A new study by the Ateneo de Manila University reveals that health system reforms under Universal Health Coverage (UHC) are being held back by gaps in training, poor working conditions and restrictive hiring rules.
Titled “Health workforce issues and recommended practices in the implementation of Universal Health Coverage in the Philippines: A qualitative study,” the research highlights how most Filipino doctors and nurses are trained for hospital-based care but lack preparation for the policy and administrative implementation roles expected in public health.
“May mga doctor and nurse, they spend significant amounts of their time in the hospital and that’s perfectly fine … but you see, when you go to public health work … you have to be in charge of the implementation of government programs, how you will roll these programs on the ground,” said the study’s co-author Veincent Christian Pepito.
“These things, they are not being taught in our medical or nursing schools,” he told ABS-CBN News.
The study points to civil service and licensure requirements that exclude otherwise qualified applicants from non-clinical roles.
Local government budget caps further limit hiring flexibility.
Though a joint government circular lifted the 45-percent salary cap on local personnel services, local government units remain hesitant to act on it due to fear of violating budget rules.
“It’s probably better that these people who implement government programs do not have a nursing license. The people who are training to provide clinical care can provide it instead,” Pepito said.
High training costs also deter UHC participation. Some clinics pay up to P50,000 for UHC-required staff courses, but receive only P2,000 in government reimbursement, the study showed.
Low pay, job insecurity and better opportunities abroad also continue to drive workforce attrition.
To retain talent, the study recommends scholarships with return service agreements, free tuition for dependents of health workers, flexible, skills-based hiring, curriculum reforms in primary and community care, and revisions to the Local Government Code. (ABS-CBN News)