*Population in 2020，GNI and life expectancy in 2019 are updated based on UN's data.

 *Medical information is based on WHO's report of 2017 Mental Health Atlas-country profile.

I.    Overview

　　The Republic of the Philippines is an archipelago country, with a total area 299,764 square kilometers and located in Southeast Asia and the east of South China Sea, and consists of 7,641 islands. Geographically, Luzon is in the north and Mindanao in the south in which are the two largest islands, while in the middle is the Visayas islands. It located in the western Pacific typhoon belt, and is a part of the Pacific Ring of Fire where has so many volcanoes, and therefore, it is one of the most severe natural disaster areas in the world.

　　The Philippines mainly has four levels of autonomous administrative units, from high to low, there are 17 autonomous regions including the national capital region Manila and two other autonomous regions; for the the second level, there subdivide into 76 provinces (provinsiya) and independent cities (lakanbalen), There cover 1,490 municipalities (Munisipalidad) and 144 cities (siyudad) in its third level, and 42,029 towns (barangay) at the fourth level.

　　The republic is the second country in Southeast Asia with a population of over 100 million (next to Indonesia, estimated 107,225,000, as of 2019, and ranked 13th in the world), but the population is unevenly distributed, which has as many as more than 10 million people living in the capital region Manila and is also the biggest metropolitan city in Luzon. The main ethnic residents are Visayans (34%) and Tagalogs (28%), and the Chinese is the minority with less than 1.2% of its population. The main religion is Catholicism, while the Muslims are concentrated at the islands of Mindanao. The official languages are Filipino and English. The gross national income in 2019 was US$3,850, and the average remaining life in 2019 by World Health Organization (hereinafter called WHO) was 70.4 years.

　　The Republic of Philippines has a presidential system with the separation of administrative, legislative, and judicial powers. The executive department manages and monitors the health system of the central and local governments, and the budget and funding are authorized and need to be approved by the legislative department. The Ministry of Health (hereinafter called MoH) is the main health agency in Philippines, and responsible for providing the health products and services to ensure all Filipinos have access to basic and good quality medical care.

　　The health care system in Philippines includes government units, the MoH, local government units, and non-governmental organizations for profit and non-profit medical units. According to the Local Government Act of 1991, the health system managed and controlled by the MoH was to delegate to the local government, however, MoH is still in charge of managing the national policies and the large teaching hospitals, including specialist hospitals like health centers, psychiatric specialties and research institutions. Local (provincial) governments are to manage its general hospitals, while the municipality and city government are to run the small primary hospitals and medical units, such as district hospitals, obstetric clinics and rural health units. The local governments have their autonomous powers in some medical services, however, most of which are controlled and supervised by MoH technologically and financially in major cities in the country. As a matter of fact, most hospitals are privately owned in Philippines, and the public hospitals account for only about 30%.

　　The Philippines' total medical expenditure in 2017 accounted for 4.5% of the overall GDP, of which nearly half was self-financed. The country has established a national medical insurance institution-Philippine Health Insurance Corporation, called PhilHealth in short. At the end of 2017, the insurance coverage rate was 93%, but the utilization rate only covered 12% of the insured persons, and the implementation efficiency needs to be enhanced. The reform of the medical system in Philippines is mainly to solve the three main issues, which is poor accessibility, inequality and inefficiency, and require to emphasizes and focus on the following six points, such as Management, Service provision, Regulations set-up, Finance, Information system and Human resources, and also to invest greatly on infrastructures and upgrade the equipment.

　　In February 2019, President Rodrigo Duterte of the Philippines signed the Universal Health Care (UHC) Act, which promoted large-scale reforms of the Philippine health sector. One of the distinguishing features of the UHC law was the expansion of population, service and financial coverage through a series of health system amendments. What follows is a paradigm shift from planning to primary care, which should be the core and center of all health reforms for universal health coverage. There were 33 advanced implementation sites preparing to roll out universal health coverage in 2020, and another two more batches of implementation sites to cover the whole country in the following years.

　　With universal health coverage, all Filipinos have equal access to high-quality and affordable healthcare products and services, which will protect them from financial risks anyway. UHC also helps to ensure that every Filipino stay healthy, free from health hazards and risks, and have the accessibility to a readily available medical services that suit their needs.

　　Every Filipino should have the access to preventive, promotional, therapeutic, and rehabilitative health services. The UHC Act will improve and strengthen primary care system by emphasizing close to homes and communities, supported by hospitals contracted as a network, and making every Filipino automatically a member of PhilHealth. This will ultimately lead to the establishment of a better network of providers and facilities so that everyone can gain health.

II.       Mental health policy and system

　　The Philippine Mental Health Act was passed by the house of representatives and senate in 2017 (Senate Bill No. 1354, 2017), and signed into law on June 21, 2018. Prior to this bill, the Philippines were a few of countries with no mental health legislation. The clinicians lacked guidance on legal and ethical aspects for their practice, and patients' rights were not clearly defined. The passing of this bill is a major milestone in the history of psychiatry in the Philippines and it provides a rights-based mental health legislation, and to mandate for the provision of psychiatric, psychosocial and neurological services in all hospitals, as well as basic mental health services in the community. However, the compulsory treatment is limited to hospital settings, and not to the community.

　　Under its provisions, the Philippine Mental Health Act protects the rights of patients, such as the right to non-discrimination, to protection from torture, cruelty, inhumanity, and degrading treatment; the right to receiving the aftercare and rehabilitation; the right to being adequately informed about psychosocial and clinical assessments; right to participating in the treatment plan of being implemented; right to evidence-based or informed consent and confidentiality; and right to counselling among others, and so on.

　　The Act also incorporates the rights for "concerned individuals", which is to include the patients' relatives and mental health professionals. In this context, the mental health professional refers to any medical doctor, psychologist, nurse, social worker or any other appropriately-trained and qualified person with specific skills which are relevant to the provision of mental health services (Section 4 of the Act). The Act highlights the need to provide psychosocial support for the family members of the patient(s) if required and, with informed patient's consent, to cover them in the planning of treatment for the patient.

　　It further recognizes the role of mental health professionals, protecting their rights to participate in mental health planning and development of services, and ensure their safe working environments, accessibility to continuing education and autonomy in their normal way of practice. Additionally, it is to foresee and seek the integration of mental health into the educational system by promotion in the schools and other organizations.

III.     Human Resources

　　According to the 2017 WHO data, the number of psychiatrists per 100,000 people is 0.52, child and adolescent specialists are 0.06, psychologists are 0.88, occupational therapists are 0.3, speech-language pathologists are 0.26, and there is no data on psychiatric nurses and social workers.

　　Candidates who finish a foundation degree courses must pass the National Medical Admission Test (NMAT) before they can apply for medical school. The students with completion of a four-year professional doctor of medicine (MD) program in a medical school and a one-year graduate internship degree program are eligible to take the Philippine Medical Licensing Examination. After graduating from the medical school and passing the examination of the Board of Physicians, the physicians are marked as general practitioners.

　　Medical specialization usually requires three to six years of residency training in accredited hospitals and clinics, and then it needs to pass the examinations organized by a committee of medical experts in a specific field. After being  specialized and certified, the doctor can start to engage in the professional field or to receive one to three years of specialist training/scholarship.

IV.  　Mental health system and promotion

V.   Major issues, challenge, and opportunities

　　The Philippines does not have a national unit to count the number of patients with mental illness. The commonest treated diseases in psychiatric hospitals are mental disorders (71%) and emotional disorders (18%). Substance abuse and psychosis are the most common cases in outpatient clinics. According to a small-scale epidemiological survey in 2006, the lifetime prevalence of mental health problems among respondents was 32%, mostly, the diagnoses are specific phobia (15%), alcohol abuse (10%) and depression (6%). Usually, men are more likely to have substance abuse problems.

　　Because it has not been integrated with primary medical care, only a few areas provide mental health services. A total of 17 general hospitals have psychiatric beds, and 20 general hospitals provide outpatient services. In order to improve the accessibility, the Philippine government had promoted the accessible program of psychotropic substances.

　　The vast majority of primary-level medical staff have not received on-the-job training related to mental health in the past five years, and they did lack the relevant regulations for the treatment and management for mental health patients. According to the official statistics of the Philippines government, 14% of the 1.4 million people with disabilities in the Philippines suffer from mental illnesses. Recent information (2014-2016) provided by the Philippine MoH shows that 42% of the 2,562 patients are receiving treatment for schizophrenia. According to data from the WHO in 2016, the overall suicide rate in the Philippines is 3.2 per 100,000, with a higher rate of 4.3 for men than those of 2.0 for women.

VI.     Potential exchange issues

　　Potential exchange topics, which include the assistance in training for the international students and professionals, and the development for mental health manpower especially in the field of child/adolescent psychiatry, can be further discussed. The launch of social workers and occupational therapists system, and the issues such as primary medical care, community mental rehabilitation model and mental health promotion, etc., are critically required in the coming days.