Where are the health workers?
MANILA, Philippines – Migration, devolution, and population growth.
These are just some of the reasons why the country still lacks health workers despite thousands of licensed professionals every year.
In a health forum Tuesday, February 11, Dr Adrian Rabe of the Philippine Society of General Internal Medicine (PSGIM) said:
ANNUALLY, PH LICENSES20,000 nurses
2,900 medical technicians
750 physical therapists, occupational therapists and speech language pathologists
“We already have many licensed [health professionals] and graduates every year. Why do we still lack health professionals? If we have a lot of graduates, where are they going?” Rabe said in a mix of English and Filipino.
The Department of Health (DOH)'s Health Human Resource Development Bureau said the country only has 3.5 doctors for every 10,000 population – a far cry from the the ideal ratio of 1 to 1.5 doctors for every 1,000 population.
The numbers get smaller in areas serviced mainly by public doctors: the average is a “measly” 3 doctors for every 100,000 population, Health Undersecretary Ted Herbosa said.
1-1.5 doctors:1,000 patients
3.5 doctors:10,000 patients
AREAS SERVED BY PUBLIC DOCTORS
3 doctors:100,000 patients
But the shortage of doctors, he said, is not only a national problem but also a global one.
In fact, the Philippines has become a solution to other countries' shortages, as many Filipino nurses and doctors migrate to other countries for higher-paying jobs.
There is also a “maldistribution” of health workers in the country, according to Herbosa, with most physicians wanting to stay in urbanized areas. Rabe said this is because most development efforts are in the cities where the money is.
But one doctor did just the opposite: after growing up in America, he went back to the Philippines to study and practice medicine here.
Dr Moses Princesa, 38, was one of the brave few who wanted to help in far-flung town like Balabac and Busuanga, both in Palawan.
He served in Balabac for 3 months until he was asked by the mayor to leave when his staff said he was overbearing to them. He said he was wrongfully accused.
He then moved to Busuanga, where he has been serving since 2008. But in the last 6 years, the idealistic doctor became a tired municipal health officer serving 14 barangays (villages) or 20,000 patients in Palawan.
He asked the government to take better care of the care givers.
“Pansinin 'nyo rin po 'yung ibaba. Opo, na-devolved kami. Ang problema, 'di nyo 'binaba 'yung pondong sapat para alagaan 'yung nag-aalaga ng kalusugan sa 'baba,” Princesa said.
(Pay attention also to people on the ground. Yes, we were devolved, but the problem is that you did not devolve the funds that are enough to take care of those workers who are attending to the health needs of the communities.)
Since 1992, the delivery of health services has been devolved to local government units (LGUs), including the nitty-gritty of service – that is, health reporting and health care. (READ: 5 things we serve barangay officials on a silver platter)
The devolution also placed hiring and the salary of health professionals at the discretion of the LGUs.
In January, Health Secretary Enrique Ona told Rappler that the DOH will be proposing that the Local Government Code be amended to revert to the department the direct supervision of provincial health officers and municipal health officers, away from governors and mayors so health services can be spared from politics. (READ: Ona: Take health care out of politicians' hands)
Herbosa said a big bulk of the 2014 DOH budget will be allotted for the funding of the Magna Carta benefits for public health workers.
According to Rabe, 6 out of 10 or a majority of Filipinos die without ever seeing a doctor.
Doctors called the shortage on doctors a health workforce crisis, and population growth is aggravating it.
This year, the Philippine population is expected to hit 100 million. The Professional Regulation Commission (PRC) listed only about 70,000 licensed doctors at present.
That's 7 doctors for every 10,000 population, with every doctor allotting 15 minutes per consultation at 4,500 consultations every year.
PH POPULATION (2014)
7 doctors:10,000 patients
Princesa said if more health workers are sent to the front line, especially in rural areas like Palawan, the government can focus its services on preventing diseases instead of treating them.
“It will cost the government less to prevent sicknesses instead of treating them,” he said in Filipino.
Herbosa said the country needs more long-term, system-wide solutions like incentives for doctors to serve in the country especially in rural areas, and incentives for LGUs to improve the local health system in the country. – Rappler.com