Barriers to Universal Health Care in the Philippines: A Study

Recent research from Ateneo de Manila University sheds light on the significant workforce challenges hindering the implementation of Universal Health Coverage (UHC) in the Philippines. Despite being a leading exporter of healthcare professionals, the nation grapples with a severe shortage of medical personnel, including a deficit of at least 127,000 nurses and less than eight doctors per 10,000 individuals.

The study, published in Human Resources for Health, reveals that many health graduates in the Philippines are inadequately equipped for public health roles. Their education often emphasizes hospital-centric training, neglecting essential skills in community-based care and UHC principles. As a result, graduates frequently lack the necessary knowledge and training for effective deployment in public health settings.

Moreover, financial limitations and policy barriers have exacerbated staffing shortages in both public and private healthcare facilities. Public hospitals struggle to recruit sufficient staff due to budget constraints, while private institutions find it challenging to retain their employees, who are often lured by significantly higher salaries abroad.

A public health administrator expressed concern over the loss of skilled nurses, noting that those who leave are often the most qualified, leaving behind either inexperienced newcomers or older staff. This trend highlights a critical issue: the disparity in compensation between local and overseas employment opportunities.

Additionally, restrictive hiring policies imposed by the Department of Health create obstacles in workforce management, forcing health professionals to juggle multiple roles to meet bureaucratic requirements. For instance, a nurse may simultaneously serve as a records officer and an IT administrator, reflecting the strain on health facilities to comply with staffing regulations.

The enactment of Republic Act No. 11223, known as the Philippine Universal Health Care Act, was intended to ensure that all citizens have access to affordable health services. This law mandates the automatic enrollment of all Filipinos in the National Health Insurance Program and empowers local government units to manage health service delivery. However, the implementation of this law has been fraught with challenges, particularly in workforce preparedness and the coordination of health services across national and local levels.

Currently, the physician-to-population ratio in the Philippines stands at 7.92 per 10,000 residents, falling short of the international standard of 10. The shortage of nurses is predominantly felt in the private sector, and the phenomenon of 'brain drain' continues to impact the availability of qualified health personnel.

To address these pressing issues, the researchers put forth several recommendations aimed at enhancing health workforce recruitment and retention. Key suggestions include:

• Strengthening collaborations between educational institutions and healthcare facilities to facilitate graduate placements under return service agreements.
• Providing educational incentives and postgraduate training opportunities for health workers committed to serving locally.
• Ensuring a fair distribution of specialist training slots for physicians.
• Revising medical and health education curricula to incorporate community health and UHC principles.
• Implementing reforms in higher education and civil service policies.
• Encouraging local governments to devise long-term strategies for health workforce recruitment and retention.
• Updating health workforce training programs and their associated costs.
• Providing UHC training for current staff and new hires.
• Establishing more balanced labor agreements between countries supplying and receiving health professionals.

These recommendations aim to alleviate workforce shortages and promote a more equitable healthcare system under the UHC framework. The findings of this study underscore the urgent need for sustained investment in the local health workforce to transform the promise of universal healthcare in the Philippines into a reality.