A new leg, a new lease on life in the Philippines

September 2013

In September 2013 for the first time, the Philippines government’s health insurance programme made prostheses available for people who have lost a limb.

In April 2013, Alan Santos, a 25-year-old construction worker hit a live electrical wire while working on a building site and sustained injuries that required amputation of his leg below the knee. His contract did not provide health insurance or hospital benefits. He is married, has a one-year-old child and was his family’s sole breadwinner. Without his monthly wages, his family was impoverished.

In the "World report on disability", published in 2011, WHO recommended that countries include rehabilitation within health insurance schemes to increase access for people like Alan.

Rehabilitation services included in health insurance

Alan Santos walks down a hospital hallway on his new leg.
WHO/Alan Esquillon

The Philippines has been a frontrunner in the realm of universal health coverage. In 1995 the government launched PhilHealth, the Philippine Health Insurance Corporation, and has steadily expanded its membership base and the package of services it covers. With guidance from WHO and local disability and rehabilitation sector partners, in September 2013 the Philippines launched another pioneering effort: inclusion of rehabilitation services for people with disabilities in its insurance package.

It was clear from the outset that Philhealth could not adopt all rehabilitation measures in a single sweeping expansion. Instead, the task was approached step by step, but the question was, where to start?

Prosthesis provision: first rehabilitation service

Philippines rehabilitation service providers and organisations representing disabled persons began discussions with Philhealth. In 2012, the Philhealth board was presented national data which showed that an estimated 30% of people with disabilities in the Philippines could return to work if provided with an assistive device like a prosthesis for a missing limb. The gap was substantial—one NGO had a registry of some 2000 people in need of a prosthesis but could not afford one.

The board was convinced. Prosthesis provision was selected as the first rehabilitation service to be covered by Philhealth, and is called the "Z package". Integration of rehabilitation into universal health schemes increases access and is in line with the Convention on the Rights of People with Disabilities.

Life changing "Z package"

"The ‘Z package’ represents exciting progress. When people with disabilities get the rehabilitation and assistive devices they need, it is life changing. This is a very fitting step in addressing barriers experienced by people with disabilities in the Philippines,"

Dr Julie Hall, WHO Representative

With support from the local government, Alan Santos was able to subscribe to Philhealth and become the first recipient of a “Z package” prosthesis. In September, he was admitted to the Philippine General Hospital in Manila to be measured for a prosthesis and receive training on how to walk on his new leg. His employer has offered to re-hire him after his discharge.

For Santos, the "Z package" has offered a new lease on life, and not only because it means he can return to work and support his family. “I don’t want my child to grow up seeing me without a leg, not being able to run and play with her, and eventually becoming dependent on her when I should be the one taking care of her,” he says.