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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.
2.
3.
4.
Background : Philippine Healthcare
UHC : Where are we now ?
Healthcare Workforce Crisis
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.
Doctors
Nurses
Active in Professional
Regulation Comm.1
66,000
500,000
74,000
Employed in
Government Facility2
2,838
4,576
17,000
0.2
0.4
1.7
Ratio per 10,000
population3
1 PRC
Midwives
database, 2014
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
affected
Rate per
100,000
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
Cause of Death
1. Diseases of the Heart
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
Filipino of the highest
possible quality of health
care that is accessible,
efficient, distributed
adequately funding, fairly
financed, and
appropriately used by an
informed and empowered
public."
• It is also known as
Kalusugan
Pangkalahatan, which
the Aquino administration
describes as the
"availability and
accessibility of health
services and
necessities for all
Filipinos."
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
Income
2013
PhilHealth
Utilization Income
Poorest
Poor
18%
23%
Middle
24%
Rich
Richest
28%
33%
NDHS 2003
Poorest
Poor
High Middle
Low Middle
Rich
Richest
Faraon et al, 2013
PhilHealth
Utilization
33%
71%
48%
54%
70%
88%
Are patients benefiting?
• Out-of-pocket spending remains high at 57%
• The top conditions paid by
P Pneumonia
PhilHealth do not match
H Hemodialysis
priority health conditions
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
Sin Tax Revenues, 1998-2013 (in PhP billions)
80.0
70.0
60.0
50.0
40.0
30.0
20.0
10.0
0.0
70.4
32.9
33.0
16.8
23.9
12.4
Tobacco
Alcohol
Prevalence of Never, Current and Former
Smokers. Philippines, NNS 1998-2015
70
Prevalence (%)
Never Smoker
60
54.5
55.0
59.1
63.7
54.3
50
Current Smoker
40
32.7
34.8
31.0
25.4
30
20
10
23.3
Former Smoker
12.8
14.7
15.5
2008
2013
10.2
13.0
0
1998
2003
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.
2.
3.
4.
5.
6.
1
PhilHealth coverage has increased from 51% in 2010 to 88%
in 2015 (PhilHealth) 1
But PhilHealth utilization remains low, especially amongst
the poorest (only 33%) 2
The health budget increased from PhP28.7B in 2010 to
PhP205B in 2015 3
But the number of Filipinos who die without seeing a HCW
increased from 45% to 66% 4
We are the number 1 exporter of nurses in the world 5, and
the number 2 exporter of doctors 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
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.
2.
3.
4.
Unemployment (unfilled positions for HCW’s)
Underemployment (underpaid for workload)
Misemployment (job orders and casuals)
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
42 years old
From Busuanga
Mrs. Rosete
50 years old
From Quezon City
- High Blood
- Diabetes
- Tuberculosis
- Diarrhea (gastro)
- Stroke (neuro)
- High Blood (cardio)
- Diabetes (endo)
- Kidney ds (nephro)
- Gout (rheuma)
- Pneumonia (pulmo)
No consultation
No medications
66% of deaths among
Filipinos are not attended
by a doctor, nurse or
midwife
1.5M families a year pay
for catastrophic health
expenses.
PHS 2011
Ulep et al 2013
A Primary Care System
1° CARE
2° CARE
3° CARE
THE PROBLEM
Funds have increased but services have
deteriorated
INADEQUATE
WORKFORCE
INEQUITY
IN HEALTH
INADEQUATE
FACILITIES
INADEQUATE
TESTS/MEDS
THE PROPOSAL
Healthcare SYSTEM reform: Tunay na KP!
FUNDS FOR WORKFORCE
(AT THE FRONTLINES)
PHILHEALTH
PRIMARY CARE
OUTPATIENT PACKAGE
FUNDS FOR FACILITIES
(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
& COMPREHENSIVE
CARE
2. COORDINATOR OF
HEALTH SERVICES
Laboratories
Patient
Primary Care
Provider
Pharmacies
3. PRINCIPAL POINT OF
CONTINUING CARE
Specialists
Facilities
How do we get there?
(How to Reform the Healthcare System)
Roadmap to a Primary Care System
Threshold density 5:1000 (WHO)
RECRUIT
- Graduate doctors, nurses,
midwives
RETRAIN
- Current practitioners
RETAIN
- Private & Public sector
REGULATE
REASSESS
Roadmap to a Primary Care System
Workshops on DOH priorities:
RECRUIT
- Infectious Diseases
- Non-Communicable Diseases
RETRAIN
- Health System Navigation
RETAIN
REGULATE
REASSESS
Roadmap to a Primary Care System
RECRUIT
RETRAIN
- Pay for outpatient care!
- In public sector – provide and
RETAIN
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
Health workers – accreditation
REGULATE
Patients – require primary care
REASSESS
Roadmap to a Primary Care System
RECRUIT
RETRAIN
RETAIN
REGULATE
REASSESS -
Better Quality of Care
Better health
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 magaalaga sa taong bayan! – Coalition for Primary Care