The philippine hhh presentation at tulane

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The Philippine HHH presentation at Tulane
Ma. Lourdes K. Otayza, MD, MHA October 10, 2007
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7,107 islands 300,000 sq. km. area 36,289 km
coastline Major infectious diseases
degree of risk HIGH Food/ waterborne
bacterial diarrhea, hepatitis
A Typhoid fever Vector-borne
dengue , malaria Animal control rabies 3 of
GNP (1.6- 1.1 of budget)
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Dept. of Health BUDGET
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People

• 91,077,287 (July 2007 est)
• CBR 24.48 births/1000
• CDR 5.36 deaths/1000
• IMR- 22.12 deaths/1000 livebirths

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Comparative data (HHH countries)
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• LE at birth 70.51 M/F 67.61/73.55
• Total fertility Rate 3.05 children born/woman
• HIV/AIDS adult -0.1
• HIV deaths lt500 (2003 est)
• Net migration rate -1.48 migrants/1000 popn.

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Brain Drain the Silent Epidemic of Health Workers
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Outline Introductory Remarks I. Symptoms II.
Issues III. Developing the Cure
)
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President of the Philippines
Private sector
Secretary of Health
Attached agencies
Undersecretaries/ Asst. Secretaries
Governor
Different bureaus
Regional Directors
Provincial health office
Regional Offices (Program coordinators, DOH
representatives)
Regional Medical Centers
Municipal health office
Provincial district hospitals
Baranggay health workers
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I. Symptoms
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Distribution of Health Professionals
Source NSCB, 2005
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Nurse Deployment TrendSource POEA, 2004
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Nurse Medics

• Enrollment in nursing in NCR increased from 8,600
  in 1998-99 to 34,277 in SY 2003-04
• Enrollment in medicine declined from 7,162 in SY
  1998-99 to 6,551 in SY 2003-04
• MDs to RNs (PNA 2005)
• June 2004 458/13,000 3.5
• December 2004 1,183/12,000 10
• June 2005 662/26,000 2.55

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Health Professional Outflows
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Outflow Effects
(Galvez-Tan et al)

• Doctor applicants to residency training and
  public health - 60
• Many DOH T/T Hospitals lack resident physicians
• At least 3 hospitals in Mindanao with no nursing
  staff
• 2 hospitals in Mindanao cannot operate new wards
  for lack of nurses
• PGH now employs non-UP graduate doctors and nurses

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II. Issues A. Inequality in distribution of
health human resources
Trends in Medical Education

• only 2/ 36 medical schools maintained quota

• decline in NMAT takers by 24 (4475) in 2003
• 11 (4070) in 2004
• decline in enrolment from 10 to 70

• Cost of medical education -as high as 1848/sem
  
• 
  (P85,000/sem)

• Passing rate 51.4 - 66 over the last 5 years

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Distribution of Medical Schools by Region as of
June 2004 Total 36 - 3 had closed
down Source Association of Phil. Medical
Colleges, APMC  
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Trends in Nursing Education

• 43 nursing schools abbreviated courses for MDs
• about 2,347 doctors took the nursing board (2004
  2005)

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No Rational Basis for Opening of Schools (CHED,
2005)
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Nursing Licensure Performance(Source PRC 2005)
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Organizations with HRH Functions
B. Functions of organizations with
HR roles are not integrated

• Government organizations
• 12 agencies
• Conflicting policies
• 8.5B (2004)- 8x total investment in 2003
• 14B (2006)- double the value 5 years ago
• 
  -Hookway, J., Wall Street Journal, Aug.31, 2007
• Academe
• Professional Organizations and paraprofessional
  organizations
• Private organizations and health facilities

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Policies on Human Resources for Health
C. lack of integrated policies on HRH

• Professional laws
• 12 professions regulated by PRC
• 2. Code of Ethics
• Compensation and Benefits
• Magna Carta for Public Health Workers
• Barangay Health Workers benefits and Incentives
• DOH Issuances
• Policies and Guidelines on Private Practice
• Standards for Licensing and Accreditation
• Operational Guidelines for Deployment
• Other Government and Private issuances

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• HRH devt. policies regulate, not stipulate the
  production, utilization continuing devt of
  professionals (Rebullida
  Lorenzo, 2002)
• Should the government manage or promote the
  deployment?

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D. Poor Working Conditions Limited Career
Progression Opportunities Unfavorable Terms of
Employment
Working Environment

• Minimal information available on career
  opportunities
• Unclear/ Lack of career path
• lack of mobility
• Minimal success in career planning
• Underemployment of health workers
• Labor list
• Job order

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Health Professional Salaries
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HRH Compensation
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Justification for the GCCA 2006
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Staffing Standards
E. outdated staffing standards

• 1. Government and Private Hospitals
• Standards for HR requirements for MD, RN, NA/
  MW,DMD, Dental Aide, Nutritionist/ Dietitian,
  Admin. Staff
• Birthing Home
• Infirmary
• Hospitals
• 2. Public Health Facilities
• Population- based ratios
• For MD, RN, MW only

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Health Science Schools
F. No rational bases for opening schools

• 1. Distribution of schools in the country
  especially in underserved areas
• High cost of education
• Performance of schools in the licensure
  examinations
• 4. Competitiveness of Health Sciences
  Professions Popularity of Health Sciences
  programs over other professional programs

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HRH Information System
G. weak information system

• HRH data available
• PRC cumulative, disaggregated data
• CHED List of health science schools, enrollees
  and graduates
• POEA international deployment by age, sex,
  gender and year
• NSCB Distribution of some government health
  workers
• No information system in place at the local
  government level
• Limited data on HRH from the private sector
• DOH Information System
• has integrated critical variables consistent with
  HRH system needs
• Personnel Information System has to be upgraded
  and updated
• Has yet to interface with other HRH data in other
  agencies

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III. Developing the Cure Philippine HRH Master
plan

• A long term strategic plan that
• Provides a framework for phased operational
  planning
• Describes short , medium, and long term
  strategies that may still be refined
• Dynamic plan that can be evaluated and revised
  between phases
• Utilizes various planning tools like SWOT
  analysis, LFA, workforce planning software
• Allows customized responses of partner
  stakeholders.

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Phase I 2005-2010

• Ensure equitable distribution of HRH
• Manage HRH Migration
• Install critical basic HR systems
• HRH Information System
• Job Analysis and Competency Development
• Career Development and Management
• Capacity Enhancement
• 4. Training for Workforce Plan Validation
• 5. Policy Development
• 6. Monitoring of Phase 1 progress

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HRHMP Time Frame (Phase I)
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Phase II 2011-2020

• Expand and institutionalize HRH Systems
• HRH Planning
• CDMS Systems (Individual Career Plan, Career
  Path, Succession Plan, Retention Plan)
• Competency Development Proficiency Assessment
• Establish Public-Private Partnerships
• Promote development of quality schools and health
  facilities
• Maintain an integrated HRHIS
• Policy Development
• Monitoring of Phase II progress

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Phase III 2021-2030

• Implement CDMS in public and private sectors
• Maintain and monitor HRH Systems implementation
• Evaluate attainment of the goals of HRHMP
• Synthesize results of HRHMP monitoring and
  evaluation
• Plan for the next HRHMP

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• What to watch

• Other Evolving initiatives

• Presidential EO DFA, DOLE,
• POEA,
• OWWA
• HRHD Master Plan

• Institutionalization of national network on HRHD
• Exploring bilateral negotiations w/ destination
  countries
• Forging North-South hospital partnerships
• Returnee integration programs
• Natl. Health Service Act
• PHA,PHIC,PNA police power vs. exploitation
• Active participation in intl org. (WHO, ICN, ILO)

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• Alburo, Florian, Abella, Danilo. Skilled Labor
  Migration from Developing Countries Study on the
  Philippines, International Labor Office, Geneva,
  2002.
• Baptise-Meyer, J. The Brain Drain new aspects of
  the South/North exodus, The Courier ACE-EU, July
  August 2001
• Buchan, J. International Recruitment of Nurses
  UK Case Study, Queen Margaret University
  College Scotland, UK, July2002
• Dayrit, Manuel. Global Perspectives on the
  Health Workforce The World Health Report, 2006
  WHO Geneva
• Galvez-Tan,Jaime, Sanchez, Fernando, Balanon,
  Virginia, Javier, Lara Salud. Brain Drain
  Phenomenon and its implications toHealth.
  Unpublished position paper.
• Egger, Dominique, Lipson, Debra Adams, Orvill,
  Achieving the Right Balance The Role of
  Policy-making processes in managinghuman
  resources for health problems Discussion paper
  No.2, WHO Geneva 2002
• Findalay, A Lowel L. Migration of Highly
  Skilled persons for developing countries impac
  policy responses, Geneva, ILO. International
  Migration Papers, No. 43.
• Rebullida, Ma. Lourdes G. Lorenzon, Fely
  Marilyn, Health Human Resource Development
  Policis effects on the Health Profession.
  Monograph National Institutes of health,
  University of the Philippines, Manila 2002
• Ronquillo, Kenneth, Lorenzo ,Fely Marilyn,
  Nodora, Rodel, Human Resources for Health
  Migration in the Philippines A Case Study
  Policy Directions, Paper for Asean Action
  Alliance for Human Resources for Health, Bangkok,
  Thailand, 2005
• Hookway, James, Wall Street Journal, Aug.31, 2007
• http//www.cia.gov/library/publications/the-world-
  factbook/geos/rp.html
• Professional Regulation Commission Annual Report
  (2005)
• Commission on Higher Education Annual Report
  (2005)
• Dept. of Health Center for Health Development
  Survey on Physician Vacancies (2004)
• Philippine Human Resource for Health Master Plan,
  Department of Health 2005
• Primer on the Government Classification and
  Compensation Act of 2006, Philippine Civil
  Service Commission

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Maraming Salamat po!