6  INEQUITABLE DISTRIBUTION OF HEALTHCARE WORKERS
The toll that the COVID‐19 pandemic has taken on the country’s human resources for health (HRH) reminds us of the impact of the continuing migration of doctors, nurses, and other health care personnel to developed countries. Figures from the Professional Regulations Commission show that out of 84,783 licensed Filipino physicians, only 28,428 are actually practicing in the country.65 Dela Rosa, R. (2020, May 13). Sponsorship Speech, Committee Report 86, Senate Bill No. 1520. Senate of the Philippines. Retrieved May 18, 2020, from http://www.senate.gov.ph/press_release/2020/0513_delarosa1.asp
And while the country licensed an average of 26,000 nurses from 2012 to 2016, there were around 18,500 who moved abroad each year.66 Bloomberg. (2020, April 25). PH, Supplier of World’s Nurses, Struggles to Fight COVID‐19 at Home. Manila Bulletin. Retrieved April 27, 2020, from https://mb.com.ph/2020/04/25/ph‐supplier‐of‐worlds‐nurses‐struggles‐to‐fight‐covid‐19‐at‐home/
There is an estimated shortage of 23,000 nurses nationwide and yet there are approximately 150,000 Filipino nurses working in the United States.67 Ibid.
According to Michael Obrigo and Danica Ortiz, researchers from the Philippine Institute of Development Studies, “less than 25 percent of cities and municipalities have HHR (human health resource) density above the 41 physicians, nurses and midwives per 10,000 population recommended by the WHO [in 2016].”68 Macaraeg, P. (2020, March 28). About 75% of Cities, Towns in Philippines Lack Health Workers. Rappler. Retrieved July 27, 2020, from https://rappler.com/nation/about‐75‐pecent‐cities‐towns‐philippines‐lack‐health‐workers‐pids
According to 2017 statistics, among the 17 regions of the country, the number of doctors ranged from 10.6 to 0.9 (average of 3.9), the number of nurses ranged from 15.8 to 4.2 (average of 8.6), and the number of midwives ranged from 9.9 to 2.3 (average of 4.1) per 10,000 population.69 Dayrit, M.M., et al. (2018). The Philippines Health System Review Health Systems in Transition Vol. 8 No. 2 2018. New Delhi: World Health Organization, Regional Office for South‐East Asia. Retrieved April 24, 2020, from https://apps.who.int/iris/bitstream/handle/10665/274579/9789290226734‐eng.pdf?sequence=1&isAllowed=y
To keep up with the continuing requirements for HRH, emergency hiring has been going on at a frenetic pace, sometimes to the extent of including interns who still lack the experience that would otherwise have been necessary.70 Anonymous. (2020, May 18). DOH to Deputize Med Grads to Assist in Nat’l COVID‐19 Response. Department of Health. Retrieved July 27, 2020, from https://www.doh.gov.ph/press‐release/DOH‐to‐deputize‐med‐grads‐to‐assist‐in‐nat%E2%80%99l‐covid‐19‐response
As part of COVID‐19 measures, the DOH issued a call for volunteer doctors and nurses in three state hospitals. In response, almost 600 Filipino doctors and nurses volunteered regardless of experience and readiness to address the needs in stations for which they have not been thoroughly prepared.71 Anonymous. (2020, March 28). Nearly 600 Doctors, Nurses, Volunteer for COVID‐19 Fight in PH. ABS‐CBN News. Retrieved April 27, 2020, from https://news.abs‐cbn.com/news/03/28/20/nearly‐600‐doctors‐nurses‐volunteer‐for‐covid‐19‐fight‐in‐ph
This has also been going on in other countries that are more economically endowed.72 Mitchell, J. (2020, March 26). Baker Requests Federal Disaster Assistance, Asks Med Schools to Graduate Students Early. WBUR. Retrieved July 27, 2020, from https://www.wbur.org/news/2020/03/26/baker‐massachusetts‐coronavirus
, 73 Minder, R., & Peltier, E. (2020, March 24). Virus Knocks Thousands of Health Workers out of Action in Europe. The New York Times. Retrieved July 27, 2020, from https://www.nytimes.com/2020/03/24/world/europe/coronavirus‐europe‐covid‐19.html
, 74 Sopel, J. (2020, April 2). Coronavirus: the Young Doctors Being Asked to Play God. BBC. Retrieved July 27, 2020, from https://www.bbc.com/news/world‐us‐canada‐52137160
Here, we are made to wonder how this could be happening when, for many years, the Philippines has, in effect, accepted the responsibility of providing care to patients in other countries by encouraging the migration of its own healthcare professionals. This encouragement can be seen in the country creating bureaucratic institutions and promoting legislation to facilitate labor migration since the 1970s.75 Ladrido, P. (2020, May 6). How the Philippines Became the Biggest Supplier of Nurses Worldwide. CNN Philippines. Retrieved July 27, 2020, from https://www.cnnphilippines.com/life/culture/2020/5/6/ofw‐nurses.html
, 76 Mendoza, D.R. (2015, June 16). Human Capital: the Philippines’ Labor Export Model. World Politics Review. Retrieved July 27, 2020, from https://www.worldpoliticsreview.com/insights/15998/human‐capital‐the‐philippines‐labor‐export‐model
The long‐standing dilemma was highlighted again recently when public officials themselves debated a proposal to allow Filipino healthcare workers to leave for abroad in the midst of the pandemic.77 Philippine Overseas Employment Administration Governing Board. (2020, April 5). Governing Board Resolution No. 09 Series of 2020. Retrieved May 17, 2020, from https://www.philembassy.no/newsroom/covid‐19‐public‐advisory‐no‐18‐on‐the‐temporary‐suspension‐of‐overseas‐deployment‐of
, 78 Aning, J. (2020, April 12). DFA Chief Hits Deployment Ban on PH Health Workers. Inquirer.net. Retrieved May 17, 2020, from https://globalnation.inquirer.net/186772/dfa‐chief‐hits‐deployment‐ban‐on‐ph‐health‐workers
Eventually, a decision was reached to allow the departure of those who already had legally binding contractual obligations but to temporarily prevent others from entering into new contracts to work abroad.79 Romero, A., & Jaymalin, M. (2020, April 15). To Ban or Not to Ban: Health Workers Asked to Rethink Plans to Leave Phl. One News. Retrieved May 17, 2020, from https://www.onenews.ph/to‐ban‐or‐not‐to‐ban‐health‐workers‐asked‐to‐rethink‐plans‐to‐leave‐phl
, 80 Calonzo, A. (2020, April 14). Philippines Relaxes Ban on Nurses Leaving for Jobs Overseas. The Jakarta Post. Retrieved May 17, 2020, from https://www.thejakartapost.com/seasia/2020/04/14/philippines‐relaxes‐ban‐on‐nurses‐leaving‐for‐jobs‐overseas.html
More recently, the DOH authorized the recruitment of fresh medical graduates to work as deputized physicians without having to pass medical board examinations.81 CNN Philippines Staff. (2020, May 16). DOH to Authorize Medical Graduates to Work as Deputized Physicians during COVID‐19 Crisis. CNNPhilippines.com. Retrieved May 17, 2020, from https://cnnphilippines.com/news/2020/5/16/doh‐medical‐graduates‐deputized‐physicians.html
Clearly, the measures described in this section to address the lack of HRH in the context of the COVID‐19 emergency are intended to be in place temporarily. Emergency healthcare staff are being recruited to work only during the period of the pandemic under contracts lasting only for 3 months.82 Mercado, N.A. (2020, April 27). DBM Approves Hiring of Additional 15,700 Healthcare Professionals. Inquirer.net. Retrieved May 22, 2020, from https://newsinfo.inquirer.net/1265554/dbm‐approves‐doh‐request‐for‐hiring‐of‐additional‐15700‐healthcare‐professionals‐duterte‐report#ixzz6NBzR1XL8
The ban on deployment of HRH to foreign countries will be lifted as soon as the pandemic subsides. Recruitment calls for foreign healthcare jobs have not slowed down, and processing of applications is ongoing. The conscription of pre‐licensed fresh medical school graduates to work in emergency healthcare facilities will stop when the crisis ends. Hence, the measures cannot be expected to have an impact on the country’s capability to deal with the insufficiency or maldistribution of HRH that will plague the country beyond the period of the current pandemic. These measures fail to take into consideration the continuing nature of the issues that need to be addressed. They only help to cope with the exacerbation brought about by SARS‐CoV‐2. While it is important to deal with the exacerbation, it is even more important in the long run to maintain a level of readiness that can only be attained by ensuring a sound HRH profile within the country. As it is, we have a situation where because of poverty, a majority of Filipinos are forced to seek the services of government healthcare facilities that are served by only 4.5% of the country’s doctors, only about 1% of its nurses and about 23% of its midwives.83 Anonymous. (2017, February 21). Shortage of Health Professionals in the Philippines, a Growing Concern. HealthCareAsia Daily. Retrieved May 22, 2020, from http://www.healthcareasia.org/2017/shortage‐of‐health‐professionals‐in‐the‐philippines‐a‐growing‐concern/
As the country maintains its position as an HRH supplier to much of the developed world, it must do more to improve healthcare access in rural areas as well as in urban yet under‐served areas.84 Ibid.
While telehealth helps to mitigate problems arising from inequitable HRH distribution, there is a lot to do to improve the overall HRH profile and prepare the healthcare system for the impact of future pandemics or disasters. The systemic inequities, rooted as they are in the social determinants of health, are entrenched in the prevailing healthcare system; they perpetrate injustices against disadvantaged sectors of the population. These injustices violate the principle of the prioritization of the worst off.
Similar inequities need also to be addressed in the implementation of quarantine measures in the country.