Address uneven distribution of health workers in PH—PIDS study

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March 28, 2020

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A STUDY of state think tank Philippine Institute for Development Studies (PIDS) found that Filipino healthcare professionals are more likely to work in areas where earnings are potentially high and near communities where they were trained.


According to PIDS Senior Research Fellow Michael Abrigo and former PIDS Research Associate Danica Ortiz, authors of the study “Who Are the Health Workers and Where Are They? Revealed Preferences in Location Decision among Health Care Professionals in the Philippines”, the supply of healthcare workers such as nurses, physicians, and midwives are highly uneven in terms of their geographic distribution in the country.
 
The authors noted that the composite density of physicians, professional nurses, and professional midwives in the Philippines reached 40.8 per 10,000 population in 2015.
 
This was above the thresholds recommended by the World Health Organization (WHO) in 2006 and the International Labour Organization (ILO) in 2011. The WHO proposed “a density of 23 skilled health care workers, comprising of physicians, nurses and midwives, per 10,000 population”, while the ILO suggested “a density of 34 physicians, nurses and midwives per 10,000 population”.
 
Subsequently, WHO updated its threshold to 45 skilled healthcare workers per 10,000 population in 2016 while ILO updated it to 41 per 10,000 population in 2014.
 
While these international metrics suggest that there is a sufficient supply of healthcare workers in the Philippines, Abrigo and Ortiz argued that this is not the case based on the country’s disaggregated data on health human resource (HHR) density.
 
“Less than 25 percent of cities and municipalities have HHR density above the 41 physicians, nurses and midwives per 10,000 population recommended by the WHO [in 2016]. This leaves as much as three-quarters of cities and municipalities in the country with potentially insufficient number of HHRs to provide healthcare services,” they explained.
 
The authors also found that these cadres of healthcare professionals are more likely to work in cities and municipalities that have greater access to amenities like hospitals and clinics. However, they are less likely to work in areas with high levels of ethnic concentration. 
 
The continuing maldistribution of healthcare workers can aggravate the country’s problem on limited access to healthcare services.
 
To address this issue, the authors highlighted some policy considerations in designing programs that will attract and retain healthcare workers especially in underserved areas.
 
One is to boost household incomes through local economic development, which is “essential in ensuring the economic viability of any professional practice, particularly in health care”.

The role of the private sector should also be strengthened in providing healthcare services to the people. “Supporting private healthcare practices through the country’s social health insurance system or a similar voucher scheme may provide greater incentives for healthcare workers to practice in underserved areas,” the authors said.

They also proposed for the reassessment of common- and deep-rooted beliefs on healthcare professional practice. However, they pointed out that “although altruistic motives among healthcare practitioners to serve in rural areas may be important in recruiting HHR for rural practice, it may not necessarily be the most sustainable.”  
 
The authors also suggested using technology as an alternative mode of service delivery, particularly in conducting remote medical consultations and diagnosis, and in record management.
 
Lastly, they recommended the “certification of some primary healthcare skills that may be done by other cadres of healthcare professionals, instead of relying on the limited supply of physicians.” They cited as an example nurses in the United States, Canada, and the United Kingdom who are certified to assess patients’ needs, interpret diagnostic and laboratory tests, prescribe medication, and formulate treatment plans. This strategy may also be explored in the Philippines, the authors said.


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