THINK PAPER

on the

HEALTH SECTOR

for the

ROUND TABLE DISCUSSION

National Manpower Summit 2006
 A. PROFILE OF THE HEALTH SECTOR/INDUSTRY

1. Composition of the Sector1

Health Care in the Philippines is delivered in two networks. The Facility-Based

health units provides curative, treatment and diagnostic services; and the
Community-Based health units conducts promotive and preventive work.

The facility-based health units are grouped according to the following:

o General hospitals and medical centers
o Dental and optometric clinics
o Ambulatory surgical facilities
o Dialysis centers and specialized hospitals
o Clinics and institutions.

Based on the report of the Bureau of Health Facilities and Services (BHFS) of
the DOH, the distribution of these facility-based delivery health units are shown
in Table 1.
Table 1
Distribution of Facility-Based Delivery Health Units, 2002

No. of Health
Facility-Based Delivery Health Units Units %
Government 38.03
- General hospital 617 661
- Specialized 44
Private Hospitals and Clinics 1,077 61.97
Total 1,738 100

Government hospitals accounted for 661 or 38% of all DOH licensed hospitals
and medical clinics in the country and 1,077 or 62% are private hospitals and
clinics. More than 90% of government hospitals are general hospitals and the
rest are specialized.

The BHFS also reported the distribution of hospitals according to type and bed
capacity as shown in Table 2.

Table 2
Distribution of Hospitals by Type and Bed Capacity, 2002

Hospitals Type No. of Hospitals % Total Bed capacity %

- Primary 836 48.10 13,917 16
- Secondary 654 37.63 25,731 30
- Tertiary 248 14.27 45,518 54
Total 1,738.0 100 85,166 100

1
National Strategic Skill Plan, Health Sector, 2004
2
Of the three types of hospitals, 836 (47%) are primary hospitals with 13,917
beds, 654 (38%) are secondary hospitals with 25,731 beds and 248 (14%) are
tertiary with 45,518 beds. While government hospitals are fewer, they have on
the average bigger bed capacities than the private hospital. A total of 45,395
beds are housed in the government sector, accounting for 53% of total hospital
bed capacity in the country.,

The general hospitals are further distributed by location as reflected in

Table 3.

Table 3

Distribution of General Hospitals by Location, 2002

Location No. of Hospital %

- National 28 5
- Regional 26 4
- Provincial 46 7
- Sub-Provincial (district and municipal)
hospitals and treatment facilities 517 84
Total 617 100

Not all of the 79 provinces have provincial level hospitals. District and municipal
hospitals combined cover only 35% of the 1,496 municipalities of the
Philippines. All government, municipal hospitals are primary hospitals while the
provincial hospitals are either secondary or tertiary. All regional and national
government hospitals are tertiary.

The community-based health units consist of rural health units (municipal

health centers and rural health stations) of the municipal or village level of local
governments. The distribution of these health units are as shown in Table 4.

Table 4

Distribution of Community-Based Health Units

No. of Health
Community-based Health Units Units %
- Municipal Health Centers 2400 15
- Rural Health Stations 13400 85
Total 15800 100

There are 15,800 community-based health units, where 2400 (15%) are
municipal health centers, and 13,400 (85%) are rural health stations. They are
servicing 1,496 municipalities and 41,943 barangays across the country.

These municipal health centers do not have accommodation facilities and have
only one doctor, one nurse and a midwife as core crew. Similarly, the rural
health stations do not have doctors and nurses and are staffed by only one
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 midwife. However, they are supported by a cadre of volunteers from the
barangays within the municipality, the most common of which are called
barangay health workers or BHWs. These volunteers are not professionals but
are trained in various promotive and preventive measures. They perform a
critical role as far as advancing the health of the community is concerned from
various preventive perspectives – from nutrition to sanitation and disease
prevention. These rural health units are government “owned” and operated. In
general, the community based delivery system is set up by the government with
the assistance of some non-government or international development agency.

Based on the Current Labor Statistics (DOLE) January 2006 issue, there was a
slight decreased on employment of health and social workers (PSIC) from 2001-
2003. In 2001, the health and social workers registered at 28,231 while in
2002 and 2003 the employment in this category was 28,183 and 28,201,
respectively.

2. Economic Contribution of Health Sector

The total health expenditure of the country reached P136 billion in 2003,
indicating a 16% increase compared to 2002 expenditure of P117.2 billion. The
share of health expenditures to GNP exhibited an increase from 2.8 percent in
2002 to 2.9 percent increase in 2003, breaking the downward trend observed
since 1998 (PNHA). In 2001, the share of total health expenditure to GDP
reached 3.2 percent. Countries like Japan, Cambodia, Maldives and Mongolia
allocated more than 6 percent of their GDP to health expenditure.

Health spending of the government and social insurance sectors spurred the
growth in total health expenditure of the country in 2003. The government
increased its health spending from P36.3 billion in 2002 to P46.5 billion in 2003
demonstrating a 28.2 percent growth. Likewise, social insurance spending grew
from P10.6 billion in 2002 to 12.9 billion in 2003, translating to a 22.3 percent
increase. Although private sources registered a mere 8.8 percent growth in
2003, it continued to be the highest health spender at P74.7 billion. The private
schools showed the fastest rate of increase among the private sources at 25.3
percent followed by the HMOs at 11.4 percent. Out of pocket expenditures also
increased by 9. 1 percent and is still the biggest contributor to health
expenditure amounting to P59.8 billion. The biggest share of health spending
comes from the private sources at 54.9%.

4
 The distribution of health spending by the different sources of funds is shown in
Table 5.
Table 5
Distribution of Health Expenditure by Sources of Funds
CY 2002 and 2003
Growth Rate % Contribution
Amount (In billion pesos) (in percent)
SOURCE OF FUNDS 2002 2003
GOVERNMENT 36.3 46.5 28.2 34.2
National 18.5 22.7 23.1 16.7
Local 17.8 23.8 33.5 17.5
SOCIAL INSURANCE 10.6 12.9 22.3 9.5
Medicare 10.3 12.8 23.8 9.4
Employees’
Compensation 0.3 0.2 -36.8 0.1
PRIVATE SOURCES 68.6 74.7 8.8 54.9
Out-of-pocket 54.8 59.8 9.1 44.0
Private Insurance 3.4 3.4 0.6 2.5
HMOs 4.2 4.7 11.4 3.5
Employer-Based Plans 4.8 5 4 3.7
Private Schools 1.5 1.9 25.3 1.4
OTHERS 1.7 1.8 9.1 1.3
ALL SOURCES 117.2 136 16 99.9
Source: National Statistical Coordination Board

B. EMPLOYMENT SITUATION IN THE HEALTH SECTOR

1. Overview of Employment Situation in the Sector

a. Local Employment Scenario

From 2001-2005, the total employment of the country registered an average

annual growth rate of 3.32%. However, the health and social work industry
group exhibited an average annual growth rate of 1.71% only. This means that
the increase in the employment is higher in other industry sectors than in health
and social work sector.

Table 6
Employed Persons in Health and Social Work (in 000)
2001 2002 2003 2004 2005 Annual Average
Growth Rate
Total Employment 30,08 30,251 31,553 31,741 32,876 3.32
5
Health and Social 339 347 370 361 362
Worker Employment
% of Health and 1.13% 1.15% 1.17% 1.14% 1.10% 1.71%
Social Work to the
Total Employment
Sources: Current Labor Statistics, DOLE/BLES; NSO
5
 This scenario could be attributed to the limited work available in the country for
the health care workers specifically for medical doctors, nurses and other
hospital-based professionals. There were limited opportunities for health care
workers.

The clinical workforce employed in rural health units in year 2000 was estimated
to be only 25,400. These consisted of only 2,400 doctors, 2,400 nurses, 2,400
dentists, 2,400 medical technologists and 2,400 nutritionists (or one each in the
2400 municipal health centers across the country) 13,400 midwives or one in
each of the 13,400 barangay health stations.

In 2000, there were 194,577 active barangay health workers (BHWs) with local
government units who perform mostly volunteer work with some allowances
from the LGUs. On average, there are eight barangay volunteer health workers
for every one professional medical staff deployed at the community level. While
much of the burden of preventive work rests on the zeal of these volunteers they
are not given much systematic training and financial incentives.

The government health service workers cannot increase despite the need for
additional workers because of the limited plantilla positions available. Unless
the government increase government budget to expand access, improve quality
and efficiency of public health, employment of health workers is not expected to
increase in the same manner as the other sectors such as tourism and other
service sectors.

In the absence of sufficient government hospitals and health units, there are
private hospitals and a network of health facilities that are available nationwide
that cater to the health needs of our growing population. These also become
the source of employment for our health workers. Despite private sector
contribution to the health sector, the sector is still experiencing “chronic”
underinvestment by both the public and private sectors. Investment in health
sector is only 2.9% of our GNP in 2002.

Based on the 2004 Philippine Statistical Yearbook, the average monthly income
of health and social worker personnel was only P10,440.00. The medical
doctors and the professional nurses receive an average monthly wage of
around P12,971.00 and P9,595.00, respectively.

b. Overseas Employment of Health Care Workers

The overseas employment remains one of the country’s supply measures to

ease the current economic crisis and the rising unemployment. From 2000-
2005, total deployed OFWs reached 1,612,345 or an average annual increase
of around 268,724 (See Table 7).

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 By sectoral distribution, topping the list is health and social services with
627,165 from 2000-2005, followed by tourism and construction sectors with
222,105 and 117,391, respectively. The annual average share of the three
sectors registered at 38.90% (104,527), 13.78% (37,017), and 7.28% (19,565)
respectively (See Table 7).

Table 7. Total Number of Deployed OFW by Sector, 2003-2005

Grand %
Sector 2000 2001 2002 2003 2004 2005 Total Share
AGRI -FISHERY
(including Rubber) 965 725 947 736 959 541 4,873 0.30

AUTOMOTIVE 1,283 1,420 1,298 949 1,022 864 6,836 0.42

CONSTRUCTION 15,513 19,728 21,998 17,367 18,046 24,739 117,391 7.28

DECORATIVE
CRAFTS
(Ceramics) 60 85 102 114 91 55 507 0.03

DECORATIVE
CRAFTS (Jewelry) 57 86 88 30 51 99 411 0.03

ELECTRICAL 3,508 4,109 4,775 4,393 4,188 4,757 25,730 1.60

ELECTRONICS 1,349 1,178 2,541 1,722 1,589 3,224 11,603 0.72

FOOTWEAR 37 16 28 15 36 26 158 0.01

FURNITURE AND
FURNISHING
(including
Handicrafts and
Wood Carvings) 514 403 355 385 422 421 2,500 0.16

GARMENTS 5,119 5,738 6,208 6,556 8,047 8,677 40,345 2.50

HEALTH &
SOCIAL
SERVICES 96,530 102,421 103,957 86,323 110,837 127,097 627,165 38.90

INFORMATION &
COMMUNICATION
TECNOLOGY / IT-
Related Services 544 529 395 284 453 367 2,572 0.16
LAND
TRANSPORT 1,393 1,090 1,003 751 840 1,166 6,243 0.39
LOGISTICS
SERVICES 412 671 821 946 1,320 1,108 5,278 0.33

MARITIME 302 531 337 104 385 106 1,765 0.11

METALS &
ENGINEERING 12,764 12,093 12,621 12,918 14,057 11,526 75,979 4.71

MINING 52 66 86 103 65 63 435 0.03

PROCESSED
FOOD AND
BEVERAGES 225 340 499 447 753 796 3,060 0.19

TOURISM 41,407 42,480 40,093 31,755 38,947 27,423 222,105 13.78

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 Grand %
Sector 2000 2001 2002 2003 2004 2005 Total Share

OTHERS 58,586 61,892 76,550 65,746 79,703 66,063 408,540 25.34

Cannot be
Classified 12,410 14,149 11,426 9,867 3 994 48,849 3.03

Grand Total 253,030 269,750 286,128 241,511 281,814 280,112 1,612,345 100.00
Source: POEA

By country of destination, Saudi Arabia topped the list with a total of 136,603
(21.78%) Filipino health and social services workers from 2000-2005. This was
followed by Hong Kong and Kuwait with 126,115 (21.11%) and 85,981 (13.65).
Taiwan was reported to have 76,452 ( 12.19%) as seen in Table 8 .

Table 8. Total Number of Deployed OFWs:

2000-2005, Health and Social Services
Grand % Average
Destination 2000 2001 2002 2003 2004 2005 Total share (00-05)

BAHRAIN 708 596 746 730 1,230 1,677 5,687 0.91 948

BRUNEI 607 577 521 378 290 164 2,537 0.40 423

CANADA 1,019 2,219 2,344 1,868 2,580 807 10,837 1.73 1,806

CYPRUS 930 1,047 1,219 604 1,116 988 5,904 0.94 984
HONG
KONG 27,714 27,514 22,872 14,003 16,507 17,505 126,115 20.11 21,019

IRELAND 158 1,938 1,248 466 250 304 4,364 0.70 727

ISRAEL 1,823 3,764 2,999 1,770 3,320 2,577 16,253 2.59 2,709

ITALY 1,747 513 79 97 289 76 2,801 0.45 467

JORDAN 65 65 12 51 131 2,741 3,065 0.49 511

KUWAIT 9,702 10,759 13,558 12,344 18,498 20,730 85,591 13.65 14,265

LEBANON 1,592 2,050 1,933 1,674 6,074 11,701 25,024 3.99 4,171

MALAYSIA 776 1,542 1,380 970 1,162 925 6,755 1.08 1,126

OMAN 871 580 25 72 674 1,492 3,714 0.59 619

QATAR 1,433 1,953 2,287 2,431 4,708 7,289 20,101 3.21 3,350

SAIPAN 59 140 142 130 307 191 969 0.15 162

SAUDI
ARABIA 20,099 22,350 24,498 20,462 22,322 26,872 136,603 21.78 22,767

SINGAPORE 2,307 2,351 2,147 1,548 1,722 2,736 12,811 2.04 2,135

SPAIN 958 639 617 328 550 125 3,217 0.51 536

TAIWAN 13,316 7,514 11,728 15,932 15,277 12,685 76,452 12.19 12,742

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 Grand % Average
Destination 2000 2001 2002 2003 2004 2005 Total share (00-05)
UNITED
ARAB
EMIRATES 6,886 7,155 7,832 6,811 9,621 12,978 51,283 8.18 8,547
UNITED
KINGDOM 2,647 5,468 3,548 2,172 1,666 1,375 16,876 2.69 2,813
UNITED
STATES 340 853 888 564 729 455 3,829 0.61 638

Grand Total 96,530 102,421 103,957 86,323 110,837 127,097 627,165 98.9832 104,528
Source: POEA

The ageing population of developed countries especially the European Union

provided the Philippines bright prospects for our health care workers. At
present, increasing deployment of OFW health workers are evident in United
Kingdom, Ireland, etc.

The on-going bilateral arrangements, i..e, Japan-Philippines Economic

Partnership Agreement (JPEPA), ASEAN-Korean Free Trade Agreement, etc.
also provide positive prospects of deploying Filipino health workers in the
coming years. In addition, based on the reports of the Philippine Overseas
Labor Office (POLOs), the government has been working to tap the following
markets for health workers: nurses; caregivers; medical workers; and
occupational therapist

The “pull” and “push” factors encourage the Filipino workers in general to
engage themselves in overseas employment. The “pull” factor is basically
economic in nature (economic difficulties, limited employment, low pay in the
Philippines) while the “push” factor is basically the wage differentials between
local and overseas wages. The overseas Filipino health workers are receiving
salaries 10 to 15 times higher than the salaries they are earning locally.

2. Demand for Health Care Workers

The concern in health care today is the emerging critical shortages of allied health
professionals and auxiliary health workers. Based on the TESDA Provincial Skills
Priorities: 2005-2007, generated from consultations and consensus-building
processes with different line agencies and private industries of six districts in
NCR, four major cities (Baguio City, Cotabato City, Davao City, Zamboanga City)
and the 79 provinces in the Philippines, there are about 16,954 health and related
skills that are in demand nationwide. The priority skills identified are the following:
caregiver, midwife, technicians (biomedical, CT scan, dialysis, ultrasound, dental,
x-ray), pharmacy aides, therapists, and barangay health workers. ( See Table 9)

Apart from the critical skills identified above, there are other groups of critical skills
related to health, social and other community development services such as: a)
9
Hairdressers, Barbers and Beauticians (2,615), b) Security Specialists (1,632),
and c) Masseurs (65).

By region, about 70% (9,820) of the total demand for caregivers come from
Western (Region VI) and Central Visayas (Region VII) from 2005-2007. Ninety-
six percent of the total demand for Nurses also come from Western Visayas (see
Table 9). The demand for nurses is also high in Region VI.
Table 10. TOTAL SUPPLY, DEMAND AND GAPS BY REGION, CRITICAL SKILLS OF
HEALTH SECTOR: 2005-2007
Demand Gaps
Supply,
Region/Skills 2005 2006 2007 Total 2005 2006 2007 Total Ave_Gaps
2005

I 32 9 13 54 12 20 (3) 1 18 6
Biomedical
Technicians 7 2 3 12 2 5 - 1 6 2
CT Scan
Technician 7 2 3 12 2 5 - 1 6 2

Dialysis Tech 2 1 1 4 1 1 - - 1 0
Ultrasound
Tech 5 2 2 9 3 2 (1) (1) - -
X-Ray
Technician 11 2 4 17 4 7 (2) - 5 2

Region IV-A 150 229 300 679 206 (56) 23 94 61 20

Barangay
Health
Worker 25 37 50 112 30 (5) 7 20 22 7
Biomedical
Technicians 5 8 10 23 4 1 4 6 11 4

Caregiver 43 69 86 198 79 (36) (10) 7 (39) (13)

Dental
Technicians 5 8 10 23 9 (4) (1) 1 (4) (1)
Emergency
Medical
Technicians 18 27 37 82 21 (3) 6 16 19 6

Midwife 5 7 10 22 6 (1) 1 4 4 1

Nursing 20 30 40 90 18 2 12 22 36 12

Therapists 22 32 43 97 23 (1) 9 20 28 9
X-Ray
Technician 7 11 14 32 16 (9) (5) (2) (16) (5)

NCR 2,000 1,000 600 3,600 400 1,600 600 200 2,400 800

Caregiver 2,000 1,000 600 3,600 400 1,600 600 200 2,400 800

Region V 15 20 25 60 15 - 5 10 15 5

Nutritionist 15 20 25 60 15 - 5 10 15 5

Region VI 1,795 3,230 5,755 10,780 456 1,339 2,774 5,299 9,412 3,137

Caregiver 1,565 2,680 4,185 8,430 256 1,309 2,424 3,929 7,662 2,554

Midwife 30 40 50 120 - 30 40 50 120 40

Nursing 200 500 1,500 2,200 200 - 300 1,300 1,600 533

Nutritionist - 10 20 30 - - 10 20 30 10

Region VII 350 460 580 1,390 450 (100) 10 130 40 13

Caregiver 350 460 580 1,390 450 (100) 10 130 40 13

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 Demand Gaps
Supply,
Region/Skills 2005 2006 2007 Total 2005 2006 2007 Total Ave_Gaps
2005

Region X 24 5 5 34 2 22 3 3 28 9
Pharmacy
Aides 24 5 5 34 2 22 3 3 28 9

Region XII 108 119 130 357 110 (2) 9 20 27 9

Caregiver 108 119 130 357 110 (2) 9 20 27 9

Grand
Total 4,474 5,072 7,408 16,954 1,651 2,823 3,421 5,757 12,001 4,000
Source: TESDA Provincial Skill Priorities 2005-2007

Based on the National Strategic Skills Plan (NSSP) on Health Sector, the
estimated total demand for the health care human resource in the country by
2020 would be 960,893. The occupations involved in these estimates are
professionals such as physicians, nurses, midwives, dentists, pharmacists,
medical technologists, radiological technologist, physiotherapists, occupational
and other therapists, dieticians or nutritionists and sub-professionals such as
attendants and aides and technicians.

It is interesting to note that attendants and aides, who are sub-professionals,

make up the second biggest bulk of the requirement, numbering 209,974, next to
the requirement for nurses.

a. Job Prospects/Projected Overseas for Filipino Health Workers

Based on the 2000-2005 deployed health and related OFWs from POEA as
presented in the previous discussion on overseas employment, Table 10 shows
the projected OFWs from 2006-2010. The overseas market will remain a big
employment market for Filipino health and social services and related workers
with a total of around 643,962 for 2010. The nursing professional, nursing aide,
physiotherapists and occupational therapists and caregivers/carers are in
demand due to the aging population structure especially in Europe and other
advance economies. However, still a big portion of the needed OFWs are the
domestic helpers.

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 Table 10. Projected Number of Deployed OFWs: 2006-2010

OCCUPATIONS 2006 2007 2008 2009 2010

CAREGIVERS AND CARETAKERS 26,349 36,559 46,769 56,978 67,188

CARETAKERS BUILDING 13,711 21,939 30,167 38,395 46,623

CARETAKERS BUILDING CHAR WORKERS
CLEANERS AND RELATED WORKERS ( N E C ) 250 327 404 481 558

DENTAL ASSISTANTS 668 993 1,318 1,643 1,968

DENTISTS 129 187 246 304 363

DIETITIANS AND PUBLIC HEALTH
NUTRITIONISTS 169 262 356 450 543

DOCTORS MEDICAL 184 271 358 445 532

DOMESTIC HELPERS AND RELATED
HOUSEHOLD WORKERS 148,030 213,806 279,583 345,360 411,136

FIRE-FIGHTERS 92 145 198 251 304

HAIR DRESSERS BARBERS BEAUTICIANS AND
RELATED WORKERS 2,017 2,810 3,602 4,394 5,187
HOUSEKEEPING AND RELATED SERVICE
WORKERS 1,227 1,840 2,453 3,066 3,679
LAUNDERERS DRY CLEANERS PRESSERSAND
RELATED WORKERS 1,373 177 266 354 443
MAIDS AND RELATED HOUSEKEEPING
SERVICE 69 121 175 227 281

MEDICAL ASSISTANTS 35 58 82 106 129

MEDICAL DENTAL VETERINARY RELATED
WORKERS 897 1,025 1,154 1,282 1,410

MIDWIFERY PERSONNEL ( N E C ) 128 206 285 364 442

MIDWIVES PROFESSIONAL 448 667 887 1,106 1,325

NURSES PROFESSIONAL 16,701 26,324 35,948 45,572 55,195

NURSING PERSONNEL ( N E C ) 1,116 1,560 2,004 2,448 2,892

OPTOMETRISTS AND OPTICIANS 133 209 285 360 436

PHARMACEUTICAL ASSISTANTS 207 319 431 543 655

PHARMACISTS 165 230 296 362 427

PHYSIOTHERAPISTS AND OCCUPATIONAL
THERAPISTS 813 1,204 1,596 1,987 2,379

PROTECTIVE SERVICE WORKERS 3 3 4 4 5

PROTECTIVE SERVICE WORKERS NOT
ELSEWHERE CLASSIFIED 773 1,104 1,434 1,764 2,095
SERVICE WORKERS ( N E C ) 13,478 17,948 22,418 26,888 31,358

12
 OCCUPATIONS 2006 2007 2008 2009 2010

SERVICE WORKERS OTHERS 24 27 31 35 38

SOCIAL WORKERS 12 19 25 31 38
SUPERVISOR EMPLOYEES` HOUSING
SERVICES 12 14 17 20 22
SUPERVISORS HOUSEKEEPING AND RELATED
SERVICE 455 685 916 1,145 1,376

TECHNICIANS LIFE SCIENCES / TECHNOLOGIST 614 1,025 1,436 1,846 2,257

TECHNICIANS MEDICAL X-RAY 882 1,245 1,608 1,971 2,334

TECHNICIANS PHYSICAL SCIENCE 125 180 235 289 344

GRAND TOTAL 231,286 333,490 436,982 540,470 643,962

Source: baseline data (2000-2005) – POEA

Based on the reports of the POLOs and presented during the DOLE Labor
Opportunities Program(DOLOP) in 2005, the government is currently working on
expanding overseas labor markets for OF health workers. These are in the following
countries:

Table 11.
Overseas Filipino Health Workers Employment Prospects by Country
Country Employment Prospects
Israel Caregivers
Australia, Norway, Trinidad and Tobago Health workers
Bahamas Medical workers
United Kingdom Occupational therapists
Slovenia Nurses
Cyprus Nurses, workers in hospitals
Italy Nurses, caregivers
Hungary Caregivers
Netherlands Health workers
Source: POLO’s Report

Japan has always been mentioned to be a potential market. However, its job
market remains closed and is not yet employing nurses and caregivers.

Demand for workers is also driven by several factors

9 Demand for health services – the demand for specific types of health
care services, which is driven by the health care problems, perceived
health care needs, and health care seeking behavior of the population, as
well as the diagnostic technologies and treatments available

13
 9 Demand for culturally and linguistically competent services related to
health services – the demand for providers who can speak the primary
language of patients and clients and who can understand cultural beliefs
related to health and illness, behavioral and socio-cultural dynamics of
health and illness, and the role of self care, mutual aid, and family
support

9 Reimbursement to providers of health services – reimbursement and

other types of payment for services to health service providers

9 Costs of providing services – costs of providing services

9 Licensure and certification requirements – whether certain types, or

numbers, of workers are required for the facility to be licensed to operate
or to be certified to receive reimbursement

9 Salaries, wages, benefits and other incentives – salaries, wages, benefits

and other incentives that health service employers are willing to pay to
obtain services of workers and to retain them

b. Opportunities for Health Systems that Arise from globalization

There are a number of examples of related opportunities more specific to the

health sector, and arising from new technologies and expanding Internet
connections. These include:

Telehealth, which offers opportunity for greater access to health care through the
use of technology; and

Telenursing, which extends access to nursing services;

3. Supply Of Health Workers

Based from the data gathered from the Commission on Higher Education, the
number of enrollees on medical and allied courses increased from AY 1999-2000
to 2003-2004. The total enrolment from AY 1999-2000 to AY 2003-2004 was
around 676,600. The medical and allied field comprised the following disciplines:
medicine, midwifery, nursing, nutrition & dietetics, occupational therapy,
optometry, physical therapy, radiologic technology and veterinary medicine. The
increase in enrolment could be caused by the high demand for graduates on the
said areas. Bulk of enrollees are from the National Capital Region which
comprises 36% of the total number of enrollees during the 5-year period followed
by Region 7 (11%), Region 6 (8%), Regions 1 and 4 (both 7%), and the other 11
regions has a combined 31% share. With the increasing trend of enrollment in
the medical and allied group, it is expected that graduates would increase in the
coming years (See Table 12).
14
 On graduates, from AY 1999-2000 to AY 2002-2003, there were about 113,227
who graduated from medical and allied group. The annual average turn-out of
graduates is around 28,307. Similar to the enrolment data, graduates are
concentrated on the following regions: NCR, Region I, Region IV, Region VI and
Region VII. The combined graduates of these regions accounted for 70% or
78,884 graduates. These are the prospective graduates entering the labor force
and normally joining the professional group under the PSOC classification.

Table 14 shows the comparative passing rates in the licensure examination on

graduates of medical and allied field. On the average, from CY 1997 – CY 2001
passing rate decreased from 49.4% to 46% or a 3 percentage point decrease.
Except for nutrition and nursing, all other courses are on the decreasing trend.

Table 14. Comparative Table of Passing Percentage in the Licensure Examination

Medical and Allied Field, CY 1997-2001
DISCIPLINE CY CY CY CY 1998 CY Average
2001 2000 1999 1997
Dental Medicine 36% 38% 25% 23% 33% 31.00%
Medicine 62% 65% 69% 65% 71% 66.40%
Midwifery 48% 52% 51% 48% 52% 50.20%
Nursing 54% 50% 50% 56% 50% 52.00%
Nutrition & Dietetics 58% 55% 54% 46% 46% 51.80%
Occupational Therapy 37% 35% 44% 37% 50% 40.60%
Optometry 37% 15% 19% 27% 57% 31.00%
Pharmacy 62% 63% 67% 72% 68% 66.40%
Physical Therapy 24% 25% 24% 24% 30% 25.40%
Radiologic Technology 42% 37% 31% 40% 37% 37.40%
AVERAGE 46% 43.5% 43.4% 43.8% 49.4% 42.22%
Source: Professional Regulation Commission

TVET provides an avenue for the development of more manpower for the health
sector. Health related TVET programs are now registered with TESDA through the
Unified TVET Program Registration and Accreditation System (UTPRAS).
Hundreds of schools nationwide are offering different non-degree health related
programs (Table 15).

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 Table 15.
No. of Registered Health Related Programs under UTPRAS, 2004
Region No. of Programs
CAR 26
NCR 259
1 67
2 19
3 94
IVA 98
IVB 17
5 35
6 75
7 33
8 19
9 15
10 31
11 45
12 20
ARMM 1
CARAGA 22
TOTAL 876

Relative to the registration of the health and related training programs, the TESDA
Board has approved and promulgated the Training Regulations on the following
occupations: a) security services (NC I and II); b) Caregiving (NCII); c)
household service (NCII); and d) health care services (NC II). The training
regulations serves as a basis in the formulation of competency assessment and
the development of curriculum and instructional materials and provides the
national competency profile of occupations.

For the period 2002-2005, from a total of around 46,786 health and health-related
graduates that were assessed, around 28,542 only have been certified. The
average certification rate during the 4-year period is only 61%. The highest
certification rate was registered in 2004 at 76.83%.

Table 16. Assessment and Certification, Health and Related Sector

2002-2005

Certification
Year Assessed Certified Rate
2002 9,074 3,075 33.89
2003 12,401 7,323 59.05
2004 14,638 11,247 76.83
2005 10,673 6,897 64.62
Total 46,786 28,542 61.01
Source TESDA

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 The relatively low licensure examination and certification rates are concerns that
need to be addressed by both CHED and TESDA.

a. Implications on Employment in the Health Sector

Given the global trends in health care, it would seem that the health workforce of
the future will have to be prepared to meet a greater number of behaviorally
determined health problems, the health impacts of continuing environmental
degradation, and emerging and re-emerging infectious diseases. Generally, there
is a need for health workers to integrate themselves into the community they
serve, providing the human touch rather than simply tackling disease. This will
promote support for their initiatives and actions. They will also need to have the
communication skills to undertake patient education and health promotion
activities like exercise or physical activities, eat healthy foods, and stress
management.

Opportunities also abound for exchange of health services between and among
countries. There are four key areas and forms of international trade in health
services:

1. cross-border supply – where the supplier of a health service in one and country
makes the service available to the population living in another country, e.g.
telehealth;
2. consumption abroad – where patients travel from one country to another to
obtain treatment;
3. commercial presence or “establishment trade” – the provision of health services
on a for-profit basis by foreign-owned health care providers or health
transnational corporation;
4. provision of health services by foreign people – the delivery of health services in
a given country by foreign individuals or the movement and migration of health
workers, e.g. physicians, nurses.

In 1998, 50 countries (nearly half the World Trade Organization membership)

included one or more aspects of health services in their GATS schedule of
specific commitments. Preparations for the 1999 WTO Seattle Ministerial
Conference indicate that the health industry will continue to be a key focus of
future international trade negotiations and agreements.

Today’s trends indicate that hospital-based care is giving way to alternative

delivery systems exemplified by multiple small care centers and clinics. These
range from health maintenance organizations and physician group practices to
ambulatory surgery units, maternity clinics, hospices, drug abuse centers and
long-term care facilities. Hospitals are no longer seen as the main centers of
treatment, although they will remain the most important provider and the ones
with the highest concentration of qualified staff.

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 These developments will mean a concomitant change in the working conditions
in the sector. The provision for acute care is becoming more and more
decentralized. Whereas many health workers are employed full time in
hospitals, clinics and physicians’ surgeries, there will be more and more
services being offered by part-time or independent care providers who are
willing to travel to the patient’s home. These include visiting nurses, midwives
and physiotherapists.

b. Identifying Education and Training Opportunities for Health Workers

The health system faces major human resource challenges given the recent
development in the domestic and international fronts. Many of the challenges
facing the health care delivery system require the upgrading of human resource
competencies and productivity within the sector. The exodus of the Filipino
health care workers overseas as well as the increasing demand domestically
due to increasing population and the Philippines as prospective tourism haven
in Asia are just some of the human resources challenges facing the health
sector. Together with the increasing demand is the

One potential response is to upgrade the competencies of sub-professionals to

take on certain nursing functions to free nurses to undertake the more complex
nursing care functions.

In September of 2002, TESDA spearheaded a national consultation on technical

education in the health care industry to facilitate the establishment and
implementation of essential technical education frameworks that will pave the
way for the development and implementation of curricular programs responsive
to the priority and critical occupations of the health care industry (Executive
Report). It brought together for consultative discussion health practitioners in the
community-based and hospital based sub-sectors and the managers of relevant
public and private agencies and associations to identify the priority health care
technical occupations, in terms of high market demand, critically low in supply
and emerging technology requirements.

The following were the identified occupations for the health sector:

Hospital-based Community-based
Bio-medical technician Emergency health care
coordinator
Hospital waste manager Community ambulance driver
rescue worker
Hospital waste technician Preventive maintenance & repair
– medical equipment
Bereavement/death assistance Community health worker
counselor
Embalmer Info. & communication technician
officer
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 Laboratory technician Garbage/sewage collector
Emergency medicine technician Caregiver for the elderly
Hospital cleaners Sanitary inspector
Infection control technicians Community health facility
administrator
Clinical assistant Community insurance advocate
Customer service officer Medical transcriptionist
Admitting clerk Ambulance driver
Cremator Medical waste management
manager
Clinical medical technician
Post hospital caregiver
Waste water treatment
operator/technician
Pollution control technician
Telemetry technician
Healthy lifestyle educator
Clinical assistant or nurse aide
Medical encoder/statistical clerk

C. POLICY ISSUES/IMPLICATIONS

The rise of globalization provides a very bright employment prospects for health
workers. However, this undermines the stock of medical professionals and allied
groups available for domestic demand. How do we balance the opportunity for
better employment in the global market and the need to provide adequate supply
for domestic requirements? This calls for a strong and immediate measures to
downplay the effect of overseas employment on domestic requirement but at the
same time facilitating access to opportunities for overseas employment.

It should be considered that with the advent of medical tourism, the demand in the
domestic front provides good prospects.

The areas of particular interest for policy action are:

ƒ Equitable access to quality health and social services

ƒ Health insurance portability and adequate coverage
ƒ Equitable distribution of pharmaceuticals and medical equipment
ƒ Sound professional (as opposed to trade-motivated) regulation of nursing
education and practice
ƒ Impact of health sector reform generated by trade or economic interests, e.g.
substitution of professional workers with lesser-qualified staff
ƒ Health sector pay and working conditions that support the provision of quality
care and recruitment/retention of competent personnel
ƒ Viable human resources development policies and incentives, including
attractive career structures, international accreditation of qualifications
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 ƒ Nurses’ access to decision-making bodies nationally and internationally
ƒ Issues identified during the 2005 TVET Congress
¾ low deployment of caregivers due to high placement fee
¾ the need for mandatory competency assessment
¾ lack of consultation with the industry in the preparation of training
regulations

D. RECOMMENDATIONS

A. Training and Development of Health Workers

ƒ A sector-wide alliance that will play a major role in ensuring quality in the
provision of education and training for health workers
( competency standards and qualifications for health occupations
( training modules and materials
( program registration and accreditation systems requirements
( competency assessment requirements
( capability building for training providers in the proper implementation of
competency-based training
ƒ Strengthen regulatory role of TESDA over non-degree health and other allied
courses; CHED for degree health and other allied course
ƒ Strengthen institutional arrangements between and among public and
private entities to ensure updated data to provide better signals in terms of
specific/priority areas for training and development
ƒ The ladderization mechanism for health and allied programs should be
defined and put in place to widen education and training access and
opportunities
ƒ Ensuring industry-led training and development and for the government to
ensure a healthy policy environment for the health sector

B. Deployment/Employment

ƒ Bilateral arrangement with countries where bulk of overseas employment is

seen
ƒ Government facilitation on overseas deployment/employment requirements
(one-stop shop for OE requirements)

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 Table 12. Enrollment (Public and Private)
Medical and Allied Group
AY I II III IV V VI VII VIII IX X XI XII NCR CAR ARMM CARAGA TOTAL %
1999- 2000 11,348 2,086 4,190 9,253 4,068 10,084 16,970 2,052 3,332 3,793 4,670 3,436 65,471 8,457 374 1,050 150,634 6.35
2000-2001 8,627 1,809 4,632 9,998 3,815 10,960 17,260 2,085 3,845 3,717 6,230 2,834 55,567 8,883 392 1,117 141,771 5.83
2001 - 2002 11,008 3,498 5,985 11,383 5,740 12,405 16,046 2,518 5,257 3,844 8,449 4,920 62,859 8,456 549 1,083 164,000 6.65
2002-2003 15,665 6,065 9,167 15,940 7,010 18,740 20,009 3,136 7,022 11,534 10,328 4,227 73,165 14,551 1,844 1,792 220,195 9.07
2003-2004 24,497 9,871 15,978 28,090 10,728 28,929 27,414 4,198 10,600 17,583 19,552 8,402 87,957 21,069 1,647 3,259 319,774 13.21
Total 71,145 23,329 39,952 74,664 31,361 81,118 97,699 13,989 30,056 40,471 49,229 23,819 345,019 61,416 4,806 8,301 676,600
Source: Commission on Higher Education

Table 13. Graduates (Public and Private)

Medical and Allied Group
AY I II III IV V VI VII VIII IX X XI XII NCR CAR ARMM CARAGA TOTAL %
1999- 2000 2,197 441 763 1,907 1,141 1,661 1,598 448 923 1,308 1,058 992 14,107 1,234 46 229 30,053 8.57
2000-2001 1,045 408 953 1,587 651 1,387 2,291 339 412 764 1,055 610 10,625 936 77 264 23,404 9.44
2001 - 2002 1,630 761 1,012 2,028 1,058 1,837 2,398 364 1,040 978 910 480 10,662 917 222 177 26,474 6.90
2002-2003 2,792 1,250 1,140 2,084 1,167 3,166 2,801 371 1,425 1,890 1,378 764 11,081 1,229 276 482 33,296 8.29
Total 7,664 2,860 3,868 7,606 4,017 8,051 9,088 1,522 3,800 4,940 4,401 2,846 46,475 4,316 621 1,152 113,227
Source: Commission on Higher Education

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