While many were confined to their homes when the Philippines went under lockdown in 2020, groups of volunteers were mobilized to roam the streets as frontliners against the coronavirus.

These were the barangay health workers (BHWs), whose typical work day involves going door-to-door to provide residents with medicine and disseminate health information. During the pandemic, BHWs were tapped to continue their house-to-house visits and implement contact tracing. 

The work of BHWs mandates them to interact with potential – and even confirmed – carriers of the virus. BHWs were tasked with monitoring the health status of community members and providing medicine to COVID-positive patients.

Yet despite risking their lives at the frontlines, BHWs have not been taken care of in return. 

Many BHWs have reported not receiving hazard pay, despite promises from the national and local government. In some cases, BHWs had to pay for their own expenses when they and their families contracted the virus. 

This neglect is not unique to the pandemic context. Despite being introduced to the health system since the early 1980s, BHWs remain considerably overlooked in the health value chain.

Overworked, underpaid

The Republic Act 7883 or the Barangay Health Workers’ Benefits and Incentives Act of 1995 defines BHWs as those who have “undergone training programs under any accredited government and non-government organization and who voluntarily renders primary health care services in the community.”

Within the country’s decentralized health system, BHWs are often the first point of contact for Filipinos seeking care. They act as a bridge between the community and the health system. BHWs are especially critical in far-flung areas, serving as the key source of information and health care delivery in these disadvantaged communities.

The BHW Act outlines the general duties and responsibilities of a BHW as a community organizer, educator, and health care services provider. In practice, BHWs perform plenty of tasks, ranging from caring for pregnant residents and assisting in vaccination drives to census-taking and record-keeping. Moreover, their roles are not limited to health and are highly dependent on orders from the top, lending to the job’s ambiguity.

BHWs take on an excessive amount of work. The DOH recommends a ratio of 1 BHW per 20 households. However, BHWs in reality typically deal with 200 to 300 households. Moreover, they are expected to be available 24/7, with residents relying on them for emergencies. Additional competency training, while important, will not solve a numbers concern, one which arguably can compromise quality of care.

Despite the amount of work they do, BHWs receive meager compensation, ranging from P800 to P1,000 pesos monthly, depending on the barangay. BHWs are only considered volunteers and not regular workers. As such, they only receive compensation in the form of honoraria instead of salaries. 

By itself, being a BHW is not seen as a viable source of income, with BHWs relying on other working family members and taking on part-time jobs to get by.

The pitfalls of benevolence

“Mahirap pero masarap” – difficult but rewarding – is a recurring phrase used by BHWs in describing their work. The desire to serve their community motivates them to become and remain volunteers. This drives them not only to perform their tasks tirelessly but to extend assistance to community members by covering their travel costs and purchasing medicines for those with insufficient resources.

Their goodwill does not go unnoticed. BHWs enjoy a great deal of respect and appreciation from local government officials, health workers, and residents alike. The role of BHWs is even viewed as a form of martyrdom. However, extolling the benevolence of BHWs risks overlooking the realities of their exploitation. 

BHWs’ commitment to serve is often used to excuse the inadequacy of their compensation. Worse, BHWs themselves become willing to overlook their meager remuneration. However, in viewing compensation as secondary or even optional, the gravity of the financial struggles of BHWs is greatly reduced, diluting the calls to raise their compensation.

While several BHWs have expressed wanting to decrease their workload, many have docilely accepted it as an irrevocable part of their job. In fact, BHWs are primarily considered indispensable because of their ability to handle whatever work is handed to them – and regardless of how much.

BHWs are praised for doing the work that many reasonably decline. However, dependence on volunteerism creates instabilities, conferring BHWs with weak accountability.

Policy recommendations

Barangay health workers need more than recognition. There is an urgent need to improve their conditions. Several reforms are urged.

Firstly, there is a need to coordinate census and registry information. A better-integrated and computerized system of census-taking is recommended to lessen redundancy of work.

Next, RA 7883 must undergo a comprehensive policy review and reform to better implement and strengthen its provisions.

Thirdly, BHWs must be turned into regular government employees. This is the most radical yet most urgent recommendation. BHWs must be made civil servants with fixed salaries, benefits, and insurance coverage to provide them with protection and accountability. Because providing health care is complicated, there is better accountability if one is not treated as a volunteer.

The fourth recommendation is to connect and integrate BHWs into the health system through a clearer program and a dedicated office in the DOH.  The question we should be asking is how a BHW can be part of the Universal Health Care value chain.

Finally, career-pathing for BHWs must be established and strengthened, providing BHWs with opportunities to progress into a health career such as midwifery and nursing. – Rappler.com

Kenneth Y. Hartigan-Go is the Senior Research Fellow for Health Governance at the Ateneo Policy Center at the Ateneo School of Government.

Sheena A. Valenzuela is the Research Associate and Program Coordinator for Health Governance at Ateneo Policy Center at the Ateneo School of Government.

Melissa Louise M. Prieto is the Research Assistant for Health Governance at the Ateneo Policy Center at the Ateneo School of Government.