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Asia

Shortage of hospitals and health


workers in the Philippines
February 14, 2018
|

Hans Jesper Del Mundo

Author: Hans Jesper Del Mundo


Editors: Motoi Miura, Akihiko Ozaki

(This essay was written when the author stayed in Japan in summer 2017.)

The Philippines is a Southeast Asian country consisting of 7,641 islands. It has a land area of
343,282 km2 and tropical climate with an average of twenty typhoons a year. It currently has a
population of 100.98 million with the median age being 24.4 years, sex ratio (M:F) of almost 1 and a
population growth rate of 1.51%. Our official languages are Filipino and English.

Although the Philippines currently faces the numerous health problems, only 4.2% of the country’s
total budget is spent on health. One of its most important health problems is the high maternal
mortality ratio, which was far from our goal 2015. Most of these deaths happen in rural and
geographically isolated areas with no access to health facilities or health professionals. Such a
situation implicates as if our country lacks doctors, nurses, midwives and others, though this
assumption is not really the case.

In reality, it can be said that the Philippines yearly produces a sufficient number of physicians and
nurses, with the annual production of about 38,000 nurses and 4,500 physicians. Further, it has
been reported that there are currently 130,000 physicians and 500,000 registered nurses in our
country. However, despite these numbers, a ratio of doctors and nurses to the total population is still
very far from the ideal, because there are just not enough job opportunities even in government
hospitals. This is the main reason why most health professionals practice abroad or even considers
changing careers.

I live in a town called Maddela, which suffers a shortage of hospitals and health workers such as
doctors, nurses, and midwives. This is why most of the residents there either have to travel to the
nearest city for consult or not seek medical care at all. The hospitals and health workers are
concentrated in the urban areas, which causes a great maldistribution of health workforce. There is
just lack of incentives for doctors to serve in rural communities, which is what the Department of
Health is working on right now to be able to deploy more doctors in rural areas. However, even with
incentives there’s still lack of equipment in health centers and hospitals in rural areas, which also
discourages physicians to practice there for even short term.

There are also about 180,000 hospitals in the country. Yet, 60% of them are operated privately, and
the majority of them are located in in the urban areas, which further adds up to the maldistribution of
health service provided in the Philippines. Among the 18 regions, only four have sufficient numbers
of beds per 1000 population. All of these problems in healthcare delivery, which was built up without
enough consideration of health problems the country is confronted with, delivered adverse impact on
our country’s current health status, which is why we never reached most of our Millennium
Development Goals by 2015. But still I am hopeful that we can address all these challenges and that
in the future our health indicators can be just as good as developed countries like Japan.

Top 10 Facts on Healthcare in the Philippines

1. The WHO refers to the Filipino Healthcare System as “fragmented.” There is a history of unfair and unequal
access to health services that significantly affects the poor. The government spends little money on the
program which causes high out of pocket spending and further widens the gap between rich and poor.
2. Out of the 90 million people living in the Philippines, many do not get access to basic care. The country has a
high maternal and newborn mortality rate, and a high fertility rate. This creates problems for those who have
especially limited access to this basic care or for those living in generally poor health conditions.
3. Many Filipinos face diseases such as Tuberculosis, Dengue, Malaria and HIV/AIDS. These diseases pair with
protein-energy malnutrition and micronutrient deficiencies that are becoming increasingly common.
4. The population is affected by a high prevalence of obesity along with heart disease.
5. Healthcare in the Philippines suffers from a shortage of human medical resources, especially doctors. This
makes the system run slower and less efficiently.
6. Filipino families who can afford private health facilities usually choose these as their primary option. Private
facilities provide a better quality of care than the public facilities that lower income families usually go to. The
public facilities tend to be in rural areas that are more run down. These facilities have less medical staff and
inferior supplies.
7. Only 30 percent of health professionals employed by the government address the health needs of the
majority. Healthcare in the Philippines suffers because the remaining 70 percent of health professionals work
in the more expensive privately run sectors.
8. To compensate for the inequality, a program called Doctors to the Barrios and its private sectors decided to
build nine cancer centers, eight heart centers and seven transplant centers in regional medical centers.
9. The Doctors to the Barrios included Public-Private Partnerships in a plan to modernize the government-owned
hospitals and provide more up to date medical supplies.
10. More than 3,500 public health facilities were updated across the country.

Although advances have been made to improve healthcare in the Philippines, there are still many issues
that the country has yet to overcome to achieve a high quality, cost efficient healthcare system.
Classification of Philippine Hospitals
Posted on September 17, 2013by reyojoson

CLASSIFICATION OF PHILIPPINE HOSPITALS

Derived from: Administrative Order No. 2012-0012

Rules and Regulations .Governing the New Classification of Hospitals and Other Health
Facilities in the Philippines (Effective: August 18, 2012)

A. ACCORDING TO OWNERSHIP

1. Government – created by law. A government health facility may be under the national
government, DOH, Local Government Unit (LGU), Department of National Defense
(DND), Philippine National Police (PNP), Department of Justice (DOJ),
StateUniversities and Colleges (SUCs), Government Owned and Controlled
Corporations (GOCC) and others.

2. Private – owned, established and operated with funds through donation, principal,
investment or other means by any individual, corporation, association or organization.
A private health facility may be a single proprietorship, partnership, corporation,
cooperative, foundation,

religious, non-government organization and others.

B. ACCORDING TO SCOPE OF SERVICES

1. General – a hospital that provides services for all kinds of illnesses, diseases, injuries
or deformities. A general hospital shall provide medical and surgical care to the sick and
injured, maternity, newborn and child care. It shall be equipped with the service
capabilities needed to support board certified/eligible medical specialists and other
licensed physicians rendering services in, but not limited to, the following:

a. Clinical Services

1. Family Medicine;

2. Pediatrics;

3. Internal Medicine;

4. Obstetrics and Gynecology;


5. Surgery;

b. Emergency Services;

c. Outpatient Services;

d. Ancillary and Support Services such as, clinical laboratory’, imaging facility and
pharmacy.

2. Specialty – a hospital that specializes in a particular disease or condition or in one


type of patient. A specialized hospital may be devoted to treatment of any of the
following:

a. Treatment of a particular type of illness or for a particular condition requiring a range


of treatment.

Examples of these hospitals are Philippine Orthopedic Center, NationalCenter for


Mental Health, San Lazaro Hospital, a hospital dedicated to the treatment of cancer.

b. Treatment of patients suffering from diseases of a particular organ or groups of


organs.

Examples of these hospitals are LungCenter of the Philippines, Philippine Heart Center,
National Kidney and Transplant Institute, a hospital dedicated to treatment of eye
disorders. .
c. Treatment of patients belonging to a particular group such as children, women,
elderly and others.

Examples of these hospitals are Philippine Children’s MedicalCenter, National


Children’s Hospital, Dr. Jose Fabella Memorial Hospital.

C. ACCORDING TO FUNCTIONAL CAPACITY

1. GeneralHospital

a. Level l

A Level I hospital shall have as minimum the services stipulated under Rule V. B. 1. b. 1.
of this Order, including, but not limited to, the following:

1. A staff of qualified medical, allied medical and administrative personnel headed by a


physician duly licensed by PRC;
2. Bed space for its authorized bed capacity in accordance with DOH Guidelines in the
Planning and Design of Hospitals;

3. An operating room with standard equipment and provision for sterilization of


equipment and supplies in accordance with:

a. DOH Reference Plan in the Planning and Design of an Operating Room/Theater


(Annex A);
b. DOH Guidelines on Cleaning, Disinfection and Sterilization of Reusable Medical
Devices in Hospital Facilities in the Philippines (Annex B);

4. A post-operative recovery room;

5. Maternity facilities, consisting of ward(s), room(s),a delivery room, exclusively for


maternity patients and newborns;

6. Isolation facilities with proper procedures for the care and control of infectious and
communicable diseases as well as for the prevention of cross infections;

7. A separate dental section/clinic;

8. Provision for blood station;

9. A DOH licensed secondary clinical laboratory with the services of a consulting


pathologist; •

10. A DOH licensed level 1 imaging facility with the services of a consulting radiologist;

11.A DOH licensed pharmacy.

b. Level2

A Level 2 hospital shall have as minimum, all of Level l capacity, including, but not
limited to, the following:

1. An organized staff of qualified and. competent personnel with Chief of


Hospital/Medical Director and appropriate board certified Clinical Department Heads;

2. Departmentalized and equipped with the service capabilities needed to support board
certified/eligible medical specialists and other licensed physicians rendering services in
the specialties of Medicine, Pediatrics, Obstetrics and Gynecology, Surgery; their
subspecialties and ancillary services;
3. Provision for general ICU for critically ill patients.

4. Provision for NICU (Neonatal Intensive Care Unit)

5. Provision for HRPU (High Risk Pregnancy Unit)

6.. Provision for respiratory therapy services;

7. A DOH licensed tertiary clinical laboratory;

8. A DOH licensed level 2 imaging facility with mobile x-ray inside the institution and
with capability for contrast examinations.

c. Level3

A Level 3 hospital shall have as minimum, all of Level 2 capacity, including, but not
limited to, the following:

1. Teaching and/or training hospital with accredited residency training program for
physicians in the four (4) major specialties namely: Medicine, Pediatrics, Obstetrics and
Gynecology, and Surgery;

2. Provision for physical medicine and rehabilitation unit;

3. Provision for ambulatory surgical clinic;

4. Provision for dialysis facility;

5. Provision for blood bank;

6. A DOH licensed tertiary clinical laboratory with standard


equipment/reagents/supplies necessary for the performance of histopathology
examinations;

7. A DOH licensed level 3 imaging facility with interventional radiology.

2. Specialty Hospitals (refer to Rule V. B. 1. b. 2.·ofthis Order)

3. Trauma Capability of Hospitals

The trauma capability of hospitals shall be assessed in accordance with the guidelines
formulated by the Philippine College of Surgeons (PCS).
a. Trauma-Capable Facility – a DOH licensed hospital designated as a TraumaCenter.

b. Trauma-Receiving Facility – a DOH licensed hospital within the trauma service area
which receives trauma patients for transport to the point of care or a trauma center.

DOH admits lack of beds in Metro


Manila hospitals
By

Jovee Marie de la Cruz

August 15, 2017

239

Last updated on August 15th, 2017 at 08:28 pm

THE Department of Health (DOH) on Monday admitted that the shortage of beds
remains a challenge in government hospitals, as 800 people struggle for one hospital bed,
a 1:800 ratio in Metro Manila alone.

During the budget deliberations of the DOH, Health Secretary Paulyn Jean B. Rosell-
Ubial said in the Autonomous Region in Muslim Mindanao (ARMM), the doctor-patient
ratio is 1:4,200.

She added at least 42,000 hospital beds are required for Filipinos who need medical
assistance.
Rosell-Ubial said the majority of government hospitals are overoccupied, from 150
percent to 250 percent.

Rosell-Ubial noted the lack of doctors working in rural areas as the country focuses its
improvement in urban centers.

The DOH is asking for a P164.86-billion budget next year.

Rosell-Ubial said P9.6 billion of the agency’s budget for 2018 will be allotted to augment
human resource for health in rural facilities to strengthen the capability of local health
work force to support the national and local health system.

Next year the secretary said 435 doctors, 15,893 nurses; 4,000 midwives; 324 dentists; and
441 medical technologists will be deployed to rural areas in the country.

She added 291 pharmacists; 417 universal health-care implementers; 504 health
associates; and 2,587 public-health associates will also be made available in far-flung
areas.

But, under 2018 budget, Rosell-Ubial said P29.03 billion will be allocated to fund health
facilities in the country, including 1,455 barangay health stations, 539 rural/urban health
centers, 257 local government hospitals, 70 DOH hospitals, 22 other national
government hospitals, 14 treatment and rehabilitation centers, 22 psychiatric facilities,
127 blood-service facilities and 8 quarantine stations.
Why does the Philippines have poor healthcare?
There's a story about a leading hospital trying to
claim property, at far less than its value, to pay the
bill of a deceased patient, before they would release
the body.
http://www.manilatimes.net/the-ugly-side-of-st-lukes-medical-center/101421/

6 Answers

Marcus Abbah, Living here


Answered Jun 8 2014 · Author has 374 answers and 1m answer views

The linked story is not so much the quality of healthcare as it is the usurious tendencies and
insensitive behaviours of our healthcare institutions.

In terms of the quality of healthcare however, the Philippines actually has a decent quality,
in that most illness can be treated. It is the more unusual care, say brain surgery, and
mental care, where one may find options are limited. I have been to St Lukes, Asian
Hospital, and Makati Medical City, amongst the premier hospitals in the country, and they
are really good. The doctors are generally competent. However, the cost is ridiculous. For
instance, an executive check-up is in the order of Php60k+. A similar package at Adventist
would cost just over Php20k (USD450). The quality is quite decent but definitely not the
level of the premium hospitals.

What the Philippines lack is accessible healthcare for most. The hospitals I mention above
are generally for the middle class and up. The poor have to contend with the likes of PGH,
Orthopedic (which has been sold SM I think), and other smaller hospitals and clinics. You
can find well trained medical staff in these places too, but the lack the funds, equipment,
medicine makes provision of quality healthcare an ongoing challenge.

Away from Manila, the situation gets destitute. My mother got stung by Jellyfish in the
idyllic seaside town of Port Barton, Palawan, and had to be rushed to Puerto Princessa to
deal with it. Forget about complex procedures in over 90% of the country, and so those that
can afford it fly to Manila when they need to undertake more involved care.
Difficulties of accessing care in the Philippines
Public health care issues
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The healthcare system in the Philippines is a mixed public-private system.


Although the public healthcare system in the Philippines is considered to be
decent, more and more skilled doctors are turning away from it in favour of
private practice or working overseas. The result is a limited public healthcare
system, not only in terms of quality, but in accessibility too.

Medical brain drain


Many Philippine doctors are highly qualified and speak English, having gone abroad
and received a Western education. While many initially return to the Philippines to
practice, the wages offered by the public healthcare system are small in comparison
to that available in the private system and overseas. Many doctors abandon the
public sector to look for these higher paid jobs, resulting in the Philippine public
health system to begin to collapse.
With public hospitals understaffed, doctors are overworked, with the number of
patients reaching breaking point. Not only do waiting times increase, but the quality
of care is diminished due to stress and a need to see as many patients as possible.

Even in cases of emergency, patients can wait for several hours before being
attended to.

Access to public health services


Limited access on the islands
Over 1,000 hospitals have closed over the past decade due to the shortage of
doctors, most of them in rural parts of the country. So while the Philippines’ 7,000
islands might make the country a beach paradise, living on one of the sparsely
populated islands means your access to public healthcare is severely restricted.

Emergency access to medical specialists


The shortfall of doctors in the public sector has also caused problems for certain
patients who are looking to find a specialist when they are facing a medical
emergency. This means that even though basic medical care is available throughout
the country, some hospitals only provide limited treatments, making it hard for
everyone to access them. This is mostly a problem in rural areas, but patients living
in the bigger cities might also face a long wait before being able to see a medical
specialist they need.

Private healthcare
With doctors seeking higher wages and the resulting decline in the public healthcare
system, private healthcare companies have taken advantage of both to grow
extensively in the island nation. The result is better access to facilities and a wider
range of treatment for both in the urban and rural regions. We recommend that
expats have access to private healthcare; Cigna Global’s international health
insuranceprovides access to a range of hospitals and doctors across the Philippines.
PH needs 45,000 hospital beds
BY RHAYDZ B. BARCIA, TMT
JUNE 16, 2017

 HOME
 /
 NEWS
 /
 REGIONS
 /
 PH NEEDS 45,000 HOSPITAL BEDS

LEGAZPI CITY: The Philippines is in need of 45,000 additional


hospital beds and more public health physicians to provide medical
services to 105 million Filipinos across the country, especially in the
Autonomous Region in Muslim Mindanao (ARMM), Health Secretary
Paulyn Jean Rosell-Ubial said.

Ubial, who was here for the Asean Dengue Day 2017 event, added
that the country has 1,900 hospitals with at least 82,000 beds in the
government and private sectors, also has a shortage of rural health
units (RHU) and health centers.

Aside from the 45,000 backlog in hospital beds, the country is also in
need of more than 1,000 government and private hospitals.

“For 105 million Filipinos, we need around 126,000 hospital beds


throughout the country meaning we are short by 44,000 to 45,000 beds
for a ratio of one bed for every 800 people,” the health chief said.

“For the rest of the country, the situation is one bed per 2,500 people.
The situation in Metro Manila is better compared to other regions with
the ratio of one bed per 590,” Ubial said.
“We also have a shortage of rural health units (RHU) and health
centers. For every 20,000 people, we need at least one RHU.
Currently, we have 2,600 RHUs so we have a shortfall of 5,200 RHUs
and health centers,” she added.

In the Bicol region, Ubial said there is a ratio of only one bed for
every 1,900 patient. With a population of more than five million, the
region needs 12,000 more hospital beds.
Philippine health care system,
from bad to worse

Posted on March 28, 2016


Streetwise
Carol
A country’s health care system is a sensitive indicator of how Pagaduan-
government values the health of its people, underscoring the truism Araullo
that the people’s general health constitute the very foundation of
socio-economic development and ultimately, the people’s well-
being and happiness.

Even as a medical student more than three and a half decades ago,
it was already starkly clear to me that the Philippines health care
system was sick. It was a dual system: one for those who could afford to pay;
another for those who could not. One was private, the other public.
On the whole, private health care was of better quality in terms of facilities and personnel although
one could find substandard care in private hospitals because of poor regulation and the overriding
motivation to turn a profit rather than provide a badly-needed social service. The public system
sufficed for the majority of the population who had little choice when stricken by disease except to
avail of what was available and affordable regardless of quality.

These hospitals and clinics were clustered in urban centers. The tertiary centers or the most well-
equipped with the widest choice of specialist doctors would be found in Metro Manila. In the rural
areas, people continued to live and die without ever seeing a nurse, much less a physician because
health care was absent or inaccessible, physically and financially.

Of course, there were the crown jewels of the Marcos martial law era, the Heart, Lung and Kidney
Centers and the Philippine Children’s Medical Center that were part of the showcase edifices of First
Lady Imelda Marcos but that’s another story.

In time, with the growing social inequality, there was hardly room left for anything in between as even
the not-so-rich but not-yet-miserably-poor started to avail themselves of public hospitals to avoid
dissipating their life savings on health care. That was when the so-called middle class could be seen in
the Philippine General Hospital’s charity wards or, at best, its more affordable but scant private rooms.

As the cost of curative care soared (after all everything, from the simplest syringe to the state-of-the-
art diagnostic machines, is imported) and the public health budget became tighter due to chronic
misprioritization, the trend towards charging fees for laboratory procedures and making patients buy
their own supplies became the norm even among supposed “charity” patients. (Government hospital
pharmacies are notorious for always running out of medicines and supplies so that patients have to
buy from private boticaslocated just outside the hospital premises.)

Meanwhile, most public hospitals in the urban centers continued their slide towards decline and decay,
starved of government subsidy. Brain drain among poorly paid health personnel was the rule rather
than the exception, mitigated only by the vagaries of the market for nurses and doctors abroad.
Negative effects included a constant turn over of hospital personnel even in critical-care units
requiring highly-trained staff.

Private hospitals continued to do brisk business catering to the country’s elite but became more and
more unaffordable to the shrinking middle class. Medical health insurance for the regularly employed
through the old Medicare covered only a small portion of hospitalization costs such that out-of-pocket
expenses ballooned uncontrollably.

Clearly the system could not remain the same -- inaccessible and unaffordable to the vast majority
because it was urban-centered, curative care-oriented, and dualistic. Health reform was urgently
needed but what kind?

Apparently government heeded World Bank recommendations that were geared towards reforming
how health care was to be paid for, less from scarce public funds and more from the private pockets of
patients and their families. The assumption was that there were far too many freeloaders availing of
the public health care system when it should be focused on providing services only for the very poor
(who now have to prove their state of indigency).

The trend towards commercialization of medical services and eventually the privatization of entire
public hospitals stealthily crept up on the unsuspecting public. The shining examples held up to policy
makers of how a government hospital can be top-of-the-line without being a drain on the national
health budget are the National Kidney and Transplant Institute and the Philippine Heart Center.

These public hospitals have spanking new facilities for pay patients while maintaining some beds for
charity patients. They have leased portions of hospital property to private businesses such as shops
and restaurants. They seem to have resolved the problem of financing their operations by increasingly
catering to pay patients and relying less on government subsidy.

Under the Aquino administration, the acceleration of privatization and commercialization of public
hospitals reached a new high with the targeting of a slew of hospitals for conversion into public-
private-partnership projects.

Prime example is the National Orthopedic Hospital that was slated to be auctioned off to the highest
bidder for conversion into a modern, state-of-the-art facility. This would have meant throwing out the
thousands of charity patients depending on the old ramshackle facilities and leaving them willy-nilly to
their own device to get adequate medical assistance. Only the united opposition of patients, health
reform advocates, hospital staff and administration as well as social activists and sympathetic media
practitioners prevented the corporate takeover.

In the meantime, the government has been overhauling the national health care insurance system
called PhilHealth. The claim is that there is now close to universal coverage with more than 90% of the
population able to avail of health insurance.

Are these the wide-ranging and fundamental health reforms our people have been waiting for? Or are
they merely exacerbating the deteriorating health situation of our people by denying them access to
basic and life-saving health care?

Next week’s column takes a critical look on PhilHealth.

Carol Pagaduan-Araullo is a medical doctor by training, social activist by choice, columnist by accident,
happy partner to a liberated spouse and proud mother of two.

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