In a poor country where one out of every two people dies without receiving any medical attention, 50 percent of the population do not have access to health care, 40 percent do not have access to essential medicine, 10 mothers die daily due to pregnancy and childbirth-related causes, and 100 municipalities are doctorless and nurseless[1] while more than 7,700 nurses, 83 doctors, and 196 professional midwives leave the country yearly[2] to work abroad, trainings to equip ordinary citizens attend to the basic health needs of poor and neglected communities should be welcomed.

And a government that is sensitive to the needs of its people should support such initiative, or at least be thankful to medical professionals and volunteers who give their skills, knowledge, time, and resources in order to help bridge the widening gap between the need and availability of health services in the country.   

So when 43 health workers – including two medical doctors, a registered nurse, a registered midwife, and 39 community health workers – while conducting a training-seminar, were illegally arrested, and later tortured, by the police and military on outrageous claims that they were making bombs, you know at once that something is seriously, terribly wrong.

Community-based health programs

The Council for Health and Development (CHD), which together with the Community Medicine Foundation Inc. (CMFI) organized the training-seminar attended by the 43 health workers, is the national organization of non-government community-based health programs (CBHPs) in the Philippines. It raises resources for the CBHPs including reading, education, and training materials as well as financial support. The group, which is registered in the Securities and Exchange Commission (SEC) as non-stock and non-profit, also conducts trainings and consultations with CBHPs.[3]    

Since 1973, non-government CBHPs has formed part of the Philippine health care system. From simply providing training for paramedics in far-flung and neglected rural communities, CBHPs have overtime become part of the common people’s aspirations and struggles.[4]

Programs considered as CBHPs aim to respond to the basic health needs of the people through education, training, and services. Unlike episodic health campaigns such as breastfeeding or immunization programs, for example, CBHPs deal with the health issue in a holistic approach, i.e. health problems of the community are recognized to be inter-related with the economic, political, and cultural problems of the society. Thus, they do not provide solution to health problems but assists and facilitates in laying the foundation of a health system that is governed by the people at the community level.[5] Maybe this concept of CBHPs is too “communist” for the Armed Forces of the Philippines (AFP) and the Philippine National Police (PNP)?

But the CBHPs have long been recognized even by the United Nations (UN). In the late 1970s, CBHPs were institutionalized globally following an international conference on primary health care organized by the World Health Organization (WHO) and the UN International Children’s Emergency Fund (UNICEF). That conference officially recognized the role of paraprofessionals or auxiliary health workers in lieu of physicians in the rapid extension of health services in the Third World. They were to play a key role in achieving universal access to health services.[6] In fact, CBHPs in the Philippines were recognized by the UN Development Programme (UNDP) as among the most “innovative social organization and practices of the South.”

Lack of human resources for health

CBHPs and medical volunteers play a crucial role in the Philippines where there has been a noticeable trend of outward migration of doctors, nurses, midwives, therapists, and other medical professionals. From 1992 to 2006, the country has already deployed 115,871 professional nurses as overseas Filipino workers (OFWs); 2,945 professional midwives; and 1,247 medical doctors. The Philippines is the biggest “exporter” of nurses in the world.[7] The Philippine General Hospital (PGH) alone is losing as much as 500 nurses every year out of their 2,000 health workforce.[8]

These exported medical professionals tend to be well-trained, skilled, and experienced because of their specializations but are enticed to go abroad mainly due to economic factors. Nurses in the Philippines, for instance, are volunteers or casuals without plantilla positions and thus do not enjoy job security and other benefits. The Philippines has been mass producing nursing graduates every year not to attend to domestic health demands. A 2000 estimate, for example, said that 85 percent of the total demand for Filipino nurses are found abroad. Health workers employed in the country, meanwhile, endure low and variable wage rates that do not allow them to earn decent living wages.[9]

The obvious and immediate end-result of this phenomenon is a shortage in health professionals to meet the country’s own requirements. One indicator is the health professional to patient ratio. In some hospitals, one nurse attends to as much as 60 patients[10], which have implications on the quality of health services. A separate report claimed that the nurse to patient ratio in some government hospitals in the Philippines even reached 1:100 while the international standard is pegged at only 1:4.[11]

Meanwhile, processed data from the World Health Organization’s (WHO) online database show that there is only one doctor for every 2,000 Filipinos and one nurse/midwife for every 167. The WHO said that countries with fewer than 2.5 health care professionals (physicians, nurses, and midwives) per 1,000 people failed to achieve adequate coverage rates for selected primary health care interventions as prioritized by the Millennium Development Goals (MDGs) framework.[12]

Consequently, the 2007 Philippines Midterm Progress Report on the MDGs shows that based on the country’s current pace, the 2015 deadline on health-related targets will not be achieved. As of 2006, the number of maternal deaths per 100,000 live births was pegged at 162. The MDG target is to reduce the maternal mortality ratio to 52. Meanwhile, access to reproductive health care was pegged at 50.6 percent while the UN goal is 80 percent access.[13]

Government neglect, double injustice

The exodus of Filipino health professionals is reflective of the backward state of the Philippine economy and aggravated by wrong policies and priorities of past and present governments. The export of labor including medical professionals has been a flawed government policy since the Marcos years to provide jobs and generate dollars for the economy. In recent years, government has even intensified the export of health workers such as through the 2008 ratification the Japan-Philippines Economic Partnership Agreement (JPEPA), which supposedly guarantees access for Filipino nurses and caregivers to the Japanese health labor market.

These policies combine with total government neglect to provide basic social services including health. At an average of 1.8 percent national budget allocation since 2001, the Arroyo administration has allocated the smallest portion of the country’s budget for health services among all post-Marcos governments.[14] Actual spending is even worse. In 2008 (latest available data), public spending for health comprised only 1.2 percent of total spending (while debt servicing for principal and interest accounted for 47.6 percent).

Lack of public health services has forced many Filipinos to rely on their own. In a 2009 survey, Sun Life of Canada found out that 76 percent of Filipinos are concerned about paying for health treatment and an overwhelming 85 percent rely on their own savings when they get sick.[15] But because of poverty, medical needs are largely not met as indicated by the alarming national health statistics

Official poverty statistics show that there are 27.6 million poor Filipinos or 32.9 percent of the total population,[16] although independent estimates such as IBON’s claim that as high as 8 to 9 out of every 10 Filipinos do not meet decent living standards.

The situation is more severe and more felt in the countryside, where an estimated two out of three poor Filipinos live. These are the people that CBHPs serve in remote barangays and sitios where government services such as health are absent.

Thus, by arresting and torturing the 43 health workers, the Arroyo administration and its armed forces have twice committed a grave injustice – first against the victims and their families, and second against the countless poor people long neglected by government and that these health workers serve. ###

Sources, references, and notes   

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[1] Galvez Tan, Jaime Z. (2004), “The brain drain phenomenon and its implications for health: 10 strategic solutions for action by Filipino leaders”, p. 5, paper read at the International Conference on the Medical Workforce sponsored by the United States Educational Commission for Foreign Medical Graduates (ECFMG), Washington DC, 4-7 Oct. 2004

[2] Based on 1992-2006 (latest available data) cumulative OFW deployment per skill and per country as compiled by the Philippine Overseas Employment Administration (POEA 

[3] Council for Health and Development website, http://www.chdphilippines.org/about.php 

[4] __________ (2001), “Community-based health programs”, p. 7, Examples of Innovative Social Organizations and Practices of the South”,  Vol. 6, UNDP Special Unit for South-South Cooperation

[5] Ibid., p. 6

[6] Ibid., pp. 3-5

[7] Lorenzo, Fe Marilyn E., RN, DrPH et al. (2005), Migration of health workers: Country case study Philippines, Institute of Health Policy and Development Studies, National Institute of Health, University of the Philippines, pp. 14, 21, International Labour Office, Geneva, 2005 

[8] Op. cit., Galvez Tan (2004)

[9] Op. cit., Lorenzo (2005), 18-19

[10] Ibid., p. 44

[11] Makilan, Aubrey SC (2005), “Poor pay, working conditions are driving health professionals abroad”, Special report (last of three parts), Bulatlat.com, Vol. V No. 43, 4-10 Dec. 2005, http://www.bulatlat.com/news/5-43/5-43-poor.htm

[12] World Health Organization Statistical Information System, Human resources for health, WHO website, http://www.who.int/whosis/indicators/compendium/2008/3hwo/en/index.html

[13] __________ (2007) “Philippines Midterm Progress Report on the Millennium Development Goals”, p. 15

[14] IBON Features (2010), “Violations of economic, social rights severe under Arroyo administration”, Bulatlat.com, 12 Dec. 2009, http://www.bulatlat.com/main/2009/12/12/violations-of-economic-social-rights-severe-under-arroyo-administration/

[15] Dumlao, Doris C. (2010) “Most Filipinos have nothing to leave their children, study shows”, Philippine Daily Inquirer, INQUIRER.net website, 6 Feb. 2010 http://business.inquirer.net/money/breakingnews/view/20100206-251545/Most-Filipinos-have-nothing-to-leave-their-children-study-shows

[16] National Statistical Coordination Board, Philippine Poverty Statistics, NSCB website, http://www.nscb.gov.ph/poverty/2006_05mar08/table_2.asp