the case may be.

As it is supposed to be, applicants of driver’s licenses are asked to tick on their application forms whether they would want to be an organ donor or not, presumably if they would die in an accident of course. I found out however that this is more of a decorative feature of the actual license, because there is really no system for collecting or harvesting organs from a deceased driver in the event of a fatal accident, and there is also apparently no system for storing or delivering the same however.

That is just too bad or too sad, because all the ingredients for collecting, harvesting, storing and delivering human organs are already present. As usual, some detractors would say right away that there is no budget for this project and therefore it could not be done, but I say otherwise that if there is a will, there is a way. Besides, I am about done in developing an online blood bank, and the software that I am using for it could already be tweaked as a template.

Actually, ticking a box in the driver’s license is not the only way to signify a desire to donate one’s own organs. One’s desire could be manifested when one is applying for many other public documents, such as a passport or a business permit, for example. What the public wants to know however is whether or not the system is transparent or incorruptible, because the surviving family members would not want the body parts or organs of their relatives to be desecrated if these are transplanted to an “undesirable host”.

As it is supposed to be however, the relatives of donors could not really demand what goes where, if the organ donation is valid in the first place. Perhaps resit has not happened yet, but in some evil or immoral scenario, human organs of celebrities could fetch a higher “price”, even if everybody knows that organs are not for sale.

                As it is now, there are many technologies that could be used so that beneficiaries could get the human organs that they need, and it would really be a waste of human lives if we could not put these technologies to work. As I see it, time and motion is the biggest challenge of this supply chain, because there is a time limit, the ultimate deadline before a human organ spoils and could not be transplanted anymore. It is a challenge of motion, because these organs have to move as fast as possible in order for these to become useful.

With millions of cell phones in our hands however, it would be very easy to develop a mobile app that could make this whole process faster and better. Fortunately, a global company based in Singapore (www.ccs.sg) has already developed a template for a virtual blood bank that could now be used as a template for a human organs bank.

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Primary, urgent health care

BANTAY GOBYERNO 

Ike Señeres

As defined by Wikipedia, primary care refers to essential healthcare that is makes universal healthcare accessible to all individuals and families in a community. Although the definition of what is essential could still be debatable in this case, there is clearly no debate about the subject of accessibility.

And not only that, there is no debate that primary care should not only be family based, it should also be community based. As far as I know however, there seems to be no clear definition of the space or gap between primary care and secondary care. Because of that, it seems that it is not common knowledge at what point primary care should end, and at what point secondary care should start. That may just be plain semantics, but the clear definition or the lack of it could mean life or death to some patients.

 Maybe it is simply unique to this country that we live in, or maybe it has something to do with our culture, but apparently, we do not have a clear definition either as to when an outbreak could be defined as such, and at what point an outbreak becomes an epidemic.

Thankfully, it is very easy to tell when an epidemic becomes a pandemic, but of course we always hope that we would never have to do that. No matter how it is done and no matter who gets to do it, I think that this should obviously be a numbers game. As I understand it, there seems to be an argument that an outbreak could already be declared, even if there is only one incident. I really do not know the wisdom behind that, but it seems to me that if it is going to be a numbers game, there should be a higher minimum number before a series of incidents could be declared as an outbreak. In connection with that, I think there should also be a minimum number of locations where outbreaks are reported, before it could be declared as an epidemic.

 It seems very clear that the rationale for having urgent care centers is to have alternative locations where patients could be brought to, instead of bringing them directly to the emergency rooms of the regular hospitals. As far as this is concerned however, there is no question as to what point a patient should be referred to or transferred to an emergency room, because it is the attending doctor at the urgent care center who makes that decision.

Similarly, we could perhaps assume that an emergency medical technician (EMT) or a paramedic on board an ambulance could also make the decision as to where he or she should bring the patient to, whether to an urgent care center or to an emergency room. Perhaps that would not even be a big issue if there two facilities are co-located in the same hospital, but that does not seem to be the case in most places.

There appears to be sufficient literature available, pointing to the fact that a primary care clinic could also function as an urgent care center, and vice versa. I think that that is a very practical idea, and I would like very much to know how that combination could be implemented here in the Philippines. As I understand it, a primary care clinic does not need much equipment but an urgent care center does, but what is the worth of money if we are talking about saving lives?

As I see it, the costs of urgent care equipment are not beyond the reach of Local Government Units (LGUs) and even if these are, the LGUs have money anyway from their own local collections and on top of that, they all have significant shares of the Internal Revenue Allocations (IRAs). Granting that these LGUs really do not have the money, there are several government banks that could extend them loans, guaranteed by their IRAs.

If I would have my way on my lucky day, I would convert all Barangay Health Centers into urgent care centers, and needless to say, these should also function as primary care centers. As I understand it, urgent care centers are required to have the means of communications that would enable them to contact the emergency rooms in the event of the need to transfer.

That should not be a problem nowadays because cell phones are everywhere, and so are landline phones and handheld radios. What could become a problem however are the means of communications between the ambulance units and the emergency rooms, while these are speeding en route to the hospitals. I am sure that there is a solution for that somewhere, and we could worry about that later. In the meantime, we should worry about upgrading the quality of the ambulance units, so that they could meet the new demands.

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Localizing health care programs

BANTAY GOBYERNO

Ike Señeres

A former Congressman told me about the tendency of some local politicians not to build local public hospitals, because they would rather have the indigents who are their voters to come to them for help, so that they could refer them to some national agencies for financial assistance. When I heard that, I remember stories about colonisers who did not want to educate their subjects, out of fear that if they become educated, they would rise up against their rule. It reminded me also about stories that some local politicians would not want to relocate the informal settlers who live within their jurisdiction, because they might lose their votes.

Just like the subjects of colonizers who remain uneducated, the indigents who are constituents of these evil politicians remain untreated. I say that these corrupt politicians are evil, because they do not care if their constituents would live or die, as long as they are able to win and election and steal the money of the people.

Although I believe in the wisdom of that former Congressman, it appears that some local politicians have succeeded in building their local public hospitals, never mind if their motive is to gain the support of the indigents who patronize these hospitals. In other words, these local politicians would get the votes anyway, whether they would build hospitals or not. Going deeper into the problem however, it appears that some local politicians are able to build the structures needed to function as hospitals, perhaps making money in the kickbacks earned as a result of the construction, but never ever supplying these hospitals with the equipment needed, and never ever providing these with medicines and other medical supplies either. That is the reason why indigents who have the misfortune of being admitted to these hospitals have to buy their own medicines, assuming that they have the money for that also.

Although it might have sounded like a good idea to devolve the administration of the public hospitals from the national government to the local government, the bright boys who planned the devolution apparently did not realize that some of the local politicians had other ideas about how to spend their local funds, and healthcare does not seem to be one of their top priorities. I do not really understand how local graft and corruption works, but it seems to me that some local politicians have become experts in balancing acts, in this case balancing the need to steal as much money from the local coffers as much as possible, and doing enough, perhaps just enough to win enough votes for the next coming elections. Sad to say, local politics have become a business enterprise in some local jurisdictions without even a bit of corporate social responsibility to go with it.

Given the fact that locally elected public officials may not necessarily be good managers, it may be a good idea to convert public hospitals into locally owned and controlled corporations so that these could be run by professional managers. On that note, it would also be timely to say that good doctors may not necessarily be good managers also, and doctors who do not have solid management backgrounds should not even be chosen for selection either.

Perhaps this insight could also be applicable to our public schools, wherein even the best of the teachers may not necessarily be good managers either. As I understand it, many hospitals abroad are privately managed even if they are publicly owned. As privately managed corporations, they are evaluated and rated in the same way as private hospitals, and they are very competitive because of that.

It seems to me that the fate of poorly run public hospitals are comparable to the fate of poorly run cooperatives, two separate businesses that are both failing because their managers are not really professional and are generally hired because of political reasons and not because of technical capabilities. In the case of cooperatives however, members only suffer from the loss of money, and nobody dies.

It’s another matter in the case of hospitals, because there is a life and death proposition in many of their functions. There is hardly any data available anywhere, but given the right surveys, the data could come out that many people die in public hospitals because of the lack or doctors, equipment and supplies. And unlike in other countries, nobody ever gets sued, and more often than not, the guilty ones would always _{get away with it.}

As it is now, there is already a system for grading the performance of hospitals, but more often than not, the local government executives are not taken to task for the failures of the hospital managers to pass the standards. Perhaps due to the lack of awareness, the constituents of these executives are not aware that their local executives are directly responsible for the hospital managers who are under them, and should even be liable as well in case of lawsuits.

It is a big wonder that despite the poor quality of services in local public hospitals, inept politicians are always elected one term after another, as if their performance has nothing to do with the life and death of their constituents.

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Inclusive health care

 BANTAY GOBYERNO 

Ike Señeres

In a manner of speaking, “inclusive growth” could just be a meaningless buzzword that could eventually lose its meaning in a sea of slogans. Maybe it’s just me who is saying it now, but the term could either be an oxymoron or a non sequitur, depending on who is talking. I say that it is an oxymoron, because by my own definition, “growth” is not planned as opposed to “development” that is supposed to be planned.

Given that definition, I would say that there is no way to plan ahead to make “growth” inclusive, because growth could not be planned. On the other hand, it would be correct to use the term “inclusive development”, being a result of planned development. For whatever it is worth, “inclusive society” seems to be coming out of that sea of slogans, if it is not planned how the marginalized sectors (those who are now excluded) could be “included”.

For the lack of a better understanding, we could perhaps say that Universal Health Care (UHC) could be, or should be synonymous to “inclusive healthcare”. In my mind, it is really that simple because logically, if it is not “inclusive”, then it is not “universal”. By definition, “inclusive” means “everybody”, and that goes the same for “universal”. For the lack of a better term, I would say that “access” is the common denominator between inclusivity and universality.

What I mean is gaining access to healthcare or to be more precise, “full access”. Perhaps that is what is meant by “no balance billing” (NBB), as in all hospital charges will be paid for by the government on behalf of indigent patients. If that is going to be the case, then it would really mean “universal access”, and it would really mean “inclusive”.

It would be fair to assume that rich people would be able to pay for 100% of their hospital bills, not unless they have become “needy”, at least so to speak. That is not the case when it comes to poor people, who would always have a balance to pay, not unless the government would pay for it on their behalf.

That is actually one of the UHC law; for the government to pay for the PHILHEALTH premiums of the poor people so that they could have health insurance coverage just like the rich people. As I understand, that is where NBB would become useful, because as it should happen, the government should still pay for the rest of the balance, even if it has already paid for the premium that enabled the poor people to have health insurance coverage in the first place. As it actually happens however, even the large health insurance coverage of the rich people would not be enough if they fall victim to major medical expenses.

 In theory, it could be said that if only there is no graft and corruption in the Philippines, we would have enough money to fund our own version of UHC, perhaps patterned after the Canadian and the Cuban models. As of now however, that would seem to be water under the bridge, because graft and corruption here may not disappear as fast as we want it, therefore socialized medicine may not appear here as fast as we want it to. However, there is one way to actually realize the goal of universality, by way of playing a numbers game.

Towards that goal, we could say that if universality is synonymous to accessibility, then all we have to do is provide more access to more people, something that could be done through telemedicine, for example. The other way to increase the numbers is to provide access to more people with minor medical needs.

                Perhaps very few people have noticed it, but a charity ward inside a government hospital is an aberration, actually an oxymoron also at the very least. That is so because a government hospital is supposed to be a charity hospital in its entirety.

That is not simply a theory, because that is how it is supposed to be in the first place. On the other hand, as it is supposed to be, there is supposed to be a charity ward in every private hospital. Well, I say that is only how it is supposed to be, because the requirement is for private hospitals to make sure that 10% of their patients are charity cases.

How else could that be interpreted? It could just be a play of words, but why not convince the private hospitals to put up charity wards. I do not know how and why it happened, but as of now, there are very few charity hospitals left standing. Perhaps we should really examine ourselves, and then try to bring back what ought to be.

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Reinventing universal health care

BANTAY GOBYERNO

Ike Señeres

At the outset, I originally thought that aiming for zero casualties in a typhoon or zero backlogs in a maze of bureaucratic targets. Eventually, I came to realize that universal healthcare is doable, depending of course on how we define the nature of the objectives. Obviously, the number of casualties in a typhoon is beyond our control and we could not even say that it is preventable.

Perhaps, we could say at most that we could try to aim for lesser casualties with some amount of safety precautions, in the same way that we could aim for lesser backlogs by adding more manpower. In the case of universal healthcare however, it involves more than just manpower, because it is an entire universe of factors that are interacting with each other, like planets colliding with meteors.

As I see it, it would be more practical to aim for “universal access to healthcare”, rather than aim for “universal healthcare” per se. I do not mean to sound sarcastic, but “having access” does not necessarily mean “unlimited access” or “open access”, if you know what I mean. In reality, everything in this equation boils down to “healthcare coverage” and further down, it boils down to what the patient pays at the bottom line. In other words, the real bottom line here is how much the patient still has to pay after deducting what the Philippine Health Insurance Corporation (PHILHEALTH) has to pay in terms of the coverage that is due to their members. In a manner of speaking therefore, it could be said that PHILHEALTH could be a tool in allowing most everyone to have access to healthcare, but it does not mean that everything will be paid for.

I recall that I was the one who prepared the first comprehensive Information Systems Strategic Plan (ISSP) for PHILHEALTH. I accepted the assignment based on the joint assumption that it is an insurance company, and not a social services agency. On the basis of that assumption, I submitted the completed plan that was then accepted and approved.

Later on, I found out that the ISSP was eventually disapproved, because a foreign consultant had opined that it did not provide for a social component. Having heard that, I realized that my original assumption had been demolished, and it saddened me, because I knew from the very start that because of that, the actuarial science of PHILHEALTH would not be precise, because I do not see how an insurance company could double up as a social services agency.

Fast forward to today, it appears that President Rodrigo Roa Duterte has found a solution to the problem, by coming out with a Universal Health Care (UHC) law that mandates certain government agencies to contribute funds so that everyone could be covered.

In other words, those who would have the capacity to pay would contribute their own money for the premiums, while those who do not have the capacity to pay would in effect have their premiums paid for by the mandatory contributions. It’s actually a simple idea but it is a brilliant move, because by doing that, everyone as in everyone would have coverage, and in other words, that could already be interpreted to mean universal access to healthcare.

Going direct to the point, we should all understand that universal access to healthcare should not only mean insurance coverage, but also it should mean being able to access all other medical services that are not covered by medical insurance, and that could mean a lot. In that context, having access to private hospitals and clinics is not part of the equation, because in those places, the private patients could presumably pay for every service or procedure, regardless of whether these are covered by medical insurance or not.

Again in this context, what should be in the equation are those patients who have no other choice but to go to the public hospitals and clinics, where in theory everything should be free, such that having medical insurance has no direct bearing at all.

In order to provide for all other medical services that are not covered by medical insurance, it would be necessary to upgrade the facilities of all public hospitals and clinics everywhere. That might sound too ambitious, but it is not any more ambitious than aiming for universal access to healthcare. Of course it could not happen overnight, but it could be a long term goal that could be achieved over the years.

In as much as President Duterte is trying to a lot of things at the national level, it is about time for the local government units (LGUs) to more at their level. After all, these are the local constituents that we are talking about. Perhaps in order to make that happen, we have to reverse history because in the past, many LGUs have not funded their own public hospitals and clinics.

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Technology and empathy

BANTAY GOBYERNO

Ike Seneres

As far as I can remember, my late brother, former Ambassador and Congressman Roy Villareal Seneres was the only public official who kept talking about empathy or the need for empathy in dealing with others, particularly in dealing with the general public. Although it sounds like a profound word, the dictionary defines empathy as “the ability to understand and share the feelings of another”.

I am very sure that empathy does not necessarily mean sympathy, but it seems to me that both words are closely related to the vernacular word “malasakit”.  Perhaps it may just be a play of words, but sharing the feelings of another is about the same as feeling what another person would feel. That may mean putting oneself in the shoes of another and if that is so, that may also mean having a lot of humility, because the other person might be lower than our station in life.

In contrast to the behavior of my late brother, I have seen the behavior of many public officials past and present, who does not seem to have any empathy in dealing with the general public, as if they do not owe anything to the general public, and as if it would be too much of a burden for them to do any form of service to the general public.

God forbid, I hope that these people are not graduates of state universalities and colleges; otherwise they would have forgotten that they owe the people for having given them the education that has elevated them to their present station in life. God forbid, let no one make the mistake of calling them public servants, otherwise that would be the overstatement of the century. But wait! Is empathy really something that we can teach in school? Is it not something that we should first learn from our parents?

As I have previously written in my newspaper columns, a citizen is also a customer who is also a voter and a taxpayer. If these four capacities are not enough reasons for any public official to serve anyone in the general public with a mega doze of empathy, I do not know what will. On the other hand, I would even think that any public official who fails to treat anyone with empathy should either be disciplined four times, or be meted with quadruple punishments. On second thought, that may be too harsh and instead let us just spend our energies with recruitment or retraining programs that would increase the emotional quotients (EQs) of public officials. Either that or we can develop Customer Relations Management (CRM) programs that could possibly institutionalize customer friendly practices in government agencies.

From the corporate perspective, CRM programs could either be classified as “voice” and “non-voice”, the latter a catch all term that includes electronic mail, text messages, Facebook, Twitter and LinkedIn, among others. Either way, what is important is that an agent should be able to reply or answer within a few minutes, at worst within a few hours.

Being unable to do so and delaying response to a few days would be sign of poor CRM. It seems however that this challenge is easier said than done, because many government agencies and even private companies are struggling to make this happen. Generally speaking however, it would be best to consider outsourcing options. Slowly but surely, some private companies are already using artificial intelligence (AI) in the form of chat bots.

Even if technologies are available to improve public services, it would be a waste if empathy does not accompany the delivery of these services. There is however a higher concern in relation to this issue and that is the issue of public equality.

Without good and efficient CRM, the poor people are placed at a disadvantage because unlike the rich people, the poor do not have the right connections that are usually needed in order to avail of these services. My wish actually is that by way of good and efficient CRM, no one needs to know anyone who could help them avail of public services. They do not need to know anyone, as long as they know how to talk on a phone or to type words into a device. On the upside, President Rodrigo Roa Duterte is clearly on the side of the people when he says that he wants people to be happy about public services, and that he wants to remove or reduce the long lines usually seen in government agencies.

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Public cell phone numbers

BANTAY GOBYERNO

Ike Señeres

It’s really a grand irony that our country is the texting capital of the world, and yet not every government agency has a public cell phone number that anybody can send text messages to. Much more ironic than that, the few government agencies that have published their public cell phone numbers rarely ever respond to the text messages sent to them, and if they ever do, it really takes them a long time to do so.

As I see it, our government agencies should behave very much like ordinary people do; that they should always reply to the text messages sent to them, and do so in the fastest possible time, out of love or out of respect, as the case may be.

It is said that in the Philippines, there are more cell phones than people, in much the same way that in New Zealand, there are more sheep than people. The analogy stops there however, because in New Zealand, they are making money from their sheep, while here in the Philippines, we are just spending money on our cell phones.

Obviously, that is not a very productive way of using these devices that were put up using billions of pesos worth of infrastructure. If you wish however that there would be a more productive way of using these devices, why not use them as a means for the people to be able to contact the government as a way to complain about bad deeds or even compliment good deeds? I am sure that many citizens have lots of bad deeds to complain about, but we should also be open to the possibility that there could be many good deeds that would be worth complementing.

               It may just be a play of words, but a citizen is also a customer, in much the same way that he is also a voter and a taxpayer. That should be enough reasons for government agencies to open their lines of communications so that they could be contacted by using any available means, not just via text messaging actually.

Again, it may also be a play of words, but a report could also be a request, it much the same way that a complaint could also be a compliment. Either way or both ways, the bottom line is that anyone should be able to contact any government agency at any time, using any available device, using any means, and not just via text messaging.

According to statistics, about half of the cell phones out there are already smart phones, either with Apple or Android operating systems. What that means is that these smart phones are already capable of using mobile apps, even if these are still also capable of sending and receiving text messages.

Based on my own estimates however, many owners of smart phones are still not using mobile apps, meaning to say that they would rather stick to sending and receiving text messages. Since 100% of cell phone owners of any type are capable of sending and receiving text messages, which should really justify why all government agencies, all the way down to the division level and the provincial offices should publish their public phone numbers.

Fortunately, there is now a mobile app (https://www.we.cards/) that could be used by all government agencies to publish their public phone numbers. Developed by the CCS Group (http://ccs.sg/), WeCards will actually enable the entire Philippine government to in effect have a mobile directory of all government agencies, again all the way down to the division level and the provincial offices.

Not only that, it will enable the entire government to save on the printing of paper calling cards, because in effect, WeCards functions as an electronic calling card. Once the public cell phone number of any government agency is already in WeCards, anyone could send it not only text messages, but also email messages and chat messages, the latter via Facebook Messenger, Viber or WhatsApp, among others.

It’s another story, but the Philippines is also the call center capital of the world, and yet there are very few government agencies that have call centers that could be contacted by anyone at any time. Fortunately, President Rodrigo Roa Duterte has created Project 8888, and I am very fortunate to have been part of its conceptualization and implementation. My wish however is that it would evolve from receiving complaints to processing requests for services, in effect becoming a Customer Relations Management (CRM) facility that would be fully transactional, so that it could become a showcase not only of electronic governance, but also of open governance. I know for a fact that many companies are willing to help the government in doing that, among them the CCS Group.

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First responders network

BANTAY GOBYERNO

Ike Señeres

I would not usually want to compare what a first world country with what a third world country is doing or not doing, but I also think that there are basic actions that all countries should undertake, regardless of their state of development. The issue of having an exclusive communications network for the use only of first responders to emergencies might still be debateable, but there is no argument that each country should have one early in its development, or as soon as possible no matter what barriers it would face. But for the sake of argument however, it could be said in theory that any country could decide not to have one for whatever reason, but that should come with the caveat that the leaders who made that decision should be able to take full responsibility for the loss of lives and property in the event that disaster strikes.

As far as I know, the Philippines does not have a First Responders Network (FRN) as of now. What that means is that as of now, the first and the subsequent responders have no other choice but to use the existing commercial networks, assuming that they are still up during extreme emergencies and assuming that the heavy commercial traffic will allow commercial messages to go through. In the past, there were actually reports about certain persons in authority who wondered why they could not find a signal on their cell phones, until some people of average intelligence told them that the cell sites are down. Our over dependence on cell sites has a matter of fact spoiled us to the point that many of us would completely be at a loss if and when the cell sites are down. What is worst is that there seems to be little awareness that aside from cell phones, there are many other ways to communicate that do not depend on telco signals.

As many of us have been spoiled by the use of cell phones, not too many would seem to realize that no matter how high tech cell phones are, these are still using radio frequency (RF) signals and there is really nothing modern about that. Even the most touted Long Term Evolution (LTE) technology that is supposed to be new is really not that new, being an old RF signal that has been revived, so to speak. Even microwave signals that may sound so high tech are also using RF. We need not go too far however, because even the very well known GPRS actually means General Packet Radio Service, a packet based wireless communications service. Yes Virginia, radio is radio and as long as it is radio, the signals are always broken up into packets that would always assemble at some point after it disassembles. So where does that take us?

Before we go any further, let us not forget that Amplified Modulation (AM) and Frequency Modulation (FM) spectra are also using RF, even if these are only used for one way broadcast communications. My point in mentioning that reality is to bring out the truth about the fact that broadcasting stations including the television stations using either the Very High Frequency (VHF) and or Ultra High Frequency (UHF) bands are supposed to interrupt their broadcasts every so often in order to test the required emergency messages, but very few are doing it. I am sure that that has nothing to do with the FRN concept, but something tells me that since these required tests are not being done, there will be a steep uphill climb in implementing the concept. Hopefully, the awareness of its need will grow, and we will come around to it.

Based on the experience of the United States, it would seem that the best approach is to allow a private company to operate and use the FRN reserved frequencies, with the caveat that these could be immediately and instantly pre-empted in the event of emergencies. That way, these frequencies could be income generating in the meantime, and that could be an important factor in its sustainability. While it is very clear that the 911 Commission would be the default user of the FRN during “normal” times, it goes without saying that the National Disaster Risk Reduction and Management Council (NDRRMC) would also need to use it during incidents of national disasters. Beyond that, the Quick Response Center (QRC) would certainly need it too, in times of crisis beyond national disasters.

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