Oversupply of Nurses in the Philippines

Nursing is the nations largest health care profession, with 2.6 million registered
nurses (RNs), and many more needed in the future. Nurses are the largest single
component of any hospital staff, primary provider of hospital and community patient care
and they deliver most of the nations nursing home care. Nurses work in variety of other
settings. Nursing has become the preferred course of the growing number of number of
college enrollees. The CHEDs Policy, Planning, Research and Information Office sees
almost half a million or 497,000 students taking the nursing course in school year 20082009. While many countries in the world are experiencing nursing shortage, Philippines
appear to have an oversupply of nurses. The Officer-in-Charge of the Professional
Regulation Commission (PRC), Commissioner Ruth R. Padilla, revealed that the country
has an oversupply of 400,000 licensed nurses and that the hospitals can only
accommodate 60,000 nursing positions (Jaymalin, 2008). Padilla also pointed out that
the country yearly produces 100,000 licensed nurses; however, no additional positions
are created in the government and private hospitals nationwide.
Graduate nurses are now facing massive unemployment and underemployment.
Statistics of unemployed nurses hit a whopping 150,000 (estimated count) in 2008.
Although many of the unemployed nurses passed the board exam, one of the key pains
of nursing recruiters in the governing of nursing recruiters in the country is the lack the
nurses experience in actual and community work. The Philippine Nurses Association
through its National President LEAH Paquiz has a disclosed that the oversupply of
nurses is fast becoming the countrys problem (Melencio, 2008).
To correct this situation, the nurses said that the government has to take the lead in
hiring more nurses to take lead na. However, one problem is the difficulty in getting
accurate statistics. In the Philippines what we have is an oversupply of fresh nursing
graduates and undersupply of skilled nurses. Barcelo said that the supply problem

started sometime in 2003-2005, when foreign manpower exerts projected that the global
demand was estimated to be about 1 million by 2020). This triggered a demand for
nursing courses, resulting in a huge leap from 170 nursing schools in 2003 to 472 in
schools in 2010.
To solve this problem, the government has found a new way of creating jobs for
unemployed nurses in the country. Department of Health (DOH) gave birth to the
programs namely, Nurses Assigned in Rural Areas (NARS), Registered Nurses for
Health Enhancement (RNHEALS) and Nurses Deployment Project (NDP).

Community Health Nursing in the Philippines

Community Health Nursing in the Philippines is established as a professional
field since many decades. Conceptually it unites elements of nursing sciences and
Public Health. Community Nurses, which are officially called Public Health Nurses, are
linked into a net of governmental and non-governmental national health services. The
Department of Health practices regulative strength over the health intuitions and the
appropriation of health services while their activities are directed mainly by a centrally
controlled framework of actions (standards, health plans, laws). With a decentralization
of National Health Service onto regional and local level the Philippine authorities hope to
meet health problems and needs of the clients better on the community level. At last a
decree was formulated in 1993 when the local government units were recognized as
acting and self-reliant partners of DOH in attaining of the national destinations (RA 7160:
local government code in Cruz & Maglaya, 2000, pp. 12).

The task of Community Health Nursing

In the literature Community Health Nursing is understood as a special subject of
the nursing practice. In integrates general aspects and principles of nursing with

concepts of Public Health. Public Health is described by the World Health Organization
(WHO) with reference to the definition of Dr. E. Winslow as follow: the science and art of
preventing disease, prolonging life and promoting life through organized efforts of
society (Committee of Community Health Nursing 1995, pp, 21). Therefore, Public
Health has the task to create social systems that safeguard a health receiving standard
of living for every human being, so that his birth right to health and life can be fulfilled.
Following this definition Community Health Nursing is understood in the Philippines as
an answer to the health needs of population. However, the claim on the practice of this
profession is a well general as it is comprehensive, since the work in the community
pertains to longer time periods and most different requirements in the community.
One important objective of Community Health Nursing is to provide basic health
services to individuals, facilities and communities. Considering Community Health
Nursing as it is described in the above mentioned literature, it reveals, that in the
Philippines this professional field of nursing has been established since decades. Its
obvious that a governmental framework of action (standards, programs) determines the
roles and functions of a Community Health Nurse. This is to help the nation by the
identification, reduction and solving of the most urgent and most alarming health
problems. Community Health Nurses work according to qualification and status of
regional or local health units and cooperate with either, their subordinated employees
and authorities on local, regional and national level in the presence of the diverse roles
and functions that are ascribed to the Community Health Nurse in the Philippines.

Universal Health Care

To address the remaining gaps and challenges on inequity in health, the Aquino
Health Agenda (AHA), through Administrative Order No. 2010-0036 was launched. It
contains the operational strategy called Lalusugan Pangkalahatan (KP) which aims to

achieve universal health care for all Filipinos. KP seeks to ensure equitable access to
quality health care by all Filipinos beginning with those in lowest income quantiles.
The DOH shall facilitate the implementation of the JP by influencing the manner by
which Provinces and component LGUs, cities govern local health systems. The DOH
recognizes that LGUs have the primary mandate to finance and regulate local health
systems, including the provision of the right information to families and health provides.
Leveraging for LGU participation and performance will be accomplished by entering to
ARMM-wide, province-wide or city-wide agreements with the LGUs. The agreement
shall define annual performance target and resource commitments by DOH, LGUs,
PHIC, development partners and private sector. The province-wide agreements will also
serve as basis for the development of CHD support plans for LGUs that will be
consolidated into the annual budget proposal of DOH.
GOALS
The implementation of KP/ Universal Health Care shall be directed towards the
achievement of health system goals of financial risk protection, better health outcomes
and responsive health system.
Financial Risk Protection
To protect all Filipinos, especially the poor, against the catastrophic cost of ill
health, JP shall strengthen the National Health Insurance Program (NHIP) as the prime
mover in improving financial risk protection, generating resources to modernize and
sustain health facilities and improve the provision of public health services to achieve the
Millennium Development Goals (MDGs).
Responsive health System
Kp aims to enhance the responsiveness of the health system and client
satisfaction by improving the quality hospitals and health care facilities. Government
owned and operated hospitals and health facilities will be upgraded to expand capacity

and provide quality services to health attain MDGs, attend to traumatic injuries and other
types of emergencies, and manage non-communicable diseases and their
complications.
Better health outcomes
KP aims for the attainment of health-related MDGs by focusing on reduction of
maternal and child mortality from TB and malaria, and the prevalence of HIV/ AIDS, in
addition to being prepared for emerging disease trends, and prevention and control of
non-communicable diseases.
The success of the KP shall be measured by the progress made in preventing
premature deaths, reducing maternal and newborn deaths, controlling both
communicable and non-communicable diseases, improvements in access to quality
health facilities and services and increasing NHIP coverage, benefit utilization and
support value, prioritizing the poor and the marginalized (such as Geographically
Isolated and Disadvantaged Area (GIDA) population, indigenous population, older
persons, differently-abled persons, internally-displaced population and people in conflict
affected areas). These performance measure are the result of effective interaction
between families and healthcare providers (both public and private) in local health
systems.

Projects Similar to Nurses Deployment Project

NARS
Project NARS is a training cum Deployment Project, jointly implemented by
Department of Labor and Employment (DOLE), the Department of Health (DOH) and
Professional Regulation Commision, Board of Nursing (PRC-BON), designed to mobilize
unemployed registered nyrses to 1,000 poorest municipalities of the country to improve

delivery of health care services. In line with the pump priming strategies under Economic
Resiliency Plan of the Arroyo Administration to mitigate the impact of the global financial
crisis, i.e. to save and create as many jobs as possible and expand social protection.
This was launched by President Arroyo last February 9, 2009 during Multi-Sectoral
Summit on Joining Hands Against Global Crisis in Malacanan Palace, Manila.
This project aims to address the oversupply of inexperienced nurses, promote
health of the people and bring the government closer to them. The idea is to mobilize
nurses cooling their heels in their hometowns (due to low local and overseas demand of
service inexperienced nurse) for work among their own people. Nurses will be mobilized
as their hometown warriors for wellness to do the three Is:
1. Initiate primary health, school nutrition, maternal health programs, first line
diagnosis;
2. Inform about community water sanitation practices and also do health
3.

surveillance;
Immunize children and mothers.

Competencies gained by the nurses upon completion of the training program shall cover
both clinical and public sectors. The project provided nurses with learning and
development opportunities to enhance their capacity to provide quality nursing and
health care and consequently increase the nurses employability.
B. Objectives
1. General Objectives
Project NARS aim to improve delivery of health care services to our
population and create a pool of registers nurses with enhanced clinical and preventive
health management competencies for national public and private sector employment.

C. Delivery Mechanism

Nurses were deployed at an average of 5 per town in 1,000 poorest

municipalities for six month tour of duty. Another batch was deployed for the second half
of that year. Nurses did undergo training and development for competency enhancement
in accordance with the training program designed by the PRC-BON in collaboration with
DOH. The training programed covered both the clinical and public health functions.
Nurses trainees rotated in their in their assigned hospital or rural unit for a period of
three (3) months. At the end of the third month, nurses who had completed their rotation
in the hospital was re-assigned to a rural unit or vice-versa.
A Certificate of Completion/ Competency was issued by the DOLE, DOH and
PRC after an assessment of the gained competencies of nurse trainees. While on
training, nurses were given a stipend/allowance of 8,000.00 per month. This translates to
about 366,00 per day for a 40 (40) hours training/workweek. As these nurses were
already in their hometowns, transportation fees was no longer a problem.

D. Expected Outcomes
1. Create a pool of 10,000 nurses who are adequately-trained with enhanced
clinical and public health competencies and readily available for local and
overseas employment;
2. Provide disposable money of 8,000 per month to 5,000 unemployed nurses for
the first six months and to another 5,000 for the second half of the year, to help
pump prime the economy;
3. Promote health of the people through the improvement of the delivery of nursing
and health care services, particularly in the 1,000 poorest municipalities; and
4. Bring the government closer to the people.

Registered Nurses for Health Enhancement (RNHEALS)

The project, billed RNHEALS, seeks to make essential health services available
to all Filipinos by training and deploying 10,000 unemployed nurses in communities to be
identified by the DOH in collaboration with Department of Social Welfare and
Development (DSWD).
RN HEALS, an acronym for Registered Nurses for Health Enhancement and
Local Service was expected to address the shortage of skilled and experienced nurses
1,221 rural and underserved communities for one year.

I.

Rationale

The Registered Nurses for Health Enhancement and Local Service Project otherwise
known as RNHeals Project was conceptualized in response to the countrys
constitutional mandate to make essential health goods and social services available to
all Filipinos, especially the poor.
Last February 14, 2011, RNHeals was launched in collaboration with the Department of
Social Welfare and Development (DSWD), Department of Interior and Local Government
(DILG). Professional Regulatory Commission of Board of Nursing (PRC-BON) and
Philippine Nurses Association (PNA). RnHeals is a learning and deployment project
designed to mobilize registered nurses in identified priority areas to improve delivery of
quality health care services. As such, RNHeals is a collaborative effort of national and
local government, government and private organizations, professional organizations and
other stakeholders. While RNHeals is envisioned to improve access of poor
municipalities to quality healthcare with social services, this also aims at increasing
nurses employability by creating a pool of registered nurses with enhanced clinical and
public health management competencies.
RNHeals does not intend to provide employment but rather learning and
development. The nurses under RNHeals are therefore not regular employees but pre

service trainees. They are given allowance/stipend not salaries and are deployed in
areas where nursing services are mostly needed.
Implementing Mechanisms
1. Strengthen nurses capabilities in the DOH Hospitals and Rural Health Units as a
form of technical assistance towards the delivery of DOH thrusts in a wellcoordinated manner.

Nurses Deployment Program

Extracted from Department Circular No. 2013-0404 .

RATIONALE

Relative to the implementation of the Department of Health (DOH) Deployment of

Human Resources for Health Program, these guidelines have been developed for the
Nurse Deployment Project to standardize its implementation and management.
The Department of Health (DOH) has designed the Nurse Deployment Project to
improve local health systems that will support the countrys attainment of Universal
Health Care. The project did hire registered nurses (RNs) under a contract of services
with priority deployment in the 20 poorest provinces and 1,233 focus municipalities of the
National Anti-poverty Commission (NAPC) and the Department of Social Welfare and
Development (DWD) Pantawid (3Ps) or Conditional Cash Transfer (CCT) areas.
Consequently, the project shall require partnerships with other agencies.
General Guidelines

Nurses shall be assigned in CTT areas of the DSWD, 20 poorest provinces and

1,233 focus municipalities identified by NAPC.

The nurses shall be hired on Contract of Services status with an item of Nurse I,
Salary Grade 11 with monthly salary of 18, 589. Their contract is for six (6)
months that can be renewed based on a very satisfactory performance for a

maximum of two (2) years.

A distribution list shall be provided by the Health Human Resource Development
Bureau (HHRDB) to all Centers of Health Development (CHDs) through their
cluster heads. The CHDs shall finalize/reallocate the distribution considering

capacity of receiving units/ municipalities/ level I hospital in accepting nurses.

After the satisfactory completion of their development, the nurses shall be

awarded with a Certificate of Employment.

The CHDs through their respective cluster heads in close collaboration with
HHRDB and stakeholders shall monitor the implementation of the project.

Pre-deployment

The CHDs shall set their timelines for accepting and selecting applications

within the prescribed period.

Applicants shall accomplish the official project application form through DOHs

website.
Applications shall be submitted directly to the CHDs. Applications received by the
RHUs, PHOs, and DOH Central Office shall be forwarded to the concerned

Centers for Health Development.

Application shall be open to all nurses with official and validated license from
Professional Regulatory Commission (PRC). Nurses who are graduates of the

RNHeals project shall be given a priority.

Applicants shall undergo the recruitment as selection of the CHDs.
Applicants shall be submitted directly to the CHDs. Applications received by
RHUs, PHOs, and DOH Central Office shall be forwarded to the concerned

Centers for Health Development.

Applicants shall undergo the recruitment and selection process of the CHDs.
Nurses must be physically and mentally fit. A medical certificate from a

government health facility is required before start of employment.

Priority shall be given to nurses residing in the localities where the recipient rural

health unit/ health facilities are located.

The officially accepted nurses will be informed by the receiving facilities through a
letter or email of any mode of communication. All nurses are required to attend

the Pre-Deployment Orientation before the start of deployment.

The nurses shall sign a contract of service in pursuit of their commitment to
complete the project.

Deployment

Prior to deployment, the accepted nurses must be formally endorsed to the local

government executives by the Center for Health Development.

The nurses are then, assigned to RHUs, Birthing homes, Barangay Health
Stations, and Level I LGU hospitals giving preference to the identified areas of
DSWD and NAPC under the supervision of the Public Health Nurse or Chief

Nurse.
The nurses shall perform the functions of a Staff Nurse or Public Health Nurse.
Nurses assigned in the RHUs are also developed as trainers and supervisors of

the community Health Teams (CHTs) of DOH.

The project shall provide nurses with a salary of Php 18, 549.00 per month. This
shall be given in full for nurses who have completed the number of working days.
In case of absences and tardiness, the salary is subjected to deductions based

on existing rules and regulations.

The nurses shall submit their Daily Time Record (DTR) every month to their
respective CHDs as basis for salary. This shall be duly approved by the Public

Health Nurse of Municipal Health Officer in the RHUs.

The nurses are also required to submit a Monthly Accomplishment Report
describing the highlights of their activities, target achievements, learning insights,
issues and concerns and recommendations. The accomplishment report shall be
submitted to their immediate supervisors for notation. These shall be forwarded
to the CHDs through their Public Health Nurse or Chief Nurse for Level I LGU

hospital or DOH Representative

The CHDs shall also conduct a midterm and end of deployment evaluation. The
results of the evaluation shall be submitted to HHRDB as an input to the Program
Implementation Review (PIR)

Post- Deployment

Nurses who completed the project shall be awarded with a Certificate of

Employment signed by the CHD director.

The nurses shall be evaluated after every semester to measure their
performance during their Deployment period using the Performance Evaluation
Form (PEF). Only nurses with very satisfactory performance are eligible for

renewal of contract.
The CHDs through the finance unit shall submit a disbursement report every 10th

day of the month to Finance and HHRDB

All savings incurred after the implementation of the project shall be returned to
the DOH Finance Service at the end of the Year.

Job Description of NDP Nurses

I.

That the Second Party shall perform the functions equivalent of a Nurse I and
shall be assigned in Public Health/ Birthing Homes. The Second Party shall
perform the functions of a Public Health Nurse but necessarily be limited to the
following works:

a.

Assists in the implementation of various health programs of the Local

Government Unit in accordance with the goals and objectives of the Department

of Health and Health sector.

b. Provides technical assistance in the implementation of health programs.
c. Assists in the conduct of disease surveillance.
d. Conducts health education and training.
e. Assists in the supervision, monitoring and submission of Community Health
f.

Team (CHT) forms.

Assist in the conduct of regular monitoring and evaluation of various health

programs for the community.

g. Assists in the preparation and analysis of report on clinici and community
activities.
h. Submits monthly accomplishment report and DTRs to the Provincial Health Team
Office describing the highlights of their activities, targets and accomplishement,

learning insight, issues/concerns and recommendatiom and duly assigned/

i.

initialed by their immediate supervisor.

Performs other related functions as may be assigned.

Summary of the said Programs

For over 150 years, nursing has become one of the noblest profession since time
of Florence Nightingale. It is an art and science of compassionate caring doubled with a
strong sense of ethical values and responsibility.
At the beginning of this administration, a study showed that around 30-40% of
sick Filipinos die without ever seeing a health professional. More over, more than 5
million poor Filipinos families, that is a quarter of population, did not have any form of
health insurance. To many Filipinos, good health seemed illusory; it was practically
unattainable due to their physical and economic limitations. These fortunate
circumstances molded and inspired the blueprint of for the current health reform agenda
dubbed a Kalusugan Pangkalahatan (KP) or Universal Health Care (UHC). UHC is now
the mantra for many emerging and middle income countries, and also the government
strategy to achieve inclusive growth, poverty reduction and bring better health to the
people especially the poor (Ona, 2014).
Kalusugang Pankalahatan is anchored in three (3) pillars, namely: 1. Financial
risk protection, 2. Available and equipped health facilities, and 3. The attainment of
Millennium Development Goals (MDGs) in health-4, 5, and 6 to reduce maternal infant
mortalities and malnutrition; control of infectious diseases such as tuberculosis, malaria
and to reduce and control non-communicable diseases.
To attain the health-related Millenium Development Goals (MDGs), Department
of Health (DOH) recognized the importance of human resources for health in localities
and high concentration of poor families who are unable to access critical public health

services. It was also recognized the challenge that there is an imbalance of health
human resources between urban and rural areas.
In 2012, records from the Professional Regulations (PRC) showed that we have
526,897 registered nurses nationwide. Last June 2013 Nursing Board Examination
produced additional 16,219 passed the exam. And almost 11,000 nurses passed the
NLE given last December 2013.
The employment data from the Philippine from Philippine Overseas Employment
Administration (POEA) reveals that 177, 414 nurses are employed abroad. In 2012, the
National Database of Human Resources for Health Information system reports that there
is are only 38,488 nurses employed in the countrys government and private hospitals.
While the Philippines have a huge human reservoir for health, they are unevenly
distributed in the country. Most are concentrated in urban areas such as Metro Manila
and other cities. There is a job and skill mismatch due to inadequate job oppurtunities
and, limited labor market preparation and inadequate preparation. In response to above,
the Department has designed a program that will deploy registered nurses (RNs) for the
improvement of local health systems and support the countrys sttainment of its MDG
targets. The 20 poorest provinces and 1,233 focus municipalities are given preference.
For the past 3 years, DOH have deployed 750,000 nurses to augment workforce
in 1,496 municipalities, 143 cities and 70 DOH hospitals under the Registere Nurse for
Nurse Employment and Local Service (RNHeals) program. They made a reform
converting RNHeals into Nurse Deployment Project starting January 2014 with a budget
of Php 2.5 billion.