FOR the Philippines, at the heels of its well performing economy and a GDP anticipated to hit 6.9% this year, it can be quite perplexing to hear that it is at a crux of healthcare crisis due to a deficit of health professionals in the local healthcare system.
Experts at the recently concluded Healthcare Asia (HCA) Forum held in Makati City, Philippines attributed this shortage to migration of healthcare workers, as well as to fewer students going into medical schools. A lower medical school enrolment turn out may also be witnessed in the near future, according to Dr Jesus Jardin, President of Philippine Hospital Association (PHA) President and panelist at the said forum.
The HCA forum, organised by Charlton Media Group, delved on key issues, including healthcare financing, medical technology and professional migration.
Dr Elvira Dayrit, Director, Human Resources Bureau of the Department of Health (DOH) explained that the country’s chief health agency is polishing up a masterplan to pave way for solutions to address these issues, likewise adding that the agency still needs the help of the various stakeholders to enable legislations and national policies concerning the healthcare system. Shortage of healthcare workers disrupts delivery of equal, sufficient and affordable primary care.
Money at the root of the crisis
Migration is a global concern. Agencies like the World Health Organisation (WHO), for example, have exacted means to prevent exodus of health professionals from one country, while at the same time, control their influx to the country of destination.
Healthcare workers, who may consist of doctors, nurses, and midwives, community health workers, as well as other allied professionals including like dentists, therapists, medical technologists, dentists and others are driven to seek greener pastures elsewhere that offers higher wages, more benefits and better professional growth.
WHO, which acknowledges in its 2013 report, Migration of Health Workers, also denotes the need to address this issue in policy level, because, first and foremost, the imbalanced distribution of healthcare workers across the globe impacts primary care delivery – a basic human right.
Through the WHO’s Global Code of Practice on the International Recruitment of Health Personnel, the so-called receiving countries are encouraged to see how their policies and actions will be impacting the countries from which health workers migrate.
As an exporter of health care workers, the Philippines’s compliance to this code has not been clear.On the other hand, the country’s position as a “supplier” of healthcare workers imperils healthcare access in rural areas, let alone in urban yet under-served areas. Inequity in health care access remains prevalent more aggravated by shortage of health workers and providers as well as inadequate health facilities.
In 2014, groups from the healthcare and medical sectors sought Government action to mitigate what they called crisis in the workforce.
In figures, the groups led by members of the Philippine College of Physicians (PCP) and health agency officials, estimated that there were 2.3 healthcare workers per 10,000 population. Majority of Filipino patients also rely on services of public health facilities served by only 4.5% doctors out of the 66,000 total (at the time of the report). Moreover, there were only about 1% of the 500,000 nurses and some 23% of 74,000 midwives in the country were serving in public facilities.
Meanwhile, Dr Dayrit projected an increase of 20% within the next five years to 2023 from the current 2,200 health professionals and practitioners – the figure representing a significant shortfall to an expected 6,000 required health workers and professionals.
Ideally , about 44 healthcare workers are needed per 10,000 population, based on the WHO’s estimates, Dayrit said, adding that in 2016, the country has the ratio of 17.2 health workers per 10,000 population or categorically, 3.9 doctors per 10,000 population.
Low medical school enrolment
Dr Jardin spoke of the currently dwindling number of medical school graduates and passers, thus translating to fewer physicians in practice. Dr Allen Bacallan, Vice President & Chief Information Officer of Cardinal Santos Medical Center refuted this, saying that the number of enrolees, both local and foreign students were growing by the year.
Medical school tuition fees, which can range from roughly Php 20,000-250,000 (about US$400-5,000) per semester, not to mention other extra costs like books, kits, etc., are quite steep for a good number of Filipino students who would rather take the practical road with degrees that require lesser fees and number of years of study. In short, the “return of investment (ROI)”, so to speak, is quicker and comparably achievable.
And since we are talking in “investments” term, the low wages for public physicians and other such challenges faced by doctors with the current state of the health care system are also discouraging students to opt going to medical schools.
Dr Dayrit explained in her presentation that graduates from medical schools located outside of Metro Manila would stay behind to work locally; while the ones coming from Metro Manila schools would eventually overseas. Moreover, the agency is also encouraging schools to produce more general practitioner doctors to be deployed in communities and who are also able to work together with local government units.
What this inequity means to Filipinos
Filipinos making do with their meagre income slayed by already high cost of living may not be able to appreciate how these statistics play out in the looming healthcare crisis; but the mental, emotional and physical ordeal resulting from the inability to access adequate medical assistance due to either lack of nearby facilities or the exorbitant cost of healthcare fees and out of pocket expenses not covered by the national health insurance (Philhealth) benefits is an experience that cannot be quantified.
Solutions such as expanding adoption of mobile health or telehealth technologies; setting up specialty clinics or polyclinics in areas that do not have established medical facilities; as well, recruitment (and retaining) of skilled health workers are only winning half the battle. The other half is to ensure the affordability of quality health care, which, unfortunately has been tackled merely as election rhetoric rather than a real-time plight that requires immediate, tangible attention.