Table 1 Illustrative quotes on health workforce issues in implementing UHC in the Philippines
Quote ID | Issue | Quotation |
|---|---|---|
H1 | Poor preparation of graduates in school for implementing UHC | “I finished my MD from (school redacted), one of the best in the country. But when I worked here, it’s an entirely different ballgame. We weren’t trained how to deal with the local administration and procurement, how to talk to local chief executives. I wasn’t prepared nor trained for this but this is how we make things happen.” - Municipal health officer from a rural, geographically-isolated and disadvantaged area |
H2 | Lack of specialists and training opportunities outside Metro Manila | “If we really want Universal Healthcare, they should prioritize areas where the specialists are not concentrated like NCR. They should look at the bigger level. For example, here, we only have two cardiologists and no cardiac surgeons. So, I hope if there are TCVS (Thoracic and Cardiovascular Surgery fellowship vacancy) in Manila, if there are applicants, I wish, I hope they can prioritize applicants from other areas.” - Administrator of a public tertiary facility in an urban area |
H3 | Government budget caps for personnel services | “The 45% cap on personnel services really prevents us from hiring additional human resources. That’s the main reason why you see a ward nurse being assigned as the public health nurse. You see a community nurse being assigned as a records officer. That’s an extra job but there’s no extra compensation. If you notice, the health programs are not implemented properly because the program officers are working on many programs simultaneously. To be fair, I have heard that this cap is waived for UHC implementation, but I am not sure. I do not want to go to jail for it.” - Provincial level implementer from the public sector |
H4 | Difficulty in recruitment due to restrictive government hiring policies | “We have many job vacancies but it is hard to fill them. Government policy states that for certain positions, you can only hire those who have civil service eligibility. Not many people have that but I think there are many people who do not have civil service eligibility out there who can actually do the job. And then you have some vacancies for positions like records officers or program managers. They are looking for registered nurses for that vacancy. I mean, you do not have to be a nurse or have a PRC (Professional Regulations Commission) license to manage a health facility’s records or implement government programs. In fact, it is probably better if these people are not trained healthcare providers so that those who are trained in giving healthcare services can stick to providing care to patients. There is probably a need to revisit the eligibility requirements for vacancy positions in government.” - Provincial level implementer from the public sector |
H5 | Difficulty in recruitment due to restrictive government hiring policies | “The DOH has many (requirements) that are difficult to provide. Especially for manpower. We need a records officer, Information Technology administrator, but what happens is the nurse is the administrator, she is also in the records. So, the nurse is also the IT that should be designated just to meet the criteria.” - Public primary care provider from an urban area |
H6 | Poor working conditions | “You need an enabling environment, safe workspace, engaging them for something to make their workplace positive so that they will stay and the key there is the leader. Because if they are demotivated because of something and you ignore it, they will really leave. It’s not all about the money. I have interviewed some of them, why are you here in (office redacted)? There is more money in clinical. (They said), even if there is more money in clinical, you end up with mental health issues there because of the job, the supervisor, etc.” - Administrator of a public tertiary facility in an urban area |
H7 | Uncompetitive salaries in private sector relative to public sector, and public sector relative to overseas | “The problem with us here is that we will not be able to compete with (the salaries offered by) government. Especially with the salary. The entry level salary of our nurses here is just half of the entry level salary of government nurses.” - Administration of a private tertiary facility from an urban area |
H8 | Uncompetitive salaries in private sector relative to public sector, and public sector relative to overseas | “The nurses we lost are our best nurses. It is painful that the trained ones are the ones who leave. The ones left with us are either the new ones or are very old, because their salary (overseas) is five times what we pay here.” - Administrator of a public tertiary facility in an urban area |
H9 | Exorbitant fees for trainings | “For example, our medical records officer is currently in Manila undergoing training in data recording as part of DOH accreditation. And we’ve spent a lot. We’ve spent a lot. In our setting, we started May of this year (2023), as a primary care facility, we have already spent PHP 50,000 (~ USD 1,000) for trainings alone. Yes, the DOH is asking us to pay, and yet what we earned from primary care is barely PHP 2,000 (~ USD 40). These are actual data; we can show you the documents. They haven’t paid us for our previous (Konsulta) check-ups. We understand that there are processes, but realistically, how are we going to survive? Our stakeholders are questioning the wisdom of helping (in) Universal Healthcare.” - Administrator of a private primary care facility in an urban area |
H10 | Exorbitant fees for trainings | “And the training of the records officer, that is out of pocket, and she has to travel to Manila for that and spend PHP 20,000 (~ USD 400) just for training fees. And nobody wants to spend that much money so the renewal (of our license to operate) is still pending.” - Public primary care provider in an urban area |
H11 | Lack of job security for nationally deployed personnel | “Look, the nurses deployed in the NDP (Nurses Deployment Program) have been great in helping us with our health programs. However, her contract ends in a few month’s time. Thus, it will be a waste to send her to trainings considering that it is unsure if her contract will be renewed or that she will be hired again. We cannot send anybody else in the office. If only the contract of the NDPs are longer, we will not have this issue. It would also be nice because they will have benefits if they stay longer.” - Administrator of a public primary care facility in an urban area |
H12 | Poor crisis management | “There is a brain-drain in (agency redacted) due to recent scandals, (agency redacted) is getting pilloried (in the media and in the public), the effect to the organization is severe, and there are many policy developers before, they are gone now.” - National level implementer from the public sector |
H13 | Pull of migration overseas | “That’s a chronic problem. It’s (a) universal problem. Because, oh my God, medical or nursing staff, it is a problem. In our facility, we need specialists. That is why we send (our staff) abroad for fellowship because there are no offers here. And then our nurses, very big problem. Once they serve here for a year, they really go abroad.” - Administrator of a public tertiary facility in an urban area |