Addressing Health Human

Resource Gaps in the

Philippines
• Tony Leachon, MD
• Philippine College of Physicians Foundation
• Coalition for Primary Care
• May 4,2016
 Disclosures
• PhilHealth , Independent Director as
Representative of the Monetary Board
• President, PCP Foundation Inc.
• Member, Coalition for Primary Care
• References : Research work of Dr A.Dans,
DOH,PHIC , PCP, PSGIM, AER, Coalition for
Primary Care
 Agenda
1. Background : Philippine Healthcare
2. UHC : Where are we now ?
3. Healthcare Workforce Crisis
4. Recommendations :
– Primary Care system
– 5 R’s
5. Summary
47.6% of deaths among Filipinos are
unattended by a medical doctor or
allied health provider.
 Health Human Resource, Philippines.

Midwiv
  Doctors Nurses es
Active in
Professional
Regulation 74,000
Comm.1 66,000 500,000
Employed in
Government
Facility2 2,838 4,576 17,000
Ratio per 10,000
1 PRC database, 2014 1.7
population 3
0.2 0.4
2 Philippine Statistical Yearbook, 2010.

3 Total 2.3 HCW’s/10,000 pop;

WHO recommends 24/10,000.
Supply of Health Care Workers’ is
Decreasing
1. We are #1 exporter of nurses
2. We are #2 exporter of doctors
3. ASEAN integration will open doors.
 Top 10 Causes of Mortality, Philippines 2010
Number Rate per
Cause of Death
affected 100,000
1. Diseases of the Heart 102,936 109.5
2. Diseases of the Vascular Sy stem 68,553 72.9
3. Malignant Neoplasms 49,817 53.0
4. Pneumonia 45,591 48.5
5. Accidents 36,329 38.6
6. Tuberculosis, all forms 24,714 26.3
7. Chronic Lung Disease 22,877 24.3
8. Diabetes Mellitus 21,512 22.9
9. Nephritis/nephrotic syndrome/nephrosis 14,048 14.9
10. Perinatal disease 12,086 12.9
Philippine Health Statistics, 2010
 Double Burden :3 Chronic Problems
• 1.Chronic healthcare workforce shortage
– PH # 1 exporter of nurses, and the number 2 exporter of doctors in
the world.
– This shortage is at its worst where healthcare workers are needed
most – in rural and urban public facilities, where they are both
underpaid and overworked.
•  2. Fragmented system
– characterized by 46 separate but overlapping healthcare programs
driven by donor initiatives rather than population needs.
– This has hindered our ability to integrate, harmonize and prioritize
solutions to problems in health.
• 3.Healthcare system is also fragmented administratively, 
with local government units placed in charge of frontline 
healthcare delivery.  
– This has politicized the healthcare workforce and has made it difficult
for the DOH to orchestrate a unified healthcare program.
 Universal Health Care(UHC)
Inaugural Address 2010
• “Provision to every • It is also known as
Filipino of the highest Kalusugan
possible quality of Pangkalahatan, which
health care that is the Aquino administration
describes as the
accessible, efficient,
"availability and
distributed adequately accessibility of health
funding, fairly services and
financed, and necessities for all
appropriately used by Filipinos."
an informed and
empowered public."
 Universal Health Care(UHC)
Republic Act 10606
• A government mandate aiming to
ensure that every Filipino shall
receive affordable and quality health
benefits and services such as :
– Human resources
– Health facilities
– Health financing
One Peso DOH Consultant
2011-2013
Sin Tax Law Signing
Dec 20, 2012
2003 2013
PhilHealth PhilHealth
Income Utilization Income Utilization
Poorest 18% Poorest 33%
Poor 23% Poor 71%
High Middle 48%
Middle 24%
Low Middle 54%
Rich 28% Rich 70%
Richest 33% Richest 88%
NDHS 2003 Faraon et al, 2013
 Are patients benefiting?
• Out-of-pocket spending remains high at 57%
• The top conditions paid by
P Pneumonia
PhilHealth do not match
priority health conditions H Hemodialysis
and are focused on costly I Infections (UTI)
interventions
C CS / Cataract
 Sin Tax Funds to PhilHealth
• Republic Act No. 10351 (or the Tobacco and 
Alcohol Tax), signed by President Aquino 
on Dec. 29, 2012
– gives the government the financial capacity to cover
the full subsidy of the premium coverage of 14.7
million poor Filipino families (or more than 45 million
Filipinos), amounting to P37 billion for 2015 and an
increase of the Department of Health budget to
P103 billion (an increase never received before).
DOH Sec Enrique T.Ona , PDI July 2015
 What the Sin Tax Law has already achieved

150 Php in 2015

• Revenue generation
80.0
70.4

60.0

40.0 32.933.0
31.7
27.624.2
23.123.726.823.2 20.621.8
26.0
22.923.9
16.816.517.419.420.120.0 17.016.118.819.8
12.412.513.012.512.913.916.0
20.0

0.0

Tobacco Alcohol
 Prevalence of Never, Current and Former
Smokers. Philippines, NNS 1998-2015
Prevalence (%)
70
63.7
Never Smoker 59.1
60 54.5 55.0 54.3

50
Current Smoker
40 34.8
32.7 31.0
30 25.4
23.3

20
Former Smoker

10 14.7 15.5
12.8 13.0
10.2
0
1998 2003 2008 2013 2015
Sin Tax Law Health Updates NNS 2015
1. Prevalence of smoking among adult Filipinos went
down from 31.0% in 2008 to 23.3% in 2015.
2. This means there are ~4 million less smokers in the
country today because of the Sin Tax Law.
3. The drop is not from people who stopped
smoking. It is from people who avoid starting to
smoke.
4. At least 70,000 deaths have been averted since
2013.
5. Health benefits were greatest in price sensitive
populations – the poor, rural folk, the very
young and the very old.
 Strategic Questions
How Doctors Think

1.Where are we now ?
Diagnosis ? State of The
Nation’s Health
2. Where do we want
to go ? Towards UHC
3. How do you get
there ? Eg Plan of Action
 Where are we?
(The Philippine Healthcare System)
 Good News and Bad News about
the Philippine Health Situation
1. PhilHealth coverage has increased from 51% in 2010 to 88%
in 2015 (PhilHealth) 1
2. But PhilHealth utilization remains low, especially amongst
the poorest (only 33%) 2
3. The health budget increased from PhP28.7B in 2010 to
PhP205B in 2015 3
4. But the number of Filipinos who die without seeing a HCW
increased from 45% to 66% 4
5. We are the number 1 exporter of nurses in the world 5, and
the number 2 exporter of doctors 6
6. In the public sector,
- There are only 5 HCW’s per 10,000 population (ideal = 25)
- There is only 1 doctor per 20,000 (ideal = 20) 7
1 Philhealth, 2 Faraon et al, 2013, 3 Department of Health, 4 Philippine Health Statistics, 5 Matsuno et al, 6 World Health Organization, 7 Dans et al
 Why healthcare workers leave 1
1. Unemployment (unfilled positions for HCW’s)
2. Underemployment (underpaid for workload)
3. Misemployment (job orders and casuals)
4. Unjust working conditions (eg - politicalization of
appointments, non-issuance of magna carta benefits)

Why healthcare workers stay 2

1. To serve the country
2. To be with their family

1 Ebesate J, 2012, 2 Lorenzo M, 2005

 Where do we want to go?
(Ideally ,A Primary Care System)
The Philippine Healthcare Situation
Too Little Health Care Too Much Health Care

Mr. Jose Mrs. Rosete

42 years old 50 years old
From Busuanga From Quezon City

- High Blood - Diarrhea (gastro)

- Diabetes - Stroke (neuro)
- Tuberculosis - High Blood (cardio)
- Diabetes (endo)
No consultation - Kidney ds (nephro)
No medications - Gout (rheuma)
- Pneumonia (pulmo)

66% of deaths among 1.5M families a year pay for

Filipinos are not attended catastrophic health
by a doctor, nurse or expenses.
midwife

PHS 2011 Ulep et al 2013

 3° CARE
2° CARE
1° CARE
ALL
HEA ERG
RT IES
DIS
EAS
SKI
ND E
ISEA
SE
INT
EST SURG
INA ERY
BLO L D
OD ISEA
C ON SE
INF
ECT D ITIO
IOU NS
WO S DIS
ME EAS
N’S E
HEA
PRE LTH
G
BRA NANC
IN D Y
ISEA
SE
CAN
LUN CER
GD
A Primary Care System

KID IS
NEY EASE
DIS
EAS
E
 THE PROBLEM
Funds have increased but services have deteriorated

INADEQUATE
WORKFORCE

INADEQUATE
INEQUITY FACILITIES
IN HEALTH
INADEQUATE
TESTS/MEDS
 THE PROPOSAL
Healthcare SYSTEM reform: Tunay na KP!

FUNDS FOR WORKFORCE

(AT THE FRONTLINES)

PHILHEALTH PRIMARY CARE FUNDS FOR FACILITIES

OUTPATIENT PACKAGE (AT LGUs, RHUs)

FUNDS FOR TESTS & MEDS

(PREVENTIVE CARE FINALLY)
 A Primary Care System
A Healthcare System that enables patient access to
healthcare providers with 3 main functions:

1. FIRST CONTACT
Patient
& COMPREHENSIVE
CARE
2. COORDINATOR OF Primary Care 3. PRINCIPAL POINT OF
HEALTH SERVICES Provider CONTINUING CARE

Laboratories Pharmacies Specialists Facilities

 How do we get there?
(How to Reform the Healthcare System)
Roadmap to a Primary Care System

RECRUIT Threshold density 5:1000 (WHO)

- Graduate doctors, nurses,
RETRAIN midwives
- Current practitioners
RETAIN - Private & Public sector

REGULATE
REASSESS
Roadmap to a Primary Care System

RECRUIT Workshops on DOH priorities:

- Infectious Diseases
RETRAIN - Non-Communicable Diseases
- Health System Navigation
RETAIN
REGULATE
REASSESS
Roadmap to a Primary Care System

RECRUIT
RETRAIN - Pay for outpatient care!
RETAIN - In public sector – provide and
augment salaries of HCWs
REGULATE - In private sector, subsidize
payments for healthcare.
REASSESS
Roadmap to a Primary Care System

RECRUIT
RETRAIN
RETAIN Facility – electronic records
REGULATE Health workers – accreditation
Patients – require primary care
REASSESS
Roadmap to a Primary Care System

RECRUIT
RETRAIN
RETAIN
REGULATE - Better Quality of Care
- Better health
REASSESS - Reduced healthcare expenses
- Reduced out of pocket payment
Roadmap to a Primary Care System

RECRUIT
RETRAIN
RETAIN
REGULATE
REASSESS
 Summary
• Despite the rising budget and increasing Philhealth
coverage, healthcare is deteriorating.
• The deterioration is mainly due to a shortage of healthcare
workers caused by massive migration
• Healthcare workers who stay (especially those in rural areas)
are patriots who want to serve the country.
• The government need to take better care of those who care
for our health.
• Primary care is vital in achieving genuine UHC.

Walang kalusugang pangkalahatan, kung walang mag-aalaga

sa taong bayan! – Coalition for Primary Care