The Civil Society Coalition on the Convention on the Rights of the Child (CRC Coalition Philippines) and Child Rights Coalition Asia (CRC Asia) call for the inclusion of a child rights perspective in the pending legislation on the universal health care system in the Philippines.
CRC Coalition and CRC Asia welcome the efforts of the Philippine Congress to uphold the right to health in accordance with Article 13: Social Justice and Human Rights of the 1987 Philippine Constitution, and in contribution to achieving the Sustainable Development Goal to “ensure healthy lives and promote well-being for all at all ages.” Establishing a universal health care system also presents a promising direction towards a strengthened public financial management for the realization of the fundamental rights and freedoms of all Filipinos. Nonetheless, CRC Coalition and CRC Asia deem that the pending legislation needs to acknowledge the special measures entitled to children to uphold their right to health and health services as enshrined in the United Nations Convention on the Rights of the Child (UN CRC) Article 24, which says that:
“States Parties recognize the right of the child to the enjoyment of the highest attainable standard of health and to facilities for the treatment of illness and rehabilitation of health. States Parties shall strive to ensure that no child is deprived of his or her right of access to such health care services.”
In this regard, CRC Coalition and CRC Asia recommend the following to be included in Senate Bill 1896: An Act Instituting Universal Health Care for all Filipinos, prescribing reforms in the health care system, appropriating funds therefore and for other purposes:
a. Declaration of Principles and Policies
Sec. 2. Declaration of Principles and Policies. It is the declared policy of the State to protect and promote the right to health of every Filipino and instill health consciousness among them. Towards this end, the State shall adopt…:
[Insert:] (e) a rights-based approach that upholds the principles of universality, interdependence, interrelatedness, and indivisibility of rights; non-discrimination and equality; rule of law; accountability; due diligence; participation; survival and development; and best interest of the child.
The policy on a universal health care system should be anchored on the respect, protection, and fulfillment of human rights. In relation to children, the realization of their right to health should be guided by the principles of non-discrimination, best interests of the child, right to survival and development, and child participation in accordance with the UN CRC.
UN CRC General Comment No. 15 (2013) on the right of the child to the enjoyment of the highest attainable standard of health expounds on these child rights principles. The principle of non-discrimination means that the fulfillment of the right to health should not be undermined by the child’s or the parent’s or legal guardian’s race, color, sexual orientation, gender identity, language, religion, political or other opinion, national, ethnic or social origin, property, disability, birth, or other status, such as mental status or HIV status. The principle of the best interest of the child means that all health-related decisions concerning individual children or children as a group should be made according to the children’s best interests. The right to survival and development obligates the States to ensure the physical, mental, moral, spiritual, and social dimensions of a child’s development, and this could be determined by structural conditions, the child’s individual characteristics, and the mother’s and caregiver’s health status. The child participation principle means that the views of children in matters that affect them should be given due weight in accordance to their age, maturity, and evolving capacities.
b. Framework for Universal Health Care (UHC)
Sec. 6. Service coverage. a) Every Filipino shall be provided access to preventive, promotive, curative, rehabilitative, and palliative health services, delivered either as population-based or individual-based [insert:] or child protection services…
Sec. 7. Financial coverage… The services covered shall be financed through a mix of general and earmarked taxes, pooled funds from other national government agencies, and NHIP premium contributions, with clear delineation of payers. In particular:
[Insert:] c) Child protection services. The National Government through the DOH and LGUs shall finance the delivery of services for children who are victims of violence and children who are in disadvantaged situations, including, but not limited to, children in street situations, children in early pregnancy, children living with HIV, children in alternative care and children who are unregistered.
The service and financial coverage of universal health care should provide special considerations to children in disadvantaged situations. Victims of violence against children should be entitled to special measures so that they can speedily access financial support to avail all the necessary health services due to their victimization. Similarly, children in street situations, children in early pregnancy, children living with HIV, children in alternative care, children who are unregistered, and other children in disadvantaged situations should be given the special considerations to access the health services and financing they need.
c. Service Delivery Networks
Sec. 14. Integration of Local Health Systems into Province-wide and Urban Health Systems. The public-sector health system at the subnational level shall be composed of province-wide health systems, which integrates existing municipal and component city health systems, and urban health systems in highly urbanized and independent component cities [Insert:], including child protection units and systems…
The financing of service delivery and human resources of child protection units and systems should be part of the universal health care system and, subsequently, be included in the integration of services at the subnational levels to ensure proper referral of services for children.
Child protection units are child-friendly and gender-sensitive service providers that use a multidisciplinary approach and networking to provide comprehensive medical, psychological, social, and legal services to children and their families who experienced abuse, exploitation, and neglect. As of 2017, there are 94 women and child protection units in the Philippines, covering 50 provinces and 10 cities.
d. Governance and Accountability
Chapter VII. Governance and Accountability
[Insert new section:] Complaint and Remedy Mechanisms for Violations of Right to Health. The National Government through the DOH and LGUs, especially at the barangay level, shall establish functional, accessible, and child-friendly complaint and remedy mechanisms to seek and obtain reparations when their right to health is violated or at risk. The mechanisms should be coordinated with relevant stakeholders, including, but not limited to social workers, health professionals, child protection specialists, and the Commission on Human Rights.
According to UN CRC General Comment No. 15 (2013), the States should “put in place functional and accessible complaints mechanisms for children that are community-based and render it possible for children to seek and obtain reparations when their right to health is violated or at risk.” In this regard, the universal health care system should include complaint and remedy mechanisms for violations of the children’s right to health as part of its governance and accountability. These mechanisms should be functional, accessible, and child-friendly.
The operations of the complaint and remedy mechanism must also be used to inform the monitoring and evaluation of the universal health care system.
e. Monitoring and Evaluation
Sec. 27. Monitoring and Evaluation. a) The DOH, National Economic Development Authority, and the Philippine Statistical Authority shall develop a monitoring and evaluation framework to validate the accomplishments of the provisions of the Act…
[insert:] e) The monitoring and evaluation of the universal health care system shall include indicators for effectiveness, efficiency, equity, transparency, and sustainability.
The finance management and functionality of the universal health care system must be monitored and evaluated using indicators that correspond to the system’s effectiveness, efficiency, equity, transparency, and sustainability, as mentioned in the UN CRC General Comment No. 19 (2016) on public budgeting for the realization of children’s rights.
An effective management of public funds means that the budgets are planned, implemented, and monitored through a results-based approach, while an efficient use of funds indicates maximum value on investments. Equity involves decisions that aim to contribute to greater equality in the enjoyment of the rights of children, especially those children that are most excluded. Transparency refers to access to timely and user-friendly information that facilitates meaningful participation of adults and children in the budget processes. Sustainability in public budgeting means taking into account the best interests of present and future generations of children.
f. Health Promotion
Sec. 32. Health Promotion. … The Health Promotion Bureau shall perform the following: a) Develop and update the national health promotion policy framework and action plan…. h) Formulate the necessary education and awareness promotion, information campaign, and social marketing strategies [Insert:], with consideration for child-friendly, gender-sensitive, and disability-inclusive approaches
The comprehensive and coordinated approach to health promotion should include a strategy to increase the awareness and understanding of children. As such, the efforts should be implemented in a child-friendly manner and in a language that children can understand. Moreover, medical professionals, health care providers, and even parents should be informed and trained to use child-friendly terms in explaining medical conditions, procedures, policies, and other health-related information. Communicating to children in a child-friendly manner and language is crucial in upholding the child participation principle in health-related decision-making processes.
Sec. 34. Appropriations. The funds requirements to implement this Act shall be earmarked and sourced from the following:
[Insert:] e) Proceeds of crimes related to violence against children, including, but not limited to, child trafficking and child pornography, provided that the compensation and assistance to victims have already been deducted from these proceeds of crime.
Proceeds of crimes related to violence against children, including child trafficking and child pornography, should be earmarked for health-related child protection services.
Moreover, funds for the implementation of the universal health care system should not only be sourced from existing sin taxes, but also from upcoming excise taxes levied on certain goods that deemed harmful and unhealthy to society, particularly to children.
[Additional Section:] Participation. Civil society, including children, shall be given a space to have meaningful contributions to the evidence-informed sectoral policy and planning, monitoring and evaluation, health impact assessment, and health technology assessment, health promotion, and other processes of the universal health care system.
The universal health care system should have mechanisms for citizen participation, including child participation. The participation mechanisms could help in safeguarding the universality of the right to health, and in ensuring that the efforts are people-centered, inclusive, and in accordance with the child rights principles. To facilitate citizen participation, there should be timely, user-friendly, and accessible information.
In involving children, there should be understanding of the children’s evolving capacities in the decision-making on their health issues. This is crucial in upholding the principles of informed consent, privacy, and confidentiality for children and adolescents. Children should have the opportunity to express their views, and their views should be taken seriously, in accordance with their age and maturity. As UN CRC General Comment No. 15 pointed out:
“This includes their views on all aspects of health provisions, including, for example, what services are needed, how and where they are best provided, barriers to accessing or using services, the quality of the services and the attitudes of health professionals, how to strengthen children’s capacities to take increasing levels of responsibility for their own health and development, and how to involve them more effectively in the provision of services, as peer educators. States are encouraged to conduct regular participatory consultations, which are adapted to the age and maturity of the child, and research with children, and to do this separately with their parents, in order to learn about their health challenges, developmental needs and expectations as a contribution to the design of effective interventions and health programmes.”
UN CRC General Comment No. 15 expounded that:
“In accordance with their evolving capacities, children should have access to confidential counselling and advice without parental or legal guardian consent, where this is assessed by the professionals working with the child to be in the child’s best interests… States should review and consider allowing children to consent to certain medical treatments and interventions without the permission of a parent, caregiver, or guardian, such as HIV testing…”
As such, supportive policies and procedures must be in place for the children, parents, and health care providers to have rights-based perspective on involving children in decision-making processes.
Civil Society Coalition on the Convention on the Rights of the Child (CRC Coalition Philippines)
CRC Coalition Philippines is an alliance of child rights organizations committed to lead civil society efforts towards strengthening government accountability through systematic monitoring of the implementation of UN Convention on the Rights of the Child.
For information, please contact:
Magnolia Eva Escobedo, Secretariat Coordinator
Aena Zoraya Briones, Advocacy and Communications Officer
firstname.lastname@example.org | email@example.com
About Child Rights Coalition Asia (CRC Asia)
CRC Asia is a network of child rights organizations working together to be a strong voice for child rights in the region by leading in strengthening child rights movements, promoting innovative programs, and advocating better policies for and with the children.
For information, please contact:
Amihan Abueva, Regional Executive Director
Hazelyn Joy Bitaña, Advocacy and Communications Coordinator