National Human Resources For Health Master Plan 2020-2040 (Updated As of 12 Nov 2021)

NATIONAL
HUMAN RESOURCES FOR HEALTH

MASTER PLAN
2020 - 2040
NATIONAL
HUMAN RESOURCES FOR HEALTH
MASTER PLAN
2020 - 2040
Updated 12 November 2021

National Human Resources for Health Master Plan 2020-2040
© Department of Health 2021
Published by:
Department of Health
San Lazaro Compound
Rizal Avenue, Sta. Cruz
Manila 1003, Philippines
Editorial Team and Lay-out:
Health Human Resource Development Bureau
The mention of specific companies or of certain products does not imply a preferential
endorsement or recommendation by the Department. This report may be reproduced in
full or in part for non-profit purposes without prior permission, provided proper
attribution to the Department is made.
An electronic copy of this publication can be downloaded at http://bit.ly/NHRHMP
Suggested Citation: Department of Health (2021). National Human Resources for Health
Master Plan 2020-2040. Manila, Philippines: Department of Health.
Table of Contents
List of Tables and Figures .................. iv.

Acknowledgement . . . . . . . . . . . . . . . . . . . . . . vii.
Foreword ......................... viii.
Message from the Undersecretary of Health . . . . . . . . . . . . . ix.
Message from HRH Network Lead Convener . . . . . . . . . . . . . x.
Executive Summary . . . . . . . . . . . . . . . . . . . . . . xi.
Chapter 1 .....................
Introduction 1
Chapter 2 .........
HRH Situation, Results Framework, and Strategies 15
Chapter 3 ...
NHRHMP as a People Strategy and Its Architecture as a Social System 35
Chapter 4 ...
NHRHMP Strategic Management Framework, Principles and Practices 45
Chapter 5 ........
HRH Data Governance and Information Management 59
Chapter 6 ..........
Health Education Strengthening and Regulation 89
Chapter 7 .........
HRH Welfare, Protection, and Career Development 113
Chapter 8 ..............
HRH Migration and Reintegration 149
Chapter 9 ..........
NHRHMP Institutionalization and Localization 167
Chapter 10 Institutionalization and Strengthening of the Human Resources for

................
Health Network Philippines 183
.....................
Chapter 11 Call to Action 197
List of Acronyms ....................... 205

Annex A .........
Risk Governance Frameworks and Change Models 210
Annex B
..........
Projecting the Requirements for Selected Health Professionals to Achieve
Universal Health Coverage in the Philippines 212
Annex C Assessing Workload and Human Resources for Health Requirement
.........
through the Workload Indicators of Staffing Need 283
Annex D ................
NHRHMP Legislative Agenda 301
List of Figures and Tables
List of Figures
Chapter 1
1 Alignment of NHRHMP to global and national plans and frameworks
2 FOURmula One Plus for Health Strategy Map
3 Health Labor Market Framework for UHC
4 Step by Step Development Process of the National HRH Master Plan
Chapter 2
5 Licensed Health Professionals per Cadre, 2020
6 Health Professions with the Highest Ratio per 10,000 population
7 Health Professions with the Lowest Ratio per 10,000 population
8 Distribution and Density (per 10,000) of HRH Licensed to Practice in the Philippines, 2020
9 Distribution and Density (per 10,000) of Practicing HRH in the Philippines, 2020
10 Distribution and Density of Doctors, Nurse, and Midwives Licensed to Practice in the
Philippines, 2020
11 Average Distribution of HRH in Clinical and Primary Care Facilities, 2020
12 Average Distribution of Doctors, Nurses, Midwives, Dentists between Public and Private
Sectors, 2020
13 National HRH Master Plan 2020-2040 Results Framework
Chapter 3
14 Four Phases of HR Transformation
15 NHRHMP People Strategy Supporting and Enabling the NHRHMP Strategy
Chapter 4
16 HRH Management System Conceptual Framework
17 Skilled Management Practices for Attaining Results
18 Process of Strategy Management (Adapted from Fred David)
19 ISO 31000 Risk Management Framework
Chapter 5
20 Sample Data Maturity Scale
Chapter 6
21 Total Number of Schools by Course, SY 2005/06 – 2017/18
22 Public and Private HEIs per HRH Course by Regions, 2018
23 Share to Total Enrollment by Cadre, SY 2005/06 – 2017/18
24 Passing Rates by course, 2006-2018
25 Distribution of Board Exam Passers by Gender, 2002-2016
26 Average Annual Cost of Tuition in Health Science Courses at Private Institutions
Chapter 7
27 Distribution of LGU-hired HRH (Doctors, Nurses, Midwives) Occupying Plantilla Positions
Chapter 8
28 Top 3 HRH Cadres with Highest Permanent Migration Rates
29 Top 3 HRH Cadres with Highest Temporary Migration Rates (2011-2019)
Chapter 10
30 HRH Network Philippines Structure
31 Proposed Management Structure of the HRH Network for the NHRHMP Implementation
32 Proposed Structure and Members of the Technical Working Committee on HRH Data and
Information
iv
List of Tables
Chapter 1
1 HRH Management and Development Stakeholders
Chapter 2
2 Explanation of the Vision Statement
3 Explanation of the Mission Statement
4 Explanation of the Outcome Statements
Chapter 5
5 Possible Sources of HRH Data
6 List of HRH Information Systems
7 KRA1 Indicators and Targets
8 Strategies for Harmonized HRH Data Governance, Data Analytics, and Information
Management Systems
9 Strategies for Complete, Accurate, and Up-to-Date Data Available and Accessible at all Times
10 Strategies for Enhanced HRH Research Capacity and Research Output Utilization
11 Various Stakeholder Organizations and Roles for KRA 1
Chapter 6
12 Composition of the Philippine Health Workforce
13 Attrition Rate in Government and Private HEIs, 2005-2017
14 Government Agencies Providing Various Financial Assistance
16 Strategies for Strong Inter-sectoral Collaboration and Harmonized Plans and Policies
17 Strategies to Ensure Needs-Based Production and Retention
18 Strategies for Regulatory Measures to Ensure Quality and Efficient HRH Production
19 Strategies for Reorienting HSE Curriculum to Produce Health Professionals Responsive to
Local Health Needs and Demands
Chapter 7
21 Key Policies and Regulatory Frameworks Governing Filipino Workforce
22 Pay Rates in Local Government
23 Base Pay for Nurses, General Physicians, and Dentist in Top Destination Countries
25 Strategies for Providing Permanent Positions for Health Workers
26 Strategies for Rationalized Roles of Community Health Workers
27 Strategies for Providing Standardized and Competitive Compensation, Benefits, and Incentives
for Health Workers
28 Strategies for Enhanced HRH Scopes of Practice
29 Strategies for Enhanced Competencies and Career Opportunities for HRH
30 Strategies for Establishing Performance Management Systems
31 Strategies for Establishing OSH Policies and Wellness Programs for HRH
32 Strategies for Providing Optimal Support and Working Environment for HRH
33 Strategies for Optimizing HRH Capacity During Public Health Emergencies and Surge
Situations
Chapter 8
35 Top 10 Countries with the Most Number of Deployed Nurses
36 List of Agreements Currently in Effect
37 Agencies Involved in Managing the Migration and Reintegration of OFWs
v
39 Strategies for Monitoring of Local and International Policy Instruments Governing HRH
Migration Management
40 Strategies for Harmonized Data and Information Systems on HRH Migration and Reintegration
41 Strategies for Establishing Reintegration Programs for Returning Health Workers
Chapter 9
44 Strategies for Raising Awareness and Buy-in of Local Stakeholders
45 Strategies for Building Co-Ownership and Co-Implementation of the HRHMP
46 Strategies for Financial and Technical Support, and Capacity Building of Subnational Bodies
Chapter 10
48 List and Categories of HRHN Member Organizations
50 Strategies for Institutionalizing National Mechanism for HRH Governance and Dialogue
51 Strategies for Capacity Building of DOH and other Agencies for HRHMP Implementation
53 Proposed HRHN Committee Functions
vi
Acknowledgement
The National Human Resources for Health Master Plan 2020-2040 was developed by the
Department of Health and the HRH Network Philippines, with the support from the United
States Agency for International Development HRH 2030 Project Philippines and the World
Health Organization.
Sincere gratitude and appreciation to the Human Resources for Health Network Philippines
members, DOH’s Health Policy and Systems Development Team, Public Health Services
Team, Health Facilities and Infrastructure Development Team, Health Regulation Team, Field
Implementation and Coordination Team, Centers for Health Development, Local Government
Units, health professional associations and organizations, health workers, student networks,
and development partners for their invaluable contributions to the development of the Plan.
vii
Foreword
The management of health in the country is

multifarious and complex. It entails several building
blocks to be delivered as a whole, including one the
most significant elements -- the human resources for
health or the health workers.
Our experiences with COVID-19 pandemic have

highlighted the crucial participation and invaluable
contribution of our health workers in establishing a
responsive and resilient health system.
Recognizing the value of our health workers, the

National Human Resources for Health (HRH) Master Plan was crafted to guide the
management and development of the HRH in the Philippines, according to the goals of
Universal Health Care (UHC). Anchored on an extensive vision of HRH, the plan sets out
policies and strategies for the appropriate generation, recruitment, retraining, regulation,
retention, and reassessment of the health workforce based on population health needs.
The National HRH Master Plan underscores the importance of our health workers and
their contribution to our healthcare systems. The strategies in the Plan were built on real-
life stories, ground situations, as well as the needs and challenges confronted by them.
To further improve HRH management, the Master Plan looks extensively at their working
life span: from their education, their workforce, their exit, and for some, their eventual
reintegration to the Philippine health sector.
This Master Plan shall be the basis or reference for goal-setting for HRH policies, projects,
and programs, intended to contribute to implementable and sustainable reforms for the
sector. While this offers carefully studied and developed strategies, it also encourages
creativity and flexibility from our national and local government implementers, partners
in the private sector, and all other stakeholders concerned.
Indeed, the National HRH Master Plan is not just about achieving the goals of the UHC. It
is also about nation building as a whole. May this Master Plan be our profound expression
of value for one of our most significant human capital - our Filipino health workers.
Ang malasakit para sa health workers ay kalinga para sa sambayanang Pilipino.
FRANCISCO T. DUQUE III, MD, MSc

Secretary of Health
viii
The country’s human resources for health (HRH) is one of the
most significant components of its health system. Their
knowledge, skills, and motivation relative to the organization
and delivery of health services directly affect the achievement
of improved health outcomes.
From early 2020 to 2021, the world’s healthcare system was

tested as never before by the COVID-19 pandemic. In the
Philippines, as elsewhere, the health workforce rallied to deal
with the spread of the disease. Our health workers’ untiring
dedication during this difficult moment in history is remarkable
and worthy of utmost recognition. At the same time, the
unrelenting demands placed on the country’s healthcare systems shone a spotlight on weaknesses
and gaps in our HRH.
The experience of dealing with COVID-19 taught hard lessons as it revealed unexpected strengths
and opportunities in bringing out the full potential of the Philippine health workforce. We are
blessed to have an HRH that is globally known to be competent in providing the best care. We must
however ensure that they are able to answer the needs of the health system, now and in the future;
that our cadres of health workers are well-trained and highly motivated and valued to contribute to
the country’s well-being. To be able to do this, we must continue the work on the provision of decent
working conditions for our HRH as well as encourage retention in the country.
Amidst all these challenges and opportunities, the National Human Resources for Health Master
Plan was developed. It primarily aims to formulate the multisectoral goals, targets, and strategies
for the improvement of HRH planning, management, and development. Moreover, it also aims to
contribute to the attainment of Universal Health Care.
This Plan will serve as our strategic roadmap to help us navigate towards our desired future for our
HRH, regardless of sector and affiliation. In other words, the ultimate aim is for our HRH to have
decent jobs, be adequately and equitably distributed, and be competent and compassionate.
Neither the DOH nor the HRH Network can do this alone. We enjoin all the key players, the
lawmakers, other key national agencies and regulatory bodies, the local government unit leaders,
the private sector, and the health workers themselves to share this vision with us. We shall fuel this
journey with shared responsibility, accountability, and inclusivity.
For our HRH and for the Filipinos, mabuhay tayong lahat.
MARIO C. VILLAVERDE, MD, MPH, MPM, CESO I

Undersecretary of Health
ix
My felicitations to the Health Human Resource Development
Bureau of the Department of Health and the HRH Network for
spearheading the Health Human Resources for Health
Master Plan (HRHMP) completion with the able support of
the HRH203O project under the United States Agency for
International Development, the World Health Organization
and the Philippine HRH Network.
The Universal Health Care (UHC) Act of 2019 galvanized the

realization of the 2020-2040 Human Resources for Health
(HRH) Masterplan. Now we have in our hands, the
overarching long-term progressive strategic plan that will
guide the health sector achieve the outcomes such as but
not limited to sustainable and equitable production of human
resources for health; skill mix and access to the health sector
including the expansion of scholarships; accessibility, redistribution and retention of practice-
ready health workforce for primary health care and higher level management skills; job
generation and competitive incentives especially in geographically isolated and disadvantaged
areas, also among clinical areas, and service types; and a national health registry that will be
maintained to monitor movement within the health labor market; all of which contribute to the
achievement of universal health care for the Philippines.
The COVID 19 pandemic has shown the realities and the fragility of our health care system but,
it also underscored that more than the infrastructure and equipment, human resources for health
are our most valuable capital in securing the health of the individual as well as that of the
communities. It has also shown how health workers sacrificed their own lives in the service of
others. More than compliments and applause, let us honor our health workers by fully employing
the HRH Master Plan to the fullest. We pay tribute to our fallen colleagues by ensuring that our
health system and the health workforce comprising it are resilient to the onslaught of challenges,
pandemic, or otherwise.
Thank you and God bless!
Kenneth G. Ronquillo, MD, MPHM, CESO III

Assistant Secretary
Health Policy and Systems Development Team
Lead Convener, HRH Network Philippines
x
Executive Summary
The Republic Act No. 11223, “Universal Health Care Act” provides that the DOH, together with
stakeholders shall ensure the formulation and implementation of a National Health Human
Resource Master Plan that will provide policies and strategies for the appropriate generation,
recruitment, retraining, regulation, retention, and reassessment of the health workforce based on
population health needs.
This long-term strategic plan shall be used for Human Resources for Health (HRH) policy-making,
program or activity planning, implementation, and monitoring for the management and
development of the country’s HRH according to the goals of Universal Health Care.
The NHRHMP was developed with the following principles: (a) it is a multi-sectoral plan which
will require a whole-of-society, whole-of-government approach; (b) it is built with social system
architecture, ensuring harmonized and concerted efforts through accountable governance and
agile management; (c) it is not prescriptive, but rather strategic; (d) it considers the different
characteristics of the local health systems wherein implementers are given leeway to prioritize
what is most feasible, and adopt and calibrate strategies to make it more compatible and
applicable to their context; (e) it is intended to be a living document which shall be regularly
updated to consider significant events that might affect the health system.
The NHRHMP uses the Health Labor Market (HLM) framework which depicts HRH movements
from the production of health workers and professionals to being part of the health workforce,
and exiting and re-integration to the country’s workforce. Specifically, it analyzes two markets:
the market for the supply of health workers, which is also known as the health education market;
and the internal and external demand for health services and health workers or the labor market.
The HLM framework also highlights the overall goals for the health workforce -- sustainable
production, practice-ready training, job generation and competitive salaries, accessibility and
retention mechanisms, productivity and career development, all of which lead to providing the
right number, competence and skill mix of health workers performing the right work at the right
place and time, with the right compensation.
The NHRHMP reformulation is based on the analysis of the current HRH situation in the country.
The Health Labor Market Analysis and the HRH situational analysis revealed core problems in
HRH management which are (a) lack of accurate information on the health workforce to guide
planning and policy; (b) limited collaboration among stakeholders with multiple roles in the HRH
sector; (c) fragmented HRH governance and unclear accountabilities; and (d) lack and poor
implementation of policies. These problems contribute to persistent challenges on the
inadequate and inequitable distribution of HRH.
At the forefront of achieving the goals of the NHRHMP is the Human Resources for Health
Network Philippines. Six key result areas (KRA) and specific strategic objectives (SO) for each
xi
have been identified to guide the HRH Network and other implementers in addressing the
identified HRH challenges. The NHRHMP strategies are distinguished as transformative which
span the whole health labor market spectrum, from entry to workforce, to exit and re-entry; and
the enabling or cross-cutting strategies on HRH data, localization and institutionalization, and
governance.
The KRA 1 is on HRH Data Governance and Information Management which provides strategies
to establish a data governance framework and enhance research capacities for evidence-
informed workforce planning, policy formulation, program design and execution, and monitoring
and evaluation. The KRA 2 on Health Education Strengthening and Regulation aims to produce
practice-ready HRH responsive to local health needs, and improve retention in the local health
sector. The KRA 3 aims to raise HRH productivity and responsiveness by designing programs
that would ensure their welfare, protection, and career development. The KRA 4 on HRH Migration
intends to manage the migration rate to a sustainable level and formulate reintegration programs
for returning health workers. By achieving the target outcomes of the KRA on HRH welfare, the
key issues in HRH migration are anticipated to be positively affected. The KRA 5 emphasizes the
importance of institutionalization and localization of the NHRHMP to ensure realization of the
goals of the Plan. Lastly, KRA 6 aims to harmonize and strengthen inter-sectoral governance by
utilizing the HRH Network as a platform for collaboration.
The Plan’s principle of social system architecture underscores the need for a multi-sectoral
approach in navigating the path towards the achievement of its goals for the HRH. It enjoins the
lawmakers, members of the HRH Network, other key national agencies and regulatory bodies,
local government leaders, private sector, international partners, and the Filipino health workers to
share the vision with shared responsibility, accountability, and inclusivity.
The accompanying annexes of the Plan includes (a) Risk Governance Framework & Change
Models which guides planning to integrate risk and change management strategies; (b) the HRH
Projections presents an assessment of the current gaps and determine the future requirements
for HRH to accelerate UHC in the country; (c) the WISN Activity Standards provides for HRH
requirement in primary care settings; and (d) the NHRHMP Legislative Agenda identifies priority
areas that will be advocated for legislation to set out unifying frameworks that will guide relevant
stakeholders in implementing the HRH-related initiatives.
The NHRHMP shall be regularly updated every five years to consider significant events that might
occur such as changes in health situation and HRH landscape, development in governance
landscape, enactment of landmark legislations, increase or decrease in domestic and global
demands, health phenomenon or public health emergency, and technology advancement.
Likewise, scenario building exercises will be conducted to identify signals of change that could
impact the health and wellbeing of the population.
xii
CHAPTER 1
Introduction
CHAPTER
1
CHAPTER ONE
INTRODUCTION
The National Human Resources for Health Master Plan (NHRHMP) 2020-2040 is aimed at guiding the
management and development of the human resources for health (HRH) of the Philippines according to
the goals of Universal Health Care (UHC).
HRH master planning underpins the crucial connections between UHC as a foundational policy and the
health workforce required to implement its provisions. The NHRHMP will set out policies and strategies for
the appropriate generation, recruitment, retraining, regulation, retention, and reassessment of the health
workforce based on population health needs. The NHRHMP also builds upon earlier efforts in HRH policy
making and reform, as well as on the growing interest and engagement of a diverse range of health system
stakeholders, both within and outside government.
The NHRHMP is expected to undergo a continuous process of refinement and recalibration throughout the
course of its implementation. This dynamic approach is expected to generate appropriate responses to
guide the growth and development of HRH at all stages, from health workers’ education and training,
licensing as health professionals, entry into the workforce, deployment and career development, exit from,
and re-entry into the health labor market. In an external review of HRH planning, it is advised that the
National HRH Master Plan should be viewed as a “process”, rather than as a “document”; a verb rather than
a noun1. This means that the Plan should be operational, continuously evolving, and that implementers
should be held accountable for agreed, valuable, and observable outcomes and deliverables.
Human Resources for Health under the Philippine Health Care System
The Philippines has a mixed public-private health care system, in which the private sector, which has
substantially more financial resources and staffing than the public health system, caters to only about 30
percent of the population2. The public health sector is mainly financed through a tax-based budgeting
system while private health care is largely market-oriented, with health services generally paid for at the
point of service3.
With the passage of the Local Government Code (LGC) in 1991, the provision and management of public
health services such as health programs, promotive and preventive health care, and primary and secondary
general hospital services were transferred to local government units (LGUs). The provincial government,
headed by the governor, manages the provincial health system (i.e. the provincial health office, as well as
the provincial and district hospitals). The city government, which runs highly urbanized and independent
cities, manages city hospitals, medical centers, rural health centers (RHUs) and barangay health stations
(BHSs). The municipal government, headed by the mayor, manages the municipal health system composed
of RHUs and BHSs.
1 Gorman, D. (2019). Feedback on Philippine HRH Master Plan Blueprint. Unpublished Report.
2 Department of Health (2018). National Objectives for Health 2017-2020. Manila, Philippines. Retrieved from
https://www.doh.gov.ph/sites/default/files/health_magazine/NOH-2017-2022-030619-1(1)_0.pdf
3 Dayrit MM, Lagrada LP, Picazo, O.F., Pons, M.C., Villaverde, M.C. (2018). The Philippines Health System Review. Vol. 8 No. 2. New
Delhi: World Health Organization, Regional Office for SouthEast Asia. Retrieved from
https://apps.who.int/iris/bitstream/handle/10665/274579/9789290226734-eng.pdf?sequence=1&isAllowed=y
Introduction | 3
CHAPTER
1
The Department of Health (DOH), on the other hand, retained certain functions such as providing national
policy direction and strategic plans, capacity building, technical assistance, and standards and guidelines
for health. The DOH is represented in all local health boards, which is present in every province, city, and
municipality and serves as an advisory body to the local chief executive and legislative council on health-
CHAPTER 1
related matters, through the DOH representatives4.
With the decentralization of health governance, local governments have had full autonomy to finance and
operate their respective local health system, including management of human resources for health.
However, with limited financial capacity and restrictions brought about by certain provisions of the Local
Government Code and other laws, LGUs have faced challenges in hiring adequate HRH and providing
competitive salaries and benefits.
Health workers who are hired at the national level (i.e. employed by DOH) are provided salaries and benefits
at national rates, which is two to three times higher than their local counterparts. On the other hand, private
health workers are generally governed by Department of Labor and Employment’s (DOLE) rules and
regulation; though most of the time, the private sector operates on a laissez faire principle.
With the highly fragmented system governing the Philippine health workforce, disparities have resulted in
inequitable distribution of HRH, causing further challenges in access to a health worker, and hence, access
to care in certain areas of the country. To ensure harmonized creation and implementation of policies and
programs for the healthcare workforce, the DOH through the Health Human Resource Development Bureau
(HHRDB) in collaboration with stakeholders, partners, and other sectors, provides guidance on the
development of HRH-related policies, programs, systems, and standards. The aim is to ensure adequate,
competent, effective, and globally competitive HRH.
Health Sector Policy Reforms
The country’s health system has undergone several policy reforms and organization changes since the year
2000 with the inception of the Health Sector Reform Agenda. The key sector reform plans introduced or
implemented through the DOH include:
● Health Sector Reform Agenda (1999-2004), which aimed to improve the way health care is
delivered, regulated, and financed through systemic reforms in public health, the hospital system,
local health, health regulation, and health financing 5.
● FOURmula One (F1) for Health (2005-2009), which implemented the reform strategies in service
delivery, health regulation, health financing, and governance as a single package that is supported
●
critical health interventions6. Introduction
by an effective management infrastructure and financing arrangements, with particular focus on
Health Financing Strategy (2010-2016), which supported the overall sector goals of improving
financial protection, achieving efficiency gains, and ensuring access to quality care through five
pillars: creating more fiscal space for health (pillar 1), sustaining membership in PhilHealth-pooling
4 United States Agency for International Development. (2019). Human Resources for Health Masterplan: Situational Analysis. Draft
Report.
5 Dayrit MM, Lagrada LP, Picazo, O.F., Pons, M.C., Villaverde, M.C. (2018). The Philippines Health System Review. Vol. 8 No. 2. New
Delhi: World Health Organization, Regional Office for SouthEast Asia. Retrieved from
https://apps.who.int/iris/bitstream/handle/10665/274579/9789290226734-eng.pdf?sequence=1&isAllowed=y
6
Ibid., 186.
Introduction | 3
4 | Introduction
CHAPTER
1
(pillar 2), who pays for what (pillar 3), provider payments (pillar 4), and fiscal autonomy of health
facilities (pillar 5) 7.
● Kalusugan Pangkalahatan (2010-2015), which prioritized financial risk protection, access to quality
health facilities and services, and the attainment of health-related millennium development goals.
● All for Health Towards Health for All (2016-2017), which called for improved financial protection,
better health outcomes, and an improved health system.
● FOURmula One Plus (F1 Plus) for Health (2018-present), which aims to provide UHC to Filipinos
in the medium to long term through better health outcomes, responsive health care delivery
systems, and equitable and sustainable health financing.
● The Universal Health Care Act (2019-present), which has expanded access to health services by
automatically enrolling all Filipinos in PhilHealth's National Health Insurance Program (NHIP), with
the aim of providing all Filipino citizens with access to a comprehensive set of health services
without financial hardship.
These reforms brought about the following strategies for HRH development:
● Improve access of Filipinos to a health care worker by deploying HRH, especially in underserved
areas;
● Encourage HRH to serve in high-risk or geographically isolated and disadvantaged areas (GIDA) by
streamlining HRH compensation package and incentives;
● Provide fully-funded scholarships for HRH, prioritizing those hailing from GIDAs or IP groups and
formulate mechanisms for mandatory return service and retention of graduates;
● Update staffing and job standards;
● Revise health professions curriculum to be more primary care-oriented and responsive to local
needs; and
● Provide traditional and innovative schemes for continuous professional development.
These current health sector reform initiatives also support the macro development goals of improving HRH
in terms of quantity, quality, and distribution, as contained in Ambisyon Natin 2040 and Philippine
Development Plan (PDP) (2017-2022).
Despite the number of health reform initiatives developed and implemented, systemic inefficiencies and
inequities remain. The Philippine health care system continues to be hampered by challenges in its
fragmented health service delivery, inequitable health financing, and complex governance structure, among
others.
Challenges of the Philippine Health Workforce
In 2019 to early 2020, the DOH-HHRDB, with assistance from the United States Agency for International
Development (USAID) - HRH2030 Philippines Project, conducted literature reviews, extensive series of
consultations and writeshops to review and reformulate previous HRH Master Plans. The draft report
identified four core problems that continue to challenge the health system:
1. Lack of accurate HRH information to guide planning and policy;

2. Limited collaboration among stakeholders with multiple roles in the HRH management;
7
Ibid., 186.
Introduction | 5
CHAPTER
1
3. Fragmented HRH governance and unclear accountabilities; and

4. Poor implementation of policies on HRH management and development
These core problems have resulted to:
1. Inadequate number of health workers in the health sector; and

2. Inequitable distribution of HRH.
The health sector recognizes that these HRH challenges are not new, and had been previously identified,
but these long-standing problems were exacerbated as we were confronted with exigencies that health
system managers are unable to plan or prepare for. The Philippines’ experience in the recent public health
emergencies brought about by the COVID-19 pandemic exposed systemic gaps and weaknesses in the
healthcare system -- especially in the health workforce. This also highlighted the centrality of HRH in
achieving the goals and objectives of the country’s health sector reforms.
Hence, the UHC Act mandates the creation of a long-term National Human Resources for Health Master
Plan to address these HRH core problems and to have a unified strategic framework on which plans,
policies, and programs for HRH management and development should be anchored.
The Need for a National Human Resources for Health Master Plan
The HRH is the cornerstone of the health care delivery system -- directly influences the access, quality, and
effective delivery of health interventions for improved health outcomes.
Given the complexity of the health system, notwithstanding the recent public health emergency, it is
imperative that a multi-sectoral long-term plan be institutionalized to harmonize the goals and coordinate
the actions of key stakeholders on HRH planning and management. The objective is to address the long-
standing challenge of ensuring that the adequate number of the right HRH, are in their right place, at the
right time, to deliver high quality health services through a networked and synergistic approach at national
and local levels, as well as across public and private sectors.
In 2004, the first HRH Master Plan was developed to address the steadily increasing migration rate of health
workers, which was seen as draining the country of its health workforce. The Plan was reformulated in 2014
to provide more up-to-date, strategic directions for HRH management, development, and utilization.
Among the accomplishments of the previous master plans were the introduction of:
● HRH Network (HRHN) Philippines, a body established in 2006, composed of government and non-
government agencies that meet regularly to discuss and decide on HRH-related concerns;
● Integrated Database System for HRH Information System (IDSHRHIS), which collects data on HRH
from various sources; and
● Health Labor Market Analysis (HLMA), which provides a detailed protocol to assess HRH supply
and demand;
6 | Introduction
CHAPTER
1
Despite these accomplishments, progress in HRH has been incremental, and stakeholder engagement has
been limited. The key challenges identified in previous Master Plans (e.g. inequitable HRH distribution, HRH
migration, poor working conditions, and so on) still persist.
As such, the reformulated National HRH Master Plan will provide for a comprehensive strategy to guide the
development of HRH, with UHC as the foundational policy shaping the management of the Philippine health
workforce. The NHRHMP includes analysis, change agenda, results/outcomes framework, strategies,
performance indicators, and proposed projects and activities to address HRH concerns and issues. It also
builds on shared leadership and strong collaboration to ensure the success of implementing its strategies.
National HRH Master Plan Overall Framework
The NHRHMP is aligned with the following global and national plans and framework:
In order to achieve Sustainable Development Goal (SDG) 3––ensure healthy lives and promote well-being
for all at all ages––the country needs an adequate and competent health workforce. It is not enough to
have a sufficient number of health workers; they must be equitably distributed so that they are accessible
to all, equipped with the required competencies, able to deliver quality care that is suitable and culturally
acceptable to the people they serve, and adequately supported by the health system. This has been proven
to be true and is known in many parts of the world; but many countries, including the Philippines, continue
to struggle and maintain a health workforce that adequately serves its population’s health needs.
The World Health Organization (WHO), in its Global Strategy on Human Resources for Health: Workforce
20308, set a vision to “Accelerate progress towards universal health coverage and the UN Sustainable
Development Goals by ensuring equitable access to health workers within strengthened health systems''.
This can be fulfilled by “combining the adoption of effective policies at national, regional, and global levels
with adequate investment to address unmet needs5”. However, it also states that although there has been
progress, “it has not been fast or deep enough,” and problems such as shortages, skill-mix imbalances,
maldistribution, barriers to interprofessional collaboration, inefficient use of resources, poor working
conditions, a skewed gender distribution, and limited availability of health workforce data persist. Hence, it
identifies the need for countries to “reappraise the effectiveness of past strategies and adopt a paradigm
shift in how to plan, educate, deploy, manage, and reward health workers 5”.
Ambisyon Natin 2040 defines the collective long-term vision and aspirations of the Filipinos to enjoy a
matatag (strongly rooted), maginhawa (comfortable) at panatag na buhay (secure), which all sectors of
society, whether public and private, should align their efforts with. All key players in health have one goal—
that all Filipinos live a long and healthy life by 2040. One key strategy to achieve this goal is to ensure that
all Filipinos have access to affordable and good quality health care.
8
World Health Organization (2016). Global Strategy on human resources for health: Workforce 2030. Geneva, Switzerland. Retrieved
from https://www.who.int/hrh/resources/global_strategy_workforce2030_14_print.pdf?ua=1
Introduction | 7
CHAPTER
1
The Philippine Development Plan 2017-

2022, which is geared towards the
realization of Ambisyon Natin 2040, aims
to transform human capital development
towards greater agility. Specifically, the
PDP’s strategies to improve nutrition and
health outcomes for all are: a) to provide
care services at all life stages; b) to ensure
a responsive and resilient health system
while expediting the recovery of the
economy; and c) to sustain equitable
financing of nutrition and health services.
One of the specific strategies under
ensuring a responsive and resilient health
system is to improve the status and supply
of HRH.
With the aim to address the multifarious

issues in the health system and improve
health outcomes, the DOH adopted a
strategic health reform framework,
branded FOURmula One Plus (F1+) for
Health in 2018, which espouses three
strategic thrusts: 1) better health
outcomes, 2) responsive health system,
and 3) equitable and sustainable health
financing. The HRH, as critical input to
achieve the goals, is incorporated in the
Service Delivery Pillar of this framework.
The framework also added performance
accountability as a cross-cutting pillar.
Following the adoption of F1+ strategy, the

Republic Act No. 11223, otherwise known
as the Universal Health Care Act, was
passed providing strong legislative
support for all the health system goals and
priorities. The UHC Act mandated the
Department of Health and its stakeholders
to ensure the formulation and
Figure 1. Alignment of NHRHMP to global and national plans
implementation of a National Human
and frameworks
Resources for Health Master Plan that will
provide policies and strategies for the
appropriate generation, recruitment, retraining, regulation, retention and reassessment of the health
workforce based on population health needs. DOH recognizes that universal health care cannot be fully
realized without a comprehensive and responsive HRH framework.
8 | Introduction
CHAPTER
1
The F1+ for Health, UHC Act, Ambisyon Natin 2040, PDP 2017-2022, and the Global Strategy on Human
Resources for Health: Workforce 2030 are the context and framework within which this Master Plan’s
strategies were anchored and its results framework developed.
Figure 2. FOURmula One Plus for Health Strategy Map
Health Labor Market Analysis for UHC
The NHRHMP uses the concept of the Health Labor Market which depicts HRH movements from the
production of health workers/professionals, to being part of the health workforce, and exiting and re-
integration to the country’s workforce.
Specifically, it analyzes two markets: the market for the supply of health workers, which is also known as
the health education market; and the internal and external demand for health services and health workers
or the labor market.
The health education market shows the production of qualified health workforce through the provision of
scholarships, training and education in health. This pool of qualified health workforce will then participate
in the health labor market once they are employed in the health sector through any of the following career
paths: non-clinical fields of practice such as health policy, public health administration, academe, research
and development; and clinical fields such as primary health care and hospital care. In addition, it captures
the attrition of HRH due to unemployment or employment in the non-health sector, and migration to other
countries.
Introduction | 9
CHAPTER
1
This framework also highlights the overall goals for the health workforce -- sustainable production, practice-
ready training, job generation and competitive salaries, accessibility and retention mechanisms,
productivity and career development, all of which lead to providing the right number, competence and skill
mix of health workers performing the right work at the right place and time, with the right compensation.
Figure 3. Health Labor Market Framework for UHC
National HRH Master Plan Formulation
The formulation of the National HRH Master Plan components underwent five key processes before
finalization of the plan (Figure 4). It was initiated with an analysis of the current situation of the HRH in the
country through the Health Labor Market Analysis, a series of extensive reviews and consultations was
conducted to determine the gaps and prioritize issues. To address these issues, a roadmap was developed,
specifying strategies and targets in the short, medium, and long term; and a governance structure and
accountability framework was defined to ensure success in implementation.
Figure 4. Step by step development process of the National HRH Master Plan
10 | Introduction
CHAPTER
1
In line with changes in the governance landscape brought about by the COVID-19 pandemic and making
use of lessons learned, the NHRHMP strategies have been updated and recalibrated to ensure that it would
include a clear plan of actions to manage and mobilize HRH during public health emergencies, and ensure
their resiliency.
The current NHRHMP included inputs from health workers from various fields and levels, local government
units, national government agencies, non-governmental organizations (NGOs) and others involved in HRH
management. The planning process also incorporated a framework for accountable governance and agile
management. The formulation of the NHRHMP sought to ensure participatory process, establish co-
ownership, and, most importantly, build shared leadership and collaboration.
Given that the NHRHMP 2020-2040 spans 20 years, it is important to consider the Plan as a dynamic
document that can be revised to adapt to changing conditions and emerging realities. This flexibility will
allow for inclusion of enabling strategies responsive to the health needs of the population. By ensuring that
the right number of competent, committed, and productive health professionals and workers are produced
and retained in the health workforce across the country, the Plan would be able to contribute to building a
strong human capital for national development and growth.
Intended Users and Use of the National HRH Master Plan

The NHRHMP is intended to guide key stakeholders in achieving desired common goals for better HRH
management and development in the Philippines. These key stakeholders include: public sector (national
and local), private sector, health care providers and consumers, and international health development
partners. A number of these stakeholders are already active in HRH Network Philippines, a body composed
of government and non-government organizations established in 2006 to harmonize policy directions and
actions for better HRH management. Others have been engaged, in different capacities, with DOH and local
governments on HRH-related projects and activities. There is still a need, however, to expand or strengthen
partnership with these stakeholders and to identify entry points for collaboration with new potential
partners.
Table 1. HRH Management and Development Stakeholders
Public Sector
Department of Health The lead agency with its relevant technical bureaus:
● Health Human Resource Development Bureau (HHRDB)

● Health Policy Development and Planning Bureau (HPDPB)
● Bureau of Local Health Systems and Development (BLHSD)
● Bureau of International Health Cooperation (BIHC)
● Health Facility and Development Bureau (HFDB)
● Knowledge Management and Technology Service (KMITS)
The Personnel Administration Division, under the Administrative Service,

also plays a key role, and oversees the Magna Carta Council for Public
Health Workers.
Introduction | 11
CHAPTER
1
The Centers for Health Development (CHDs), being the regional arm of the
DOH, are critical as they directly collaborate with local government units
and local partners.
Other Departments/ Among these would be the Commission on Higher Education (CHED),
Agencies, and Regulatory Professional Regulation Commission (PRC), Technical Education Skills
Bodies Development Authority (TESDA), Department of Interior and Local
Government (DILG), Department of Labor and Employment (DOLE), Civil
Service Commission (CSC), Department of Finance (DOF), Department of
Budget and Management (DBM), National Economic and Development
Authority (NEDA), Overseas Workers Welfare Administration (OWWA),
Philippine Overseas Employment Administration (POEA), Commission on
Filipinos Overseas (CFO), Bureau of Immigration (BI), and all the other
agencies and sub-agencies involved in HRH management and
development.
Local Governments These range from regional and provincial governments down to cities,
municipalities, and barangay units.
Legislators Members of Congress responsible for crafting laws and policies pertinent
to HRH.
Educators Curriculum developers and implementers responsible for the formation of

competent health professionals and workers.
Private Sector
Non-governmental Philippines-based or international NGOs with interest in strengthening
Organizations health systems.
Corporate Foundations These serve as channels for corporate social responsibility initiatives to
and Networks strengthen the health system.
Health Professional These include organizations of medical and allied health professionals
Associations (physicians, nurses, etc.) and specialist associations.
Academic and Research These include health education institutions responsible for the production
Institutions of health workers/professionals, and independent scientific and research
organizations able to assist in formulating evidence-based health care
policies.
Employee Organizations These groups are mainly composed of the organization’s health workers
which aim to protect and advance the interests of its members in the
workplace.
Health Care Providers and Consumers
Health Facilities Public and private institutions which employ HRH, and provide training
opportunities aimed at strengthening the health workforce.
Health Workforce Health professionals and health workers are the primary focus of HRH
planning, management and development.
12 | Introduction
CHAPTER
1
Consumers Clients or patients who are recipients of care, and interacts with health
workers/professionals
International Sector
Multilateral Organizations These include the WHO, and other bodies with an interest in strengthening
the Philippines’ health care system.
Individual Donor These include the United States (through USAID), Australia (AusAID),
Countries Republic of Korea (KOICA) and other individual country aid arms with an
interest in providing assistance to the health sector.
Regional Bodies These include the Association of Southeast Asian Nations (ASEAN), of
which the Philippines is a member state. The ASEAN Health Ministers'
Meeting (AHMM) and Senior Officials’ Meeting on Health Development
(SOMH) determine regional health policies and the framework for meeting
health emergencies in the region. The ASEAN Coordinating Committee on
Services oversees the development and implementation of Mutual
Recognition Agreements for Health Practitioners.
This NHRHMP serves as an overarching document that guides the whole of society and the whole of
government, including the aforementioned stakeholders, to meet the HRH component of UHC goals, other
national policies and goals, and international commitments.
Key stakeholders can use this National HRH Master Plan as a reference for policy-making and program or
activity planning, implementation, and monitoring of initiatives affecting HRH development. The Plan can
also inform the preparation and alignment of investment plans. The LGUs in particular, can refer to the
strategies of the NHRHMP in developing their local investment plans for health. It can also provide guidance
in creating implementation plans and communication strategies that are designed specifically for the
users.
The NHRHMP strategies can also guide the implementation of programs that are cyclical in nature, making
sure that interventions are needs-based, adaptive to current context and aligned with the long term goals
for the health workforce. These strategies are laid out in a progressive nature but need not be conducted
in a sequential order. Rather, they should be implemented as resources and inputs are available, prioritizing
quick wins and demonstrating proof of concept to encourage stakeholder participation in the process.
These are also designed to be bold and broad to allow flexibility and encourage innovation, and
resourcefulness amongst the stakeholders, and to fit their local situation, needs and priorities.
Limitations
There were limitations encountered throughout the development process of the NHRHMP. Among these
are:
Limitations in data
● Most of the quantitative data are on four cadres of health professionals: physicians, nurses,
midwives, and medical technologists.
Introduction | 13
CHAPTER
1
● Community health workers (CHWs), i.e. barangay health workers (BHWs) and barangay nutrition
scholars (BNSs) were included but not other auxiliary personnel or health workers, e.g. nursing
assistants, caregivers, etc.
Limitations in planning activities conducted

● Scenario-building exercise for future long-term projections was not included in the development
process, but was identified as a key activity during the implementation phase.
● The omnibus policy review did not take into consideration whether previously established policies
were still in effect or being implemented. International policies (e.g. ASEAN regional declarations
on health) were also not included.
● Costing for each strategy was not included as these may not truly reflect practical estimates for
investments considering that there could be peculiarities of every strategy, e.g. scope of
application, implementation period, etc.
Ways Forward
● Given the long-term Plan period, the National HRH Master Plan shall be regularly updated every five
years to consider significant events that might occur such as changes in health situation and HRH
landscape, development in governance landscape, enactment of landmark legislations, increase or
decrease in domestic and global demands, health phenomenon or public health emergency (such
as the COVID-19 pandemic), and technology advancement. Likewise, a more comprehensive
segmented data on geographic area and other socio-economic variables, such as that of public
and private, national and local, and sex-disaggregated data shall be included to study inequities in
the health workforce (as much as practicable) to inform the situation analysis and enable more
effective interventions.
● Scenario building exercise shall be an integral step in the future reformulation and/or updating of
the Plan to identify signals of change that could impact the health and wellbeing of the population.
● Regular updating of HRH projections shall also be done and would be integrated into the updating
timeline of the NHRHMP.
14 | Introduction
CHAPTER 2
HRH Situation, Results

Framework, and Strategies
CHAPTER TWO
CHAPTER
HRH SITUATION, RESULTS FRAMEWORK, AND STRATEGIES
2
Strategic planning exercises pose three fundamental questions: Where are we now? Where do we want to
go? How do we get there? These three questions guide each phase of the planning process and help frame
the problem being addressed, the desired state or results to be achieved, and the ways and means
necessary to realize these goals. Broad stroke approaches and schemes for each key result area identified
are provided in the succeeding chapters. With the gargantuan task at hand, each KRA is a program in itself
that will further be expounded once key stakeholders’ contribution and commitment are secured, the
governing body and program teams are established and on-boarded.
Where are we now?

HRH SITUATION IN THE COUNTRY
Access to Health Care: A Persistent Problem
In the past years, the government had made large investments in health to address health care gaps that
had widened over the decades, while also trying to meet increasing demand brought about by population
growth. This proved to be a great challenge for the government, and while the investments brought about
positive human development outcomes, they were rather uneven 1.
People’s access to health care improved through an increase in health insurance coverage for indigents
beginning 2013, as the government ramped up budget support for the National Health Insurance Program
(NHIP). The Universal Health Care Law expanded health insurance to automatically cover all Filipinos and
enhance benefit packages to reduce out-of-pocket medical expenses. Despite universal coverage, out-of-
pocket share in total health expenditures remains high, primarily because not all government health
facilities designated to serve them can fully provide the medical supplies, commodities, and services they
need. Availment of NHIP benefits has also been low because some members are not aware of their health
insurance entitlements. While 75% of the poor know about no-balance-billing, only a minority know that
their PhilHealth coverage includes free primary care consultation 2. Others are constrained by geographic,
as well as supply-side barriers, in accessing health care3.
From 2010 to 2016, the government poured huge investments in health infrastructure through the
construction and upgrading of 7,713 health facilities, half of which were barangay health stations (BHS)
providing primary health care to the people. The DOH supported new construction of 351 barangay health
stations and 107 rural health units under the 2016 Health Facility Enhancement Program. Despite this,
primary care facilities remain inadequate as the country lacked over 2,500 Rural Health Units (RHUs) and
more than 500 BHSs to serve the population in 2016.
1 National Economic and Development Authority. (2017). Philippine Development Plan 2017-2022. Pasig, Philippines. Retrieved from
http://pdp.neda.gov.ph/wp-content/uploads/2017/01/PDP-2017-2022.pdf
2 Bredenkamp, C., J. Capuno, A. Kraft, L. Poco, S. Quimbo, & C. Tan. (2017). Awareness of Health Insurance Benefits in the
Philippines: What Do People Know and How?. Health, Nutrition, and Population (HNP) Discussion Paper. Washington, D.C.: World
Bank Group
3 Department of Health. (2018). National Objectives for Health 2017-2020. Manila, Philippines. Retrieved from
HRH Situation, Results Framework, and Strategies | 17

To ensure that these health facilities are adequately staffed with appropriate cadres of HRH, the DOH has
CHAPTER
deployed health professionals to augment the health workforce of LGUs. There was a significant increase
in the number of public health professionals deployed from 439 in 20104 to 29,153 as of October 20205.
2
While the majority of these HRH, especially nurses, were deployed in unserved and underserved
communities, some GIDAs still lack needed health workers.
While the government has allocated increased resources to improve access to quality health care in the
past several years, there are still huge gaps that need to be filled. The country still grapples with perennial
problems, some of them decades-old, which have not been adequately addressed. The inequities brought
about by these gaps are mostly felt by the country's poor, especially those in remote and rural areas. The
lack of health resources in these areas undermines the health system capacity to respond to disasters and
health emergencies such as outbreaks of diseases due to lack of sanitation, food, water, shelter, and
medication. Similar to how disasters expose the weakness of the health system, the COVID-19 pandemic
revealed the inefficiencies that widen disparities in health and the urgency of building a strong health
workforce for a resilient health system.
Access to Human Resources for Health
Filipinos will have varying answers if asked whether they can easily consult or seek treatment from a health
worker. Access to HRH has always been fraught with challenges and this stems from two problems:
inadequate and inequitably distributed health workers.
Inadequate Human Resources for Health
The problem on the adequacy of the health workforce becomes less apparent when looking at the total
number of licensed health professionals in the country especially considering that the ratio of those with
valid licenses in April 2020 are 862,023 results to a density of 78.32 HRH per 10,000 population 6. For the
total number of licensed doctors, nurses, and midwives, the density is 61.2 per 10,000. If all these health
professionals are practicing in the Philippine health system, the ratio will exceed the WHO indicative
threshold of 44.5 “skilled health workers” (doctors, nurses, and midwives) per 10,000 people to achieve
Universal Health Care and SDGs. However, caution should be exercised in interpreting the numbers since
the reality is not all of these health professionals are practicing their profession, or are working in the
country.
The DOH maintains a database (i.e. National Database of Selected Human Resources for Health
Information System or NDHRHIS) of practicing health professionals; however, it only captures 22% of the
total number of licensed health professionals provided by the PRC. Data from NDHRHIS point to a ratio of
only 14.74 HRH (doctors, nurses, midwives) per 10,000 population, which is far below the 44.5 threshold.
In determining the adequacy of HRH, several approaches may be used: HRH to population ratios, service
utilization approach, health needs/demand approach, and using workload indicators, among others. The
DOH recently organized a team of experts to determine the adequacy of the current and previous supply of
4 Department of Health. (2019). Number of Deployed HRH from 2010-2019.

5 Department of Health. (2020). Masterlist of Actual Hired/Deployed HRH under the DOH Deployment Program FY 2020.
6 HRH density (N) was computed through the formula: N=854,253 licensed health professionals / (109,075,238 PSA-estimated
population / 10,000)
18 | HRH Situation, Results Framework, and Strategies

10 cadres of health professionals, and estimate the future supply and demand of the same health
CHAPTER
professionals, using a combination of HRH-to-population approach and the health needs/demands
approach, which takes into consideration sociodemographic and epidemiological factors (see Annex B for
2
details of the study). The salient findings of the study are detailed below.
From 2010 to 2019, the country registered an HRH to population density of 64.7 to 74.2. However, breaking
down the data into individual cadres and taking a closer look at supply trends in 2010–2019 would reveal
a critical shortage or alarming decreasing trends in particular cadres 7. Among the 862,023 health
professionals with valid licenses as of April 2020, nurses constitute a huge majority at 60%, followed by
physicians (10%), midwives (9%), medical technologists (7%), and pharmacists (6%). Dentists, physical
therapists (PT), radiologic technologists (RT), nutritionist-dieticians (ND), and occupational therapists (OT)
constitute the remaining 9% with OTs having a ratio of only 1.15 per 50,000 population.
Figure 5. Licensed Health Professionals per Cadre, 20208
7
Liwanag, H.J, J. Uy, & R. Abrigo. (2020). Projecting the Requirements for Selected Health Professionals to Achieve Universal Health
Coverage in the Philippines. Unpublished Report.
8
Source:DOH processed data using PRC FOI Data as of April 2020

CHAPTER
2
Figure 6. Health professions with the highest ratio per 10,000 population
Figure 7. Health professions with the lowest ratio per 10,000 population

Out of all the 10 cadres, it shows that only nurses have an adequate supply production in the country. The
CHAPTER
rest of the cadres produced for the health workforce are below the threshold to ensure Universal Health
Care access. With the current supply, the nurse-to-population ratio ranges from 48.2 to 58.1 per 10,000,
2
hence the nursing workforce can sufficiently meet the WHO indicative threshold of 27.4. Although the
number is decreasing, there is still an indication of adequate capacity to produce nurses at the national
level7. In contrast, the density of physicians in the country ranges from 7.2 to 8.1 and falls below the desired
density of 14.3, despite the increasing number of new physicians entering the pool in recent years.
The density of midwives ranges from 7.8 to 9.4, higher than the target density of 2.8, but it has been
declining across the years, along with the number of newly licensed midwives entering the pool.
Comparably, while the number of newly licensed dentists is increasing across the years, the dentist-to-
population ratio is slightly decreasing, indicating that production of dentists cannot keep up with the growth
in the population.7
The density for the rest of the cadres we produce has increased or remained stable over the years. However,
access to these health professionals is not uniformly gained across the country. The caveat lies on the
number of these health professionals who are actually serving in the country. The issues surrounding
trends on the production of health professionals and keeping them in the health workforce should be
addressed. Government support should take into consideration their critical role in providing primary care
services and in advancing UHC.
More granular data would reveal huge HRH gaps at the community level, especially in GIDAs, that have
rendered the health system ineffectual in meeting the health needs of the population. An estimated 25% of
all barangays in the Philippines do not have a dedicated health worker serving their constituents9.
The inadequacy of health workers in the country is partly caused by the high attrition rates in health
sciences education; the limited number of well-paying jobs in the health sector; unclear career paths for
health workers; inadequate support for health workers’ health, safety, and well-being; and the increasing
demand for Filipino health workers in other countries.
For health workers who decide to work abroad, some of the pull factors are higher salaries; the prospect of
better social, economic, and professional opportunities; and the presence of relatives in the destination
country. The temporary and permanent outmigration of health workers has adversely affected both the
quantity and quality of workers left in the country. This is aggravated by the increasing number of health
workers, particularly nurses, working in non-health sectors (i.e. BPOs), where pay is higher and working
conditions are better than jobs offered in some health facilities.
Inequitable distribution of HRH
Closely linked to the inadequacy of workers in the health sector is their inequitable distribution across the
country, across different levels of care, and between the private and public sector.
For decades, the density of health workers, especially doctors and nurses, has always been significantly
higher in urban or economically developed areas. One can glean from the figure below that the highest
9
Department of Health (2018). National Objectives for Health 2017-2020. Manila, Philippines: Department of Health. Retrieved from

density of select health professionals who are licensed to practice, as captured by the PRC database, is in
CHAPTER
the National Capital Region (NCR) at 146.2 HRH per 10,000 population, and the lowest is in Region IV-B or
MIMAROPA at 29.12 HRH per 10,000 population (see Figure 8).
2
Figure 8. Distribution and Density (per 10,000 population) of HRH Licensed to Practice in the Philippines,
202010
As to the distribution of practicing health professionals, data gathered from the various DOH information
systems (show that the highest is still in NCR at 28.9 HRH per 10,000 population, while the lowest is in the
Bangsamoro Autonomous Region in Muslim Mindanao (BARMM) at 8.21 HRH per 10,000 population (see
Figure 9).
Figure 9. Distribution and Density (per 10,000) of Practicing HRH in the Philippines, 202011
10
Source: DOH processed data using PRC FOI Data as of April 2020
11
Source: DOH processed data from various data sources (NDHRHIS, FHSIS, Deployment Program database)

Considering only the number of licensed doctors, nurses, and midwives, five regions did not achieve the
CHAPTER
WHO - recommended ratio of 44.5 HRH per 10,000. These are: MIMAROPA (23.2), BARMM (30.12),
SOCCSKSARGEN (32.68), Eastern Visayas (35.37), and CARAGA (37.13) (see Figure 10).
2
Figure 10. Distribution and Density of Doctors, Nurse, and Midwives Licensed to Practice in the Philippines,
202012
Distribution is further skewed towards hospitals

and clinical care-setting, leaving some primary
care facilities without essential health workers.
Among doctors, 87% work in clinical facilities

and 13% in primary care, with 102 municipalities
still doctorless. Among nurses, it is 72% against
28%. Among midwives, however, 48% work in
hospitals and 52% in primary care. For the rest
of the cadres, 80% are in clinical facilities and
20% are in primary care facilities. On average,
72% of HRH are in clinical practice while 28% are
in primary care (See Figure 1113). The hospital-
centric distribution of HRH is reflective of a
Figure 11. Average Distribution of HRH in Clinical and
model of care that diverges from the desired
Primary Care Facilities, 2020
set-up of providing first contact care at the
primary care level14.
Some cadres are affiliated equally in public and private institutions. For instance, 50% of doctors are in
public institutions while 50% are in private as well. However, more nurses (61%), midwives (91%), and
12 Source: DOH processed data using PRC FOI Data as of April 2020
13 Source: DOH processed data from various data sources (NDHRHIS, FHSIS, Deployment Program database
14 Dayrit, M.M., Lagrada, L.P., Picazo, O.F., Pons, M.C., Villaverde, M.C. (2018). The Philippines Health System Review. Vol. 8 No. 2. New
Delhi: World Health Organization, Regional Office for SouthEast Asia; 2018.

dentists (87%) work in public institutions. On average,
CHAPTER
72% of doctors, nurses, midwives, and dentists are

employed in the public sector while the remaining 28%
2
are in the private sector (See Figure 1215).
The factors affecting the maldistribution of health

workers include: disparities in pay between private and
public sectors, and within the public sector, between
national and local levels; limited capacity of LGUs to
hire health workers; and poor working conditions in the
place of assignment. Many health workers do not
choose to stay in workplaces that are isolated and with
poor health infrastructure, no proper equipment and
Figure 12. Average Distribution of Doctors,
supplies, inadequate social support, limited training
Nurses, Midwives, Dentists between Public and
and educational opportunities, limited employment
Private Sectors, 2020
mobility, and with poor living conditions and
opportunities for family members. The preference for
urban or economically developed workplaces is also influenced by the location of institutions offering
health sciences education, which are mostly in urban areas.
The imbalances in geographical, sectoral (private vs public), service level (hospital vs primary care)
distribution of health workers require serious attention and urgent rectification.
Core HRH Challenges
The Philippine HRH is faced with difficult and complex problems. Several studies, such as the Health Labor
Market Analysis (HLMA) and the HRH Situational Analysis, have identified four core HRH challenges, which
the proposed strategies of the NHRHMP seek to address.
Lack of accurate information on the health workforce to guide planning and policy
The available data on the number of health workers in the country is not up to date, comes from multiple
sources, and does not accurately reflect the true HRH picture in the country.
The estimated supply of health workers, for instance, is based on the number of health workers renewing
their PRC license; however, it cannot be ascertained whether they are practicing their profession, whether
they are practicing within the country and whether or not they are still alive or able to practice.
There are disparate information systems such as on the number of HRH across the health labor market
cycle. As an example, the data on HRH in the health sector comes from DOH and PRC, while other HRH-
related data such as that on production and migration comes from other agencies. There is no data on
those who are working outside the health sector or those who are unemployed.
15
Source: DOH processed data from various data sources (NDHRHIS, FHSIS, Deployment Program database)

HRH migration data mainly comes from the CFO and POEA. While data from these two sources provide
CHAPTER
robust data on the number of HRH leaving the country, it is also limited by potential underreporting due to
migration that are not documented or in cases of health professional mobility within the ASEAN or to other
2
countries where visa is not required. Current information systems have limited capacity to track movement
of temporary migrant workers from one destination country to another or those who had visa conversion
on site (i.e. departure as tourist and direct hiring as migrant workers).
The HLMA reports that there is no comprehensive data for health workforce employment by the private and
public sector especially in the primary care level. As there is no unique data source for tracking the number
of domestically employed primary care HRH, private clinic data was derived from the latest Cities and
Municipalities Competitiveness Index (CMCI) where 95% of all LGUs report administrative data, including
that on health.
Aside from the absence of a central repository of HRH-related data and information, there is also
inadequate support for infrastructure and lack of clear governance structure for national HRH information
management.
Limited collaboration among stakeholders with multiple roles in the HRH sector
The organizational silos in the government bureaucracy also affect the management and development of
HRH especially when ineffective coordination between agencies impede progress from decision to action.
The failure to communicate and to share information, and disputes over funding and mandates serve as
barriers to needed systemic changes towards achieving sustained development outcomes. These
coordination barriers are also reflected in relationships with other government, private, and third-sector
organizations. An example is the lack of collaborative planning and execution between the academe,
industry, and government in the generation of health workers. This results in the incongruence of skills,
competencies, and clinical experience of the health workers to the health needs of the people they serve.
The weak collaboration between the health and education sectors often results in a mismatch between
professional education and the realities of health service delivery in the communities.
The HRH Network Philippines was established to act as an integrating mechanism for discussing issues;
policy making; and carrying out collaborative decision making, data sharing, and policy implementation,
among others. Its effectiveness, however, can still be improved in terms of alignment of policy directions
and investments.
Fragmented HRH governance and unclear accountabilities
The DOH is responsible for the recruitment and management of health workers for its administrative
offices, the DOH hospitals (specialty medical centers and regional hospitals) and the HRH Deployment
Program. Meanwhile, HRH in military hospitals are hired and managed by the service branches under the
Armed Forces of the Philippines. Those working in university hospitals are managed by their respective
State Universities or Colleges. On the other hand, the LGUs have the responsibility of staffing field health
facilities from the provincial to the barangay levels. The private sector, while guided by policies, standards,
and programs established by the DOLE and DOH, independently manages their own HRH.

As stated in the National Objectives for Health, operation of health facilities and the delivery of health
CHAPTER
services have become fragmented with different levels of authority involved in the system––several
national government agencies, thousands of LGUs, and private providers. Various health facilities run by
2
LGUs have been poorly maintained, poorly equipped, and poorly staffed due to local budgetary constraints
or the low priority given to health by certain local officials. Consequently, regional and national hospitals
have become congested, with patients bypassing primary health facilities even for simple illnesses due to
insufficient gatekeeping mechanisms at the local level.
Poor HRH management in various levels is reflected in the unclear job descriptions of health workers;
inadequate supervision in clinical, public health, and health systems administration; and the variable
capacity of local health systems in HRH management and development. HRH governance consists of
complex interactions and illustrates the lack of coordination among stakeholders.
Lack of and poor implementation of policies
There are several gaps and issues that are related either to the absence of appropriate policies or poor
implementation. Among the major gaps is the lack of effective policies on competency standards and skill
mix; rational deployment of HRH; strengthening of health leadership and performance management
systems; and innovative approaches to coaching, mentoring, supportive supervision, and training. Human
resources management and development (HRMD) standards, roles, and functions are also not promoted
among national and local governance structures. Additionally, there are policy gaps in setting data
standards and strengthening data-sharing.
The poor implementation of HRH policies can be attributed to the fragmented governance systems and
ineffective monitoring of issued guidelines. There is inconsistency and weak coherence in critical policies
between the education, labor, and other sectors. Policies emanating from non-health sectors, especially
the economic and financial sectors, also impact the HRH sector.
Where do we want to go?

NHRHMP RESULTS FRAMEWORK
Setting clear goals for HRH development and management is important to ensure that all stakeholders are
harmoniously working towards the same goal, their participation is sustained, and progress is measured.
The vision and mission statements and the results framework provide the relevance, depth, and breadth of
the desired results. They also depict the future direction of HRH based on the health needs for the Filipinos,
the demands of the UHC, and the plea of the country’s health workers.
Vision
By 2040, Filipinos will have access to responsive, resilient, and quality health services, anchored
on primary health care and using a networked approach, provided by an adequate and equitably
distributed competent and committed HRH, who, with a decent and supportive work environment,
enjoy the dignity of their work.

Table 2. Explanation of the Vision Statement
CHAPTER
Phrase Explanation
2
By 2040, Filipinos will have This means that by 2040, all Filipinos, regardless of socioeconomic level,
access to responsive, can have the kind of health services they need and demand. Further,
resilient, and quality health building resilience is an urgent and critical development objective, as
services identified in the updated PDP 2017-2022.
Anchored on primary health Aligned with the UHC, primary care facilities and services should be
care capable of addressing the majority of people’s health needs throughout
their lives. This is rooted in a commitment to social justice and equity
and in the recognition of the fundamental right to the highest attainable
standard of health16.
And using a networked Given the logistical and resource challenges, adopting this approach
approach opens up avenues for innovation and collaboration needed in dealing
with complex and emergency situations. This is also in line with
providing a whole-of-society approach to health and well-being. Further,
embracing this approach integrates both the stability and the dynamism
needed to be agile.
Provided by an adequate and By 2040, we also hope to solve the problems regarding HRH distribution
equitably distributed in terms of number and skills-mix.
Competent and committed The formation (values and expertise) of HRH shall be guided by this
HRH in the health sector NHRHMP and by a renewed culture where a sense of mission and
transformation is embedded in the curricula and supported by the health,
education, and labor sectors in the public and private spheres
Who with a decent and By enforcing the necessary statutes and by providing a safe and secure
supportive work environment, environment that is conducive to a lasting engagement.
enjoy the dignity of their work
Mission
Ensure the sustainable production, equitable distribution, and continuous development of

compassionate and responsive HRH at all levels to deliver health care through a continuum of
promotive, preventive, curative, rehabilitative, and palliative health interventions.
Table 3. Explanation of the Mission Statement
Phrase Explanation
Ensure the sustainable This statement guarantees that the demand for HRH nationwide is met
production, equitable by ensuring their formation, sourcing, deployment, professional growth,
distribution, and continuous and reintegration
development
16
World Health Organization. (2021). Primary Health Care. https://www.who.int/health-topics/primary-health-care#tab=tab_1

of compassionate and This defines the quality of HRH necessary in traversing the complexities
CHAPTER
responsive HRH at all levels of the health system from the community, subnational, and national
2
levels, dealing with diverse individual and group stakeholders
To deliver health care To be able to provide whole-person health care for the population,
through a continuum of throughout their life cycle, and not just for a set of specific diseases.
promotive, preventive,
curative, rehabilitative, and
palliative health
interventions
Results Framework
To attain the proposed vision, the results framework maps the logical sequence of outcomes that has to
be realized. Spanning 20 years, it succinctly narrates how this vision is to be achieved by looking into,
working out and building partnerships, investments and institutional development to form its solid
foundation. This map asserts explicit results, not vague generalized statements, as it is the vision map of
the NHRHMP geared to inspire commitment and buy-in.
Figure 12. National HRH Master Plan 2020-2040 Results Framework

Table 4. Explanation of the Outcome Statements
CHAPTER
Outcome Statements Explanation
2
Strengthened partnership A tight multi-sectoral collaboration (both public and private) is pivotal in
building for HRH reform driving the programs and transformation needed for the NHRHMP both at
the top, where policies are deliberated, and at the bottom, where health
services are delivered. Thus, the HRH Network and the health care
provider networks are the key players that the strategy hinges on.
HRH and HRH systems Any undertaking requires resources––financial or otherwise––and an

strategic investments expenditure projected to yield a greater return or a better future should
aligned with UHC always be seen as an investment. In any investment, planning for the
efficient allocation of resources with regularity or consistency makes a
difference in potential returns. Underlying this is the use of data science
and analytics for HRH.
Increased competence in Embracing a networked approach and laying down all the identified
networked and frameworks and processes compels each stakeholder involved–– HRH,
multipurpose ways of agency, and organization––to acquire and build new competencies and
working, systems transform themselves in response to the present volatile, uncertain,
management, informed and complex, and ambiguous environment which the HRH situation
collaborative decision exemplifies.
making and policy
development, and
accountable governance
Integrated HRH information In having a single repository of data pertinent to the HRH management
systems established to and where system interfaces can share or communicate with other
support decision making systems, data governance should be established to define and facilitate
shared expectations on data––particularly on data quality, ownership,
source, storage, management, security, and use
Evidence-informed and Policies, informed by objective facts or proof, provide the legal basis and
coherent policy levers impetus to create a favorable environment for HRH on every level and
strengthened and aspect of implementation––from production to workforce and exit/re-
implemented entry, based on quality data and strong policy research
Synergistic accountability Embedding a clear purpose, role expectations, and deliverables, running
mechanisms for HRH across multiple functions, sectors, and layers of governance helps in
management structures and rallying teams to work on several NHRHMP projects as a cohesive whole.
systems
Data-driven, people- In terms of design (whether for systems, products, or services), relying
centered HRH systems solely on data and detaching from what people or users actually need and
design and management want defeats the very purpose and principle of design. People––whether
as HRH overseers, clients. or workforce––should not be treated as a cog
in a system. A well-thought-out design always has its users at its center
and subtly, intelligently facilitates the value of HRH systems and their
support services.

Integrated sector-wide HRH From a fragmented way of doing things, the NHRHMP aims to establish
CHAPTER
management system, solid, concerted, and consistent end-to-end processes, operational and
2
structures, and collaborative reporting arrangements, and avenues for collective action for HRH and its
platforms agenda.
Standards for HRH Ensuring the relevance, robustness, coherence, and enforcement of
production, workforce, exit interrelated policies and standards will depend on the cohesiveness of
and re-entry enforced and the HRH stakeholders and the reliability and functionality of its data
monitored across sectors systems
Highly skilled, motivated, Individually, HRH being produced shall be highly competent, engaged, and
and productive HRH value-adding to health care service delivery
Competent HRH Collectively, public and private HRH are networked and are a force or
contributing to health movement proactively analyzing, innovating, and creating solutions for a
system reforms stronger health system; and engages themselves in the work of good
governance, which involves efforts to endorse, mediate, facilitate, hinder,
or oversee changes for the greater good of the country’s health system.
Adequate number of The goal of the NHRHMP is to have an adequate number of competent
competent and committed and committed HRH, equitably distributed in the health sector. With this,
HRH equitably distributed in Filipinos will be able to access services of HRH when and where they are
the health sector most needed.
Healthier Filipinos via This is seen to redound to an improved health system performance and
improved health outcomes improved health outcomes, thereby contributing to the vision of the
and responsive health Filipinos as one of the healthiest in Asia by 2040. This shall also contribute
systems to the accomplishment of the Philippines’ commitment to the Sustainable
Development Goals and the WHO Global Health Workforce Strategy.
Guiding Principles
The NHRHMP espouses the following principles in support of the national initiative towards the provision
of Universal Health Care. The principles are embedded in the strategic objectives and strategies of the
Master Plan.
 UHC principles including universality, equity, accountability, sustainability, participation, social

solidarity, individual and mutual responsibility, transparency, and progressive realization
 Primary health care principles including equitable distribution, community participation, inter-
sectoral coordination, and appropriate technology
 A healthy, sustainable, and productive workforce for improved patient experience, improved
population health, and reduced cost of care
 Alignment with national and international strategic directions, goals, and commitments to achieve
better health outcomes.
 Continuous monitoring and learning. Feedback is provided and lessons are learned from the
continuous review and evaluation of the quality, efficiency, and effectiveness of the Master Plan’s
strategies and activities, and the achievement of results in order to improve and strengthen
performance.

How do we get there?
CHAPTER
NHRHMP STRATEGIES
2
At the forefront of achieving NHRHMP goals is the Human Resources for Health Network (HRHN)
Philippines. Six key result areas (KRA) and specific strategic objectives (SO) for each have been identified
to guide the HRHN in addressing the HRH challenges mentioned above.
The strategies identified for the NHRHMP are distinguished between transformative and enabling, i.e.
cross-cutting strategies.
Transformative strategies address the pressing issues that were identified in the first HRH Master Plan in
2005 and continue to face the HRH sector today. These persistent and pressing issues are the inadequate
and inequitably distributed HRH in the country. KRAs 2 (Health Workforce Education, Training, and
Continuing Competence), 3 (Health Workforce Welfare, Protection, and Career Development), and 4 (Health
Workforce Migration and Reintegration) provide transformative strategies that span the whole health labor
market spectrum, from entry to workforce, to exit and re-entry.
Enabling strategies address cross-cutting issues that are the root causes or core HRH problems: (1) lack
of accurate HRH information to guide planning and policy, (2) limited collaboration among stakeholders
with multiple roles in the HRH sector, (3) fragmented HRH governance and unclear accountabilities, and
(4) lack of and poor implementation of policies. KRAs 1 (Data Governance and Information Management),
5 (NHRHMP Institutionalization and Localization), and 6 (Institutionalization and Strengthening of the HRH
Network) seek to address these core HRH challenges.
Criteria in Identifying the Strategies of the NHRHMP
The strategies are identified based on the following criteria and are expected to be implemented at the
system, facility, or institutional, and individual levels. The strategies should:
 Support the UHC law provisions, i.e. expand scholarship and training programs, reorient the
curriculum to PHC, provide permanent employment and competitive salaries, return service
agreements, and set-up a workforce registry and health workforce support system;
 Address persistent HRH issues, i.e. the causes of the core problem in order to create system
changes and the effects of the core problem;
 Build on and reinforce each other and create synergistic effects; and
 Contribute to the attainment of national and international policies and commitments.
Key Result Areas (KRA) and Strategic Objectives (SO)
The six KRAs serve as the core of the Master Plan, with a chapter dedicated to each:
KRA 1: HRH Data Governance and Information Management
General Objective: Strong data governance and information management for evidence-informed HRH
workforce planning, strategy and policy formulation, program design, execution, and oversight

 SO1: Harmonized HRH data governance, data analytics, and information management systems
CHAPTER
 SO2: Complete, accurate, and up-to-date HRH data available and accessible at all times
2
 SO3: Enhanced HRH research capacity and research output utilization
KRA 2: Health Education Strengthening and Regulation
General Objective: Practice-ready HRH responsive to local health needs, and improved retention in the local
health sector
 SO1: Strong inter-sectoral collaboration and harmonized plans and policies to ensure needs-based
production, and retention
 SO2: Regulatory measures are in place to ensure quality and efficient HRH production
 SO3: Health Sciences Education curriculum is reoriented to primary health care to produce health
professionals responsive to local health needs and demands
KRA 3: HRH Welfare, Protection, and Career Development
General Objective: Raised HRH productivity and responsiveness by promoting job satisfaction and
motivation at all levels, thereby improving retention in the Philippine health sector
 SO1a: Increased permanent positions for health workers

 SO1b: Rationalized and formalized status and roles of community health workers (BHW and BNS)
 SO2: Standardized and competitive compensation, benefits, and incentives for health workers in
both the private and public sectors, at the local and national levels
 SO3: Enhanced HRH scopes of practice aligned with the networked and team approach to support
universal health care
 SO4: Enhanced competencies and career opportunities for HRH, and established performance
management systems
 SO5a: Established occupational safety and health (OSH) policies and wellness programs for HRH
 SO5b: Optimal support and working environment for HRH
 SO6: HRH capacity optimized during public health emergencies and surge situations
KRA 4: HRH Migration and Reintegration
General Objective: Migration managed to maintain a sustainable health workforce and reintegration
programs established for returning health workers
 SO1: Retention of HRH by ensuring job satisfaction, motivation, protection, and career development
 SO2: Strong monitoring of local and international policy instruments governing HRH migration
management
 SO3: Harmonized data and information systems on HRH migration and reintegration
 SO4: Established reintegration programs for returning migrant health workers

KRA 5: NHRHMP Institutionalization and Localization
CHAPTER
General Objective: Efficient and effective implementation of the NHRHMP through a collaborative and
2
participatory approach, in both the national and local levels
 SO1: Local stakeholders are aware of the NHRHMP and realize the “power of the health workforce”
 SO2: Co-ownership and co-implementation of the NHRHMP, with clearly defined roles and
accountabilities of key players
 SO3: Support (financial and technical) and capacity-building of subnational bodies provided for
local implementation of the NHRHMP
KRA 6: Institutionalization and Strengthening of the HRH Network
General Objective: Harmonized and strengthened inter-sectoral governance for HRH
 SO1: Institutionalized national mechanism for HRH governance and dialogue to broaden ownership
and harmonize HRH strategies and policies
 SO2: Strong technical and management capacity of DOH and other agencies/sectors to plan,
develop, and implement HRH policies and programs.
For each KRA, strategic objectives determine what we want to achieve by 2040. In line with these objectives,
short (2020-2022), medium (2023-2030), and long-term (2030-2040) strategies are laid out to guide
implementers in aligning their HRH initiatives. Targets and outcome indicators are defined to allow
determination of progress towards the established goals. Strategies may be recalibrated based on
emerging HRH issues and lessons learned from implementation. They should not be implemented
discretely and independently of each other but as integrated bundles to address systemic gaps and ensure
that persistent problems are effectively solved.
Overall, this Master Plan will serve to guide the country’s journey towards a well-trained, well-managed and
optimized health workforce that supports UHC and plays a vital role in achieving Ambisyon Natin 2040 and
the Sustainable Development Goals.

CHAPTER 3
NHRHMP
HRHMP as a People Strategy
and Its Architecture as
a Social System
NHRHMP as a People Strategy and Its Architecture as a Social System | 35

CHAPTER THREE
NHRHMP AS A PEOPLE STRATEGY AND ITS ARCHITECTURE AS A SOCIAL
SYSTEM
CHAPTER
This chapter introduces the concept of a social system as the context of how the NHRHMP will be
implemented, and how such a perspective is necessary in following the thrusts of UHC reforms—using the
3
networked approach to health service delivery and working together on collaboration platforms, under a
shared leadership (with each agency/stakeholder groups playing lead roles according to their expertise and
mandates).
This is driven by the impetus to ensure the practical and agile management of the NHRHMP’s
implementation while upholding accountable governance. With this approach, a certain level of trust and
autonomy is fundamental for key stakeholders to drive innovation and commitment to pursue reforms in
the health system and ensure a responsive health care service.
The NHRHMP will root its design and implementation in the practice of shared leadership and networked
collaborative engagement. The HRH Network Philippines will pursue an intensive stakeholder engagement
and advocacy process to establish the deepening of the stakeholders’ sense of ownership of the NHRHMP.
NHRHMP Architecture as a Social System
In traversing the complexity of the country’s health system to deliver efficient and effective health services,
one cannot rely on a single individual, group, or even a body of experts to provide an optimal solution or
best response. Instead, solutions are provided through synergy of several elements such as processes,
policies, practices, partnerships, and people that make up the system.
Apart from, yet within, this whole schema, HRH, as a social system, means that it is composed of
subsystems of networks or teams and its components reinforce one another. Because it is a social system,
it is embedded within a wider system that includes culture, legislation, and institutions, among others. It is
an open system where its outside environment can influence and be influenced as well. Having closed
structures, rigid processes, and static functioning is not conducive to mounting large scale, workable,
efficient, and responsive interventions that will address each constituent’s need for primary health care.
Shifting towards dynamism and fluidity to be responsive and yet maintaining a steadiness to ensure order
is a balancing act that stems from informed tuning and grounded adaptation.
Key Principles and Characteristics in the Context of UHC
Apart from working towards engagement and retention, the main challenge of today’s human resource (HR)
function is in “aligning the work an organization needs with the capabilities that can deliver it most
effectively. It emphasizes coordination within and beyond HR units. It moves beyond a concept of HR
management as a service delivery to a way of operating1.” To turn the current traditional HR operations
1
Mazor, A., A. Alburey, E. Volini, M. Bowden, & M. Stephan. (2014). The High-Impact HR Operating Model. Retrieved from
https://www2.deloitte.com/content/dam/Deloitte/global/Documents/HumanCapital/gx-hc-high-impact-hr-pov.pdf

towards such state, below are the guiding principles to develop a future-state vision for how the NHRHMP
will operate.
Agility in Complexity
Dealing with the complexity of the current environment necessitates going beyond being adaptive. Agility
CHAPTER
exacts a certain vigor, flexibility, movement, openness, and coordination in swiftly responding to the needs
and demands of the situation, these instituted internal changes or corrective actions in the way
3
organizational interventions are structured, performs, or operates. A bureaucracy, given its distinctive
hierarchical structure, tends not to have such adeptness.
Trust and Autonomy
The gig economy2 typifies and flourishes in a way of working where organizational elements (i.e., structure,
process, activities, outputs) are defined around the work that needs to be done and ends when the key
deliverables have been produced, conducted, and approved. Forming and tapping Health Care Provider
Networks (HCPNs) to work on a certain issue or provide services would revolve around these stipulations.
This level of autonomy provided to HRH cannot happen without trust developed and nurtured among parties
involved.
Collaborative Platforms
As several recruits are hired separately and work independently, each brings to the table his or her own
creative work and unique expertise. Developing platforms of engagement that optimize the use of both
digital and non-digital channels facilitates an environment where ideas and solutions may be presented,
deconstructed, amplified, matured, and bred collectively through diverse disciplines and perspectives.
Thus, depending on the issue at hand, health service solutions and innovations in the community are
worked out from design to delivery by enlisting and engaging various stakeholders and expertise available.
Meaning-Making & Mission
Perhaps, the most important feature of a social system in this set up––and the most crucial in attaining
the vision of forming committed cadres––is that it must be bound and sustained by its shared purpose,
values, and norms (or behavioral expectations). This fundamental charter provides the foundation for
defining roles, relationships, and routines within it. It is welded further by stories past, present, and future,
communicated through formal and informal conduits that establish and cultivate its commitment, culture,
and identity.
2
Gig economy - a labour market characterized by the prevalence of short-term contracts or freelance work as opposed to permanent
jobs. (Oxford Languages); a way of working that is based on people having temporary jobs or doing separate pieces of work, each
paid separately, rather than working for an employer (Cambridge Dictionary); the term "gig" is a slang word for a job that lasts a
specified period of time; it is typically used by musicians. (Techtarget.com)
38 | NHRHMP as a People Strategy and Its Architecture as a Social System

Shifting from HR Administration to Mission-Driven Operations
Figure 14 illustrates the four phases3

of transformation that HR operations
must go through to meet the
challenges of not only aligning the
CHAPTER
demand of different communities for
health care services with the
3
capacities of health and allied
services experts but more
importantly, supporting the UHC
vision and mission, to wit: UHC is the
aspiration that all people can obtain
the health services they need, of
good quality, without suffering
financial hardship when paying for
them. Health services cover
promotion, prevention, treatment, Figure 14. Four Phases of HR Transformation
rehabilitation and palliative care, in
all levels of service delivery (from community health workers to tertiary hospitals) and services across the
life course4.
Translated into the Philippine context, this is articulated in the NHRHMP vision of building a cadre of health
professionals competently navigating and reforming the health system and ensuring that committed and
competent HRH are adequately distributed across all levels.
Most HR functions in the government agencies operate under the first phase, delivering mostly
administrative services. While some have shifted to the next phase, there is yet any indication that HR
analytics was developed and used to enable management to make the right strategic decisions in terms of
choosing what, who, where, and how to recruit, develop, and deploy people. The last phase, which is the
ideal, is for HR to function in support of the business plan of the organization––in this case, performing,
developing, and using HR analytics and integrating these findings in key agency/program objectives that
support the vision and mission of the NHRHMP and, in the long run, the UHC.
Also involved in the process is the establishment and application of policies and procedures for the
procurement, deployment, and maintenance of the agency's workforce. The operating mindset is about
control, where the HR unit ensures that all personnel adhere to set guidelines and regulations. Deviations
from these norms are generally frowned upon especially as lines of authority and role functions are often
firmly set to the point of stiffness and obsolescence.
3
Fineman, D. (2016). Enabling Business Results with HR “Measures that Matters”. Deloitte Development LLC. Retrieved from
https://www2.deloitte.com/content/dam/Deloitte/us/Documents/human-capital/us-hc-enabling-business-results-with-hr-measures-
that-matter.pdf
4
World Health Organization. (2021). Universal Health Coverage. Retrieved from https://www.who.int/health-topics/universal-health-
coverage#tab=tab_1

The shift from HR administration to strategic human resource management and development perspective
marks the next phase where the HR Management is considered a specialized and organized branch of
management which is concerned with the acquisition, maintenance, development, utilization, and
coordination of people at work, in such a manner that they will give their best to the enterprise or agency.
It refers to a systematic function of planning for the human resource needs and demands, selection,
training, compensation, and performance appraisal, to meet those requirements.
CHAPTER
The goal of HR is to provide the necessary services to the workforce with greater efficiency---automating
3
processes for employees to make for faster and better transactions—such as timeliness of leave approvals,
efficiency of monitoring tardiness and absences, logging in and out of the office, receiving field allowances
and reimbursements, etc. Most dealings with employees are mainly transactional rather than
developmental. Any analytics done at this stage is after the fact, more on operational reporting of efficiency
and compliance measures, with a focus on data accuracy, timeliness, and consistency. Benefits from this
phase include having tools and reports that are standardized and facilitating ease in responding to
information requests.
The next phase is about having an integrated talent management or a strategic HR management where
alignment is key to achieve organizational effectiveness. Talent here refers not to the whole workforce but
to its subset of potential and incumbent holders of what we call “mission critical roles.” Mission critical
roles are positions and designations that form, fuel, or facilitate an organization’s core capacities in
delivering its mandate or value to clients. It involves a top-down approach to planning where each unit’s
strategic plan drives their respective talent plans and processes to bridge the talent gap.
The ultimate goal here is to maintain a stream of talents ready to fill any significant vacancies of business
units. In this phase, HR analytics is developed and used to enable management to make the right strategic
decisions in terms of choosing what, who, where, and how to recruit, develop, and deploy people.
The last phase, is for HR to function in support of the business plan of the entire organization––in this case,
performing, developing, and using HR analytics and integrating these findings in key agency/program
objectives that support the vision and mission of the NHRHMP and, in the long run, the UHC. Thus, HRH
planning will now be an integral part of the Philippine sector and the country's human capital development.
The four dimensions of health workforce planning–– assessing HR capacity, forecasting future
requirements, identifying gaps, and integrating the plan with the various private and public sector health
service organizations’ strategies––will be crucial to the success of the NHRHMP.
HR management, then, should act as a functional broker that manages the linkages between community
needs, the UHC mandate, and the HRH. It means having a deep appreciation and understanding of the
imperatives of the UHC as well as LGU priorities and diverse community contexts. As such, HR managers
and implementers of NHRHMP ensure that their knowledge of and insights on the needs and demands of
various citizens and the situation of different localities where HRH are deployed are not static but develop
and progress over time as they seek to remain current.
Given this context, competencies on adaptability, agility, analytics, and research have to be embedded
within HR management systems, including the development of new tools and methods as they will operate
with and among networks of teams––a pioneering act without precedent in the Philippine government
experience. With this new role and function, HR managers are regarded as internal consultants, advisers,

and change agents, partnering with business units in innovating and addressing unit operations and
strategy.
HR management must be open, vigilant, discerning and purposive not simply in executing the plan but in
learning about how the plan implementation could best respond to emerging needs. Often this necessitates
straying from the plan as the concepts of work, the workforce, and the work environment are continuously
CHAPTER
being challenged and redefined by disruptions like the pandemic and advances in digital technology, among
others. In line with this, we are moving beyond focusing on just a portion of the workforce to drive outcomes
3
but the whole grid of networks and organizations involved within an ecosystem. It also compels us to think
beyond managing people and towards imagining how HR processes and workflows may be designed to
keep pace with these marked changes and the VUCA environment.
Mission-Driven and Commitment-Based People Strategy
The strategic importance of HR management cannot be underestimated. The NHRHMP acknowledges its
role as the vital link between the health workforce and the facility, organization, or community where they
serve. This is especially important, given the high demand for competent and dedicated health workforce
today and in the future. As such, the formulation and adoption of an HR strategy that is congruent with the
thrust and goals of the NHRHMP and UHC must be in place.
The UHC law mandates structural and functional reforms on governance, health financing, and service
delivery, regulation, and performance accountability. There are four distinct strategies that underlie the
UHC: 1) focus on primary health care, 2) integration of health systems at all levels, i.e. national to
community, 3) progressive health financing through the PhilHealth 5, and 4) Health Care Provider Network
(HCPN) contracting to deliver appropriate health care service.
The HCPN is envisioned as consisting of several talents, but principally responsible for delivering results
via the performance of HRH, and for leading the transformation of the health system to keep pace with the
changing demands of the environment. The network approach will form an ecosystem in which health
information and knowledge are widely disseminated, as opposed to being concentrated at the top of a
hierarchy or in executive offices at the national level. The network is synergistically governed and a key to
its success is flexibility and the ability to rapidly configure and reconfigure personnel, teams, and
competencies around the present and emerging health needs of the public.
The HRH Network Philippines, as the providers of governance oversight and technical support, will help
drive the NHRHMP agenda forward amid uncertainties and challenges. Groups of professionals and
workers catering to the HRH will be identified based on needs and key roles. They will be recruited and
selected according to appropriate criteria and on-boarded by participating in different learning and
development programs to support their career development and advancement, and to ensure their active
engagement and performance.
5
The UHC law considerably altered PhilHealth’s fundamental mandate in terms of being the primary purchaser of health services
from simply a supplier of health insurance services previously. Under the law, PhilHealth will be responsible for purchasing all
individual-based services, including supplies, medicines, and commodities, as well as maintenance and operating expenses of
health facilities.

Given the high strategic value of and high demand for the skills of deployed health professionals, the
NHRHMP will pursue a suite of placement and retention strategies that is commitment-based. This
commitment-based HR development and management strategies emphasize personal responsibility,
autonomy, and the empowerment of employees across all levels and types involved in health care delivery.
Instead of focusing on a higher power or authority, this would entail building their capability to work together
CHAPTER
as teams––individually autonomous but collaborating competently in addressing the health needs of those
they serve with inspiring commitment.
3
A commitment-based HR strategy is described as a highly relational approach, which is compared against

a highly transactional scheme, such as a compliance-based strategy that primarily uses control or a
productivity-determined strategy that homogenizes job descriptions, devoid of requirements for
collaborative tasks necessary for a network approach. This is illustrated in the figure below:
Figure 15. NHRHMP People Strategy Supporting and Enabling the NHRHMP Strategy
Support for Continuous Learning
The UHC and the NHRHMP will rapidly involve changes in health service delivery and health care, which will
change the relationship between learning and work, making them more integrated and connected than ever
before. This creates a challenge and an opportunity to build robust work-centered health provision learning

programs, which will help people consume information and upgrade their skills in the natural course of their
day-to-day jobs6.
Within this context, there are trends emerging such as: better integration with health care work and more
personal and lifelong learning. Yet it is also being pulled towards a more systemic and collective endeavor.
CHAPTER
An effective reinvention along these lines requires a health care culture that supports continuous learning,
incentives that motivate people to take advantage of various learning opportunities at work (in-service) or
3
in more formal educational settings, and a focus on helping HRH identify and develop the needed skills.
Facilitated Talent Mobility
The shift toward flatter organizational models, such as adopting a networked approach (service network
delivery of UHC and the collaboration demanded by the NHRHMP) also creates a greater need for talent
mobility. As NHRHMP stakeholder agencies and organizations start to operate in teams and networks,
health managers are realizing that open access to the diverse skill sets, backgrounds, and experiences held
by the organizations’ own people is essential to success.
To recruit and retain the desired staff for growing and evolving projects and programs, team leaders must
find expertise and commitment throughout the network, which is difficult if the organization lacks an active
and open internal mobility process7.
Hiring health workers, especially experienced health professionals with specialized skills, is highly
competitive; workers who want to reinvent themselves do not necessarily want to leave their current
employer while those seeking better working conditions and compensation migrate to find jobs in foreign
countries.
Internal mobility can be a way to embed collaboration and agility into a health care organization’s culture,
which is one of the key attributes of becoming a true social enterprise focused on health service. It must
be pointed out that agile organizations and career models dramatically improve employee engagement and
commitment7.
A Culture of Flexibility, Autonomy, and Trust
Building on the principles laid out previously, the whole idea of entrusting the work of developing and
providing health service to several autonomous network teams in communities, spread out across the
country, cannot work without a culture that will support it. This means not only a shift in structure or
processes but a shift in perspective and attitude towards performance management and managing teams.
6
Maharaj, P., & T. Page. (2019). Leading the Social Enterprise: Reinvent with a Human Focus. Deloitte Development LLC. Retrieved
from https://www2.deloitte.com/za/en/pages/human-capital/articles/learning-in-the-flow-of-life.html#
7
Volini, E., J. Schwartz, I. Roy, M. Hauptmann, Y. Durme, B. Denny, & J. Bersin. (2019). Talent Mobility: Winning the War on the Home
Front. Deloiite Development LLC. Retrieved from https://www2.deloitte.com/us/en/insights/focus/human-capital-
trends/2019/internal-talent-mobility.html

Meaningful Work
Besides the tangible benefits of having work, the intangibles are what make people stay. Working in
development areas, such as the government and social sector, provides opportunities for people to give of
themselves, and contribute meaningfully to society.
CHAPTER
From these elements, it is expected that performance and context-based opportunities, as well as
incentives, competitive benefits and compensation are provided, enabled by a value-based climate and
3
transparent leadership. All these drive the formation of HRH, the main channels of health service delivery;
thus, it is vital to have them committed and competent, sharing and owning the responsibility of providing
health care access to all Filipinos.
The focus of HRH management, then, must be to anticipate and build the competencies of HRH workers,
inspire commitment, and develop HRH teams within HCPNs that will lead reforms at the local level. The
reform part is the implementation of the NHRHMP itself. It is integrated in this drawing as this whole work
will not fly if the needed integration at the sectoral and system levels is not realized.
Critical thinking, creativity, self-directedness, and commitment will be essential in navigating complex
domains such as localizing the NHRHMP––where cause and effect can only be deduced in retrospect,
where decisions are needed even on incomplete data, where there are no easy answers; or in dealing with
chaotic domains, where a rapid response is necessary to establish order and stabilize the situation such
as in an emergency or epidemic setting.
In the face of the current situation of the country’s HRH and health system, plus the directives laid out by
the UHC, the health professionals needed to drive the HRH mission and deliver public value for the health
sector are the competent HRH committed to finding ways to address the health care needs of the
community, as well as hurdling and tackling the challenges and issues that confront the health system.
Forming this talent and developing them as a cadre of networked health professionals balances out the
gaps in the hierarchical structure and culture of the bureaucracy. As such, the health worker required for
this venture is both a dedicated performer focused on maximizing and delivering results, and, at the same
time, a reformer focused on navigating complex scenarios, managing knotty trade-offs, and initiating
alternative solutions or conduits that eventually influence building a more responsive and efficient health
system.
The HRH Network Philippines stakeholder engagement plan will inform the kind of strategy that must be
employed for external partners to support and invest in a proactive and collaborative governing of the
NHRHMP implementation and in designing responses to any emerging issues or unintended consequences
it may bring.
The NHRHMP strategies need to be crafted and implemented for identified sets of job families in health
service delivery, health governance, and management. These job families are selected based on their value
in realizing the intertwined objectives of NHRHMP––building a cadre of health professionals competently
navigating and reforming the health system, and ensuring that committed and competent health workers
are adequately distributed across all levels of care in the country.

CHAPTER 4
NHRHMP
HRHMP Strategic Management
Framework, Principles and
Practices
CHAPTER FOUR
NHRHMP STRATEGIC MANAGEMENT FRAMEWORK, PRINCIPLES,
AND PRACTICES
The NHRHMP action framework adopted the Global Health Workforce Alliance’s HRH Action Framework
(HAF). It proposes a comprehensive approach in addressing staff shortages, uneven distribution of staff,
gaps in skills and competencies, low retention, and poor motivation, among other HRH challenges. It is
expected that because the NHRHMP is a living document, it will go through several iterations of the action
CHAPTER
cycles (imagining, strategizing, planning, etc.). This section details the HAF, which provides a
comprehensive and integrated perspective and guide when the NHRHMP undergoes these iterative
4
processes. It is an elaboration of the strategic management approach and process that must guide the
detailed action planning and implementation of NHRHMP.
The HRH Action Framework
The HAF delineates six action fields or components, each of which has an area of intervention. These action
fields and interventions will guide the process of developing and implementing a comprehensive HRH plan
to achieve the desired result of an effective and sustainable health workforce.
Four fundamental basic action phases are also included in the framework to denote the critical
management steps in the decision making and planning of HRH. It is presented here to guide the future
development of strategies that are not presently covered but which can emerge during the implementation
of the current plan.
The six major action fields or components in the NHRHMP framework are shown in Figure 16 below. These
are the Human Resource Management (HRM) System (which forms the core technical system), Leadership,
Partnership, Finance, Learning and Development/Education, and Policy. The last five components are in the
third circle of the diagram.
The second innermost circle consists of all the elements needed for a functional HRM system namely: 1)
HRM information system, 2) HRH work conditions and well-being, 3) the Civil Service Commission’s
Program to Institutionalize Meritocracy and Excellence in Human Resource Management (PRIME-HRM)
core components of recruitment, selection and placement (RSP), learning and development (L&D),
workforce performance management (PM) and rewards and recognition (R&R). Having a functioning HRM
system ensures that there is an integrated use of data, policy, and practice to plan for the necessary staff,
as well as recruit, hire, deploy, develop, and support health workers. The figure below presents a visual map
of the Strategic NHRHMP Action Framework.
NHRHMP Strategic Management Framework, Principles and Practices | 47

CHAPTER
4
Figure 16. HRH Management System Conceptual Framework
NHRHMP Fields of Action / Components and Interventions
HR Core Management System
There should be an integrated use of data, policy, and practice to plan for the required staffing and to recruit,
hire, deploy, develop, and support health workers.
 PRIME-HRM
o Recruitment, selection, and placement/deployment
o Learning and development
o Performance management (performance appraisal, supervision
and productivity)
o Retention (benefits and compensation & rewards and recognition)
 Work environment and employee well-being
o Employee relations
o Welfare and workplace safety
o Career development (succession planning)
o HR information/workforce intelligence system for the integration of data sources to
ensure the timely availability of accurate data required in planning, capability
building/training, appraising, and supporting the workforce (workforce planning)
48 | NHRHMP Strategic Management Framework, Principles and Practices

Partnership
These are formal and informal linkages aligning key stakeholders (e.g., national and local governments,
service providers, donors, priority disease programs) to ensure a synchronized and collaborative action that
maximizes the use of resources for HRH. The possible interventions are as follows:
 Mechanisms and processes for multi-stakeholder cooperation (inter-agency work, health

worker advisory groups, donor coordination groups, labor-education-health stakeholders work
groups).
 Public-private sector agreements
 Community involvement in care, treatment, and governance of health services
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Finance
4
This involves obtaining, allocating, and disbursing adequate funding for HRH.
 Setting and regulating standards and levels of salaries, allowances, and benefits
 Budgeting and projections for HRH intervention resource requirements including salaries,
allowances, education, incentive packages, and protection
 Increasing fiscal space and mobilizing financial resources (e.g., government, Global Fund,
donors)
 Data on HRH expenditures (e.g., National Health Accounts, etc.)
Learning and Development/Education
This refers to the production and maintenance of a skilled health workforce.
 Pre-service education tied to health needs and UHC outcomes and approaches like the
Service Delivery Network
 In-service training (e.g., distance and blended, continuing education)
 Capacity of health education institutions, specialty boards, and other training institutions
 Training and certification, promoting the welfare of community health workers and non-
formal care providers
Policy
These are legislation, regulations, and guidelines for conditions of employment, work standards, and
development of the health workforce at the national and local levels. The possible areas for policy
interventions are:
 Professional standards, licensing, and accreditation

 Authorized scopes of practice for health cadres and career pathways
 Political, social, and financial decisions and choices that impact HRH
 Attracting the return of health professional migrants
 Employment law and rules for civil service and other employers

Action Cycles
The next layer is called the action cycle, which describes the process of coming up with a comprehensive
plan that starts with 1) analyzing the root causes of the HRH problems in the country using all the elements
in this framework, 2) setting priorities from the short term to the long term including costing, 3) sourcing,
programming and managing technologies, people, and financing to execute the recommendations of the
plan, and 4) monitoring routinely and evaluating periodically for results.
Every action taken at every level, every area of intervention, and every stage in HRHM implementation will
go through an action cycle that is fundamental to a strategic and systemic approach to NHRHMP. Thus,
the following action cycle will be iteratively applied.
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Situational Analysis
4
This requires gathering all data and information to appreciate the context of HRH challenges, such as
staffing shortages and health priorities, that needs to be considered in planning and programming over the
next strategic period (5 to 10 years). With this information in hand and with an understanding of the context,
one must use the six components of the framework and the key areas of intervention to assess the root
causes of the HR crisis in your context. The root causes are generally linked to more than one component,
so it is important to consider all components of the framework.
Planning
The HRH Action Framework is intended to result in an effective and sustainable workforce. Taking this
comprehensive approach requires careful planning. While it is critical to keep the primary goal of a
sustainable and equitably distributed workforce as the center of the HR strategy, it is useful to develop both
short-term emergency priority actions that can be taken along with long-term actions. Using the key findings
from the situational analysis above, the next step is to discuss and develop with the leadership team a
recommended strategy and an operational plan that includes both long-term and short-term actions.
Implementation
Clarify the implementation role of the HRH leadership team (HRHN, lead agencies) as well as the
responsibilities of other key stakeholders. Develop a roll-out plan, especially considering that HRHMP, as a
major change initiative, will go through a transition stage. Select performance indicators for measuring
outcomes and progress on achieving results and establish the appropriate baseline data. This process will
challenge many entrenched management practices, and will need to be approached from a change
management perspective and practices.
Monitoring, Evaluation, Accountability, and Learning (MEAL)
Establish a routine monitoring process that will provide information on the progress being made on the key
elements and processes of the NHRHMP. In addition to monitoring and evaluating the progress on the
content of the Plan and providing data to make appropriate revisions, a close tracking of the progress of
the performance indicators will be important as these are what will guarantee the commitment and support
necessary over time to solve chronic gaps in health service provision and access.

Beyond monitoring and evaluation, it is also vital that the insights and learning be drawn from the M&E data
and information so that true learning can happen. Lastly, monitoring and evaluation data and information
must be used to establish the accountability of the NHRHMP stakeholders who were given the power and
resources to steer the path to change.
Key Principles and Concepts
The UHC’s goal of ensuring that Filipinos have access to needed health care services requires an effective
human resource (HR) management policy and investment to ensure success. However, the preoccupation
of the government on size and distribution of the workforce, rather than on the more comprehensive and
strategic human resource practices has resulted in gaps in other areas of sustainable HRH management
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in the health sector.
4
The following presents the key principles that are adopted from the Health Action Framework to guide how
the HRH framework will be understood and applied so that it can serve as an important reference in the
transformation of the thinking, approach, and choice of priorities made under the NHRHMP. These
principles and concepts constitute the factors to be considered in the determination and evaluation of the
NHRHMP goals, strategies, activities, practices, and outcomes.
Content-Related Factors
 Results-focused planning and practices. HRH strategies and actions aim to achieve
measurable improvements of the NHRHMP
 System-linked alignment. HRH strategies are harmonized with the relevant components of the
health system with reference to the health labor market analysis as a guide.
 Information and knowledge-based decision making. Decision making reflects the best
available analysis of workforce data and other HRH related information, as well as documented
HRH experiences at the country and global levels
 Learning-oriented perspectives. Views indicate the use of M&E with a handful of well-chosen
performance indicators, metrics, and baselines and enriched by strategy reviews to identify
patterns of lessons learned and good practices to share within the country (across sectors and
NHRHMP stakeholders) as well as globally.
 Innovative solutions. There is openness to exploring new ways of thinking and working together
to find solutions to overcome chronic HRH issues.
 Comprehensive and integrated approaches. HRH strategies and activities are informed by,
interact with, and cut across health and other sectors using a holistic approach and with a
roadmap to guide users.
Process-Related Factors
 Stakeholder-led analysis and development of HRH initiatives. (Stakeholders refer to lead

agencies, organizations, and groups.) HRH improvements that are carried forward by the
concerned agencies, LGUs and stakeholder groups are critical to realizing HRHMP outcomes.
 Government-supported actions. The government’s commitment to support actions that
contribute to a sustainable health workforce.

 Multi-sector engagement. Engagement by all sectors relevant to building the health workforce
(e.g., finance, education, public-private providers, etc.).
 Multi-stakeholder involvement. The inclusion of interest groups relevant to actions (e.g., NGOs,
patient groups, professional associations, donor coordinating committees, etc.).
 Alignment of support from development agencies. International as well as local institutions
offering support and assistance to NHRHMP are coordinated and aligned.
 Gender sensitivity. Strategies and activities that take into account gender differences.
Management Practices
CHAPTER
Encircling the HAF are the management practices that must be embedded in all the KRAs identified, namely:
risk management, strategy management, change management, and performance management. These
4
management practices answer the WHY, WHAT, HOW, and HOW WELL of results or outcomes desired by
any organization. These practices are essential to the attainment of the UHC and NHRHMP thrusts. These
processes and practices must be entrenched as part of the business norm, through policies and guidelines,
and consequently detailed in operations manuals.
Figure 17. Skilled Management Practices for Attaining Results

Strategy Management
Strategy management practice pins down the WHY of change as it paints a clear direction that is beneficial
for the corporation and its stakeholders, after weighing different future scenarios with organizational
capacity. It defines the current state of the HRH and health system, where it wants to go, and how to get
there by determining strategic goals and initiatives. It also ensures that management rolls-out the
strategies across all levels and functions. It is a discipline that monitors, evaluates, provides corrective
measures or midcourse adaptations, and fine-tunes the strategy whenever necessary.
CHAPTER
4
Figure 18. Process of Strategy Management (Adapted from Fred David)
From the figure above, strategy formulation and management is iterative depending on the information that
is collected and generated from the ground as it goes through each process step. What is changed from
David’s rendition is that, 1) environmental scanning comes first before formulating the vision and mission,
as this makes the vision and mission statements grounded in the capacities of the agencies involved and
the situation of the Philippine health and HRH system, 2) alignment and cascading of NHRHMP strategies
to all pertinent units or agencies have to be performed, and 3) monitoring of all strategic initiatives/projects
is part of implementation because monitoring is not done after implementation but while at it. All these
process steps require constant consideration of the evolving context.
As regards alignment, each agency or organization identified as actors of the NHRHMP must identify their
respective strategies prioritizing the objectives. Institutional capacities have to be upgraded accordingly
and key agencies must synchronize efforts in identifying, developing, and pursuing their own strategies to
properly implement the plan.

As the strategy formulation can be regarded as a hypothesis on how best to achieve the goals envisioned
by the NHRHMP, it requires establishing and analyzing cause-and-effect correlations between the initiatives
undertaken and the attainment of objectives. Further, such correlations need to be tested, reviewed, and
revised whenever proven futile, obsolete, or irrelevant and henceforth to exclude strategies that are verified
as ineffective.
Risk Management
Risk management is an inherent part of any strategic planning process exercised at all levels of the
NHRHMP transformation. Threats and assumptions and measures to mitigate or eradicate them must be
identified during the planning stages to prevent any losses detrimental to the Plan’s objectives.
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It must be also noted that risk management is very much tied with service continuity management (SCM).
4
If an inopportune incident happens (e.g., IT hacks that compromise data security, adverse reputational risk,
etc.), an SCM builds the capability for an effective response that safeguards the interests of the NHRHMP
major stakeholders and their reputation. SCM encompasses service provision continuity (SC), crisis
communication (CC), crisis management (CM) or disaster recovery (DR) planning. Annex A, Table 1
contains a selection of well-known frameworks and regulations.
To guarantee that all controls will be deployed and maintained properly, agencies and organizations need
to move from ad hoc activities to a planned implementation and monitoring system. This system is known
as the Internal Control System or ICS. An Internal Control System is a tool that supports attaining the
objectives of an organization. It is defined by COSO (Committee of Sponsoring Organizations of the
Treadway Commission) as a process, effected by an entity's board of directors, management, and other
personnel, and designed to provide reasonable assurance regarding the achievement of objectives in the
following categories:
 Effectiveness and efficiency of operations

 Reliability of financial reporting
 Compliance with applicable laws and regulations
It should be noted that most governance frameworks utilize an ICS because of the need to measure and
control selected aspects of organization processes. Implementation of a governance framework requires
a (re)design of the ICS since new controls need to be added. After implementation, the established ICS
controls are used at the execution level to monitor running business processes.
Risk management strategies should also attempt to answer the following questions:
 What can go wrong? Consider the UHC implementation context, the HRH context, the agencies
involved, the workplace as a whole, and individual work.
 How will it affect the implementation and outcomes of NHRHMP? Consider the probability of
the event and whether it will have a large or small impact.
 What can be done? What steps can be taken to prevent or mitigate the loss? What recovery can
be done if a loss does occur?
 If something detrimental happens, how will the agency or organization involved in the
implementation compensate for it?

Limitations
While risk management can be an extremely beneficial practice for organizations, its limitations should
also be considered. Many risk analysis techniques––such as creating a model or simulation–– require
gathering large amounts of data. This extensive data collection can be expensive and is not always
guaranteed to be reliable.
Furthermore, the use of data in decision-making processes may have poor outcomes if simple indicators
are used to reflect the much more complex realities of the situation. Similarly, adopting a decision
throughout the whole project that was intended for one small aspect can lead to unexpected results.
CHAPTER
Another limitation is the lack of expertise and time for analysis. Computer software programs have been
developed to simulate events that might have a negative impact on the company. While cost effective,
4
these complex programs require trained personnel with comprehensive skills and knowledge to accurately
interpret the generated results. Analyzing historical data to identify risks also requires highly trained
personnel, who may not always be assigned to the project. Even if they are, there is frequently not enough
time to gather all their findings, thus resulting in conflicts.
Other limitations include:
 A false sense of stability. Value-at-risk measures focus on the past instead of the future.
Therefore, the longer things go smoothly, the better the situation looks. Unfortunately, this
makes a downturn more likely.
 The illusion of control. Risk models can give organizations the false belief that they can quantify
and regulate every potential risk. This may cause an organization to neglect the possibility of
novel or unexpected risks. Furthermore, there is no historical data for new products, so there's
no experience to base models on.
 Failure to see the big picture. It's difficult to see and understand the complete picture of
cumulative risk.
 Risk management is immature. An organization's risk management policies are
underdeveloped and lack the history to make accurate evaluations.
Risk Management Standards
Risk management standards have been developed by several organizations, including the National Institute
of Standards and Technology (NIST) and the International Organization for Standardization (ISO). These
standards are designed to help organizations identify specific threats, assess unique vulnerabilities to
determine their risk, identify ways to reduce these risks, and then implement risk reduction efforts
according to the organizational strategy.

The ISO 31000 principles, for instance, provide frameworks for risk management process improvements
that can be used by companies, regardless of the organization's size or target sector. The ISO 31000 is
designed to "increase the likelihood of achieving objectives, improve the identification of opportunities and
threats, and effectively allocate and use resources for risk treatment," according to the ISO website.
Although ISO 31000 cannot be used for certification purposes, it can help provide guidance for internal or
external risk audit, and it allows organizations to compare their risk management practices with the
internationally recognized benchmarks. The ISO recommends that the target areas or principles should be
part of the overall risk management process, as seen in Figure 19.
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4
Figure 19. ISO 31000 Risk Management Framework
The ISO standards and others like it have been developed worldwide to help organizations systematically
implement risk management best practices. The ultimate goal for these standards is to establish common
frameworks and processes to effectively implement risk management strategies.
These standards are often recognized by international regulatory bodies, or by target industry groups. They
are also regularly supplemented and updated to reflect rapidly changing sources of business risk. Although
following these standards is usually voluntary, adherence may be required by industry regulators or through
business contracts.
Change Management
Change management deals with the human side of change. It provides tools, processes, techniques, and
principles in dealing with people to achieve the desired organizational outcomes. To have a better grip at
designing, implementing, and measuring those changes, a change management approach should be able
to link three elements for a successful change: a) organizational results and benefits, b) individual behavior

and c) change management strategy execution. Organizational benefits largely deal with the desired
outcomes of the organization.
Change management is a systematic approach that includes dealing with the transition or transformation
of organizational goals, core values, processes, or technologies. The purpose of every organizational
change management initiative is to successfully implement strategies and methods for effecting change
and helping people to accept and adapt to change.
In the same manner that the changes in policies were mapped out for the UHC, the implications of these
changes and the changes the NHRHMP will bring about have to be mapped out as well. The transformation
from the current state to the desired state must be clearly defined as part of helping people adapt and
CHAPTER
prepare. This time though, what needs to be mapped out are not the implications of NHRHMP to policies
but to the IT systems, processes, staffing, structure, units, compensations, or movements, if any.
4
Several other systems and policies will have to change for the UHC law to realize its full impact. The
interaction of multiple and overlapping changes happening at the same time––in the face of shifts resulting
from the pandemic––compounds the complexity, volatility, ambiguity, and uncertainty of the whole
environment of NHRHMP.
Stakeholders will be standing on the threshold between two realities and experiencing the shift between
realities of the old and the new as the NHRHMP is being implemented. Work will be unrelenting and
stressful and more information will be needed. Interactions will be pressured and laden with stress.
Relationships will unfold rapidly; this will daunt some but inspire others with the range of possibilities to
break ground and provide better healthcare for the people.1
Second, this kind of change imposes a new way of thinking and doing––especially in implementing an
agile, networked approach of governance, which is radically different from how the bureaucracy works at
present. Hence, mindsets, behaviors, and culture must shift too. Otherwise, if people who are supposed to
run these systems will not have the proper attitude or will not be inclined or motivated to do so, the whole
implementation will not work even when the project side of things is carried out.
A strong case for change must be presented. The UHC Law and the pandemic are clear signals for such
transformation to happen, but this must be solidly presented to all external and internal stakeholders.
Annex A, Table 2 shows several models that may help in identifying change management strategies that
will facilitate these changes.
Performance Management
Performance management is an ongoing process of communication between a supervisor and an

employee in support of accomplishing the strategic objectives of the organization. The communication
1
Anderson, D., & Ackerman-Anderson, L. S. (2010). Beyond change management: How to achieve breakthrough results through
conscious change leadership [Ebrary version]. Retrieved from
https://ebookcentral.proquest.com/lib/ebooknps/detail.action?docID=624404

process includes clarifying expectations, setting objectives, identifying goals, providing feedback, and
reviewing results.
Overseeing performance -- and providing feedback -- is not an isolated event, focused on an annual
performance review. It is an ongoing process that takes place throughout the year. The ‘performance
management’ process is a cycle, with discussions varying year-to-year based on changing objectives.
The cycle includes planning, checking-in, and review.
To begin the planning process, you and your employee review overall expectations, which include
collaborating on the development of performance objectives. Individual development goals are also
CHAPTER
updated. You then develop a performance plan that directs the employee's efforts toward achieving
specific results to support organizational excellence and employee success.
4
Goals and objectives are discussed throughout the year, during check-in meetings. This provides a
framework to ensure employees achieve results through coaching and mutual feedback.
At the end of the performance period, the supervisor reviews the employee's performance against expected
objectives, as well as the means used, and behaviors demonstrated in achieving those objectives. Together,
they establish new objectives for the next performance period.
Financial Management
Sound management of financial resources is fundamental in attaining success in any project. But beyond
simple application of management practice to money matters, the government agencies’ accountability for
the taxpayers’ money and the citizens’ monthly contribution must be kept in mind.
Multiple projects and initiatives will be launched in the implementation of NHRHMP, thus necessitating
smart program and project management that will establish oversight and ensure the coherence of these
undertakings. Activities and policies that have cross-cutting requirements will need close coordination to
achieve the program goals in spite of resource and time constraints. Multiple projects and programs will
require many work teams across stakeholder groups planning, organizing, staffing, implementing, and
controlling resources.
Adaptation and learning of appropriate management practices must be guided by clearly established
standards, provided with tools, and driven by innovations. It needs a thorough consideration of the distinct
organizational contexts, purpose/mandate, and work culture of the stakeholder groups––public and private
sector, at the national and local levels.

CHAPTER 5
HRH Data Governance

and Information Management
HRH Data Governance and Information Management | 66

CHAPTER FIVE
HRH DATA GOVERNANCE AND INFORMATION MANAGEMENT
In this digital age, governments understand the growing importance of data and information as materials
for evidence-informed decisions and foundations for improved health policymaking, service delivery,
innovation, and performance management. Evidence-informed decision making in HRH policies and
practices are critical in the development and management of health programs to achieve the desired health
outcomes that are aligned with the priorities of the UHC. This can only be sustained through an effective
data governance that will ensure progressive production and management of accessible, complete, up-to-
date, and quality HRH data and research.
Data governance addresses the need for accountability in the identification, generation, processing,
analysis, and storage of data through well-defined practices and processes that will enable management
of data assets in a proactive way to achieve the NHRHMP objectives. It is a means to manage complex
integration between people, processes, and technology with appropriate governance to ensure that data is
CHAPTER
trustworthy, relevant for decision making, protected, and utilized only for its intended purpose1.
5
On the other hand, information management refers to the cycle of creation, acquisition, organization,
storage, and distribution for effective and efficient information access, processing, and use by people and
organization2. It provides guiding principles in designing, developing, managing, and using HRH information
to support decision making and create value for HRH.
SITUATION
Currently, there are multiple human resources for health information systems (HRHIS), managed by various
agencies and key players. Many data are being collected but some or most of which do not meet the
standards in terms of accuracy, completeness, timeliness, and consistency. The data problem or challenge
is further aggravated by a lack of institutionalized sharing mechanisms to ensure that relevant stakeholders
are supplied with the necessary information for their purposeful use.
Some of the most pressing problems besetting the Philippine health workforce may be solved by an
integrated information system with accurate, up-to-date, valid, and complete HRH data. It can help ensure
that the health workers' skills match the needs of the population, result in a more equitable distribution of
the health workforce, lead to better-targeted interventions, and enable government units to project the HRH
needs accurately. However, the country has yet to build such an information system.
The next few sections will map out the possible sources of HRH data, provide details on existing HRHIS
and their limitations, lay-out policies related to data governance and information management, and
introduce the National Health Workforce Account as a framework in developing a national HRH data
architecture.
1
What is HRH Data Governance Retrieved from https://www.wordofprint.com/2020/06/hr-data-
governance.html#:~:text=%22Data%20 governance%20is%20a%20 set,to%20 achieve%20 strategic%20business%20 objectives
2
Detlor, B. (2010). Information Management. Retrieved from
https://www.sciencedirect.com/science/article/abs/pii/S0268401209001510

HRH Data and Possible Sources
The scope of HRH data encompasses the health labor market spectrum:
● Entry (pre-service education, registration, licensure)

● Workforce (compensation and benefits, health workforce registry, in-service training, personnel
actions, staffing gaps)
● Exit and re-entry (staffing gaps, workforce exit/attrition, return/re-entry)
Such data should also be linked with population health needs to draw deeper insights on how HRH
becomes a critical gear in optimizing the health system.
In the Philippines, there are several key agencies and organizations that are possible sources of HRH data
and information throughout the health labor market stages.
Table 5. Possible Sources of HRH Data

CHAPTER
Source Agency / Institution / HRH-Related Data and Information

5
Organization
Entry or HRH Production Data
 Commission on  Data on HEIs: updated list of schools offering health

Higher Education sciences education and status of accreditation, number of
(CHED) qualified educators per course
 Higher Education  Data on admissions and graduates: number of applicants,
Institutions (HEIs) number of enrollees, number of graduates, number of drop-
 Association of outs, number of foreign-born enrollees and graduates
Deans/Colleges, such as:  Data on scholarships for medical and other health
professions education under the Unified Financial
- Association of
Assistance System for Tertiary Education (UNIFAST):
Philippine Medical
number of scholars, number of graduates, cost of
Colleges (APMC)
scholarships, attrition rates, return service obligation
- Association of Deans compliance
of Philippine Colleges
 Data on education financing: average tuition fee per student
of Nursing, Inc.
per year, expenditure per graduate, cost of qualified
(ADPCN)
educators per graduate, total expenditure on health
- Association of workforce education
Philippine Schools of  Data on existing policies/standards on: mechanisms for
Midwifery (APSOM) accreditation of HEIs and their programs, duration and
 Students Networks content of health sciences education
(e.g. APMC-SN)
62 | HRH Data Governance and Information Management

Organization
 Department of Health (DOH)  Data on medical and health professions’ education

scholarships under the Pre-Service Scholarship Program
 Professional  Data on registered and licensed health and allied health

Regulation professionals: number of registered professionals those
Commission (PRC) with valid licenses, professionals in active practice,
 Professional organizations distribution (geographic area, facility type and ownership,
and specialty societies etc.), specialization, etc.
 Health facilities and offices
 Technical Education and

 Data on skills and vocational trainings: list of available
Skills Development
trainings and institutions offering these trainings, total
Authority (TESDA)
expenditure per training
CHAPTER
 Data on enrolled,, assessed and certified skilled health
workforce
5
Health Workforce Data
 DOH  Data on HRH in public and private health facilities, including

 Department of the Interior primary care facilities: number of HRH, distribution,
and Local Government employment status, etc.
(DILG)  Vacancies for HRH posted on platforms, such as
 Department of Labor PhilJobNet (DOLE Bureau of Labor and Employment)
and Employment
 Data on HRH job seekers from registrants in the
(DOLE)
PESO Employment Information System (DOLE
 Department of Science Bureau of Labor and Employment)
and Technology (DOST)
 Data on HRH in academe, administrative services, health
 HEIs policy, public health, research and development: number of
 Health facilities and offices HRH, distribution, employment status, etc.
 Philhealth  Data on self-employed HRH (i.e. private practice of
profession)
 PRC
 Number of foreign-born HRH permitted by PRC to practice/
 Professional organizations and
train in the country
specialty societies
 Data on investments for HRH: compensation and benefits,
continuing professional development, financial and non-
financial support, etc.
 Minimum wages for the private sector (source:
National Wages and Productivity Commission)
 Average wages (source: various surveys conducted
by the Philippine Statistics Authority)

Organization
 Data on existing policies/standards on: mutual recognition

agreements, occupational safety and health, practice of
profession including dual practice and compulsory service,
prevention of attacks on health workers, regulation of
wages, social protection, working hours and conditions
 Data on medical and health profession training: list of
accredited institutions offering specialty training and other
in-service/continuing professional development (CPD)
opportunities
 Data on in-service training financing: cost of in-service
training per health worker
 Data on existing policies/standards on: accreditation of
specialist and other in-serving trainings/programs and
CHAPTER
institutions offering them, continuing professional

5
development
 Department of Budget and  Number of authorized and filled health and allied health
Management (DBM) positions
 Data on investments for HRH: cost of health sciences
education, scholarships, training, compensation and
benefits for the public sector, etc.
 Civil Service Commission  Number of authorized and filled positions of various health
(CSC) and allied health positions
 Data on HRH qualification standards
 DOH  Data on community health workers: Barangay Health

Workers and Barangay Nutrition Scholars
- Bureau of Local Health
System Development
(National BHW
Registry)
- Epidemiology
Bureau (Field Health
Service Information
System)
 National Nutrition Council
Exit and Re-entry Data
 Bureau of Immigration (BI)  Data on permanent and temporary migration of HRH

 Commission of  Data on HRH re-entries

Organization
Filipinos Overseas  Data on entry and exit of foreign-born HRH

(CFO)
 Data on existing policies and standards on: ethical
 National Reintegration recruitment on migrant HRH, international labor policies and
Center for OFWs (NRCO) agreements, safety and welfare of HRH OFWs
 Overseas Workers
Welfare Association
(OWWA)
 Philippine Overseas
Employment
Administration (POEA)
 Bureau of Internal  Data on HRH voluntarily leaving the health sector labor
Revenue (BIR) force: HRH in other sectors/industries or self-employed
CHAPTER
 DOLE HRH who are no longer practicing their profession
5
 Government Service  Data on HRH involuntarily leaving the health sector labor
Insurance System (GSIS) force: death, forced unemployment, long-term illness,
and Social Security System retirement, work suspension, and other reasons
(SSS)
 HRH employers: health
facilities and offices,
government agencies
 Philippine Statistics Authority
(PSA)
 Others: Home Development
Mutual Fund (HDMF), Land
Transportation Office (LTO)
In addition to these agencies/institutions/organizations, it is also highly critical to engage the private sector
as a source of HRH data and information.
Besides the quantity of collected data, equally important are the sufficiency, quality, and timeliness of
data/information to complete the picture of the country’s HRH. This shall be used to monitor and evaluate
the progress in HRH management and development described in this HRH Master Plan.
Human Resource Information Systems
Several HRH information systems, both online and offline, are maintained by various stakeholders, based
on their mandates and functions.

Table 6. List of HRH Information Systems
Name of HRH data Technology used Managed by Remarks

Information provided
System
DOH
National Information of Web-based Health Human Includes 11 cadres of

Database of HRH working in platform Resource HRH: Dentist, Physician,
Selected hospitals, Development Medical Technologist,
Human primary care Bureau (HHRDB) Midwife, Nurse,
Resources facilities, and Nutritionist/ Dietician,
for Health other health Occupational Therapist,
Information facilities Pharmacist, Physical
System licensed by Therapist, Radiologic
(NDHRHIS) HFSRB** Technologist, X-ray
CHAPTER
Technologist
5
Only captures about 22%

of all health
professionals with active
licenses, based on PRC’s
data
Field Health Number of HRH iClinicSys is an Knowledge Includes 8 cadres of

Service hired under Electronic Management HRH: Physician, Nurse,
Information plantilla and Medical Records and Midwife, Nutritionist-
System contractual that can be Information Dietitian, Medical
(FHSIS) positions of local accessed both Technology Technologist, Sanitary
integrated government online and offline Service Engineers, Sanitary
into the units Inspectors, Barangay
iClinicSys Epidemiology
Health Workers
Bureau
FHSIS used to be
paper-based
HRH Areas of Offline Excel HHRDB Includes 9 cadres

Deployment assignment Database of HRH: Physician,
Program and other Dentist, Nurse,
Database personal Pharmacist,
information on Medical
HRH deployed Technologist,
by DOH Nutritionist-
Dietitian, Public
Health Associates,
Midwife, Physical
Therapist

System
Database of Filled and Offline Excel Administrative

plantilla unfilled Database Service
positions in medical, allied Personnel
DOH- health, and Administration
managed administrative Division
health positions in
facilities DOH-managed
facilities and
offices
Other Agencies
Integrated Set-up in 2017 Web-based HRH Network Implementation has not
CHAPTER
Database of as an effort to platform Philippines been sustained
Human integrate the
5
Resources available HRH
for Health network
Information member
System institutions
from entry,
workforce, exit,
and re-entry
CHED Enrollees and Web-based Commission on

Electronic graduates from platform Higher
Collection higher Education
and education (CHED)
Knowledge institutions
System
(CHECKS)
Licensure Personal Web-based Professional Used by PRC for

Examination information of platform Regulation registration, processing
and registered and Commission of board exam
Registration licensed HRH (PRC) applications, license
Information renewal, and other PRC
System ID verifications of ALL
(LERIS) professionals
Government Number of Computer- Department of Does not include

Manpower authorized and based Budget and data from
Information filled plantilla management Management government-owned
System positions in (DBM) and - controlled

System
(GMIS) government information corporations and

health facilities system local government
and offices units3
Inventory of Filled and Web-based Civil Service Gathers relevant

Government unfilled platform Commission government personnel
Human Plantilla HRH (CSC) data, including the data
Resources positions on Job Order (JO) or
System Contract of Service
(IGHRS) (COS) personnel
Overseas Permanent Web-based Commission on Captures permanent

Filipino - CFO health platform Filipino migrants who
CHAPTER
Online migrants Overseas (CFO) underwent CFO’s

Registration registration, (physical
5
System (OF- and online) pre-

CORS) for departure orientation
Emigrants seminar, and guidance
and and counselling
Guidance program
Counseling
Program
Overseas Temporary Web-based CFO Captures medical

Filipino - CFO health platform professionals who
Online migrants (EVP underwent CFO’s
Registration participants) registration (physical
System (OF- and online)
CORS) for
Exchange
Visitor
Program
(EVP)
Registry of Information Web-based TESDA Captures information on

Certified certified platform skilled workers who
Workers workers have obtained
certification for certain
occupations nationwide
3
Department of Budget and Management. Manual on Position Classification and Compensation. Retrieved from
https://www.dbm.gov.ph/wp-content/uploads/2012/03/Manual-on-PCC-Chapter-4.pdf

System
Web-based Migrant health Web-based POEA Used by Philippines

OFW Welfare workers platform Recruitment Agencies
Monitoring to report the status and
System condition of OFWs
(OWMS) deployed until return to
the Philippines
The above-mentioned agencies and other agencies and organizations, including select medical specialty
societies, generally extract HRH data from their systems and/or databases, and transmit them to the DOH
either through MS Word/PDF/Excel raw data format or aggregate statistical reports upon official request.
The HHRDB, primarily consolidates HRH data from multiple sources, through MS Excel and is currently
transitioning to data visualization using the MS Power BI software.
CHAPTER
Initial Evaluation of HRH Information Systems
5
In 2018, an assessment of 20 HRH information systems (HRHIS), 11 of which were managed by the DOH
and 9 by external organizations, was conducted using the PEPFAR Human Resource Information System
Framework to determine HRHIS functionality and capacity within the DOH and Human Resource for Health
Network (HRHN)4. The findings of the assessment are as follows:
● HRHIS infrastructure. None of the HRHIS assessed was capable of completing the cycle of
collecting, consolidating, and arranging to produce meaningful information. Although half of the
HRHIS used advanced databases to enter and store data, most of these were available only
within the network of the agency or organizational unit. A quarter used a combination of a
database platform and Excel for data collection and the remaining HRHIS used purely Microsoft
Excel or were paper-based.
● Decentralization of access and methods of data entry. Most of the systems did not offer a portal
for an intended user to update or view his/her own data. Access was centralized to the
authorized users of the agency/organization. Half of the systems were only updated on an ad
hoc basis (e.g. registration at a training activity) while the remaining HRHIS were updated at an
established interval, usually yearly. Most of the HRHIS used electronic reporting by sending Excel
spreadsheets to a central office and direct entry into the database either through web- based or
non-web-based platforms. For a third of the HRHIS, data reporting was entirely paper-based.
● Data quality and data standards. The HRHIS assessment had a notable lack of process and
practices to ensure data quality, such as (1) existence of standardized formats for data entry, (2)
processes to ensure quality of data entered, and (3) data quality assessments. Most systems
had only minimal processes in place, which were often ad hoc.
4 Philippines Human Resource Information System Assessment Framework Report. (2018). USAID HRH2030 Philippines. Retrieved
from https://hrh2030program.org/wp-content/uploads/2020/06/HRH2030-Philippines-HRIS-Assessment- Framework-
Report_Final.pdf

There is a need to establish the data sets and standards for HRHIS. Data standards will facilitate
data sharing, whether through manual upload or automated exchange. Equally important is to
establish data exchange standards.
Implementing data quality improvement measures, such as using functionality built into
software or embedding simple algorithms to detect potential errors or duplication, is critical to
ensure data quality. Data quality must improve for decision makers to trust its use.
● Data use: Six of the nine HRHIS that used an advanced database for storage did not have the
ability to generate a report automatically. Most systems did not use data from their information
system to inform HRH management functions such as vacancy analysis, turnover analysis,
training needs, and others. Raw data was shared most often with researchers. About two-thirds
of the HRHIS did not share data. Concerns about violation of the Data Privacy Act were raised in
the context of data-sharing.
CHAPTER
Basic analysis – even simple summarization to identify gaps in completeness and quality, should
be performed. Hiring data analysts can also be explored to expand data analysis.
5
● Sustainable financing: HRHIS component systems using databases had a high degree of
financial sustainability as most were funded by local agencies/institutions. Twelve of the twenty
HRHIS had planned enhancements. This is a highly encouraging enabling factor and should be
sustained.
● Human capacity: For all HRHIS, the staff operating or supporting the systems were local and
employed by Filipino institutions. One area of concern is that most systems had few staff users,
who often held deep institutional knowledge of the system. This left the program vulnerable in
case these employees left their jobs, especially if there was inadequate system documentation.
It is recommended that staff handling HRHIS should be hired under permanent positions to
ensure sustainability.
● Interoperability: The assessment showed that interoperability was only accomplished through
exporting and uploading Excel files.
An enabling factor to initiate interoperability, or at least, data sharing, is through the HRH
Network. With an established mechanism to advocate for and collaborate on HRH-related issues,
the Network can be tapped to facilitate discussion and feedback from stakeholders, implement
and monitor HRHIS policies, standards, etc., and dedicate resources that will be required to
improve HRHIS.

Policies on Data Governance and Information Management
Policies related to information systems management stipulate legal provisions on comprehensive

regulation of ICT services5, human resource capacity development to enable personnel to operate and use
technology6, establishment of ICT physical infrastructure7, processes for data exchange and sharing8,
utilization of data9, and data privacy10. Three policies directly relevant to integrating and managing HRHIS
are: the (1) Philippines eHealth Strategic Framework and Plan 2017 11, (2) DOH-PRC Joint Administrative
Order on the Establishment, Utilization, and Maintenance of the National Health Workforce Registry
(NHWR)12, and (3) Data Privacy Act.
Philippines eHealth Strategic Framework and Plan. The eHealth plan served as the strategic framework in
the application of information communications technology to support health sector reforms and other
critical health programs. Aligned with this, the DOH developed the Philippine Health Information System
Strategic Plan, which laid out its vision, mission, priority focus, and strategies in implementing eHealth for
greater efficiency in health care, workforce productivity and optimal use of resources. This also forged a
partnership with the Department of Science and Technology (DOST), creating the Joint DOH-DOST National
Governance Steering Committee and TWG on eHealth. The joint undertaking established and implemented
CHAPTER
the Philippine Health Information Exchange (PHIE) platform for secure electronic access and efficient
5
exchange of information. Although this system is currently focused on patient medical records and
PhilHealth primary care benefits, its potential use for the integration and harmonization of HRH-related data
nationwide may be explored. The plan also provides for an impetus to the integration of HRH information
systems.
DOH-PRC Joint Administrative Order on the Establishment, Utilization, and Maintenance of the National
Health Workforce Registry. Mandated under the Universal Health Care Law, the establishment of the NHWR
will pave the way for accurate and timely health workforce data in the country. The NHWR provides a
mechanism for routine data collection and data sharing, primarily between PRC and DOH, as well as other
HRH data sources, for validation. The policy also mandates the creation of a multi-sectoral committee to
facilitate collaboration, consultation, participation, and partnership for the implementation of the NHWR
and furtherance of HRHIS efforts.
5
Philippine Congress. Republic Act 10844: Department of Information and Communications Technology Act. Manila, 2016. Retrieved
from https://dict.gov.ph/wp-content/uploads/2016/05/RA10844_DICT.pdf
6
Philippine Congress. (2000). Republic Act 8792: Electronic Commerce Act. Manila, Philippines. Retrieved from
https://www.officialgazette.gov.ph/2000/06/14/republic-act-no-8792-s-2000/
7
Philippine Congress. (2018). Republic Act 11293: Philippine Innovation Act. Manila, Philippines. Retrieved from
http://www.neda.gov.ph/wp-content/uploads/2019/12/RA-11293-or-the-Philippine-Innovation-Act.pdf
8
Philippine Congress. (1195). Republic Act 10022: Migrant Workers and Overseas Filipinos Act. Manila, Philippines. Retrieved from
http://hrlibrary.umn.edu/research/Philippines/RA%2010022-%20%20Migrant%20Workers%20Act.pdf
9
Philippine Congress. (2012). Republic Act 10625: Philippine Statistical Act. Manila, Philippines. Retrieved from
https://www.officialgazette.gov.ph/downloads/2013/09sep/20130912-RA-10625-BSA.pdf
10
Philippine Congress. (2012). Republic Act 10173: Data Privacy Act. Manila, Philippines. Retrieved from
https://www.privacy.gov.ph/wp-content/uploads/DPA-of-2012.pdf
11
Department of Information and Communications Technology. (2019). E-Government Masterplan 2022. Manila, Philippines.
Retrieved from https://dict.gov.ph/ictstatistics/wp-content/uploads/2020/03/EGMP-2022.pdf
12
Department of Health and Professional Regulation Commission. (2021). Joint Administrative Order 2021-0001: Guidelines on the
Establishment, Utilization, and Maintenance of the National Health Workforce Registry (NHWR). Manila, Philippines. Retrieved from
https://doh.gov.ph/sites/default/files/health-update/DOHPRCjao2021-0001.pdf

Data Privacy Act. The main policy that ensures data privacy in the country is Republic Act No. 10173 or the
Data Privacy Act of 2012, governed by the National Privacy Commission, a DICT-attached agency. It aims
to protect and ensure individual privacy, personal data information management, and compliance with data
protection international standards. Further, the law also provides data subjects the right to know the
description, purpose, scope, and method of their personal information that is for processing and/or
disclosure, among others. However, implications of the Data Privacy Law creation and integration of HRIS
need to be further studied as this is often seen as a barrier to data sharing.
Adopting the National Health Workforce Accounts
The country has committed to adopt and progressively implement the National Health Workforce Accounts
(NHWA) to establish a sector-wide HRH data architecture (see box on NHWA highlights). The NHWA was
developed by the WHO and other partners, through the Global Strategy on Human Resources for Health:
Workforce 2030, to continually produce quality and timely HRH data and monitor sets of indicators and
modules towards the attainment of universal health care and sustainable development goals, among
others13. The NHWA will be used to:
CHAPTER
● Identify/prioritize which data to collect, or come up with proxy indicators that are more attuned to
5
the country’s context;

● Create a harmonized, integrated approach for regular and timely collection of HRH data; and
● Improve the HRH information architecture and interoperability.
Research Development
An evidence-informed decision making is not only anchored on quality data that is secure and protected,
but also on research evidence that is informative and innovative. The DOH recognizes the importance of
rigorous research initiatives and reliable research evidence to guide national plans, programs, and projects.
Under the DOH Department Order No. 2008-0086, the Philippine National Health Research System (PNHRS)
was institutionalized to support the health sector reform efforts in the DOH. This health research system is
led by four core implementing agencies/institutions: the DOH, DOST, CHED, and University of the
Philippines- National Institutes of Health (UP-NIH). It is facilitated by the DOH- Health Policy Development
and Planning Bureau (HPDPB) and the DOST-Philippine Council for Health Research and Development
(PCHRD) as the secretariat.
The PNHRS is the overarching governance of health policy and system research in the country. It seeks to
promote, facilitate, and coordinate health research initiatives in six key areas: research agenda; ethics;
capacity building; research utilization; research mobilization; and structure, organization, and monitoring
and evaluation.
Through its Research Agenda Committee, it developed and implemented the National Unified Health
Research Agenda (NUHRA), which summarizes the health research and development directions and efforts
13
World Health Organization. (2017). Understanding National Health Workforce Accounts. Retrieved from:
https://apps.who.int/iris/handle/10665/275758

of the country for a given period. This platform may be utilized to promote researches on HRH, especially
for undergraduate and postgraduate studies.
To further the country's efforts in strengthening research that is translatable to policy formulation, the DOH
forged a partnership with other government research institutions through the Research Reference Hub
(RRH)14. The RRH became the arm of the management program for research.
Developed by the DOH, the Health Systems Research Management (HSRM) Program was formulated to
steer health research implementation and management in the DOH through organized health research
management processes, such as health research agenda-setting, procurement and contracting, health
research implementation, and health research dissemination and utilization 15.
The HSRM Program was later improved and called as Advancing Health through Evidence-Assisted
Decisions with Health Policy and Systems Research (AHEAD-HPSR) Program under AO No. 2017-001516.
This program seeks to enhance research communication and translation, to streamline research ethics
review, and to produce international research collaborations, among others. Under the Research Capacity
Development of AHEAD, the DOH also strengthened its HPSR initiatives by capacitating a pool of young
CHAPTER
professionals through the DOH Regional HPSR Fellowship Program.
5
The DOH, through HPDPB, has identified HRH-related research activities under Service Delivery, to achieve
the policy agenda under the Integrated Health Agenda 2019–2022. This includes a review of HRH skill mix
and succession planning towards appropriate staffing standards in health facilities; development of HRH
production and distribution projections; identifying optimal financial and non-financial benefit package for
HRH, and a study on the Health Leadership and Governance Program to capacitate leaders in the health
sector.
In collaboration with the HPDPB-HRD and external implementing agencies, and with the strong support of
institutional research partners (i.e. Philippine Institute for Development Studies, DOST-PCHRD, or UP- NIH),
the HHRDB has produced several research studies in the past. Two of these studies are "HRH Distribution
and Policy Impacts of the Doctors to the Barrios Program: A Formative Evaluation," done in 2014 and
"Determinants of Rural Retention of HRH" in 2016.
Currently, the HHRDB has an ongoing research entitled "Determining the Implementation Status of Benefits
under the Magna Carta of Public Health Workers in the Philippines," led by external research proponents in
coordination with the HPDPB and PCHRD. The HHRDB, based on current and priority issues, and in
consultation with relevant stakeholders, also annually comes up with HRH-related research topics, being
submitted to HPDPB for inclusion to the DOH research agenda.
14 Department of Health. (2008). Department Order 2008-0086: Institutionalizing the Philippine National Health Research System
(PNHRS) in support of the health sector reform efforts in the Department of Health. Manila, Philippines.
15 Department of Health. (2014). Department Order No. 2014-0171: Guidelines on the Implementation of Health Researches in the
Department of Health. Manila, Philippines.

16 Department of Health. (2017). Administrative Order No. 2017-0015: Framework for Advancing Health through Evidence-Assisted
Decisions with Health Policy and Systems Research (AHEAD with HPSR) Program. Manila, Philippines.

DOH units are mandated to submit reports on their research utilization and dissemination, as per DO No.
2014-0171. Research dissemination is regularly done through the National Health Research Forum for
Action and other national and international research fora and conferences.
WHAT IS THE NATIONAL HEALTH WORKFORCE ACCOUNT?

The NHWA is closely aligned with the health labor market framework for UHC. It provides a comprehensive
picture of the education and health labor market dynamics, in which the economy, population, and society
act as drivers to attaining UHC and optimal healthcare services as the outcome.
The NHWA contains 78 indicators spread over 10 modules, clustered into dimensions (e.g. HRH stock,
distribution, migration). NHWA indicators include both numeric and ‘capability’ indicators that provide
information on regulation and other mechanisms related to the health workforce. The DOH and other HRH
stakeholders initially identified 34 NHWA indicators to support the priority HRH policy needs, which are
integrated in this HRHMP.
CHAPTER
5
In 2019, through the assistance of the USAID HRH2030 Project, the DOH has endeavored to develop a
roadmap for the NHWA; adopting three (3) phases of progressive implementation: (1) conceptualization
which will lay the operational foundation and direction, (2) operationalization which will provide details on
the “how” of collection, management, and analysis of data, and (3) monitoring and evaluation which will
systematically track and review the NHWA implementation to ensure its effectiveness. Added to this is
capacity building, which is a cross-cutting activity in all the phases, to ensure that relevant stakeholders will
be able to carry forward implementation and maintenance of the system and actual utilization of the data.
DOH is currently in phase 1, wherein efforts are focused towards establishing a core governance structure,
data mapping and scoping analysis, and establishing plans and mechanisms for monitoring and evaluation.
Continuous capacity building is also being conducted.

The PCHRD, in coordination with HPDPB, developed the Philippine Health Research Registry (PHRR), a
public database where all research projects are registered by their proponents upon the approval of their
research proposals. The DOH Resource Center for Health System and Development (RCHSD) website,
where researches are monitored and stored, was also set up.
ISSUES AND IMPLICATIONS
Multiple, Fragmented HRH Information Systems
The country’s HRH information systems, both within and outside the DOH, are fragmented. HRH data
standards, data sharing, coordination, and governance structures are either not in place or require
strengthening. This has led to the development of multiple systems, difficulty in harmonizing data, and
gaps in data quality.
Despite the substantial volume of HRH data being collected, no central repository exists to integrate the
CHAPTER
HRH data from myriad systems. The fragmented structure limits the country’s ability to create a national
representation of the health workforce.
5
With the UHC Law mandating the DOH to be the central repository of data, and the recently issued DOH-
PRC policy on NHWR initiating this mandate, this may pave the way of tapping existing networks to facilitate
integration of HRH data and enable meaningful analysis and reports for evidence-based decision making
and policy formulation.
Established in 2006, the HRH Network formed the foundation of a multi-sectoral collaboration and
understanding to steer HRH policy direction and data sharing among its member agencies and
organizations. It is composed of various institutions with independent and overlapping mandates over four
themes: HRH entry, workforce, exit, and re-entry. The HRH Network continues to strengthen data-sharing
efforts among its members, which continue to increase in number over time 17.
Similar to the HRH Network, the National eHealth Steering Committee (NeHSC), co-chaired by DICT and
DOH, and the National eHealth Technical Working Group (eHealth TWG) anchors collaboration and
partnership with various institutions, to spearhead the establishment of a national eHealth system, and
other ICT initiatives, programs, and projects across the country. There are agencies and organizations that
are members of both the NeHSC and the HRH Network; however, there is minimal inclusion of HRH-related
information in eHealth data management. The eHealth initiative mainly focuses on clinical data and health-
related information.
A collaboration of the two networks could be an optimal opportunity towards a concrete HRH data
governance.
17Joint Statement of Commitment for the Creation of the Human Resources for Health Network Philippines - Memorandum of
Understanding.

Lack of Quality HRH Data
There are six primary criteria to determine data quality: completeness, uniqueness, timeliness, validity,
accuracy, and consistency. Although several mature HRH information systems have existed in the country
for years, their data quality and use are limited.
On data completeness
HRH-related information systems managed by different offices in DOH have limitations. The DOH’s
National Database for HRH Information System (NDHRHIS), which is intended to collect individual health
worker registry data from health facilities, both public and private, only captures about 22% of the PRC-
registered HRH with active licenses. The DOH’s iClinicSys, developed to collect data from primary care
facilities, has limited health worker data as it is entirely dependent on Philhealth’s accreditation, and
Philhealth only accredits physicians, dentists, midwives, and nurses. The DOH’s Field Health Information
System (FHSIS) provides numbers of health workers in local government units but it does not capture HRH
under Job Order or contractual positions.
CHAPTER
Despite the availability of HRH data from various government agencies and organizations, there is still a
5
need to strengthen data capture from the private sector, such as private clinics and diagnostic centers.
There is also a need to locate health professionals who are working outside the health sector such as in
business process outsourcing (BPO) and other industries. Further, it has been a challenge to determine if
other health care workers have already voluntarily exited the health workforce by migration or have
involuntarily exited through retirement, long term illness or disability, or death.
On data timeliness
The DOH currently only acquires HRH data from other institutions upon request, which could be time-
consuming or inefficient, especially because the data have to be manually consolidated.
Data from both within and outside DOH are usually not real-time and are mostly a year old.
On data uniqueness, validity, accuracy and consistency
Since these HRH data are gathered from different offices or agencies, the HRH data sets provided are also
in different formats and standards which affect data quality and consistency.
The various HRH data being collected are often overlapping, without proper validation and harmonization
among the offices and agencies.

Poor Capacity for HRH Research and Low Utilization of Research Results
In 2018, the average expenditure on research and development worldwide is 2.274% of GDP. The
Philippines is among the lowest in rank, spending only 0.16% of GDP18.
As part of the guidelines of HSRM and AHEAD-HPSR Programs to promote resource mobilization and
allocation for health research, the DOH offices are encouraged to allot at least 2% of their maintenance and
other operating expenses (MOOE) budget for research activities.
In 2018, the HHRDB allocated 2.17% of total MOOE for research under the Human Resources for Health
and Institutional Capacity Management line item 19. Despite the allocation of funds, some proposed
research did not push through because no researcher responded to the call for proposals.
Various research studies on HRH have been produced and published in research portals, but there is no
proper monitoring of the utilization rate of these researches for evidence-informed decision making. There
is also minimal access to these research studies. Other issues in research include: tedious and long
CHAPTER
processes of seeking technical review and ethical clearance, inability to identify competent researchers to
implement proposed research topics, fast turnover of research focal persons in HPDPB and PCHRD, and
5
the low or lack of research competence of employees in the organization.
STRATEGIES AND TARGETS
General Objective
Strong data governance and information management for evidence-informed HRH

workforce planning, strategy and policy formulation, program design, execution, and
oversight
One of the objectives in the Global Strategy on HRH: Workforce 2030 is to produce evidence-informed
policies and to strengthen data on HRH, in order to optimize, monitor, and evaluate the performance and
impact of the health workforce. To produce HRH data that are useful for decision making, the government
shall invest in effective HRH data governance; improved and well-funded HRH data science, information
management, and infrastructure; and robust production of research studies on HRH.
18
Research and Development Expenditure. Retrieved from https://data.worldbank.org/indicator/GB.XPD.RSDV.GD.ZS
19
HHRDB Work and Financial Planning - Maintenance and Other Operating Expenses Budget Summary 2018

Success Measures
Table 7. KRA1 Indicators and Targets
Indicators Targets
Existence of a national HRH An institutionalized national coordinating mechanism, with a

information system (HRHIS) dedicated unit with sufficient resources (human, financial, and
coordinating mechanism20 technical) to develop, implement, and monitor the information
system
Information from HRHIS and Contents of the HRH information system are published annually and
research used for decision used to inform decision making among health authorities at the
making16 national and subnational levels on a regular basis
Accurate, up-to-date, and 1. Master list of accredited education and training institutions at
complete data on HRH education national and subnational levels updated at least every 3 years
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and training institutions 2. Number of enrollees and graduates, by health worker

5
education and training, and by sex; provided by education and

training institutions annually
3. Number of educators, by health worker education and training,
recorded by education and training institutions annually
4. Data on investments for HRH education and production
5. Information on health sciences education regulation (e.g.
policies, standards, programs, etc.)
Accurate, up-to-date, and 1. Information on licensure exam takers and passers, by

complete data to track entrants subnational areas, by school, and by sex; provided annually
to the labor market 2. Information on certified/credentialed health workers, provided
annually
Accurate, up-to-date, and 1. Information on HRH employed within the health sector within
complete data to track HRH stock 1 year from taking the licensure exams.
in the labor market 2. Information on health workforce active stock, distribution,
flows, and demand, available and updated annually
3. Data on investments for HRH management and development
4. Information on health workforce regulation, management and
development (e.g. policies, standards, programs, etc.)
Accurate, up-to-date, and 1. Information on voluntary and involuntary exits, provided

complete data to track exits from annually
and re-entry into the labor market 2. Information on HRH returning to the country
3. Information on HRH reintegrated into the Philippine health
20
Pacqué-Margolis, S., Ng, C., & Kauffman, S. (2015). Human Resources for Health Indicators Compendium. USAID.

sector, tracked annually
4. Information on HRH migration and reintegration (e.g. policies,
standards, programs, etc.)
Strategic Objective 1
Harmonized HRH data governance, data analytics, and information management systems
The HRH data governance in the country should be established first, as this will be the foundation and
blueprint for the production of quality HRH data and harmonization of HRH information systems. The DOH,
led by KMITS, in strong partnership with PhilHealth, and other vital stakeholders, has initiated the
establishment of national health data governance through the National eHealth Steering Committee.
The HRH Network, convened by DOH through the HHRDB, may work closely with the eHealth team to
maximize its current data governance projects and include HRH data in the pipeline. The HRH Network may
CHAPTER
also revisit its organizational structure to establish an Information or Data Technical Working Group that
will oversee HRH data governance and management. Policies and mandates that will strengthen data-
5
sharing agreements among DOH and other HRH- related stakeholders shall be established and
implemented together with identified roles and responsibilities.
Within DOH, the HHRDB, in coordination with KMITS, should spearhead this mandate of becoming the
central repository of HRH data -- collecting, consolidating, analyzing, disseminating HRH data and
information for decision-making and policy formulation. The following DOH offices shall also be engaged
to contribute data to the registry: Epidemiology Bureau, Health Facility Services and Regulatory Bureau, and
Philippine Health Insurance Corporation.
HRH Data Standardization
In order to produce harmonious HRH data and information systems, the standardization of HRH data shall
be implemented and operationalized. The HRH data dictionary may be incorporated into the currently
established National Health Data Dictionary of eHealth. The HHRDB may also strengthen the
implementation of the HRH Data Dictionary, and adoption by other HRH-related stakeholders and
institutions.
It is recommended that there be an integration of the two data dictionaries as this will be significant in the
creation of a National Health Workforce Registry towards a National Health Workforce Account.
Effective and efficient data sharing among stakeholders and data harmonization among their information
systems are crucial processes of data governance. HRH data integrity should also be ensured for the
accuracy and consistency of the data collected and produced. These processes may be achieved through
a strict implementation of data privacy and data security mechanisms, along with data quality assurance,
bounded by national implementing guidelines such as those provided in the Data Privacy Act 2012.

Table 8. Strategies for Harmonized HRH Data Governance, Data Analytics, and Information Management
Systems
Short Term Medium Term Long Term
 Establish well-studied  Embed integrated HRH  Institutionalize

HRH data governance, data governance and implementation and
analytics, and information monitoring mechanisms,
information management in the and integrate these in
management systems HRH management and HRHIS, to streamline and
framework development system of monitor workforce
Output: agencies and partners, strategies
including the private Output:
o National data
sector
governance framework o HRH and NHRHMP
approved by the HRH  Agencies and partners indicators identified and
Network routinely share data and incorporated in HRHIS
collaborate on processing
CHAPTER
for monitoring and

o Plans, policies, data analytics and resource generation
5
standards, processing, information management functions

and controls are practices
anchored go the data  Establish protocols to
 Private sector actively address emerging gaps,
governance framework
coordinates and challenges, and risks to
 Streamline data consistently provides the HRH data science/
reporting mechanisms real- time HRH data analytics and data
(e.g. data definitions,
governance
standards, reporting
structures
Output:
o Internationally-
compatible standards
developed and adopted
by national agencies
and relevant
stakeholders (in
particular, for
occupation, industry,
and education)

Complete, accurate, and up-to-date HRH data available and accessible at all times
Pursuant to RA No.11223 or the Universal Health Care Act, the DOH and the PRC, in coordination with duly-
registered medical and allied health professional societies, are mandated to create the National Health
Workforce Registry (NHWR) of medical and allied health professionals. The NHWR will be the main
repository of quality health workforce data towards evidence-informed decision making in the country.
This NHWR is envisioned to be further developed as a subset of the National Health Workforce Accounts,
the main HRH data-sharing platform at both the national and international levels. The respective agencies
and organizations, processes, and information systems in place shall all function toward multi-sectoral
HRH data ownership, accessibility, and accountability, with the program owners funding the information
systems and infrastructures. The government shall also invest in the formation and capacity building of
dedicated teams who will maneuver HRH data analytics and information management in DOH.
CHAPTER
Table 9. Strategies for Complete, Accurate, and Up-to-Date Data Available and Accessible at all Times
5
 Analyze HRH data  Install and maintain  Improve and

science/analytics required IT hardware institutionalize
baseline situation (i.e. and software data science
data capture and gaps,  Ensure data is available, thinking
storage technology, routinely updated, and  Embed data
utilization, people provides a science/analytics,
competency comprehensive overview information
requirements, and gaps, of the health workforce management and data
etc.) of key agencies and (in both public and governance into agency
partner organizations private sectors): performance
Output: o HRH stock, management indicators
o Data mapping and distribution flows, and  Update HRH
gaps analysis demands projections based on
conducted o HRH education reliable health
o Learning needs workforce information,
o HRH competency
assessment of population needs, and
o Remuneration patterns scanning of scenarios
government
employees in the HR o HRH performance  Conduct regular data
system of agencies o Labor dynamics analytics and information
and LGUs conducted and mobility management quality
assurance for key
o Pilot study conducted o Attacks against
agencies and NHRHMP
as a proof of concept health workers
stakeholders. Recalibrate
for senior institutional o Performance of protocols as needed.
leaders to HRH management
demonstrate the

potential return of system

investing in building an  Conduct regular validity
HRH information checks at multiple points
infrastructure, and before, during, and after
ultimately as a way to the data analysis process
begin building trust in to prevent data misuses
the infrastructure, and and application of
its ability to empower scientific methods and
decision makers protocols for quality
 Establish a functional assurance
National Health  Regularly disseminate
Workforce Registry HRH data at both
national and international
levels through the NHWA
CHAPTER
 Improve data science,

information
5
management, and data

governance thinking
among agencies and
partners based on a set
of criteria and
measures like data
maturity Scale (see
Figure 20)
 Develop capacity on data  Ensure that HRH  Establish structures,

science/analytics, agencies each has a positions, competency
information dedicated data analytics models, and
management, and data team/unit (increase of recruitment/selection
governance the team in number, role, standards of data
Output: and specialization scientists, analysts, data
 Create plantilla items for stewards, and other
o Agencies’ strategic
the dedicated data technical IT specialists
plans and budget
include priority analytics team/unit in
capacity development key agencies and LGUs
interventions on data
analytics and
governance (e.g.
scholarships, learning
and development
programs for the
young and with high

potential data science

specialists)
Sample Data Maturity Scale
CHAPTER
5
Figure 20. Sample data maturity scale21
Enhanced HRH research capacity and research output utilization
Equally important with routine systems of data collection, is the conduct of research for obtaining empirical
evidence for HRH issues and challenges that need to be addressed. Examples of research that may be
conducted are:
● Accreditation of health sciences education and regulation of practice

● Exploring the possible roles of physician assistants and nursing assistants for community level
placement and the development of academic or vocational / technical programs
● Optimizing the contributions of the health workforce
● Defining the scopes of practice and developing appropriate skill mix in health care
While there has been a system by which to acquire and commission services of experts to take on needed
research studies, a more sustainable and long-term solution is to strengthen the capacity of employees in
Bratton, A. (2020). How to Measure Your Organization's Data Maturity. Retrieved from: https://towardsdatascience.com/how-to-
21
measure-your-organizations-data-maturity-2352cbaf1896

the organization in conducting research and utilizing research outputs as input in developing systems,
policies, and programs. Enjoining the private sector to achieve a sector-wide approach is also encouraged.
The institutionalization of monitoring research utilization also needs to be established. Indicators on the
number of HRH research publications produced, utilized, and disseminated may also be included in the
Office Performance Commitment and Review (OPCR) accordingly.
Primarily, the use of any knowledge products starts with proper, wide, and strategic dissemination. In
coordination with HPDPB-Health Research Division and PCHRD, access to HRH research databases or
registries shall be regularly improved, monitored, and promoted to the end-users especially to the policy-
and decision-makers, program managers, and relevant stakeholders, including even the general public.
These, all combined with adequate funding for research, aim to promote and encourage research to policy
translations and cultivate a research culture among policy- and decision-makers, planners, and
implementers.
Table 10. Strategies for Enhanced HRH Research Capacity and Research Output Utilization
CHAPTER
5
 Study baseline state of  Establish platform to  Establish a mechanism

HRH research efforts share and advocate HRH that ensures that
 Establish a national research results and best research outputs serve
HRH research practices on HRH as decision support for
framework and agenda, management and NHRHMP agency
and strategic plan for development stakeholders
an HRH research  Install NHRHMP design
initiative  Conduct an NHRHMP
thinking, innovation,
impact assessment,
 Ensure HRH research and grants program
disseminate results, and
match the specific health  Increase the number of use them as inputs into
system context based on research specialists or the next phase of
the health labor market staff trained with health NHRHMP planning and
analysis and provide systems and policy strategizing
results for decision research skills in
support to appropriate agencies
bodies at appropriate  Assess and update the
levels of HRH governance strategic plan on HRH
 Harmonize researches on research
HRH development and
management
Output:
o Multi-sectoral results
framework or outcome
map of the causality
of UHC-NHRHMP-data

science and
information
management
developed
o Strategic and
implementation plan
on HRH research is
crafted and regularly
recalibrated to
harmonize HRH
needs/targets,
including those of
academic partners,
and guided by the
multi-sectoral HRH
CHAPTER
research agenda
5
o HRH research
consortia composed
of partners from
academia, and other
key stakeholders are
organized
 Establish programs to
support active
participation in selected
global research calls
Implementing Agencies and Partners
Table 11. Various Stakeholder Organizations and their Roles for KRA 1
Stakeholder Role/s
1. HRH Network Philippines  Spearhead the harmonization of HRH

2. National eHealth Committee information systems (HRHIS)
3. Department of Health (DOH)  Maintain a centralized repository of

HRH data and information
 Disseminate periodical reports on HRH
 Develop HRH standards and projections
 Sustain implementation of research

Stakeholder Role/s
programs and initiatives for research

development
4. Department of Information and  Provide technical support for HRHIS

Communications Technology (DICT) harmonization, and development of
guidelines, policies, and standards
5. Department of Science and Technology  Provide technical support and enhance

(DOST) capacities of key players on HRH
research management and
development
6. Commission on Higher Education (CHED)  Provide data on HRH entry / production

7. Technical Education and Skills Development and training (see Table 5 for specifics)
Authority (TESDA)
8. Professional Regulation Commission (PRC)
CHAPTER
9. DOH
5
10. Higher Education Institutions (HEIs)

11. Association of Deans (ADPMC, ADPCN,
APSOM, etc.)
12. Student Networks / Organizations
13. Professional organizations and specialty
societies
14. Public and private health facilities and
offices
15. DOH  Provide health workforce data (see

16. Philippine Health Insurance Table 5 for specifics)
Corporation (PhilHealth)
17. Department of Interior and
Local Government (DILG)
18. Department of Labor and
Employment (DOLE)
19. Department of Budget and Management
(DBM)
20. Civil Service Commission (CSC)
21. DOST
22. PRC
23. Professional organizations and
specialty societies
24. HEIs

Stakeholder Role/s
25. Health facilities and offices
26. Philippine Statistics Authority (PSA)  Provide data on HRH exits and re-entry
27. Bureau of Immigration (BI) (see Table 5 for specifics)
28. Philippine Overseas Employment

29. Overseas Workers Welfare Administration
(OWWA)
30. Commission on Filipinos Overseas
31. National Reintegration Center for OFWs
(NRCO)
32. Government Service Insurance System
(GSIS)
CHAPTER
33. Social Security System (SSS)
5
34. DOLE

CHAPTER 6
Health Education
Strengthening and Regulation
Health Education Strengthening and Regulation | 97

CHAPTER SIX
HEALTH EDUCATION STRENGTHENING AND REGULATION
Achieving the goals of Universal Health Care requires a fit for purpose health workforce able to deliver safe,
competent, and ethical health care services. This entails establishing education programs that match the
supply and skills of health workers to the country’s needs, capacities, and development priorities. It also
entails clear and recognized standards in HRH production, as well as efficient and harmonized health
workforce production planning and management.
SITUATION
Currently, the education and training of HRH are being driven by the necessity to provide health care to
Filipino citizens at all socio-economic levels throughout the country, as well as by the requirements of
healthcare industries in other countries where Filipino graduates of medicine, nursing, and allied health
degrees seek employment. Achieving the appropriate balance between these two competing markets for
healthcare graduates, while ensuring local health needs are met, requires strategic collaboration among
different sectors.
On the part of the government, the training, development, deployment, retention, and re-entry of HRH is a
joint responsibility of the DOH, CHED, and TESDA, in collaboration with DOLE as well as local governments
to ensure retention of HRH within the country’s health sector. Key stakeholders and partners from the
CHAPTER
private sector, including higher education institutions (HEIs) and healthcare industry, also play critical
6
roles.
Coordination with ASEAN regional government bodies, multilateral agencies, and individual countries
would help to ensure that the Philippines’ healthcare workforce’s qualification is mutually recognized within
the region, and being maximized at the national and global level.
The Health Workforce
The health workforce in the Philippines, composed of professional and non-professional health workers,
provides care that relates to health promotion, health prevention, curative care, rehabilitation, and palliative
care, in both public and private sectors. The workforce also includes health managers and support
personnel, health experts, and those in the academe. The following cadres of essential workers constitute
the Philippine health workforce1:
1 Necochea, et al. 2013. Systemic Management of Human Resources for Health: An Introduction for Health Managers. Retrieved
from: http://reprolineplus.org/system/files/resources/HRH_Manual_complete_locked.pdf

Table 12. Composition of the Philippine Health Workforce
Cadre Sub-groups
Health Care Providers Medical and allied health professionals who are registered and licensed by
the PRC:
1. Dental Hygienist
2. Dental Technologist
3. Dentist
4. Medical Technologist
5. Midwife
6. Nurse
7. Nutritionist-Dietician
8. Occupational Therapist
CHAPTER
9. Optometrist
10. Pharmacist
11. Physical Therapist
12. Physician
CHAPTER
13. Radiologic Technologist

6
14. Respiratory Therapist

15. X-ray Technologist
Auxiliary personnel or health workers who are certified by the TESDA

e.g. nursing assistants, caregivers, etc.
Health Administrators Managers, administrative and support personnel
Experts Health research and health systems development, field experts

e.g. epidemiologists, molecular biologists, microbiologists, etc.
Academicians Educators teaching primary and secondary education levels, and health
sciences education in higher education institutions
Community Health Barangay Health Workers, who have undergone training by government or
Workers NGOs, and who volunteer to render primary health care services in the
community after having been accredited by the local health board, in
accordance with DOH guidelines (RA No. 7883 Sec. 3)
Barangay Nutrition Scholars, who have undergone training by a district/city

nutrition program coordinator or designated trainer- supervisor as
administered by the National Nutrition Council (Presidential Decree No.
1569)
92 | Health Education Strengthening and Regulation

Recently, under the UHC Law prioritizing primary health care (PHC), interventions are being introduced to
enhance the PHC skills of the health workforce as a whole, and to produce primary care providers—ranging
from health professionals to community health workers—who are certified by DOH to provide PHC services.
Estimating Future Health Workforce Requirements
A recent health workforce forecast study conducted by Liwanag et. al (2020) looked into the supply of 10
selected health professionals (doctors, nurses, midwives, dentists, medical technologists, pharmacists,
nutritionist-dietician, radiologic technologists, physical therapists, and occupational therapists) in the
Philippines from 2010 to 2020 to (1) determine the adequacy of supply based on target thresholds of HRH
densities to achieve UHC, (2) estimate the future supply from 2025 to 2050, and (3) estimate the future
demand based on target density and socio-demographic and epidemiologic factors (see Annex B for the
detailed study).
Salient points of the study are as follows:
1. At the national level, the number of licensed physicians, nurses and midwives produced in country
has exceeded the WHO recommended threshold level of 44.5 “skilled health workers” (i.e. nurses,
physicians, midwives) per 10,000 population for a country to achieve UHC but the picture is different
once data is disaggregated per cadre, and per region.
a. Nurses (52 per 10,000) and midwives (7.8 per 10,000) exceed the target density of 27.4 and 2.8
per 10,000, respectively. While physicians (8.1 per 10,000) fall below the desired density of
CHAPTER
14.3.
6
b. Nurses, physicians, and midwives exceed the target densities in NCR but in regions with low
HRH densities, such as MIMAROPA, nurses and physicians fall far below the target densities.
2. Most of the cadres have increasing number of newly-licensed professionals added to the pool yearly
and have increasing or steady densities in recent years (2010-2020), except for the following:
a. Nurse to population ratio has remained steady despite the significant drop in the number of
newly-licensed nurses entering the pool. This indicates an excess of nurses in the country;
although maldistribution should not be overlooked in analyzing the data.
b. There is a decline in the number of midwives, both in terms of the newly-licensed and already-
licensed. This decline in the number of midwives should be addressed and prioritized to ensure
realization of UHC.
c. The number of newly-licensed dentists is increasing through the years but the trend of dentist
to population ratios indicates that the increase cannot cope up with the increase in the
population. Production of dentists should be prioritized as dental care is an essential
component of primary care.
d. Supply of physical therapists and occupational therapists are fairly stable but they remain to
have the lowest density among health workers. This may have to be studied further as the
country experiences a high burden of complications from lifestyle-related diseases, and is
approaching a predominantly aging population.
3. For all 10 health professionals, except midwives, there is a projected rise in supply, assuming the
absence of sudden disruptive events. Therefore, there is a need to prioritize the production of
midwives to mitigate the future decline, especially when they play a critical role in the delivery of

primary care. In addition, despite the increasing projection for the supply of dentists, the increase
cannot catch up with population growth. Hence, interventions must also be applied to increase its
production.
Health Workforce Education
The education and training of the healthcare workforce is currently dominated by HEIs in the private sector,
and the majority are located in the National Capital Region. The curriculum is primarily oriented towards
producing HRH for clinical services, for practice in urban areas, and for global demand. Nursing education
predominates the rest of the health science courses. While some state-funded HEIs have developed
curriculums geared towards the specific needs of communities in the Philippines, the prevalence of HRH
training in private sector HEIs, geared towards different labor markets would indicate that the HRH needs
of the country are not being met by either the curriculum or the number of health workers produced
specifically for the public health sector.
Schools for Health Sciences Education

CHAPTER
Out of the total 864 HEIs in School Year (SY) 2017/18, those with nursing courses abound (47% of the total),
peaking at 512 in SY 2010/11, then progressively decreased to 338 in SY 2017/18. HEIs with midwifery
(31%) and medical technology (15%) programs have continuously increased, while medical schools (5%)
have shown small increments but have not exceeded 45 .
CHAPTER
6
Figure 21. Total number of schools by course, SY 2005/06 – 2017/182
2
Source: DOH consolidation of CHED data from 2005-2018

Private schools comprise 84.5% of the total 864 HEIs. As of 2018, the ratio of government to private schools
for health courses were as follows: 1:43 for medical technology, 1:4 for medicine, 1:4.75 for midwifery, and
1:4.5 for nursing. By region, the majority of health sciences schools are in the National Capital Region (17%)
and Region IV-A (11%). The rest are distributed ranging from 3% to 6% among the other regions. Regions
IV-B and ARMM have shares of less than 2% of the total 864 HEIs.
CHAPTER
6
Figure 22. Public and Private HEIs per HRH Course by Regions, 2018 3
To meet the future HRH needs and address the problem of inequitable distribution, the government has to
consider putting in more investments to put up public schools or partner with private institutions, to provide
training access especially in regions with critical shortage. Training HRH at or near place of residence or
intended place of practice increases their retention 4. Opening more programs for midwifery, dentistry, and
medicine should be prioritized to ensure enough supply to cope with future needs, and demands towards
realizing UHC. Interventions such as offering shorter professional education (e.g. two years of midwifery
vs four years) or rapid production of cadres with less educational requirements (e.g. dental hygienists,
dental technologists) while providing opportunities for catch-up or upgrade education in the future may
also be explored as these interventions have worked for Japan and Thailand in developing their HRH
towards realizing UHC5,6.
3 Source: 2018 CHED Data

4 World Health Organization. (2010). Increasing Access to Health Workers in Remote and Rural Areas through Improved Retention:
Global Policy Recommendations. Retrieved from:
https://apps.who.int/iris/bitstream/handle/10665/44369/9789241564014_eng.pdf?sequence=1
5 Akashi, H., Y. Osanai, & R. Akashi. (2015). Human Resources for Health Development: Towards Realizing Universal Health
Coverage in Japan. Bio Science Trends 9(5): 275-279. Retrieved from https://pubmed.ncbi.nlm.nih.gov/26559018/
6 Pagayiya, N., & T. Noree. (2009). Thailand’s Health Workforce: A Review of Challenges and Experiences. Health, Nutrition, and
Population Discussion Paper. Retrieved from:

https://openknowledge.worldbank.org/bitstream/handle/10986/13666/546330WP0THLHe10Box349423B01PUBLIC1.pdf?sequenc
e=1&isAllowed=y

Enrollment, Graduation, and Board Examination Results
From SY 2005/06 to SY 2017/18, the average number of enrollees per year was 322,824. Trend-wise, the
proportion of nursing students to total enrollment steadily decreased from 85% in SY 2005/06 to 24% in
2017/18, while the intake of students in other health sciences courses increased .
CHAPTER
CHAPTER
6
Figure 23. Share to Total Enrollment by Cadre, SY 2005-05 - 2017/187
Enrollment trends have recently reflected a decline beginning SY 2016/17 as a result of the implementation
of the K-12 program; hence, there will be a two-year moving up gap expected to normalize only in SY
2022/23. The decline was reflected sharply in the enrollment for medical technology and nursing and
slightly affected the midwifery enrollment. In addition, the curriculum for midwifery was changed from a
two-year diploma to a four-year course which impacted the gap for graduates for another two years.
Out of the 322,824 average annual enrollees, an annual average of 62,584 graduates, representing a 20%
graduation rate. The highest attrition rates (defined as the proportion of students that left the course or did
not graduate) are in medical technology (87%) and medicine (82%), in both public and private HEIs.
Midwifery has the lowest attrition at 55% for government schools and 69% for private schools but has the
highest board exam failing rate, with two in five unable to pass the board exams.
7
Source: DOH consolidation of CHED data from 2005-2018

Table 13. Attrition Rate in Government and Private HEIs, 2005-20178
Course Government Private Total Attrition Rate of

Licensure Examinees
(% of Total)
Medical Technology 91% 87% 87% 18%
Medicine 80% 83% 82% 7%
Midwifery 55% 69% 65% 41%
Nursing 75% 75% 75% 33%
The average annual board examination passers are: 3,219 for medicine, 32,741 for nursing, 2,664 for
midwifery, and 4,351 for medical technology, which represents a total of 42,975 health workers that are
added to the pool of qualified health workers annually.
The number of graduates and passing rates in medical technology and medicine have been continually
improving as evidenced by passing marks that exceed 75% beginning in 2012 and 2014, respectively. For
midwifery and nursing, the passing rates remained largely below 50% in the past decade, averaging at 49%
for midwives and 45% for nurses. Apparently, the large number of midwifery and nursing schools across
the country does not mean increased production and better quality of education.
CHAPTER
6
Figure 24. Passing rates by course, 2006-20189
8 Source: CHED and PRC in HLMA Report 2020

9
Source: DOH consolidation of PRC data from 2005-2018

Sex-disaggregated data on board exam passers are available but the sex-disaggregated data on total
number of graduates in HRH courses who took the board exams are unavailable. Therefore, while the share
of women board passers is generally higher than men, it is difficult to conclude which gender performs
better in board exams. This data is also a helpful proxy for the stock of HRH as there is no available sex-
disaggregated data on HRH stock.
CHAPTER
CHAPTER
6
Figure 25. Distribution of board exam passers by gender, 2002 - 201610
Cost of Health Sciences Education and Wastage
The large number of students who do not graduate nor pass the licensure exams, as mentioned in the
preceding section, implies a huge loss in the formation of human capital for health. Based on the average
tuition fee charged by private schools and the total number of enrollees and graduates from 2005 to 2017,
PhP169 billion, representing initial investments in students of health sciences education, is lost. This
translates to PhP14 billion per year in tuition fees of students who do not finish their course. Adding other
education-related expenses such as school supplies and other fees and charges would make the annual
loss in investment in health sciences education even bigger.
Plotted below are the average and range of tuition fees of private schools gathered through the online
database of finduniversity.ph, an online directory of 20,000 academic programs and 900 higher education
institutions throughout the Philippines.
10
Source: Inputs of the Professional Regulation Commission in the Philippine Statistical Yearbook 2002-2016
https://psa.gov.ph/products-and-services/publications/philippine-statistical-yearbook

Figure 26. Average annual cost of tuition in health science courses at private institutions11
Meeting HRH Requirements
Scholarships and other Financial Assistance
CHAPTER
The following government agencies provide student scholarships, loans and financial assistance programs
6
to support capacity building in the health sector:
Table 14. Government Agencies Providing Various Financial Assistance
Institution Services
Commission on Higher Education Scholarship programs, grant-in-aid programs, student loan

programs, and Cash Grants to Medical Students enrolled in State
Universities and Colleges (CGMS-SUC)
Technical Education and Skills Technical and Vocational Education and Training (TVET)
Development Authority scholarships and other educational assistance through different
TESDA programs including Private Education Student Financial
Assistance (PESFA) program, Training for Work Scholarship
Program (TWSP), Special Training for Employment Program
(STEP) and Universal Access to Quality Tertiary Education Act
(UAQTEA)
Department of Health Pre-Service Scholarship Program (PSSP) for medicine and

midwifery
11 Source: HLMA Report 2020

Institution Services
Department of Science and Science and technology scholarship programs

Technology-Science Education
Institute
Local government units and private institutions also provide scholarships and financial assistance to
deserving students.
The Unified Student Financial Assistance System for Tertiary Education Act (RA 10687) or UniFAST was
enacted in 2015 to ultimately allow citizens full access to quality education by providing adequate funding
and increasing enrollment rate in tertiary education. Under the purview of CHED, UniFAST Law strengthens,
expands, and puts under one body all government-funded modalities of Student Financial Assistance
Programs (StuFAPs) for tertiary level and special purpose education assistance in both public and private
institutions. These modalities include scholarships, grant-in-aid, student loans, other specialized forms of
assistance programs such as support to research and scientific studies, as formulated by the UniFAST
CHAPTER
Board.
Essentially, the UniFAST Law and its IRR intend to: harmonize educational aids to ensure effective and
efficient use of government resources earmarked for education, equitably distribute scholarship slots
across regions, give priority to poor and deserving individuals through beneficiary-targeting, provide
adequate guidance and incentives to young Filipinos with their career choices, produce quality human
CHAPTER
resource needed by industries and public services and ultimately increase human capital.
6
Return Service Agreements
The Universal Access to Quality Tertiary Education Act (RA 10931) provides free tuition and other fees to
students enrolled in 112 state universities and colleges (SUCs) and 78 local universities and colleges
(LUCs) but these institutions are not required to come up with return service programs for students who
benefit from free tuition and other fees as a way of “paying back” the country for their education.
The UHC Law mandates the need for return service, requiring “all graduates of allied and health related
courses who are recipients of government-funded scholarship programs to serve in priority areas in the
public sector for at least three years, with compensation, under the supervision of the DOH.”
DOH implements a scholarship/training-to-deployment scheme. Under the PSSP, graduates of medicine

and midwifery shall provide service in DOH priority areas for a period of three years.
For residency training in DOH-retained hospitals, graduates in Internal Medicine, Obstetrics and
Gynecology, Pediatrics, Surgery, and Anesthesia will be deployed for one year to areas in need to improve
service delivery and/or training capacity of LGU facilities.

Local Recruitment, Local Training, and Hometown Placement
The enactment of the Doktor Para sa Bayan Act (RA No. 11509) in December 2020 has institutionalized
another medical scholarship and return service program to expand access to education and create
opportunities for underprivileged individuals who aspire to be medical doctors. The scholarship recipient,
who is endorsed by the local community, will eventually render services to government public health offices
or government hospitals in their hometown or in the nearest adjacent underserved municipality.
The Law provides that DBM, with the recommendation from DOH, shall create plantilla positions to ensure
placement and compensation commensurate with their educational attainment and qualifications.
Likewise, the DOH and CHED shall develop programs for continuous learning and shall craft a career
pathway to ensure retention in the municipalities.
SUCCESS STORY: NEEDS-BASED CURRICULUM PROMOTES RETENTION IN THE

PUBLIC HEALTH SECTOR
Since 1976, the University of the Philippines School of Health Sciences (Leyte) has offered a “step-
ladder” curriculum focused on public service, through which each student may attain various
competencies and degrees sequentially, at different levels: first as a community health worker or
midwife, and later as a nurse and/or doctor of medicine. This competency-based and community-
based program is intended to produce clinically competent and public-spirited health workers willing
to stay and serve in depressed and underserved communities, particularly in rural areas. Graduates
CHAPTER
are required to provide two years of service per year of study.
6
A study found that 27 years after the first cohort graduated, 90% still served in areas with dire needs.
The quality of students produced through the UP-SHS curriculum is evident in the completion rates
and licensure rates. In 2018, for instance, its nursing students had completion and licensure passing
rates of 98.6% and 90.7%, respectively.
The UP-SHS curriculum has been used as a model in community-based training worldwide. It has also
been effective in addressing the problem of HRH retention.
Capitalizing on Community Health Workers (CHW)
A significant but often overlooked member of the health workforce is the community health worker.
Community health workers serve as a link between health care clients and providers in order to promote
health among groups that have often lacked access to adequate care. Contributions of CHWs include
increasing access to health care, improving the quality of care, reducing the costs of care, as well as
broader social contributions12.
Various trainings have been developed to equip CHWs with appropriate competencies on preventive and
basic medical care, while relating these with local health issues and cultural traditions. A training regulation
Witmer, A., et al. (1995). Community Health Workers: Integral Members of the Health Care Work Force. American Journal of Public
12
Health 85(8)1055-1058. Retrieved from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1615805/pdf/amjph00446-0017.pdf.

for Barangay Health Workers (BHWs) was recently developed by TESDA, in coordination with DOH, through
its Barangay Health Services NC II Program. TESDA has also started developing the training regulation in
2020 to formally open a certification program for the barangay nutrition scholars (BNSs).
Through the Barangay Health Services NC II, BHWs are trained, at minimal or no cost, in community health
and preventive health care, including health education. This training is not mandatory, however; many
barangay health workers (BHWs) are not formally trained by TESDA and only undergo orientation from the
local health office. According to data from TESDA, a total of 2,648 BHWs were certified from 2016 to 2020.
Lack of collaborative planning and implementation of policies in the production of

HRH
A major issue prior to the entry of HRH into the workforce is the lack of collaborative planning and
implementation in terms of production of HRH. The education, health, and labor sectors have different
CHAPTER
priorities and program conceptualizations, leading to the inequitable production of HRH, and adding to
budgetary and administrative constraints and inefficiencies.
Production is mismatched with local health system needs and employment opportunities. Both training
and employment opportunities are in urban areas, causing rural and disadvantaged areas to be further left
CHAPTER
behind in terms of access to human resources for health. Skill mix imbalance (i.e. nursing dominated, lack
6
of public health professionals) is also a manifestation of this mismatch.
Ineffective regulation of health workforce production
There is ineffective regulation in the provision of health sciences education, as evidenced by the
proliferation of private schools without proper quality checks on the curriculum and performance, and with
substantial differences between public and private tuition fees. The preponderance of private HEIs resulted
in the commercialization of education for health workers.
Such challenges were validated and underscored by the observations of members of the HRH Network
during consultations:
“Anybody can open a new school as long as it complies with the requirements.”
“Quality is regulated but quantity is not; the opening of new schools and programs is not being
regulated.”
“The private sector controls supply but the government cannot regulate education.”
“The priority of the country is to respond to the foreign market’s demand for health professionals.”
An emerging issue is the increasing inflow of foreign students in medical and health sciences programs,
so that private schools’ business interests will likely take precedence over local health sector demands for

HRH. Executive Order No. (EO) 285 states that only schools with accredited programs are allowed to accept
foreign students at a maximum of 30% of the student population. However, schools offering slots to foreign
students tend to abuse the 30% cap, prioritizing profit over local demand.
The public sector presence in health sciences education has been more regulatory in nature and less
oriented toward the production of HRH. Its limited presence and its lack of resources implies the need to
partner with the private sector to develop HRH for underserved regions of the country.
A standardized screening process and improved regulation needs to be developed for accepting enrollees
in education programs for much-needed health professions. While students of medicine have to pass the
National Medical Admission Test (NMAT), other students of health sciences education do not undergo a
screening process prior to entry in schools.
Monitoring of government investments in HRH education and training needs to improve. There is minimal
or no evaluation of the effectiveness of interventions and return on investments, particularly for its
supposed gains for the public sector. Impact assessment or operations research on various programs is
often neglected as a critical component of program management. Return service obligations are not strictly
implemented and monitored. There is no integrated mechanism to monitor programs, and collect and share
data among agencies.
The lack of legitimacy granted to community health workers poses a barrier to fully realizing the potential
benefits of these workforce. Consensus on scope of practice and level of training should be developed as
CHAPTER
well as standard accreditation and credentialing mechanisms.
6
Production driven by global demand over local needs
Since the production of health workers is driven by the world market, schools and training institutions do
not intentionally respond to the needs of the local healthcare system, the need for other health courses,
and for a primary health care-focused education. They aim only to provide the necessary qualifications and
training to enable graduates to work abroad.
The country passed into law the Philippine Qualifications Framework (PQF) 13, which is a quality-assured
national system for the development, recognition, and award of qualifications based on standards of
knowledge, skills, and values acquired in different ways and methods by learners and workers of the
country. Under international region-wide initiatives, mutual recognition agreements (MRAs) are formulated
to ensure that the qualifications of health professionals, recognized by the authorities in their home country,
are mutually recognized by other states who are signatories to the MRA. However, Philippine participation
to existing MRAs are limited to those within ASEAN14. The country has no MRAs or reciprocity agreements
yet with countries outside the region, especially with the top destination countries of OFWs (health
workers).
13 Philippine Qualifications Framework Law. Retrieved from https://www.officialgazette.gov.ph/downloads/2018/01jan/20180116-

RA-10968-RRD.pdf
14 AQRF Referencing Report of the Philippines. (2019). Retrieved from https://pqf.gov.ph/Uploads/PH%20AQRF%20Referencing%20
Report%20Final.pdf

General Objective
Practice-ready HRH responsive to local health needs, and improved retention in the local
health sector
Health workers need to be equipped with appropriate knowledge, skills, and attitudes to address the priority
health needs of the country, fulfill the roles expected of them, and keep them abreast of developments and
innovations in their respective fields and professions.
The UHC Law mandates the reorientation of the curriculum towards primary health care, with focus on
primary care. Further, the CHED, TESDA, PRC, and DOH shall develop and plan the expansion of existing
and new allied and health-related degrees and training programs including those for community-based
healthcare workers, and regulate the number of enrollees in each program based on the health needs of
the population, especially those in underserved areas.
CHAPTER
Providing adequate infrastructure and a suitable learning environment is critical in HRH production. Higher
education and training institutions should not only provide adequate facilities for classroom and laboratory
teaching but more importantly, ensure practice sites for clinical and community learning, and facilitate
innovative ways of teaching such as e-Learning and team-based approach. This is also in line with the goals
CHAPTER
of the updated Philippine Development Plan 2017-2022 on intensifying distance-learning methods to

promote learning continuity and retooling in light of the pandemic situation. As provided in CHED COVID-
6
19 Advisory No. 7, a flexible learning strategy shall be adopted by ensuring appropriate facility delivery
system, faculty complement, and student support. Further, the use of state-of-the-art technologies in
learning, such as Artificial Intelligence (AI) may also be considered.
Strategies and interventions at the production phase should not only focus on sustainable HRH production
but more importantly on promoting the retention of HRH within the country, particularly in underserved
areas.
Success Measures
Indicators Targets
Existence of a national An institutionalized national coordinating mechanism, with a

coordinating mechanism for dedicated unit with sufficient resources (human, financial, and
Health Sciences Education technical) to develop, integrate, implement, collaborate on, and
monitor policies, programs, and initiatives on HRH production
Regions that have the capacity All regions have the capacity to produce all 15 cadres of health
to produce all cadres of HRH professionals licensed by PRC:
Dentist, Dental Hygienist, Dental Technologist, Medical
Technologist, Physician, Midwife, Nurse, Nutritionist-Dietician,

Indicators Targets
Optometrist, Pharmacist, Physical Therapist, Occupational

Therapist, Radiologic Technologist, X-ray Technologist, Respiratory
Therapist
Number of health schools All health schools (offering clinical health sciences or public health
accredited15 education) are accredited by a recognized accreditation body
Training strategy addresses All schools of clinical health sciences will have oriented* their
community health needs education toward primary health care and community health needs
and adopted inter-professional training strategies
*Should fulfill all of these criteria:
● Training is not centered on biomedical model
● Inclusion of primary health care contents in the curriculum
● Inclusion of primary health care practices in the curriculum
(e.g. through clinical experience in community or primary
health care centers)
● Existence of inter-professional training strategies in the
schools of clinical health sciences
● Existence of financial support for community and inter-
professional training
CHAPTER
Graduation rate per cadre, per % graduation rate for all cadres and for all health education
6
health education institution institutions as determined by lead agencies and organizations
Licensure passing rate per % licensure passing rate for all cadres as determined by lead
cadre agencies and organizations
% of scholars who fulfilled return % of scholars have fully rendered their return service obligations as
service obligation determined by lead agencies and organizations
Strong inter-sectoral collaboration and harmonized plans and policies to ensure needs-
based production and retention
A mechanism for a multi-sectoral, multi-stakeholder collaboration for HRH education should be established
and functional to ensure the harmonized planning, implementation, and monitoring and evaluation of
strategies and interventions. The table below maps out the strategies to facilitate and sustain this multi-
sectoral collaboration for HRH production.
15
United States Agency for International Development. (2011). Human Resources for Health Indicator Compendium.

Table 16. Strategies for Strong Inter-sectoral Collaboration and Harmonized Plans and Policies

● Organize Health Sciences ● Strengthen public- ● Harmonize plans and
Education (HSE) or HRH private sector policies for HRH
entry/production working collaboration: production
group in the HRH Network Outputs: Outputs:
Output: ○ Advanced HSE for ○ Government
○ Expanded HEI targeted educational spending
participation and regular areas/groups aligned with
sessions conducted established employment
○ Complementary opportunities
funding for health ○ Scholarship grants
worker education/ are pooled and
training provided enforced RSAs are
● Establish harmonized
CHAPTER
partnerships with ○ Effective regulation

international conducted
education institutions ○ Enhanced quality and
to improve higher innovative HSE
education programs ○ Primary care-
CHAPTER
through various types equipped health

of institutional workers and
6
arrangements as professionals
provided in RA No. employed
11448
● Stakeholder advocacy and ● Sustained participation of relevant agencies in

campaigns conducted to committee(s) for health worker education and trainings
both public and private
players to push for HSE
interventions
To ensure a needs-based production of HRH and increase local retention, the multi-sectoral initiatives
should focus on the following: (1) provide equitable opportunities for training and employment across the
country, (2) design programs based on local health needs, and (3) incorporate strategies at the
production/education phase that will increase retention of health workers.
Table 17. Strategies to Ensure Needs-Based Production and Retention
● Conduct baseline ● Implement strategic ● Hire and retain

assessment to cover: initiatives to provide graduates locally
○ Local HRH supply and more opportunities in ● Regularly recalibrate
demand local areas human resource

○ Policies and programs Outputs: management and

on HRH production ○ SUCs or schools / development programs
○ Situation of enrollments medical and allied for the retention of and
or admission practices, health programs continuing competency
including challenges, established in areas development of HSE
drivers, and barriers to with critical shortage graduates (e.g. ensure
completion/graduation ○ HEIs/SUCs affiliated adaptability to medical
rate and performance with accredited trends/advancements,
● Formulate/revise policies hospitals and maximize the potential
based on results of community health of information and
assessments facilities in the region communication
Outputs: for internship and technology, utilize
○ Public and private immersion programs distance learning
scholarships are ● Provide support methods, etc)
harmonized initiatives for
○ Enforcement and completion/graduation,
monitoring of RSA qualification, and
○ Admission policies for placement in health labor
target groups are market of targeted
implemented (e.g. students with a rural
CHAPTER
prioritize those from background or from
underserved areas, indigenous people’s
6
indigenous people, local communities
students, etc.) ● Implement local
○ Reorientation of recruitment, local
curriculum and training training, and hometown
towards PHC placement
Regulatory measures are in place to ensure quality and efficient HRH production
Health Sciences Education (HSE) regulation is needed to ensure needs-based production of quality HRH.
To this end, CHED has adopted competency-based learning standards and shifted to outcomes-based
monitoring and evaluation. However, compliance monitoring should be strengthened.
Government investments in HSE should likewise be monitored to ensure the efficient use of limited
resources and the achievement of intended outcomes.

Table 18. Strategies for Regulatory Measures to Ensure Quality and Efficient HRH Production
● Conduct complete ● Strengthen monitoring ● Implement strategies to

inventory and profiling of and evaluation of HEIs to balance the pressure to
HSE/HEIs (e.g. capacity, ensure the train for international
performance, etc.) implementation of markets vs producing
● Secure policy support for education standards: professionals to meet
the enforcement of RSA ○ Ensure that outcome- local needs
based education is ● Conduct tracer studies to
aligned with the monitor the recipients of
guidelines established scholarships and
by CHED enforced return service
CHAPTER
memorandum orders obligations

● Organize ● Establish a monitoring
reward/recognition system, which may be
schemes for high linked with a national
performing HEIs health workforce registry
CHAPTER
● Set-up a system for to track scholarship

sharing the best practices recipients
6
of HEIs
● Establish mechanisms for
the accreditation or
credentialing of
community health
workers, including
traditional healers and
practitioners
Health Sciences Education curriculum is reoriented to primary health care to produce

health professionals responsive to local health needs and demands
The country should balance the pressure to train for international markets versus producing health workers
for local health requirements. Filipino workers are in demand all over the world not just for their knowledge
and skills but also for their willingness to show malasakit at kalinga [concern and care]. We should be able
to produce, as well, Filipino workers that have malasakit at kalinga para sa sarili nilang bayan at mga
kababayan [concern and care for their country and their people].

The health and education sectors should collaborate to promote and inculcate social accountability, public
service ethics, and professional values to deliver quality and respectful care, and respond to local health
needs. A transformative education approach may be explored as a means to improve the quality of the
health workforce. Transformative education is a strategy to empower students to deal with complex
challenges and encourage them to actively participate in building new and better societies even before they
leave school16.
Re-orienting the curriculum towards primary health care, through a transformative education approach, will
strengthen the principles of primary care, public health, and interprofessional collaboration in the health
sciences curriculum to enable health workers to effectively intervene and address the social determinants
of health, build responsive and resilient health systems, and effectively prepare and respond to public health
emergencies and disasters. Graduates of the reoriented curriculum will produce graduates not only adept
at providing primary care but also efficient and effective health system/program managers/leaders.
Table 19. Strategies for Reorienting HSE Curriculum to Produce Health Professionals Responsive to Local
Health Needs and Demands
● Identify/assess strategic ● Develop learning and ● Conduct impact

and practical challenges development programs (with a assessment on the
and interventions team of peer guides to support reorientation of
CHAPTER
towards embedding PHC HEIs in undertaking curriculum curriculum
in the HSE curriculum transformation, retooling ● Use data analytics
6
● Formulate and instructional materials, and research to
implement strategies and strategies, and instructors) inform HEI
policies for refocusing ● Strengthen pre-service curriculum and
the curriculum towards education and training on PHC instructional
PHC by exposure/immersion to development
Outputs: public health ● Establish recognition
○ Policies on re- ● Embed interventions or and award system
orientation of opportunities in the curriculum for HEIs with
curriculum in place to orient health workers significant
○ Guidebook on towards professional advancements in
curriculum standards, public health and curriculum
transformation health-related policies and transformation
towards PHC programs, interprofessional ● Include early
developed collaboration, public service exposure to and
○ Study circle organized ethics, and social appreciation for PHC
for HEI curriculum accountability, that they may in secondary
transformation contribute to building education curriculum
aligned with PHC and responsive health systems and
UHC help to empower communities
○ Quality assurance for ● Enhance capacities of health
16Mogren, A. (2019). Guiding Principles of Transformative Education for Sustainable Development in Local Schools Organizations.
Retrieved from https://www.diva-portal.org/smash/get/diva2:1368940/FULLTEXT01.pdf

curriculum workforce in emergency risk

development and assessments, prevention,
enhancement preparedness, response, and
formulated recovery
Table 20. Various Stakeholder Organizations and Roles for KRA 2
Stakeholder Role/s
1. Commission on Higher Education ▪ Promote quality health sciences education

(CHED) ▪ Ensure accessibility of HSE for those who may not
be able to afford it but have the passion and ability
CHAPTER
to serve the health sector

▪ Uphold academic freedom and foster intellectual
growth
2. Technical Education and Skills ▪ Formulate/update continuing, coordinated, and

Development Authority (TESDA)
CHAPTER
fully integrated technical education and skills

development policies, plans, and programs
6
including training regulation and competency

standards based on the needs of the health sector
3. Association of Deans (Association of ▪ Develop transformational leadership and

Deans of Philippine Colleges of management among all deans and build
Nursing, Inc. or ADPCN, Association capabilities and credibility in research and
of Philippine Schools of Midwifery or instruction in the health profession
APSOM, etc.)
4. Association of Schools/ Universities ▪ Promote quality health sciences education in the

(Association of Philippine Medical country
Colleges Foundation, Inc. or APMC, ▪ Recommend standards and policies to promote
etc.) quality education
▪ Assist schools to achieve targets
5. Higher Education Institutions ▪ Implement academic standards and innovations in
teaching
▪ Produce evidence through research, which
policymaking bodies can use
▪ Share best practices on the production of health
professionals, enhancement of primary care
competencies, interprofessional education,
implementation and monitoring of return service
agreements, ladderized programs for health
courses, etc.

Stakeholder Role/s
6. Professional Regulation Commission ▪ Administer, implement, and enforce regulatory

(PRC) laws, policies, standards, and ethics on the practice
of profession
7. Student Organizations/Network ▪ Empower and unite medical and allied health

students through the creation of linkages and
avenues for cooperation and resource sharing
▪ Take part in developing, implementing, and
evaluating policies for better HRH production
▪ Advocate for the welfare of health and allied health
student community
CHAPTER
6

CHAPTER 7
HRH Welfare, Protection,

and Career Development
CHAPTER SEVEN
HRH WELFARE, PROTECTION, AND CAREER DEVELOPMENT
Providing opportunities for decent work in the health sector is essential in addressing the country’s health
workforce shortages and achieving the goal of equitable access to quality health care.
The International Labor Organization (ILO) defines “decent work” as the sum of “the aspirations of people
in their working lives1,” including: work that is productive and delivers a fair income; security in the
workplace and social protection for families; better prospects for personal development and social
integration; freedom for people to express their concerns, organize, and participate in the decisions that
affect their lives; and equality of opportunity and treatment for all women and men.
Decent work is also defined as “safe work.” The ILO has sought to generate awareness worldwide of the
dimensions and consequences of work-related accidents, injuries, and diseases, and to place the health
and safety of all workers on the international agenda to stimulate and support practical action at all levels.
These efforts are aligned with the Sustainable Development Goals adopted by member states of the United
Nations, specifically SDG 8: Decent Work and Economic Growth. Providing decent work for healthcare
workers, along with requisite benefits, is seen as integral to economic growth and ensuring sustainable,
effective, and resilient health systems in the country.
These are also aligned with the Philippine Development Plan 2017-2022, which seeks to accelerate human
capital development through skills development and retooling by means of education and training;
facilitation of employment; expansion of internship, apprenticeship, and dual training programs; and
participation of women in the labor market.
CHAPTER
The PDP calls for productivity-based incentive schemes, greater safety and health in the workplace, and
the nurturing of workplace harmony. It also seeks to enhance labor mobility and income security through
7
unemployment insurance programs for the long-term unemployed, such as community-based employment
programs, and implementation of the minimum wage policy. DOLE likewise upholds inclusive development,
prosperity, and labor justice for Filipino workers and their families through its vision of “every Filipino worker
attaining full, decent and productive employment”; and its mission “to promote gainful employment
opportunities; to develop human resources; to protect workers and promote their welfare; and to maintain
industrial peace.”
Ensuring HRH welfare, protection, and career development will not only attract new health workers but will
also greatly improve retention, especially in disadvantaged communities. Retention of health workers is
supremely important because it is a way of ensuring that the required number of workers in the health
facility is maintained. Retention also means continuity—for patients and other health workers in the facility–
–which is crucial in providing quality healthcare.
The government has formulated many policies and regulations for the health workers’ welfare, protection,
and career development but the private sector equally plays an important role in achieving these HRH goals.
1International Labor Organization. (n.d.). Decent Work. Retrieved from https://www.ilo.org/global/topics/decent-work/lang-

en/index.htm
HRH Welfare, Protection and Career Development | 115

Health workers expectedly choose and stay in a good working environment where there is job satisfaction
as well as potential for better pay and career mobility. Monetary incentives are still the biggest pull. As
stated in Abrigo & Mortiz’ (2019) study, “although altruistic motives among health care practitioners to
serve in rural areas may be important in recruiting HRH for rural practice, it may not necessarily be the most
sustainable2.”
“Boosting household incomes through local economic development appears to be essential in ensuring the
economic viability of any professional practice, particularly in health care. While the government plays an
important role in the more equitable distribution of health care workers across the country, the critical
contributions of the private sector cannot be discounted. Supporting private health care practice through
the country’s social health insurance system or a similar voucher scheme may provide greater incentives
for healthcare workers to practice in underserved areas 2.”
SITUATION
Numerous policies have been adopted to ensure the welfare and safety of Filipino workers both here and
abroad, and in the public and private sectors. Despite these, however, the Philippine healthcare system
remains one of the more challenging work environments in the country. Prevailing labor conditions have
driven substantial numbers of skilled health workers to seek employment outside the health sector and
outside the country.
A major concern of healthcare planners, policymakers, and managers is the retention of HRH in both the
public and private health workforces, which needs to be improved to ensure that the Philippines’
commitment to Universal Health Care is met, and that health services are delivered to all populations in all
parts of the country. Shown in Table 21 are the key policies designed to support the welfare of HRH.
Table 21. Key Policies and Regulatory Frameworks Governing Filipino Workforce
CHAPTER
7
Policy Description
Equal opportunities for work and fair income
Magna Carta for Public Health Promotes and improves the social and economic well-being of
Care Workers (RA No. 7305) health workers, their living and working conditions and terms of
employment; develops their skills and capabilities in order that they
will be more responsive and better equipped to deliver health
services; and encourages those with proper qualifications and
abilities to join and remain in government service.
Universal Health Care Act Mandates DOH, DILG, CSC, and other concerned agencies to
(RA No. 11223) enforce guidelines for providing competitive benefits and incentives
for public health workers, barangay health workers, and barangay
nutrition scholars, as well as security of tenure to those with
eligibility.
2Abrigo, M. & D. Ortiz. (2019). Who are the Health Workers and Where Are They? Revealed Preferences in Location Decision among
Health Care Professionals in the Philippines. PIDS Discussion Paper Series 2019-32. Retrieved from
https://pidswebs.pids.gov.ph/CDN/PUBLICATIONS/pidsdps1932.pdf
116 | HRH Welfare, Protection and Career Development

Mandates private and non-government health facilities to comply
with minimum staffing standards set by DOH and ensure that health
workers are hired as regular employees to ensure continuity of
health services
Compensation and Position Determines the appropriate rates of pay for all personnel in the
Classification Act of 1989 executive, legislative, and judicial branches of the government.
(RA No. 6758)
Salary Standardization Law Provides standardized compensation rates and incentive scheme
of 2019 (RA No. 11466) across all government agencies
Barangay Health Workers’ Benefits Grants benefits and incentives to accredited BHWs for voluntary
and Incentives Act of 1995 (RA No. health services rendered to the community.
7883)
Security of tenure and laws on contractualization
1987 Philippine Constitution Upholds social justice by recognizing labor as the “primary social
economic force” of the country and that it is the duty of the state “to
protect their rights and promote their welfare” (Article II, Section 18).
The constitution guarantees the worker’s right to security of tenure,
humane working conditions, and a living wage (Article XIII, Section
3), which covers both the public and private sectors.
An Act to Protect the Security of Reiterates the state’s duty to respect the rights of every employee
Tenure of Civil Service Officers in the government to due process of the law before terminating or
and Employees in the dismissing them based on valid causes found in laws.
CHAPTER
Implementation of Government
Reorganization (RA No. 6656)
7
Revised Administrative Code of Authorizes the government or any of its branches or
1987 (EO No. 292) instrumentalities including GOCCS to employ job order (JO) and
contract of service (COS) workers.
It emphasizes that those contracted activities or services shall be
for a specific period of time (fixed) only and these activities
contracted are not those regularly performed by the agency’s
regular employees.
CSC-DBM-COA Joint Circular No.1, COS refers to “engagement of services of an individual, private firm,
s. 2017 other government agency, non-governmental agency, or
international organization as consultant, learning provider or
technical expert to undertake special projects or jobs within a
specific period.”
JO refers to piece work (pakyaw) or intermittent or emergency jobs
of short-duration and for a specific piece of work.

Rules Implementing Articles 106 Defines non-permissible forms of contracting and subcontracting
to 109 of the Labor Code, as arrangements that undermine the constitutional and statutory right
amended (DOLE DO No. 174 s. to security of tenure of workers.
2017)
Security in the workplace and social protection for workers and their families
Occupational Safety and Health Ensures safer workplaces by requiring employers to provide
(OSH) Law (RA No.11058) complete safe work procedures, information dissemination about
work-related hazards, safety and health training, and protective
equipment.
Occupational Safety and Health Institutionalizes occupational safety and health (OSH) in
Standards for the Public Sector government workplaces to protect government workers from the
(CSC-DOH-DOLE Joint dangers of injury, sickness, or death and to prevent loss or damage
Memorandum Circular No.1, of properties through the adoption of safe and healthy working
series of 2020) conditions.
National Occupational Health and ▪ DOH-DOLE-CSC Joint Administrative Order No. 2017-01)
Safety Policy Framework ▪ PhilHealth Law (RA No. 7875)
▪ SSS Law (RA No. 8282)
▪ GSIS Law (RA No. 8291)
▪ Employee Compensation and State Insurance Fund
(Presidential Decree No. 626)
Guidelines Governing the Provides guidelines for the employment and working conditions of
Employment and Working health personnel in the private sector to strengthen occupational
CHAPTER
Conditions of Health Personnel in safety and health, including regulation for volunteer programs and
the Private Healthcare Industry allowable training.
7
(DOLE Department Order No. 182)
Guidelines for the Implementation Guides private sector employers and workers in effectively
of Mental Health Workplace implementing mental health workplace policies and programs.
Policies and Programs for the
Private Sector (DOLE Department
Order No. 208 s. 2020)
Labor Code of the Philippines, Empowered the DOLE to set and enforce mandatory OSH
Renumbered, DOLE Edition (Book standards to eliminate or reduce occupational safety and health
4 - Health, Safety and Social hazards and institute new, and update existing, programs to ensure
Welfare Benefits) safe and healthful working conditions in all places of employment.
Occupational Safety and Health OSH standards are mandatory rules and standards set and
Standards enforced to eliminate or reduce occupational safety and health
(as amended, 1989) (OSH) hazards in the workplace. The provision of OSH standards
by the State is an exercise of police power, with the intention of
promoting the welfare and well-being of the workers.

An Act Strengthening Compliance Ensures safe and healthful workplace for all workers by affording
with Occupational Safety and them full protection against all hazards in their work environment;
Health Standards and Providing provisions of the Labor Code of the Philippines, all domestic laws,
Penalties for Violations Thereof and internationally-recognized standards on occupational safety
(RA No. 11058) and health are being fully enforced and complies with by the
employees; and provides penalties for any violation thereof.
Implementing Rules and Covers all the mandates functions and duties of stakeholders to
Regulations of Republic Act No. facilitate the implementation of the provisions of RA No. 11058.
11058 entitled "An Act
Strengthening Compliance with
Occupational Safety and Health
Standards and Providing penalties
for Violations Thereof" (DOLE DO
No. 198 s. 2018)
Improved prospects for personal development and career development
Continuing Professional Mandates and strengthens the continuing professional

Development Law (RA No. 10912) development program for all regulated professions.
Omnibus Rules on Appointments Guides civil service appointments and other human resource
and Other Human Resource movements in government.
Actions (ORAOHRA)
Support and protection of HRH during disaster and health emergency response
National Guidelines on Mental Prevents and manages team-related problems while the service
CHAPTER
Health and Psychosocial Support providers and volunteers are in the field, and provide opportunity
in Emergencies and Disasters for service providers and volunteers to review and process their
7
(NDRRMC Memorandum No. experiences in the field with a trained facilitator before they go
2017-62) back to their respective regular work assignments
National Policy on Disaster Risk Organization and mobilization of health emergency response
Reduction and Management in teams that are equipped with adequate and appropriate tools,
Health DRRM-H (AO No. 2019- supplies, and equipment.
0046) All levels of governance and stakeholders shall support increased
investments on DRRM-H to include human resources for health
National Policy on the Protection of all types of team that are mobilized during events,
Mobilization of Health Emergency emergencies, and disasters to provide health and health-related
Response Teams (AO No. 2018- services by any health sector agency/organization, whether local
0018) or international.
Guidelines in the Provision of the Provides support to staff who experienced extreme events upon
Essential Health Service Packages manifestation of significant behavioral changes.
in Emergencies and Disasters (AO Protection and promotion of responder’s well-being during
No. 2017-0007) preparation, deployment, and follow-up phases.

Interim Guidelines on the Protects the mental health and well-being of all service providers
Implementation of Mental Health and ensure access to mental health and psychosocial care through
and Psychosocial Support peer-to-peer support initiatives, team meetings, rotation shift,
(MHPSS) in the Coronavirus support groups on social media, link to confidential helpline and
Disease 2019 (COVID-19) information dissemination on positive coping strategies
Response (Department
Memorandum No. 2020-0230)
Policies and Guidelines on Together with DOH-NCHFD, HEMB shall design and conduct
Hospitals Safe from Disasters (AO necessary training on Hospitals Safe from Disasters.
No. 2013-0014)
Challenges and Opportunities of Public Health Workers
As defined in RA No. 7305, Section 3, public "health workers" (PHWs) are all persons who are engaged in
health and health-related work, and all persons employed in all hospitals, sanitaria, health infirmaries, health
centers, rural health units, barangay health stations, clinics, and other health-related establishments owned
and operated by the government or its political subdivisions with original charters, and shall include
medical, allied health professional, administrative and support personnel employed regardless of their
employment status. Likewise, as provided by the UHC Law Chapter 3 Sec. 15, PhilHealth personnel mainly
in charge of financing for health are also classified as PHWs.
Generally, public health workers in the country are employed and managed by either the national
government or the local government, which is one of the facets of its devolved health system. The national
PHWs are mostly under the jurisdiction of the Secretary of Health and are often employed in national health
facilities such as DOH hospitals and treatment and rehabilitation centers. They are provided with a national
CHAPTER
salary rate for government employees as stipulated in RA No. 6758. Meanwhile, local governments can
7
design and implement their own organizational structure and staffing pattern as well as provide
development opportunities for its PHWs as stipulated in the Local Government Code. Local PHWs are often
assigned in LGU-run hospitals or rural health units and pay rates are dependent on their city/municipality’s
income class in accordance with salary standardization policies 3 issued by the national government.
Despite this type of set-up, the management of all public health workers are governed by policies from
national government agencies such as the CSC and DBM. All civil servants follow CSC rules and regulations
on personnel and administrative actions such as recruitment, selection, placement, learning and
development, performance management, and other administrative processes. In terms of financing, the
DBM is primarily responsible for budget appropriations both in the national and local governments,
including the earmarking of funds for compensation, benefits, and performance-based incentives for
national PHWs.
3
Republic Act No. 11469. “Salary Standardization Law of 2019”

On Security of Tenure
The number of health workers occupying permanent (plantilla) positions, especially at the local government
level, remains generally insufficient to serve the needs of the country. While WHO recommends a ratio of
44.5 HRH (doctors, nurses, and midwives) per 10,000 population to achieve UHC and SGD targets, the DOH
Field Health Services Information System 2018 report, which provides the number of HRH hired by LGUs
under plantilla positions, reveals that none of the regions has achieved such target and 16 out of the 17
regions are below 10% of the target (see Figure 26).
CHAPTER
7
Figure 27. Distribution of LGU-hired HRH (doctors, nurses, midwives) occupying plantilla positions
To augment their local health workforce, LGUs often resort to hiring health workers as JOs, with a daily rate
equal to that of the other JO workers of the LGU.
In a validation report on National Health Insurance Program 4 produced by NEDA, PSA, and UP-NIH, findings
support that hiring of health workers in the LGU hospitals/facilities is more challenging as hiring decisions
are controlled by LCEs. There were instances wherein LGUs hesitate to allocate funds for the requested
additional staff.
One of the study sites furthered that the political situation affects hiring and renewal of staff in their
hospital. These in turn inhibit the goal of having the right number of personnel to provide appropriate health
services.
4
NEDA, PSA, UP-NIH. (2021). Validating the Performance of the National Health Insurance Program: The Financial Impact of No
Balance Billing (NBB) Policy on Government Hospitals.

On Compensation and Benefits
Compensation of public health workers is generally higher than that of their counterparts in the private
health sector. However, there can be substantial differences in pay between public health workers in the
national government and those working in local government, even if they are of equal rank.
As stipulated in Section 10 of RA No. 6758, the rates of pay in local government are determined by the class
and financial capability of different LGUs, as shown below.
Table 22. Pay Rates in Local Government
Classification For Provinces/Cities For Municipalities
Special Cities 100% of national rate 100%
1st Class 100% 90%
2nd Class 95% 85%
3rd Class 90% 80%
4th Class 85% 75%
5th Class 80% 70%
6th Class 75% 65%
RA No. 7305 mandates granting financial incentives (such as hazard allowance, subsistence allowance,
longevity pay, laundry allowance, remote assignment allowance, night shift differential) as well as non-
financial incentives (leave benefits, housing, medical examination).
CHAPTER
7
Due to the limited financial resources of many LGUs, as well as gaps in their technical capacities, the
implementation of HRH mandates has proven to be particularly challenging. This is compounded by the
generally weak enforcement and monitoring of policies.
On Career Development
In general, there are two career tracks open to a government health worker: the clinical or hospital track,
and the public health track.
Career paths are designed to be competitive, as prescribed by the policies of the Civil Service Commission
(CSC). The standard practice is for a notice of vacancy to be circulated for each post, and eligible parties
are encouraged to apply. A selection committee identified by the head of the agency recruiting for the post
is supposed to evaluate the past performance and credentials of applicants against the requirements of
the job. Decisions on promotions are made at the local levels. Moving up the career path to higher-grade
positions entails taking on supervisory and management roles.

Health workers may also opt for a career path involving lateral movement, i.e. transferring from one
agency/office to another, but with more or less the same position title and salary grade; or moving from
public health into a clinical practice, and vice versa.
The Human Resources for Health Management and Development (HRHMD) Program is a system being
implemented to improve the career mobility of all government health workers, after it was observed that
health workers in LGUs had limited access to possible career tracks within the DOH and DOH-retained
hospitals5.
The HRHMD, which was established by DOH through Administrative Order (AO) No. 2014-0044, aims to
undertake career mapping and position profiling of the workforce in rural health units, including doctors,
nurses, midwives, dentists and medical technologists. This is expected to help guide the professional
development of health workers in their respective career paths.
Further, the CSC established the “Program to Institutionalize Meritocracy and Excellence in Human
Resource Management (PRIME-HRM)” in 2012 with the aim of inculcating good practices in public service
human resource management, including that of the health sector, through a program of reward, recognition,
empowerment, and continuous development.
On Capacity Building
The DOH has institutionalized the DOH Academy through AO No. 2015-00426, with the primary objective of
integrating, harmonizing and streamlining HRH capacity development and training activities, instituting a
certification and accreditation system for academic and training institutions, and improving the efficiency
and cost of training.
As the primary training arm of the DOH, the Academy is aimed at enhancing the competencies of the health
CHAPTER
workforce in local health systems development. The HHRDB is particularly keen to develop e-learning
modules as a component strategy of the DOH Academy. This will allow health workers to continue to hold
7
their current jobs and perform their duties without interruption, while taking training courses to enhance
their competencies and avail themselves of career growth opportunities.
Currently, DOH is working with DILG’s Local Government Academy (LGA), which is responsible for human
resource development and training of local government officials and DILG personnel 7, to strengthen
capacities in health service delivery. In late 2020, the LGA initiated a leadership workshop for health
emergencies. A course on health system management and development, particularly in the context of UHC,
is currently being developed. Individual LGUs have also sought to provide short-term training programs for
their health workers in collaboration with private sector stakeholders.
5
Dayrit, M., L. Lagrada, O. Picazo, & M. Villaverde. (2018). The Philippine Health System Review 8(2). New Delhi: World Health
Organization. Retrieved from: https://apps.who.int/iris/bitstream/handle/10665/274579/9789290226734-
eng.pdf?sequence=1&isAllowed=y
6
Department of Health. (2015). Administrative Order 2015-0042: Guidelines for the Establishment of the DOH Academy. Manila,
Philippines.
7
DILG Executive Order 262, Section 14.

The RA No. 10912, “Continuing Professional Development Act” has also established a capacity
enhancement mechanism by ensuring that knowledge, skills, and values of health professionals regulated
by PRC shall be updated and upgraded. CPD is also a necessary tool for the upgrading of qualification
standards towards the formulation of Career Progression and Specialization (CPS) Program in line with the
objectives of the Philippine Qualifications Framework.
Community Health Workers
The ILO International Standard Classification of Occupations defines community health workers as health
workers who “provide health education and referrals for a wide range of services, and provide support and
assistance to communities, families, and individuals with preventive health measures and gaining access
to appropriate curative health and social services. They create a bridge between providers of health, social
and community services and communities that may have difficulty in accessing these services.”
The primary group of CHWs in the Philippines is composed of barangay health workers. These are members
of the community who are endorsed by the chairman of the barangay (district) and have voluntarily
rendered primary health care services. The other known group of CHWs are the barangay nutrition scholars,
who provide nutrition information and services to the community and monitor the nutritional status of
children, among other services. The BNS workforce was born of the BNS Project created in 1977 by virtue
of PD No. 1569 as a human resource development strategy of the Philippine Plan of Action for Nutrition.
Both BHWs and BNSs are managed by, and receive honoraria and allowances from, the LGUs in which they
serve. CHWs, the majority of whom are women, play a crucial role in helping to provide promotive and
preventive healthcare at the community level as they function as frontline health center staff and
community health mobilizers.
However, the engagement, development and retention of CHWs is hampered by the following reasons,
CHAPTER
among others:
7
▪ They lack formal recognition as part of the health workforce.

▪ They are not considered government employees, and do not receive a regular salary; they have no
security of tenure8
▪ Their honoraria and allowances may vary greatly, depending on the availability of LGU funds.
▪ Their roles and duties are not clearly defined, and there are no standardized qualifications for
serving as BHWs and BNS.
▪ There are no formal training and capacity-building programs for CHWs apart from TESDA’s
Barangay Health Services Certification (NCII) program (totaling 560 hours), which is not
mandatory
▪ The lack of formal guidelines allows the barangay chair to appoint BHWs arbitrarily; as a result,
many CHWs are appointed on the basis of personal or political relationships rather than their
willingness and capacity to serve.
8Mallari, et. al. (2020). Connecting Communities to Primary Care: A Qualitative Study on the Roles, Motivations, and Lived
Experiences of Community Health Workers in the Philippines. Retrieved from
https://bmchealthservres.biomedcentral.com/articles/10.1186/s12913-020-05699-0

Challenges and Opportunities of Private Health Workers
Private health workers are employees in the private healthcare industry who include, but are not limited to,
physicians, nurses, nutritionist, dieticians, pharmacists, social workers, laboratory technicians, paramedical
technicians, psychologists, midwives, attendants, and all other health personnel working in establishments,
workplaces, operations, and undertakings (adopted and modified from DOLE DO No. 182 s. 2017).
The private healthcare industry is generally governed by DOLE policies and guidelines. For instance, salaries
and wages in the private sector are determined and monitored by the Regional Tripartite Wages and
Productivity Board under the purview of the DOLE. Changes in the salary rate of private health workers are
under the discretion of their respective health institutions.
On Compensation and Benefits
Currently, the entry level premium for health workers in the public sector is roughly 50 percent higher than
in the private sector. There are no laws, equivalent to RA No. 7305, that mandates the provision of benefits
to HRH in private health care.
This has incentivized qualified health workers to remain unemployed and continue instead to seek jobs in
the public health care or in other industries. Low wages in private health care are also why many nurses
seek overseas employment rather than stay in the country. 9
The drive to seek greener pastures has also resulted in anomalies in the healthcare industry; for example,
nurses have been known to pay private hospitals a “training fee” for them to acquire the two years of work
experience required for overseas employment. DOLE has been looking into the plight of nurses in private
hospitals, but is unable to pursue cases in the absence of complainants.
CHAPTER
In 2020, DOLE requested DOH to initiate before Congress a proposal upgrading the salaries of nurses and
7
other medical workers in the private sector. Subsequently, House Bill No. 7569 “Minimum Wage for Nurses
in the Private Sector Act” was filed in the Congress but is still pending with the Committee on Labor and
Employment. he DOH, through the HHRDB, continues to lobby for standardized salary between public and
private health workers as espoused in many of its position papers on several HRH-related House and
Senate bills to express its strong support for fair and just treatment of the country’s health workforce.
Providing just compensation and benefits to private health workers while ensuring that private health
facilities remain financially viable is a balancing act. Like other businesses, private health facilities depend
on gains from the services they provide in order to keep running. In mid-year 2020, at the height of the initial
COVID response, private hospitals stated that, having already experienced huge losses due to the
pandemic, they might have to close down if they were obliged to provide hazard pay and other additional
compensation to their health workers10.
9
Patino, P. (2020). Proposed Healthcare Workers’ Salary Hike Timely. Retrieved from: https://www.pna.gov.ph/articles/1116263
10
CNN Philippines. (2020). Private hospitals could close down if forced to grant benefits to frontliners. Retrieved from
https://cnnphilippines.com/news/2020/7/15/COVID-frontliners-benefits-private-hospitals-could-close-
down.html?fbclid=IwAR1_CSPLD-jdEd7EkgfMDMcDITyPMEc3ixa1TDIN79x_tEAUBmX7EXlh2xE

Anecdotal reports indicate that even before the pandemic, many private healthcare workers transferred to
the public health sector as soon as jobs opened, partly because of the disparity in pay and benefits. This
resulted in the closure of some private sector hospital wards and the downgrading of health facility licenses
in some cases. While the government plays a key role in ensuring the equitable distribution of public
healthcare workers across the country, the contribution of the private sector should also be fully considered
and maximized.
On HRH Management and Development
The private healthcare industry operates in a free market driven by business forces. Although there are
regulations on various facets of private healthcare management, there is currently no national framework
to guide the management and development of private health workers, comparable to the CSC PRIME-HRM
program for workers in the public health sector.
HRH Mobilization in Health Emergencies
National agencies need to enhance and explore coordinating mechanisms in managing HRH during
emergencies and disasters. In this regard, there is a need for an overarching strategic framework or national
plan for the welfare, safety, and protection of HRH to be activated specifically for such contingencies. The
framework would cover remunerations/benefits based on prevailing policies, on top of the regular benefit
package provided during normal working conditions, such as appropriate compensation, special risk
allowances (SRA), insurance, communication allowance, accommodation, transportation, and meals,
among others. Should a health worker fall ill, suffer injury, or die in the course of duty, appropriate
compensation/benefits must be provided including emergency extraction, as needed.
The DOH has developed two sets of guidelines on the mobilization of Health Emergency Response Teams
(HERTs) for planned events, emergencies, and disasters:
CHAPTER
7
▪ DOH-HEMB Manual of Operations on Health Emergency and Disaster Response Management. This
was developed in 2015 to consolidate existing policies and guidelines in a single document; it
provides guidance for the mobilization and deployment of response teams, including volunteers,
for planned events, domestic emergency incidents/events, and emergencies/disasters in other
countries.
▪ National Policy on the Mobilization of Health Emergency Response Teams (HERTS) (AO 2018 -
0018). This provides guidance for the timely and appropriate mobilization of HERTS in dealing
with emergencies and disasters, from team composition to initial mobilization to successive
phases of emergency response, including provisions on the protection of HERTs.
“Band-aid” HRH solutions during the COVID-19 Pandemic
When the country experienced a surge in COVID-19 cases, its health system was overwhelmed by the influx
of patients being admitted in health facilities and those who needed to be isolated. This unexpected event
has caused shortage in health workers and personal protective equipment (PPE), and longer duty hours
which lead to fatigue.

The DOH implemented four strategies for augmenting the health workforce responding to the COVID-19
pandemic and to complement the expanded bed capacities of health facilities.
▪ Redeployment of some nurses hired under the DOH Deployment Program from primary care
facilities to DOH and LGU hospitals (DOH Department Memorandum No. 2020 -0152)11
▪ Redeployment of post-residency physicians in priority health facilities (DOH Department
Memorandum No. 2020-0184)12
▪ Temporary engagement of HRH to complement and supplement the existing health workforce in
hospitals or temporary medical facilities (DOH Department Memorandum No. 2020-0153)13
pursuant to Section 4(m) of RA No. 11469, otherwise known as the Bayanihan to Health as One
Act.
▪ Engagement of medical graduates (DOH Department Memorandum No. 2020-0169)14 through the
grant of Special Authorization by the Secretary of Health, to perform limited practice of medicine,
as stipulated in RA No. 2382 or The Medical Act of 1959 and RA No. 11469. The memorandum
stipulates that this shall be a last resort, when all efforts to recruit or hire the required number of
licensed physicians have been exhausted.
As of 11 December 2020, 12,434 health workers had been hired for the 16,847 approved slots for
emergency hiring in 374 health facilities, i.e. diagnostic facilities, COVID-19 referral facilities, epidemiology
and surveillance units, DOH hospitals, LGU and other hospitals, Mega Ligtas COVID- 19 Centers, temporary
treatment and monitoring facilities, other healthcare facilities (such as those of the Philippine Red Cross),
and private health facilities.
As of 10 December 2020, the DOH had redeployed a total of 10,649 NDP nurses and 4,265 other deployed
HRH from primary care facilities to participate in hospital-based and community-based COVID-19 response.
A total of 36 hired deputized/unlicensed physicians were deployed. 15
CHAPTER
Some of the health workers were also engaged for auxiliary tasks such as contact tracing. Led by DILG, the
7
government was able to hire 41,961 additional contact tracers in 2020 who tracked down close contacts
of COVID-19 patients.
Efforts to institutionalize the Medical Reserve Corps
Various House and Senate Bills (HB Nos. 6809, 6821, 7007, 7157, 7267, SB 1592, 1527, 1451) seeking the
establishment of a Medical Reserve Corps (MRC) were filed as early as May 2020, for which the DOH
expressed its support. These legislative actions were aimed at institutionalizing a mechanism for the
11
Department of Health. (2020). Department Memorandum 2020-0152. Guidelines on Temporary Re-deployment of Nurses under
the Nurse Deployment Program from Rural Health Units/Health Centers/Health Stations to Department of Health and Local
Government Units Hospitals in Response to COVID-19 Health Emergency. Manila, Philippines.
12
Department of Health. (2020). Department Memorandum 2020-0184. Directives regarding Physicians under the Post-Residency
Deployment Program in response to COVID-19 Health Event and Enhance Community Quarantine. Manila, Philippines.
13
Department of Health. (2020). Department Memorandum 2020-0153. Interim Guidelines for Emergency Hiring of Health
Personnel in Select Hospitals and Other Health Facilities in Response to COVID-19 Health Emergency. Manila, Philippines.
14
Department of Health. (2020). Department Memorandum 2020-0169. Interim Guidelines on the Grant of Special Authorization to
Medical Graduates to Perform Limited Practice of Medicine by the Secretary of Health in Response to COVID-19 Health Emergency.
Manila, Philippines.
15
Department of Health (2020). HRH Augmentation Report No. 195. Unpublished Report

mobilization of HRH/emergency response teams to augment the health workforce capacity during a state
of public health emergency.
House Bill No. 7274 proposes that the MRC be composed of resident Filipino citizens who:
▪ have degrees in the fields of medicine, nursing, medical technology, and other health-related fields
but who have not yet been issued respective licenses and/or awaiting licensure examinations in
their respective professions.
▪ are medical reservists of the Armed Forces of the Philippines (AFP)
▪ are public health experts, scientists, and non-medical volunteers trained for health, emergencies,
and other necessary services.
The proposed legislation complements the minimum population-based health service components of the
province/city-wide health system described in the Implementing Rules and Regulations of the Universal
Health Care Act, which mandates “timely, effective, and efficient preparedness and response to public
health emergencies and disasters.”
Currently, House Bill No. 72734 has been passed in the House of Representatives and a substitute bill will
be subjected to Senate deliberation and approval.
Lack of job security
The Philippine Constitution upholds security of tenure for both private and public health workers. However,
one of the pressing labor issues in the county is the continued existence of job contractualization in both
CHAPTER
public and private sectors. Based on CSC data, as cited in Villena’s (2019) study, “almost one-fourth of the
7
workers in the bureaucracy are under fixed-term arrangement, and majority are in the Local Government
Units (69.6%)16.” This is consistent with DOH’s case wherein 23% of the workers in facilities and offices
managed by DOH are under Job Order (JO) or Contract of Service (COS) status as of June 2020. No reliable
data was obtained from the private sector, but this is also a challenge that contributes to the high turnover
rate among private healthcare workers.
Studies show that hiring of workers under temporary or probationary status has an impact on productivity
and job satisfaction. Results of a study on JO and COS workers in government showed the following: (1)
while there are various motivations that drive an individual to work as JO or COS, to be a regular employee
is the main goal; (2) the lack of employer-employee relationship with the hiring agency gives rise to a lack
of social protection, making their access to social security programs self-initiatory (i.e. voluntary
contribution to mandatory social insurances); (3) while JO and COS workers are hired for a specific job and
period, their service and contributions are indispensable to their employer (agencies); and (4) there are
identified gaps in the implementation of the present circular governing JO and COS workers 16.
16
Villena, I. (2019). Exploring the Case of Job Orders and Contract of Service Workers in the Government. Philippine Journal of
Labor Studies 1(2):99-119.

Table 21 provides the relevant policies governing contractualization; however, several gaps are observed:
▪ There is no clear definition of what should constitute a “core” function, or those functions which
should not be assigned to JOs; however, the multiple renewals of JO contracts show that these
JOs are indispensable to employers and they do not perform just piecework, intermittent, or
emergency work but their workload is equivalent or more than their regular counterparts.
▪ Policies do not state or emphasize how many months or years to declare for a JO employment to
be of “short duration” and renewable
▪ Payment is based on the amount agreed upon on the contract and not on prevailing minimum
wage rates.
On the other hand, the most common reasons for accepting a JO or COS position as expressed by
individuals are: (1) to gain relevant experience, (2) no CSC eligibility during application for a regular position,
(3) no vacant plantilla position, (4) no work experience, (5) stepping stone for a permanent position, and (5)
salary of a JO or COS worker in government is higher than that of entry-level positions in the private sector.
However, the disadvantages are: (1) lack of statutory and monetary benefits, (2) length of service is not
creditable as government service, (3) they have less work-related training opportunities than their
counterparts holding permanent positions; (4) there is constant fear that they can be easily laid off or
contract not renewed; and (5) they have no employer-employee relationship but they are subject to the
same CSC or office rules.
Plantilla positions in government
While the problem of limited plantilla positions is a general challenge in government, some agencies or
institutions have specific positions that are difficult to fill due to the specialized nature and requirements
of the job. Based on the data provided by DBM on plantilla positions for doctors, nurses and midwives in
CHAPTER
government (except GOCCs and LGUs), 17% are unfilled; while CSC data shows 9% of these positions are
7
unfilled. For plantilla positions (both clinical and administrative) under the Department of Health, 16% are
unfilled. Plantilla positions in government should also be studied to identify reasons for the difficulty in
filling such positions.
Efforts should be made to widely advertise vacant positions in the health sector. There are available online
platforms, however, it is not mandatory for agencies or institutions to use them for posting job vacancies.
There is also no incentive to encourage the private sector to post their vacancies.
Recruitment and qualification standards should also be studied, along with facilitating and hindering
factors to efficiently fill plantilla or regular positions.
The Plight of Community Health Workers
The engagement of community health workers is still primarily voluntary. Although they provide the most
invaluable contributions for primary health care, they are unsung and unpaid. Anecdotal records show that
some of these health workers receive as low as 50 pesos per month despite providing services at least 4
hours a day, 5 days a week. Ideally, one BHW serves 20 households in their community but some of them

handle 100 or more. Some of them even shell out cash to help their indigent constituents. Despite their
dedication, their service as community health workers is subject to political and personal considerations.
Pay disparities
There are substantial disparities between the wages of health workers hired by the national vs local
governments, among those working in the public sector vs private sector, and those working within vs
outside the country. Further, some health workers shift from health to non-health careers due to higher pay.
Disparities between the health sector vs other industries
Health workers in general, particularly women, receive lower wages in comparison to those in similar jobs
but in different industries.17
There were reports of licensed and trained health workers who opted to work in BPOs, handling either health
and non-health related work, due to higher pay and better or favorable working conditions. The Technology
and Business Process Association has reported that BPO firms have contacted the association to help
recruit nurses for employment as medical transcribers and related positions.
During one of the consultations with the HRH Network, it was said that an effect of this is the deskilling of
health workers–– their clinical or health skills are no longer up to par when they return to work in health
care.
Disparities between national vs local government, public vs private sectors
RA No. 11466, otherwise known as the “Salary Standardization Law of 2019,” provides for current salary
scales and increase in base pay through step increments for civilian personnel, which includes public health
CHAPTER
workers. However, its implementation in LGUs is still subject to Section 10 of RA No. 6758, which dictates
7
rates of salary based on the income class of the LGU. This means that a health worker hired by the national
government and first class cities will receive 100% of the salary provided by the said law, while those in
sixth class municipalities are only entitled to 65%.
In addition, the grant of benefits mandated under the Magna Carta for Public Health Workers varies
between levels of government and across LGUs, depending on the capacity to pay.
While the government has already implemented two rounds of salary standardization, no similar scheme
was prescribed for the private health sector. The entry level premium for health workers in the public sector
is roughly fifty percent higher than in the private sector. Benefits for private health workers are also not
standardized. No counterpart Magna Carta policy exists for private health workers at present
These have basically resulted in a health worker migration trend from the private sector to the public sector;
and from the local government to the national government.
17
USAID HRH2030. (2020). HLMA Technical Advisory. Unpublished Report.

The DOH HRH Deployment Program inadvertently had this unintended effect. Health workers, under this
program, initially received only allowances in exchange for part-time services in government health facilities
allowing them to gain both clinical and public health experience, and increasing their employability.
Eventually, this became a strategy to augment HRH in LGUs––providing the deployed HRH with COS
positions. As COS workers, they are not given benefits but their salaries are relatively higher than that of
their regular counterparts in the LGUs and in private health facilities.
Recently, these HRH positions were converted from COS to PS-contractual positions, which means that the
health workers are provided salaries and benefits at national rates with contracts being renewed every year,
subject to their satisfactory performance, and more importantly, subject to available funds provided under
the annual General Appropriations Act. This has caused private and LGU employers to seek assistance
from the national government in levelling the field in terms of providing salaries and benefits and voice out
their difficulty in hiring health workers as they cannot compete with the capacity of the national
government.
Disparities between Philippines vs other countries
The comparatively low wages of health workers in the country have driven many to seek overseas
employment9.
Table 23 shows how the average monthly base pay (in Philippine peso) for the top 3 emigrant health
professionals in top destination countries are far from wages in the Philippines.
Table 23. Base Pay for Nurses, General Physicians, and Dentist in the Top Destination Countries, expressed
in Philippine Peso (PhP)18
ASEAN Countries20 Non-ASEAN Countries

Philippines19
CHAPTER
Cadres United Saudi
Singapore Thailand Indonesia Germany
Public Private Kingdom Arabia
7
Dentist 38,464 22,269 332,615 227,113 104,495 280,413 264,142 105,338
Doctor 59,353 27,500 317,666 127,419 114,619 355,589 254,236 122,702
Nurse 32,503 9,517 93,431 56,908 35,952 135,440 98,000 56,627
Effects of the Disparities in Pay on HRH and to the Country
Disparities in pay have caused HRH to seek employers with the most competitive offer, causing the
imbalance of HRH distribution in the country. Such disparities have demotivated some health workers to
serve, especially in disadvantaged, underserved areas, which are mostly low income class municipalities.
18
Cadres and countries are based on latest data from POEA
19
Philippines rates are based from Salary Standardization Law and available data from DOLE website
20
ASEAN and NON-ASEAN countries’ rates are retrieved from http://www.salaryexplorer.com, https://www.glassdoor.com,
https://www.paylab.com, https://www.payscale.com; conversion was based on BSP Exchange Rates
https://www.bsp.gov.ph/SitePages/Statistics/ExchangeRate.aspx

Several sixth class municipalities have relied on the Doctors to the Barrios Program for several years
because they cannot afford an attractive pay for a doctor to stay.
This has also caused unintended tension among LGU-hired and DOH-deployed HRH within primary care
facilities. Since DOH-deployed HRH are paid higher, they are expected to have a heavier workload; however,
since they are not hired by the LGU they serve, questions on accountability surface.
The HRH deployment program, although nobly intended to ensure access of all Filipinos to a health worker,
has caused several spillovers. This has become a disincentive for LGUs to find all possible means to hire
adequate numbers of HRH. For years, the LGUs tend to rely entirely on the HRH deployment program for
HRH to serve their constituents.
Mechanisms and safeguards should be designed to put and retain health workers where they are needed—
ensuring balance between private and public health sectors, as well as national and local governments.
Unoptimized health workforce: a closer look at HRH workloads, scopes of practice,

and skill mix
A recent study was conducted on HRH staffing in select health facilities in the country using the Workload
Indicators of Staffing Needs (WISN) tool of the WHO. WISN determines the HRH requirements for a
particular facility based on the activities that take most of the daily working time of health workers. The
tool also indicates the pressure level of specific cadres of health workers such as that if they are
overburdened, optimized, or underutilized.
The study revealed that for HRH in primary care facilities, some workers (i.e. doctors) are clearly
overburdened, while others (midwives and medical technologists) are underutilized or offer limited services
against their prescribed scopes of practice and training background. Overlapping scopes of practice was
CHAPTER
also noted. For example, both nurses and midwives perform basic consultation and childhood
7
immunization in their assigned barangay health centers.
On the other hand, HRH in secondary and tertiary health facilities are overburdened with primary care
consults when they should have been offering specialized services not offered at lower levels.
Inequitable workloads and overlapping scopes of practice have resulted in workforce inefficiency and
dissatisfaction among health personnel.
HRH skill mix in the country is also not optimized. For example, the previous chapters have established the
apparent lack of doctors and surplus of nurses. Mechanisms should be established to fully take advantage
of this situation such as adopting micro-credentialing or just-in-time training for nurses to allow them to
perform certain functions of doctors, especially in primary care facilities. However, the rigid regulation of
roles by professional groups, prevents or limits such innovative solutions, even if these are well established
and proven in other countries to be effective and efficient.
As such, HRH workloads, scopes of practice, and skills mix should be further studied to optimize the
existing workforce in pursuit of Universal Health Care.

Challenges in ensuring quality health workforce: lack of career development and
training opportunities, and weak performance management systems
Universal Health Care demands increased competencies of HRH, especially in service delivery, leadership,
and health system management. Ensuring capable and equipped HRH is not only achieved by providing
training opportunities but also establishing HRH performance management systems. To further sustain the
motivation of health workers, defining career opportunities and career pathways is equally important.
However, several challenges and gaps are observed.
On Training Opportunities
The CPD Act mandates that healthcare professionals must complete continuing professional development
training in order for their professional licenses to be renewed. All registered and licensed professionals are
supposed to complete the required credit units within a compliance period. These credit units may be
obtained through: a professional track, whereby units are granted for participating in recognized events; an
academic track, whereby units are granted for acquiring relevant academic degrees or credentials; and a
self-directed track, whereby units are granted for participating in accredited training and education
programs.
Compliance with these training requirements, however, has posed challenges as most of the trainings with
accredited CPD units are available for a fee. Government health workers with plantilla positions may avail
of these trainings for free as government shoulders registration fee of select trainings. Unfortunately,
trainings for most private health workers and JO/COS health workers are out-of-pocket.
DOH provides training for its health workers and those under the local government units but the way these
trainings are scheduled and designed has resulted in absenteeism among health workers and further
CHAPTER
crippled the overstretched workforce.
7
Reports from the ground reveal that some HRH trainings are not needs-based (i.e. not based on
competency and performance gaps). Those who are prioritized for training are the regular employees.
Since training needs identification is not purposively done, there are employees who are sent to training
without considering if they have attended a similar training before, or if they need such based on gaps.
Moreover, the benefits or effectiveness of such training to the employee are not regularly monitored or
evaluated through improvement of knowledge, skills, or attitudes.
On Performance Management and Career Development
CSC has prescribed the Strategic Performance Management System (SPMS) to gauge performance of
employees in terms of achieving set targets and guide supervisors in improving the performance and
competencies of their supervisees. However, the SPMS is only applicable to regular employees. No such
standard exists for JO and COS workers, and even to some private health care workers.
Without such systems, an employee’s performance and gaps are not fairly and accurately assessed against
performance targets and standards. Performance management systems also motivate employees to
provide better results because of the clarity of performance targets and to innovate through a structured
process.

To maximize performance management systems, they should be linked with career planning and
development. However, unlike in the corporate world, where career ladders are well defined, the health
sector is yet to design and/or refine existing initially known career paths for health professionals in both
public and private sectors.
There is also a need to establish coherence in the critical career development and policies that cut across
labor, education, and other sectors. More innovative approaches to coaching and training are required,
along with support for individual career path/planning.
Lack of HRH protection and support
On HRH Safety
There is a perceived lack of protection for HRH, characterized by non-assurance of safety and security. For
instance, the DOH recorded 16,552 health workers who tested positive for COVID-19 and 86 total deaths
among confirmed cases, as of 12 April, 202121.
The implementation of effective occupational health and safety (OSH) programs remains extremely limited
for the following reasons: (1) regulatory agencies have limited capability to implement minimum OSH
requirements due to lack of enforcement powers, resources, human resource, and technical training of
designated inspectors; (2) no regulatory provision for penalties on violations of OSH standards and
exposure limits; (3) high level of graft and corruption; (4) lack of awareness of management on the nature
of OSH and the advantage it can bring to the institution or business; (5) limited number of occupational
health practitioners or experts to serve the needs of the country; and lack of resources 22.
Ensuring the safety and security of migrant health workers is a problem as well. Access to and availability
CHAPTER
of OSH programs and services depend on the policies of the host countries. The Philippine government has
very little influence to ensure the workplace health and safety conditions of its health workers in another
7
nation. What often happens is that when a Filipino overseas worker becomes ill and is sent home, his or
her work-related illness or injury becomes a problem of the Philippine health care system and the
Employees Compensation Commission (ECC)20.
Several reports on health worker killings as well as discrimination (especially during this pandemic) have
surfaced but remained unresolved. There is no existing national safety protocol or policy to ensure health
worker safety and protection. Only the recent Bayanihan to Heal as One Act has touched on the issue of
discrimination against health workers.
21
Department of Health Epidemiology Bureau. (2020). COVID-19 Surveillance Report. Unpublished Report.
22
Torres, E., I. Greaves, J. Gapas, and T. Ong. (2002). Occupational Health in the Philippines. Retrieved from
https://www.researchgate.net/publication/11343362_Occupational_health_in_the_Philippines

On Providing Support and Optimal Working Environment for HRH
Health workers who do not have the means to adequately and efficiently perform their duties are easily
demotivated and seek to transfer to a working environment that provides better resources and support,
where they can fully practice their profession and hone their skills.
The recently conducted WISN study showed an underutilization of most medical technologists because of
the lack of laboratory equipment and supplies. Often this is due to financial constraints, but this could also
be a problem of lack of information. Some local governments allocate their resources to other priorities
because they are not aware of the needs for health or they do not realize the importance and benefits of
investing in people’s health.
Some health workers in public hospitals even go as far as shelling out a significant sum just to ensure that
their patients are better when they’re sent home.
Ensuring the health of health workers has not been a priority as well. Health workers exert all efforts to
provide the best care for their patients, but they, themselves, do not have the privilege to be considered
eligible under the priority lane in health facilities. Most health workers are not provided HMOs by their
employers and have to procure their own. This is anecdotally the case for most public health workers.
With the high level of stress in their line of work, the mental health and well-being of health workers should
not be taken for granted. The COVID-19 pandemic, for example, has taken a toll on the mental health of
health workers, unfortunately, response to the distress calls of the health frontliners has been slow.
Wellness programs are hard to access as well as these are less of a priority, especially in the public sector.
With all the efforts and personal sacrifices, our health workers truly deserve better if not the best working
conditions.
CHAPTER
Poor HRH resilience / responsiveness
7
In 2020, the Philippines health system failed, at the outset, to effectively manage and control the highly
infectious COVID-19 virus. Among the factors cited were the country’s limited testing capacities,
inadequate infection control measures, and weak treatment capacity. These crucial gaps in health
emergency response were exacerbated by the fragmented health financing and service delivery system
and the inadequate supply and unreliability of health care services 23 due, in part, to poor HRH management
and the resulting lack of health personnel with requisite skills in the locations where and when they were
most needed.
23
Asian Development Bank. Health System Enhancement to Address and Limit COVID-19. Retrieved from:
https://www.adb.org/sites/default/files/linked-documents/54171-002-ssa.pdf

General Objective
Raise HRH productivity and responsiveness by promoting job satisfaction and motivation
at all levels, thereby improving HRH retention in the Philippine health sector
Success Measures
Indicators Targets
Health worker geographic % of health workers whose current primary health care practice is the
retention same geographic locale that the health worker identifies as his or her
place of birth.
HRH Satisfaction % of HRH feel satisfied and well- treated by their employer or
organization as determined by lead agencies and organizations
Increase in the number of % increase in the number of health workers hired under permanent
health workers hired under positions in both public and private sectors as determined by lead
permanent positions agencies and organizations
-or-
% of P/CWHS with adequate % of P/CWHS with adequate number of permanent positions for
number of permanent positions health workers as determined by lead agencies and organizations
for health workers
Health care institutions (HCIs) % of HCIs implement Magna Carta benefits (for public health
CHAPTER
implementing Magna Carta workers) or equivalent benefits (for private health workers) as
benefits (for public health determined by lead agencies and organizations
7
workers) or equivalent benefits

(for private health workers)
Health care institutions % of HCIs implement wellness and mental health programs for health
implementing a wellness and workers as determined by lead agencies and organizations
mental health program for health
workers
HRH who received in-service % of HRH (per facility/institution) received in-service training /
training / continuing education continuing education annually as determined by lead agencies and
per cadre organizations

Strategic Objective 1a
Permanent positions for health workers
Ensuring job security for HRH will prevent a high turnover rate among health workers, ensure a better
balance between the public and private health care sectors, and encourage health professions to seek jobs
in the domestic market rather than consider migration as their primary goal.
A comprehensive study should be conducted to: (1) determine the current status of filled and unfilled
permanent positions in both public and private health sectors, vis-à-vis the number of health workers under
JO/COS positions; (2) identify the barriers to hiring health workers in permanent positions, including
reasons for the difficulty of filling health positions; and (3) recommend solutions to efficiently rationalize
positions for health workers, and increase their retention in the country.
Table 25. Strategies for Providing Permanent Positions for Health Workers
 Conduct an inventory and  Secure policy support  Review and recalibrate

evidence-based for the creation of strategies and policies for
positions the creation of permanent
assessment on the need
positions for health
for permanent positions Output: workers
for health workers at the
o Policies developed/
national and local levels amended to enable
Outputs: LGUs to provide HRH
positions (e.g.
o Comprehensive study
exemption of HRH from
conducted on filled and
CHAPTER
PS Cap limitation)
unfilled health plantilla
positions in government  Secure financing
7
vis-a-vis the number of support for the
JO/COS health regularization of health
positions; and workers or provision of
recommendations decent compensation
provided on how these and benefits
can be efficiently
rationalized
o Study conducted on the
challenges of the public
and private sectors in
providing permanent
positions for health
workers
o Minimum staffing
standards developed /
updated to serve as
basis for the creation of
positions
 Provide effective means

to access real-time
information about HRH
vacancies in national and
local levels
Outputs:
o Established a
mechanism to
harmonize all existing
databases or platforms
that provide up-to-date
information on
vacancies for health-
related work in national
and local levels
o Developed policy to
mandate public and
private sector to submit
real-time data regarding
vacancies / turnover
rates to recruitment
platforms / databases
Strategic Objective 1b
Without the community health workers, primary health care, which is the core of Universal Health Care, will
never be successfully implemented. It’s high-time that the contributions of our community health workers
are recognized and compensated fairly.
CHAPTER
Establishing standard qualifications and scopes of work for CHWs, providing security of tenure, better
7
working conditions and training/development opportunities will improve the availability and quality of our
CHWs to provide sustainable and accessible primary health care to all Filipinos.
Table 26. Strategies for Rationalized Roles of Community Health Workers
 Conduct a baseline  Rationalize and legitimize  Establish comprehensive

inventory of community roles, qualifications, and development and
health workers and an appropriate management programs
assessment of their compensation of health for community health
actual condition (e.g. workers workers
scope of work, continuing Outputs: o Recruitment and
education, benefits and selection
o Existing policies
incentives, performance
analyzed and amended o Compensation and
management, and other benefits
to support the
HR-related aspects of recognition of o Career path
their work) community health
o Training and

o Analyze existing policies workers as a formal part development
on Community Health of the health workforce o Retention
Workers (CHWs) o Plantilla or contractual o Performance
o Identify gaps and areas positions created for management
for improvement CHWs, aligned with CSC
rules and standards
 Identify financing
 Study and create
schemes for CHWs,
certification programs or
especially for
credentialing
municipalities with limited
mechanisms for CHWs
resources
 Expand the National
Health Workforce
Accounts to include a live
registry and/or accurate
up-to-date information on
community health
workers
Standardized competitive compensation, benefits, and incentives for health workers in

both private and public sectors, at the national and local levels
The government must design and establish mechanisms and safeguards to address the wage and benefits
imbalance among HRH at the national and LGU levels, and between the public and private healthcare
industries, to ensure more sustainable and qualified HRH for all social sectors and across geographic
CHAPTER
regions. Strategies should also target attracting health workers to stay in the country despite the lucrative
offers and opportunities available in other countries.
7
Table 27. Strategies for Providing Standardized and Competitive Compensation, Benefits, and Incentives for
Health Workers
 Secure policy and  Provide sustainable  Reassess and recalibrate

financing support for the incentives to health policies and standards on
standardization of workers in rural areas to compensation and
competitive outweigh the opportunity benefits/incentives in the
compensation, benefits, costs of choosing to best interest of the health
and incentives, serve in rural/ hardship workers
appropriate to the areas
worker’s skills and  Implement consistently
contributions the standardized
Outputs: compensation, benefits,
o Existing policies and incentives of health
workers in both private

analyzed and amended and public sectors, at
to eliminate/decrease local and national levels
disparity in pay among
health workers (e.g.
salary rates dependent
on LGU income class)
o Financing mechanisms
developed to increase
the financial capacity of
institutions to provide
competitive
compensation and
benefits
 Push for the full
implementation of Magna
Carta Benefits
o Decrease/eliminate
disparity in
implementation among
employers (national vs
local; among LGUs of
varying income class)
Enhanced HRH scopes of practice aligned with the networked approach to strengthen
universal health care
CHAPTER
The existing health workforce should be optimized in pursuit of UHC and achievement of the SDGs.
7
Evidence-based strategies should be explored to optimize the scopes of practice vis-à-vis the supply of
generalists and specialists, medical and allied health professionals, and other mid-level and community-
based health workers. The contributions of different health worker types should be maximized by fostering
inter-professional collaboration and designing rational scopes of practice to avoid underutilization.
Table 28. Strategies for Enhanced HRH Scopes of Practice
 Standardize job  Review and enhance  Support and implement

structure/design to professional laws to community of practice in
provide health workers expand scopes of health care and other
with clear roles and practice (e.g. task- allied sectors to ensure
expectations, guidelines, sharing/shifting, inter- agility and
and adequate work professional practice) appropriateness of
process while ensuring Outputs: scopes of practice among
enough room for health workers
o Studies undertaken to
innovation in performing

required tasks identify best ways and  Adopt, evaluate, and
means to support the
 Conduct research on the recalibrate scopes of
transitions/changes
optimization of health practice by health
demanded by laws
workers’ roles through professionals across
innovative strategies such o Corresponding revision levels of care
of the curriculum
as task-sharing and inter-
following the revised
professional collaboration laws/policies identified
to generate evidence on and conducted
its feasibility and
o Enhanced scopes of
effectivity for specific
practice of health
context, health situation, workers introduced,
and needs implemented,
 Develop and establish monitored, and
mechanisms on HRH regulated in both private
and public sector, and
sharing within the health
across levels of care
care provider network
 Develop strategies to
effectively collaborate
with traditional healers
and practitioners
Enhanced competencies and career opportunities for HRH, and established performance
management systems
CHAPTER
With health care evolving at a very fast pace, ensuring capable and equipped HRH is critical and can be
7
achieved by providing needs-based training opportunities and establishing performance management
systems. These, plus a well-designed career path and career development opportunities will sustain HRH
motivation and retention.
Table 29. Strategies for Enhanced Competencies and Career Opportunities for HRH
 Establish and implement  Develop HRH competency  Institute HRH competency

competency standards building strategies and quality check schemes
for various HRH positions interventions, and career and regular reporting in
and roles, aligned with the development support both public and private
priorities set forth by the programs for health sectors
UHC workers/health  Update HRH competency
Outputs: professionals in both standards, as necessary
private and public sectors,
o Intensive and continuing
at the national and local
learning and education
levels
campaigns in the use of

competency standards, Outputs:
models for recruitment
and selection, o Career development
succession planning, pathways for health
and performance workers developed and
assessment conducted implemented
o HRH competency o Coaching and mentoring
reference guide programs, especially in
crafted the public sector,
established, including
 Establish mechanisms to capacity building for
ensure needs-based coaches and mentors
training
 Local and private entities
 Provide accessible and provide complementary
effective continuing funding to government
training programs on subsidies for health
priority competencies for worker training
health workers via
traditional and alternative
modes of learning (e.g. e-
Learning)
HRH performance management systems should also be aligned with the quality assurance and
accountability mechanisms of health facilities. To boost health workers’ morale, social recognition or
rewards of symbolic value should be provided.
Table 30. Strategies for Establishing Performance Management Systems

CHAPTER

7
 Assess HRH standards of  Develop mechanisms for  Review quality assurance

care to determine gaps health service delivery certification programs to
and revise or update quality assurance identify areas for
outcomes accordingly focusing on HRH and improvement in line with
o Revise or update patient accountability per HRH requirements
standards of care to cadre, per health facility,  Give public recognition to
determine gaps and and at HCPN level health workers (e.g.
impact on health Output: rewards/titles at local,
outcomes by cadre national and international
o HRH relevant
provisions and levels, rural health
components in the holidays) to uplift the
CSC Merit and profile of health workers
Selection Policy in rural areas and improve
(MSP) and Strategic intrinsic motivation
Performance
Management System
(SPMS) developed for
health- focused

government
agencies/sectors
implemented
Strategic Objective 5a
Established occupational safety and health (OSH) policies and wellness programs for HRH
The well-being and safety of HRH need to be recognized and supported. Current OSH policies, programs,
and practices should be re-evaluated and monitored to ensure responsiveness and efficiency in
implementation or enforcement. Health workers in the facilities must also actively participate in capacity
building activities on safety and health and other OSH programs.
Table 31. Strategies for Establishing OSH Policies and Wellness Programs for HRH
 Identify the gaps in OSH  Monitor compliance to  Conduct OSH policy

practices and policies in OSH policies; identify and reviews regularly and
health implement stronger update policies based on
facilities/institutions regulatory approaches findings
 Enhance OSH policies and  Identify the needs of  Monitor the effectiveness
ensure the health workers; institute of OSH policies and
implementation of OSH responsive OSH policies programs
standards (e.g. hazard  Incorporate OSH-related  Monitor the effectiveness
pay, PPEs, short-term data in the National of health and wellness
CHAPTER
accommodations, Health Workforce programs for HRH
appropriate duty hours) Accounts
7
and health worker
 Create and run an
protection (against
information, education,
stigma, bullying,
dissemination/ promotion
discrimination) in both
campaign on OSH across
public and private health
levels of
facilities
care and in
 Incorporate in local and
various contexts
international labor
agreements explicit  Sustain implementation of
provision on health wellness programs in the
security such as access workplace
of health personnel to all  Establish hotlines where
means of protection (e.g. HWs can forward
insurance, concerns, drop
indemnification benefits, complaints, or access
etc.) services (e.g. mental
 Assess current efforts and health / psychosocial
gaps in terms of ensuring service, referrals to

health and wellness of hospitals, etc.)
health workers; create
and implement
responsive health and
wellness programs,
including provision of
mental health support
 Implement additional
wellness programs like
stress
management/reduction
program, fitness/weight
loss programs, nutrition
education/seminars to
boost employees’
productivity and morale
Strategic Objective 5b
Optimal support and working environment for HRH
Ensuring the provision of resources and support for our health workers is an important factor for health
worker retention. Resources include equipment, drugs, medical supplies, infrastructure, protective
equipment, etc., while support may be in the form of transportation or transportation allowance,
communication allowance, healthy meals, assistance in child or family care, resources and tools to obtain
expert advice or facilitate referrals, mental health support, provision of health and wellness programs and
CHAPTER
benefits, among others.

7
Table 32. Strategies for Providing Optimal Support and Working Environment for HRH
 Formulate and implement  Harness and utilize  Sustain functionality of

policies to ensure gender- information and referral systems
sensitive employment communication  Invest in infrastructure
conditions technology opportunities, and services to improve
 Provide good and safe where feasible and cost- the living conditions of
living conditions for effective (e.g. health workers and their
health workers and their telemedicine, electronic families, especially in
families, especially in health records, e-tools for rural areas
rural areas clinical decision making,
online consultation
 Provide better facilities
among professionals)
and equipment for the
health workforce  Prioritize adequate
facilities, equipment, and
resources for the health

workforce at all times
HRH capacity optimized during public health emergencies and surge situations
The importance of HRH becomes more undeniable during public health crises and hospitals are on the
brink of operating more than their capacity, prompting certain procedures for decompression to be
followed. In such a situation, some crisis management protocols have to be in place to immediately
respond to the situation, manage public expectation, and abate any issues that may exacerbate it or
contribute to its downward spiral.
Table 33. Strategies for Optimizing HRH Capacity During Public Health Emergencies and Surge Situations
 Assess policy gaps and  Institutionalize integrated  Establish monitoring and

develop policies surge information, evaluation mechanisms
(including structure and communication, and to oversee the readiness,
funding, and assurance of mobilization management efficacy, and efficiency
fair working conditions) to systems to ensure during deployment, and
support HRH mobilization, efficient HRH response post- emergency
augmentation, and during health adjustments
management during emergencies improvements
public health Outputs:  Update protocols/
emergencies (e.g. procedures to maintain
o Strategy development
CHAPTER
Medical Reserve Corps, agility and resilience of
and planning
community health the HRH during health
conducted
7
volunteers for emergency response
surveillance and
o Protocols and
procedures for all  Provide venue for
information
stakeholders dialogue among different
dissemination)
completed and countries, different
 Provide accessible implemented sectors, and different
trainings for HRH to  Institutionalize levels of government to
enhance capacity in mechanisms on HRH discuss actions taken and
responding to public management during recalibrate
health emergencies public health strategies/interventions
o Provide technical emergencies to ensure responsiveness,
assistance / capacity effectivity, and efficiency
building opportunities of response efforts
to non-health
personnel who are
also critical to the
response efforts (eg
contact tracers,
BHERTS)

 Implement protocols that
will protect and safeguard
HRH during response
 Ensure provision of
logistics, psychosocial,
and other necessary
support during response
Table 34. Various Stakeholders and Their Roles for KRA 3
Stakeholder Role/s
1. Legislators (Health Committee in ▪ Creation of laws to ensure HRH welfare, protection,

Senate and House of management, and development
Representatives)
2. Civil Service Commission ▪ Administer and enforce the constitutional and statutory
provisions on merit and rewards system
▪ Formulate standards, policies, and regulations on
personnel administration
▪ Integrate all human resources development programs
for all levels and ranks
CHAPTER
3. Department of Budget and ▪ Promote sound, efficient, and effective management

7
Management and utilization of government funds for human

resources for health
▪ Create permanent positions for health workers
4. Department of Labor and ▪ Formulate policies, implement programs and projects,

Employment and serve as the policy- coordinating arm of the
executive branch in the field of labor and employment
especially in the private sector
5. National Economic and ▪ Formulate continuing, coordinated, and fully integrated

Development Authority social and economic policies, plans, and programs
6. Department of Interior and Local ▪ Create permanent positions for health workers
Government
▪ Manage health workers hired by LGUs
7. Local chief executives ▪ Implement local health initiatives
8. Local health officers

9. Public Services Labor ▪ Promote decent work for HRH, protection of workers’
Independent Confederation rights and welfare, and consideration of union
perspectives
10. Overseas Workers Welfare ▪ Promote the rights and interests of OFWs and their
Administration families
▪ Develop and implement welfare programs, services and
benefits that respond to the needs of OFWs
11. Professional and Specialty ▪ Promote holistic welfare of professionals

Organizations
▪ Conduct capacity building activities
12. Associations and Federations of ▪ Advocate and lobby for the welfare of health workers
Health Workers and represent their shared interests
▪ Collaborate with the different stakeholders of health
and make its services important to the beneficiaries
13. Civil Society ▪ Contribute to the formulation and implementation of

government budget and budget transparency
CHAPTER
7

9. xiii foreword.docx
CHAPTER 8
HRH Migration
and Reintegration
HRH Migration and Reintegration | 1

2 | HRH Migration and Reintegration
CHAPTER EIGHT
HRH MIGRATION AND REINTEGRATION
A migrant worker is defined by the 1990 United Nations International Convention on the Protection of the
Rights of All Migrant Workers and Members of their Families as “a person who is to engage, is engaged, or
has been engaged in remunerated activities in a state of which he or she is not a national 1.
The international migration of health personnel has been a growing phenomenon around the world in recent
decades. The negative effects of this have been felt mostly in low- and middle- income countries, where
the migration of health workers has contributed to workforce shortages, with detrimental effects on health
systems.
There are two types of worker migration 2: temporary and permanent. The former entails a temporary
change in residence but an eventual return to the area of origin; in the case of health workers from the
Philippines, temporary migration is due to employment in foreign countries. The latter, permanent
migration, entails a permanent change in residence.
SITUATION
The Philippines has become one of the world’s major sources of migrant health workers for some years
now. The constant demand for Filipino health professionals, particularly nurses, can be traced back to the
early 1970s when labor migration became a strategy for economic growth through remittances from
workers based abroad3.
Working abroad, where wage scales are higher than those of the domestic job market, was seen as a means
for workers to provide for their families. From then on, a high attrition rate of health professionals, especially
doctors and nurses, has been observed in the Philippines.
Among the negative effects of the loss of domestic labor are the “brain drain” of young, highly skilled health
workers, the depletion of the health workforce, and a reduction in the availability and quality of services
within the health system.
Based on the 2019 Survey on Overseas Filipinos, the number of OFWs who worked abroad at any time
during the period April to September 2019 was estimated at 2.2 million 4. POEA data shows that
approximately 156,739 health professionals temporarily migrated from 2011 to 2019. Approximately
21,993 health professionals were permanently lost to migration from 2011 to 2018, as indicated by CFO
data.
1
United Nations Human Rights (1990). General Assembly Resolution, Article 2. Retrieved from:
https://www.ohchr.org/en/professionalinterest/pages/cmw.aspx
2
Chen, J., K. Cosec, & V. Mueller. (2016). Temporary and Permanent Migrant Selection: Theory and Evidence of Ability-Search Cost Dynamics.
Retrieved from: http://ftp.iza.org/dp9639.pdf
3
Ladrido, P. (2020). How the Philippines became the biggest supplier of nurses worldwide. Retrieved from:
https://www.cnnphilippines.com/life/culture/2020/5/6/ofw-nurses.html
4
Philippine Statistics Authority. (2020). Total Number of OFWs Estimated at 2.2 Million. Retrieved from https://psa.gov.ph/content/total-number-ofws-
estimated-22-million

The health worker cadres supplying the biggest number of permanent migrants from 2011 to 2018 were
nurses, medical doctors, and dentists. As noted from the graph below, nurse emigration peaked in 2012
and 2015, decreased in 2016-2017, and increased once again in 2018.
Figure 28. Top 3 HRH Cadres with Highest Permanent Migration Rates
The three health worker cadres supplying the largest number of temporary migrant health care workers
from 2011 to 2019 were nursing professionals, physical therapists, and midwifery professionals. For
nurses, both temporary and permanent migration peaked in 2015, decreased in 2016-2017, and increased
once again in 2018.
CHAPTER
8
Figure 29. Top 3 HRH Cadres with Highest Temporary Migration Rates (2011-2019)

POEA’s deployment record shows that Saudi Arabia and the United Kingdom were the top destination
countries of Filipino nurses in 2018-2020.
Table 35. Top 10 Countries with the Most Number of Deployed Nurses 5
Country Number of Nurse Migrants

2018 2019 2020
Saudi Arabia 9,663 10,575 2020
United Kingdom 2,373 3,702 1,215
Germany 632 1,283 492
Singapore 300 619 166
UAE 675 742 142
Qatar 1,203 891 107
Ireland 328 403 89
Finland 7 61 67
Taiwan 312 229 43
Kuwait 271 277 31
Temporary or permanent migration––and its effects on health worker career choices––has contributed to
the high turnover rate of trained nurses in many hospitals in the country. A study conducted in 2007, also
revealed that over half of the total nurse turnover was a result of nurse migration overseas. On the average,
nurses’ vacancy rates and turnover rates are lower in government hospitals than private hospitals 6.
In analyzing migrant worker data, it should be noted that:
● While 12 cadres of health professionals are licensed by PRC, POEA data does not include
CHAPTER
occupational therapists, radiologic technologists, and respiratory therapists; CFO data does not
include radiologic technologists and respiratory therapists.
8
● POEA counts are based on contracts rather than individual health workers, hence migration
numbers may not exactly provide accurate counts. For instance, if a health worker is transferred
from one employer to another, that health worker will be counted twice. However, migrant trends
for the different cadres were confirmed in discussions with recruitment agencies7.
● On occasion, those who enter one country as temporary migrant workers will directly move to
another country for new jobs, without returning to the Philippines. A number of nurses who migrate
to work in the Middle East eventually apply for jobs in other destinations, usually the U.S. and the
5
Source: POEA Central Office Database, Generated 09 November 2020
6
Perrin, M., et al. (2007). Nurse Migration and its Implication for Philippine Hospitals. International Nursing Review 54: 219-226. Retrieved from:
https://www.researchgate.net/publication/229545530_Nurse_migration_and_its_implication_for_Philippine_hospitals
7
Recruitment agencies are a critical source of migration data, as health care services cannot be processed directly by employers abroad without
passing through regulatory mechanisms. This limits the number of direct hires.

United Kingdom. The current data capture system is not able to track these workers, although the
pattern has been observed by recruitment agencies.
● Most workers recruited to work in health care abroad migrate temporarily to the Middle East, while
permanent work migrants, mostly nurses, gravitate mainly to the United States and Canada. If such
migration is processed outside the Philippines, then those who have permanently migrated to a
second country cannot be tracked8, resulting in gaps in POEA nor CFO data.
Factors in HRH Migration
Temporary and permanent migration is prompted by a variety of factors 9, some of which attract (or pull)
workers to seek employment abroad, while others compel (or push) them to work outside the domestic job
market.
● “Push” factors
o Economic: High unemployment rate, limited job opportunities, low wages and per
capita/Gross National Product (GNP) income, poor health infrastructure
o Job-related: Poor working conditions (low salary; disparity in pay between Philippines and
other countries, national and local, public and private; lack of security of tenure; non-
uniform implementation of benefits stipulated in the Magna Carta for Philippine Health
Workers); poor working environment (lack of equipment and supplies); excessive
workloads; and no health insurance
o Career-related: Inconsistencies in practice, outdated or inappropriate curricula,
institutional politics, and limited opportunities for professional development, specialty
training, and promotion
● “Pull” factors
o Job-related: Higher income, job tenure, better benefits, and compensation packages (for
example, a nurse’s entry level salary per month in Saudi Arabia is PhP10,000 higher than
the highest monthly salary of PhP50,702 in the Philippines) 10
o Skills enhancement: Advanced knowledge and skills acquired by working in highly
developed countries, a global career, marketability, and professional growth
o Personal and socio-economic: Improvement in quality of life both for individual workers
CHAPTER
and their families (including opportunities to migrate together), improvement in financial

8
capacity, presence of relatives in the destination country

o Policy and institutional support: Destination countries’ visa provisions allow family
members to join the migrating health worker7
o Other factors: Opportunity to travel, a sense of independence, existence of social networks
which often provide connections for employment, increased demand for health
professionals due to demographic conditions (e.g. aging populations)
Among the structural factors that have encouraged health worker migration are: longstanding labor export
policies, including those pertaining to skilled contract workers and health professionals; the aggressive
8
United States Agency for International Development HRH 2030. Situational Analysis. Unpublished Report.
9
Lorenzo, F., et al. (2006). Migration of Health Workers: Country Case Study: Philippines. Geneva, Switzerland. Retrieved from:
https://www.ilo.org/wcmsp5/groups/public/---ed_dialogue/---sector/documents/publication/wcms_161163.pdf
10
Average Annual Pay of Registered Nurses, Midwives, and Doctors. (2019). Retrieved from http://payscale.com/

recruitment strategies of local and international agencies; and the Western orientation of nursing education
in the Philippines, which makes its graduates particularly marketable among foreign countries.
Local and International Policy Instruments
Migrant Workers and Overseas Filipinos Act (RA No. 10022). This law governs migration processes in the
Philippines, and provides standards for the protection and promotion of the welfare of migrant workers and
their families; it also provides mandates to key agencies involved in migration management, such as the
POEA and OWWA, and stipulates penalties for violations such as illegal recruitment.
Midterm Update of the Philippine Development Plan 2017-2022. The strategic objective of Chapter 21 of
the PDP is to protect the rights, welfare, and expand opportunities for Overseas Filipinos (OFs) to contribute
to the country’s development. The following are the desired outcomes: to protect the rights of OFs and
improve their well-being, to facilitate the participation of OFs in the Philippine development; engage OFs in
governance, and protect the rights of foreign nationals in other countries.
WHO Code for Ethical Recruitment. Adopted by WHO member states in 2010, the Code provides guidance
on the ethical international recruitment of health personnel and serves as a platform for continuing dialogue
on critical problems of health worker migration. Its effectiveness depends largely on national and
international dialogue and cooperation, including the exchange of information and data. The Philippines
has started to implement the Code by raising awareness through multi-sectoral involvement in
accomplishing the National Reporting Instrument of the Code and consultative meetings convened by the
DOH-Bureau of International Health Cooperation (BIHC) on the Philippine Migrant Health Program.
ASEAN Consensus on the Protection and Promotion of the Rights of Migrant Workers. This instrument has
established a framework for cooperation on migrant workers by ASEAN Member States (AMS). It embodies
a set of obligations of AMS to implement the purposes and commitments under the Cebu Declaration and
confirms the shared and balanced responsibilities of the AMS to protect and promote the rights of migrant
workers and members of their families in the entire migration process.
Multilateral Agreements
CHAPTER
Multilateral agreements are pacts among three or more nations aimed at generating mutual economic
benefits.
8
ASEAN Mutual Recognition Arrangements (MRAs)
MRAs facilitate trade in services by mutual recognition among member countries for professional
authorization, licensing, or certification by the respective authorities within the framework of the MRA.
Under MRAs, recognition is not automatic. MRAs instead usually set out processes for the determination
of standards and other requirements for recognition to be undertaken by competent authorities from the
origin and host countries. As such, existing domestic rules and policies of each member state on labor and
immigration shall apply.

In the case of the Philippines, any recruitment and deployment of professionals will have to comply with
Philippines rules and regulations due to the fundamental legal constraint in the country’s relevant laws.
ASEAN MRAs have been signed regarding nursing services (2008), and dental and medical practitioners
(2009); however, these arrangements are limited by certain laws of the Philippines, e.g. health professions
can be practiced only by Filipinos according to the 1987 Philippine Constitution, and access to the local
labor market is covered by strict provisions of the Labor Code and the PRC Modernization Act of 2000. 7
MRAs are subject to domestic regulations of host member states; hence, no standard process and
regulation exist.
Free Trade Agreements (FTAs)
FTAs are pacts between two or more nations, in accordance with international law, to form a free-trade
area between cooperating states; citizens enjoy economic opportunities through job creation 11.
Under Chapter 9 of the Japan-Philippines Economic Partnership Agreement (JPEPA) on Movement of

Natural Persons, the Philippines was given more access to the labor market of Japan wherein the principle
of national treatment will be observed. Under this agreement, Japan for the very first time has given market
access to foreign nurses and care workers. Likewise, the Philippines for the first time has also given a
commitment to provide nurses.
The JPEPA was the country’s first bilateral free trade agreement (FTA).
Bilateral Agreements
These are legal instruments fostered by two countries to provide access to each other’s markets, and
promote fairness and mutual benefits in various forms such as (but not limited to) health personnel
exchange, technical assistance provisions, capacity building, and information sharing.
Since 2007, the DOH, through the HRH Network, has been advocating for ethical recruitment principles in
international legal instruments12. Deployment of HRH should be covered by a bilateral labor agreement and
not a health cooperation agreement, coursed through the POEA as the official government authority on the
CHAPTER
regulation of foreign recruitment. The gains of the health sector from these current bilateral agreements
(Table 36) have to be carefully studied and evaluated.
8
11
National Economic and Development Authority. Philippine Development Plan. Manila, Philippines. Retrieved from http://www.neda.gov.ph/wp-
content/uploads/2017/12/Abridged-PDP-2017-2022_Final.pdf
12
World Health Organization. (2014). Migration of Health Workers. Retrieved from
https://www.who.int/hrh/migration/14075_MigrationofHealth_Workers.p

Table 36. List of Agreements Currently in Effect
Agreement Salient Provisions
Mutual Recognition Agreements
ASEAN MRAs for Dentistry, Medicine, and Ensures mutual recognition of qualifications to
Nursing promote mobility of health practitioners in ASEAN.
ASEAN Consensus on Protection and Promotion Safeguards the rights of migrant workers.
of Migrant Workers (2017)
Regional Comprehensive Economic Partnership Provides an avenue for Parties to facilitate

(Chapter 8 Trade in Service - Annex on engagement on the supply of professional services
Professional Services) in the region. Encourages Parties or relevant bodies
to work towards the development of mutually
acceptable professional standards and criteria in
areas such as education, examination, experience,
professional development, scope of practice among
others
Free Trade Agreements
Australia and New Zealand FTA (2010) Allows the movement of professionals under
twinning and bridging programs in higher education.
Japan-Philippines Economic Partnership Allows for practice by nurses and care workers in
Agreement - Nurses and Care Workers Japan after passing language requirements and a
licensure exam
Bilateral Agreements
Agreement Concerning the Placement of Filipino Allows government-to-government recruitment of

Health Professionals in Employment Positions in nurses following ethical recruitment principles
the Federal Republic of Germany (19 March
2013)
Memorandum of Agreement between the Ensures equal employment opportunity in terms of

Government of the Republic of the Philippines pay and other employment conditions, such as
CHAPTER
and the Government of the Kingdom of Bahrain access to training and career development
on Health Services Cooperation (4 April 2007) opportunities; provides for rights of workers
8
following International Labour Organization (ILO)
conventions.
U.S. Visitors Exchange Program Facilitates educational and cultural exchanges for
doctors, among others, for technology transfer upon
their return.
Managing Migration and Reintegration
Several national agencies are involved in managing the migration and reintegration of Filipino workers,
including health workers, as noted in the following table:

Table 37. Agencies Involved in Managing the Migration and Reintegration of OFWs
Name Mandate
Bureau of Immigration Responsible for the regulation of entry, stay, and exit of foreign nationals in
(BI) the country and monitoring of entry and exit of Filipino citizens in
compliance with Philippine laws and other legal procedures.
As mandated by Commonwealth Act No. 613, “The Philippine Immigration
Act of 1940”
Commission on Upholds the interests, rights, and welfare of overseas Filipinos and
Filipinos Overseas strengthens their ties with their home country. It mainly facilitates
(CFO) permanent migration of Filipino health workers.
As mandated by Batas Pambansa Blg. 79, “An Act Creating the Commission
on Filipinos Overseas and for Other Purposes”
Department of Foreign Responsible for planning, coordinating, and evaluating the total national
Affairs (DFA) effort in the field of foreign relations.
As mandated by Executive Order No. 132, “Reorganizing the Department of
Foreign Affairs”
Department of Labor and Serves as the overseas operating arm in the implementation of Philippine
Employment- Philippine labor policies and programs for the protection of the rights and promotion of
Overseas Labor Office the welfare and interests of Filipinos working abroad.
(DOLE-POLO) As provided in Republic Act No. 10022, Rule X, Sec. 2 “An Act Amending
Republic Act No. 8042, otherwise known as The Migrant Workers and
Overseas Filipinos Act Of 1995, as amended, Further Improving the Standard
of Protection and Promotion of the Welfare of Migrant Workers, their
Families and Overseas Filipinos in Distress, and for Other Purposes”
National Reintegration Provides a mechanism for the OFWs’ reintegration into Philippine society,
Center for OFWs taps their skills and potential for possible new jobs, and serves as a
(NRCO) promotion house for their local employment.
As mandated by Republic Act No. 10022, “An Act Amending Republic Act No.
8042, otherwise known as The Migrant Workers and Overseas Filipinos Act
of 1995
CHAPTER
Overseas Workers Promotes the rights, interests of the OFWs and their families; and develops
8
Welfare Administration and implements welfare programs, services and benefits that respond to the
(OWWA) needs of OFWs.
As mandated by Republic Act No. 10801, “An Act Governing the Operations
and Administration of the Overseas Workers Welfare Administration”
Philippine Overseas Facilitates the generation and preservation of decent jobs for Filipino migrant
Employment workers; it is mainly involved in the temporary deployment/ employment of
Administration (POEA) health workers in various countries and regulates, among others, private
sector participation in the recruitment and placement of workers for
overseas employment.
As mandated by Executive Order No. 797, “Reorganizing the Ministry of Labor
and Employment, Creating the Philippine Overseas Employment
Administration, and for other purposes.

In the Department of Health, two key multi-sectoral networks have been established to coordinate policies
and actions for better migration management:
Philippine Migrant Health Network (PMHN). A multi-stakeholder network convened by the DOH- Bureau of
International Health Cooperation for Filipino migrants’ health and welfare, composed of government
agencies (DFA, POEA, OWWA, NRCO, CFO, and the Department of Social Welfare and Development), as well
as representatives from NGOs, civil society organizations, and the private sector 13.
HRH Network Philippines (HRHN). A network of government and non-government agencies convened by
DOH HHRDB; one of its three technical working committees is focused on health workers’ exit from and
reentry to the health sector. This TWC involves POEA, CFO, OWWA, BI, DOLE-NRCO, and the Public Services
Labor Independent Confederation.
Sources of Data and Information
There are multiple sources of data for migrant HRH, on voluntary and involuntary exits from the health labor
market. Data on workers who are involuntarily inactive due to retirement, long-term illness, work
suspension, death, and other reasons may be gathered from the Philippine Statistics Authority (PSA), Social
Security System (SSS), Government Service Insurance System (GSIS), PAG-IBIG, and Bureau of Internal
Revenue (BIR), among others.
Health migrant data are available from POEA for temporary migrants and the CFO for permanent migrants.
Other possible sources include OWWA, NRCO, and BI.
Steady increase of HRH migration
The rise in the migration rate of health professionals in the Philippines, especially nurses, can be attributed
to several long-standing “push and pull” factors, resulting in losses in health worker investment, and in an
CHAPTER
understaffed and fragile health care system.
8
Another phenomenon observed was “brain waste”14 wherein a migrant HRH is underutilized in the recipient
country due to challenges in meeting the professional accreditation needs or standards of certain
countries. For instance, doctors unable to compete in the growing market for physicians trained abroad are
shifting to research and jobs in pharmaceutical companies; a professional nurse licensed in the Philippines
works as a nursing assistant or aide in the destination countries.
The COVID-19 pandemic has been an additional stressor affecting the country’s health systems, particularly
in HRH. The current workforce, grappling with this unprecedented health emergency, has reported
increases in worker burnout, inadequate compensation, delayed releases of salary and hazard pay, and
13
Department of Health. (2016). Administrative Order 2016-0007: National Policy on the Health of Migrants and Overseas Filipinos. Manila,
Philippines.
14
Nair, M., & P. Webster. (2012). Health Professionals’ Migration in Emerging Market Economies: Pattern, Causes, Possible Solutions. Retrieved from:
https://academic.oup.com/jpubhealth/article/35/1/157/1592927?login=true

safety risks (due to the scarcity of personal protective equipment, among others). These all serve as “push”
factors, compelling workers to consider employment abroad.
Weak enforcement and monitoring of multilateral and bilateral labor agreements and
other commitments
There is currently no data bank for national and international policies and regulation. While the Philippines
has adopted the WHO Code for Ethical Recruitment, little has been accomplished by way of
implementation. The weak monitoring of international agreements could lead to unethical recruitment,
aggravate the shortage of health workers, and negatively affect relations between countries.
In general, there is a lack of awareness of the Code and ethical recruitment practices among migrant health
workers, trade unions, and personnel recruiters. No Code-based dialogue has been taking place between
the Philippines and the countries of destination for migrant health workers, and no sanctions are in place
for penalizing recruiters and employers who violate the Code 15.
Lack of coordinated and comprehensive data and weak monitoring/tracking of health

worker migration11
Agencies involved in migration and reintegration management maintain their separate information systems
and databases. To acquire data from these agencies, the DOH must file formal requests with each, which
is time- and labor-consuming. Moreover, the data sets gathered have different formats, standards, and
definitions, which affects the quality, consistency, and efficiency of data consolidation.
There are significant gaps in migrant data. For example, the movement of health workers within ASEAN,
where work visas are not required, may be underreported. The government is not able to track those who
migrate to one country as temporary workers and move directly from there to another country to work.
As has been noted, the POEA database cannot provide comprehensive data on the actual number of
temporary migrants as their data system focuses on contracts rather than individuals, with the possibility
of duplication and inaccurate reporting.
CHAPTER
Lack of reintegration programs for returning health personnel

8
The DOLE-NRCO has not implemented any current reintegration programs designed specifically for
returning healthcare workers as the agency focuses on displaced and distressed OFWs in general. The
absence of reintegration programs and other channels for large numbers of returning workers to use their
invaluable skills and experience gained in other countries, means loss of opportunity for the Philippine
health sector.
15
Siyam, A. et al. (2013). Monitoring the Implementation of the WHO Global Code of Practice on the International Recruitment of
Health Personnel. Retrieved from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3853953/pdf/BLT.13.118778.pdf

General Objective
Migration managed to a sustainable level and reintegration programs enhanced for

returning health workers
Workers have the right to choose their career path and seek decent work where they can find it, even if it
means crossing national borders temporarily or permanently. Despite the challenges to the health sector
resulting from HRH migration, it cannot be totally eliminated.
However, the return of health personnel with skills and knowledge enhanced through their employment in
more advanced healthcare systems can be beneficial for the country if properly identified and channeled.
Exchange of health personnel between countries can also foster international relations and contribute to
the Philippines’ economic development.
The key is to provide strategies to manage migration at sustainable levels and ensure that countries will
abide by multilateral and bilateral agreements to ensure ethical recruitment and regulate the HRH outflow.
Success Measures
Indicators Targets
% decrease in temporary and % decrease in temporary and permanent migration rate as

permanent migration rate determined by lead agencies and organizations
% of local and international policy 100% of local and international policy instruments on HRH
instruments on HRH migration migration and reintegration monitored
and reintegration monitored
CHAPTER
% of returning health workers % of returning health workers reintegrated to the health system as
reintegrated to the health system determined by lead agencies and organizations
8
Accurate, up-to-date, and 1. Information on voluntary and involuntary exits, provided
complete data to track exits from annually
and re-entry into the Philippine 2. Information on HRH returning to the country
health labor market (as included 3. Information on HRH reintegrated into the Philippine health
in KRA 1: Data Governance and sector, tracked annually
Information Management 4. Information on HRH migration and reintegration (e.g. policies,
standards, programs, etc.)

Retention of HRH by ensuring job satisfaction, motivation, protection, and career

development
Many of the strategic interventions described in Chapter 7 (KRA 3 HRH Welfare, Protection, and Career
Development) are designed to attract healthcare graduates to work in the country’s health sector, and could
also have a positive effect on worker migration. Tables 25, 27, 28, 29, 30, 31, 32, and 33 of Chapter 7 provide
strategies on providing permanent positions, providing standardized and competitive compensation and
benefits, enhancing scopes of practice, enhancing competencies and career opportunities, establishing
performance management systems, establishing OSH policies and wellness programs, providing optimal
support, and working environment, and optimizing HRH capacity during public health emergencies.
Such interventions, once implemented, might encourage workers to work in the Philippines instead of
seeking jobs in other countries. A comparative study suggests that the share of people who have no plans
to emigrate is higher among those working in government than those in other sectors16. These interventions
would also encourage migrant workers to return to the country and seek re-entry into the health workforce,
or share their skills and knowledge through coaching and mentoring programs in the public sector.
Primary and secondary sources indicate that key factors affecting decisions of Filipino health workers to
work abroad are the poor working conditions and incommensurate and non-standardized pay of the
domestic health sector. In light of these, key strategies and programs for worker retention should be
developed, such as increasing salaries, offering further training, providing housing and transport in rural
areas, and providing career opportunities 17.
Strong monitoring of local and international policy instruments governing HRH migration
management
National migration regulations should be in place and rigorously monitored (including, for example, the
CHAPTER
issuance of work visas and ethical guidelines for recruitment of foreign health professionals). Provisions
8
stipulated in multilateral and bilateral agreements for the mutual benefit of both source and destination
countries should be fully implemented with tangible outputs and outcome, and regularly monitored.
Learning from the COVID-19 pandemic experience, protection and welfare of HRH migrants is highly
warranted, now more than ever. Safety measures should be explicitly stated in agreements to afford Filipino
HRH migrants the protection and care they deserve.
16
OECD. (2017). Interrelations between Public Policies, Migration, and Development in the Philippines. OECD/Scalabrini Migration Center. Retrieved
from: https://www.oecd-ilibrary.org/docserver/9789264272286-
en.pdf?expires=1608014129&id=id&accname=guest&checksum=F40ACC1E2391B80DDF2AEFC9802EFCE9
17
Penaloza, B., et al. (2009). Interventions for Controlling Emigration of Health Professionals from Low and Middle-Income Countries. Retrieved from
https://www.who.int/alliance-hpsr/projects/alliancehpsr_emigrationreview_chile.pdf?ua=1

The development of comprehensive, consolidated data banks containing national and international policies
as well as global statistics on health workforce migration is essential in gaining a more universal
perspective and designing effective work migration policies and regulatory frameworks. This will foster
evidence-based policy discussions and actions that will ensure balance between fiscal and economic gains
vs building a sustainable supply of health workforce to address health security and equity.
Table 39. Strategies for Monitoring of Local and International Policy Instruments Governing HRH Migration
Management

● Conduct an assessment ● Institutionalize the WHO  Develop a data bank of
of HRH migration and Code of Practice on the national and
reintegration International Recruitment international policies and
management policies of Health Personnel97 regulation, and bilateral
and programs agreements at the global
Outputs: level that can be
Output:
○ Larger dissemination accessed by all member
o Study implementation activities conducted states for education and
and impact of bilateral other purpose
○ High-level state
agreements (BLAs),
dialogues carried out
ASEAN MRAs,
commitments in WHO ○ Current laws and
legal frameworks on
ethical recruitment and
labor and workforce
other commitments
migration reviewed;
 Engage all agencies necessary revisions
involved in bilateral and deliberated upon to
multilateral labor ensure alignment
agreements in with the Code
strengthening health ○ Code translated to
workforce assessments national programs,
and information policies, and
exchange with source frameworks
and destination ● Establish mechanisms for
CHAPTER
 Provide capacity greater exchange and
building for developing, sharing of knowledge on
8
implementing, and the management of
monitoring national international recruitment
and international policy and mobility of health
instruments with personnel and integrate
health labor mobility them into the monitoring
component of bilateral and
multilateral agreements
involving recruitment of
health personnel

Harmonized data and information systems on HRH migration and reintegration
This can be addressed by establishing regular collection and reporting systems, determining standard data
definition and key indicators to collect, integrate, and harmonize all data and information on migration,
mobility, and reintegration of Filipino HRH. The tracking of migrating and returning health workers has to
be made more comprehensive and rigorous.
Equally important is the need for global action and consensus on building an international database for
health migration statistics to address the lack of coordinated and comprehensive data on health personnel
migration and mobility14.
Table 40. Strategies for Harmonized Data and Information Systems on HRH Migration and Reintegration

 Map out sources of HRH  Design and implement a  Integrate and harmonize
migration data, data mechanism that will health worker migration
collection gaps, and enable sharing of data (temporary and
bottlenecks among countries permanent) and
reintegration data through
 Establish systems for  Analyze and use data
the National Health
regular collection and from source and Workforce Accounts
reporting of data for HRH destination countries for
planning and decision
outflow (e.g. POEA for
making
HRH under contracts, CFO
for permanent migration,
BI for leaving HRH under
tourist visit and student
visas)
CHAPTER
8
Reintegration programs for returning health workers
Reintegration programs can attract health workers to stay in the country for good and contribute to the
Philippine health sector the skills, knowledge, and experience they gained from working in more advanced
healthcare settings. Mechanisms for the migrants’ re-entry into the workforce must be institutionalized to
ensure continued employment opportunities, offer avenues for knowledge- and skills-sharing, and provide
incentives and positive reinforcement to returning workers. Partnership with the private sector offering
reintegration programs must also be explored.

Table 41. Strategies for Establishing Reintegration Programs for Returning Health Workers
 Conduct an assessment  Create reintegration  Institutionalize

of existing reintegration programs to provide reintegration
placement and mechanisms for
policies, and map out
incentives for returning returning health workers
and identify gaps
health (e.g. facilitation for local
employment, knowledge
workers/professionals
and skills sharing, etc.)
Outputs:
o Policy support secured
o Close collaboration
with agencies involved
in migration and
reintegration
management
established
Stakeholder Role/s
1. Philippine Overseas ▪ Track permanent and temporary migrants

Employment Association
▪ Harmonize information systems on
2. Commission on Filipinos Overseas migration
3. Bureau of Immigration
4. Department of Health
5. Regulatory bodies of destination countries
CHAPTER
6. Department of Labor and Employment - ▪ Track reintegration
8
National Reintegration Center for OFWs
▪ Develop policies and programs for
7. Philippine Overseas Employment reintegration
Association
8. Overseas Workers Welfare Association
9. Department of Health ▪ Monitor legal instruments on migration

10. Department of Foreign Affairs and international recruitment of health
workers
11. Philippine Overseas Employment

Association
12. Bureau of Immigration
13. International & Non-government ▪ Contribute data and information on health

Stakeholder Role/s
Organizations care workers’ mobility
▪ Provide platform for dialogue and foster
partnerships between and among parties
CHAPTER
8

CHAPTER 9
NHRHMP
HRHMP Institutionalization
and Localization
NHRHMP Institutionalization and Localization | 183

CHAPTER NINE
NHRHMP INSTITUTIONALIZATION AND LOCALIZATION
“Institutionalization” is the process of embedding or establishing a concept as a norm or convention within

an organization or society. Institutionalizing the NHRHMP requires proper identification of stakeholders;
clear articulation of shared vision, objectives, and strategies among stakeholders; determination of costs
and benefits known. Additionally, the Plan has to be understood and popularized through an effective
communication strategy.
For the NHRHMP to be implemented successfully, it has to be embedded in national and subnational
policies, frameworks, and strategies. The objectives and strategies of the NHRHMP must be translated into
enforceable laws, policies, and programs that respond to, and align with, existing national and subnational
priorities. Implementation must be monitored, national and local funds must be allocated, and
accountability to the HRH and to the people ensured 1.
“Localization” is the process of considering subnational contexts in the pursuit of the NHRHMP agenda––
from the setting of goals and targets, to determining the means of implementation, and using indicators to
measure and monitor progress2. Localization pertains to bottom-up actions by local and regional
governments to support the implementation of the NHRHMP, and to determine how it can provide a
framework for strengthening local HRH initiatives to address the production and provision of competent
and committed HRH.
Localizing the NHRHMP refers to local governments––as well as partners and stakeholders––actively
owning, investing in, and implementing the NHRHMP in cities, municipalities, and communities. Beyond
local implementation, it is about placing cities, municipalities, and communities at the front and center of
strategies.
Institutionalizing and localizing the NHRHMP means more than just forging agreements and memoranda
between the DOH and relevant stakeholders. It means making the aspirations of the Universal Health Care
Law, particularly the provision of “an adequate, skilled, well-trained, and motivated health workforce,” a
shared vision among stakeholders.
In the end, it means working together to overcome constraints on affordability and sustainability of reforms
to meet the health needs of the population and uphold the best interest of our country's health workforce.
SITUATION
CHAPTER
The challenges of a devolved health system
9
The Local Government Code of 1991 aimed to: (1) provide LGUs the opportunity to tap their fullest potential
as self-reliant communities and as active partners of the national government in the attainment of national
1
Inter-Parliamentary Union. Institutionalization of the Sustainable Development Goals in the Work of Parliaments. Retrieved from:
https://www.ipu.org/file/7639/download
2
Global Taskforce of Local and Regional Governments. (2016). Roadmap for Localizing the SDGs: Implementation and Monitoring
at Subnational Level. Retrieved from: https://www.uclg.org/sites/default/files/roadmap_for_localizing_the_sdgs_0.pdf

goals, (2) facilitate faster decision making at the local level, (3) enhance the participation of ordinary
citizens, organized groups, and the poorer sectors in the conduct of public affairs and the business of
government, and (4) deliver basic services more efficiently 3.
From having a highly centralized system of health service delivery, the LGC mandated the decentralization
of regulation, financing, and delivery of health services from the Department of Health to the LGUs. The
DOH then assumes oversight functions that include general supervision of the health sector, monitoring
and evaluation functions, formulation of standards and regulations, and provision of technical and other
forms of assistance4.
However, the massive and abrupt transfer of personnel, health facilities, and budget overwhelmed the
health sector at the local levels. Many LGUs were not ready for the fiscal and managerial responsibilities
that came with the devolution. The DOH initiated numerous schemes such as continuously increasing its
budget to provide for the augmentation of health facilities, human resources for health, and other health
logistics to support the LGUs, but after almost 30 years, the true devolution of the management and delivery
of health services has not been fully achieved.
The deployment or hiring of adequate health workers has been a steady challenge within the devolved set-
up. Many of the LGUs have limited budgets, especially those within low-income classifications. The LGC
also prescribes budgetary limitations for personnel services, which further constrains the LGUs from hiring
health workers and providing the benefits mandated in the Magna Carta for Health Workers.
The prevailing laws on salaries of government personnel have also caused wide disparity in pay among
health workers as their allowable compensation rates depend on an LGU’s income class. Some health
workers felt that the devolution compromised their chances for promotion and vertical mobility; others
complained that opportunities for career advancement and continuing education were limited 5. Moreover,
the health devolution has caused geographical displacement, job loss, income and benefit changes, and
increased politicization of health and the health workforce6.
Initiatives to make devolution of health work.
The DOH has initiated several mechanisms and health reforms to respond to the challenges of the
devolution––strengthening local health boards, creating health development funds, organizing inter-local
health zones and service delivery networks, and institutionalizing health sector reforms. Unfortunately,
most of them did not last beyond the term of the administration that initiated them.
To support LGUs with health workforce distribution problems, the DOH implemented the Doctors to the
Barrios (DTTBs) Program in 1993 which deployed to 271 doctorless municipalities. After 27 years of the
CHAPTER
9
3
The Local Government Code of the Philippines Book 1. Retrieved from
https://www.officialgazette.gov.ph/downloads/1991/10oct/19911010-RA-7160 CCA.pdf
4
Department of Health - Local Government Assistance and Monitoring Service. (1993). Health Services and Local Autonomy. The
Guidebooks for LCEs and LHBs. Responding to Questions on Devolution, and RA7160 – the LGC of 1991.
5
National College of Public Administration and Governance - Center for Policy Executive Development. (2014). Devolution Effects
and Impacts on Health Service Delivery System in Selected Areas. Manila, Philippines.
6
Cuenca, J. (2018). Health Devolution in the Philippines: Lessons and Insights. Manila, Philippines. Retrieved from
https://pidswebs.pids.gov.ph/CDN/PUBLICATIONS/pidsdps1836.pdf
170 | HRHMP Institutionalization and Localization

DTTB Program, which was initially intended to be just a stop-gap measure, the number of doctorless
municipalities has even increased from 271 to 277 ––175 of the 277 are deployed with DTTBs.
This HRH deployment program has been expanded, and now covers 8 HRH cadres and all LGUs, provides
more benefits (such as allowances and salaries as Job Orders and, recently, as Personnel Service (PS) -
contractual employees), and increases its budget allocation annually. The DOH also provided scholarships,
adopting a scholarship-to-deployment scheme to produce and retain health workers in areas where they
are most needed. However, contrary to its intended purpose, the deployment of HRH by DOH has become
counterfactual to self-sufficiency of LGUs in exploring all means possible to ensure that they hire the
adequate number of HRH to serve their constituents.
With the ratification of the UHC Law, the country gleans on better hopes of making devolution work to
achieve health for all. The law aims to integrate the local health systems into province- or city- wide health
systems (P/CWHS) that are self-sufficient in terms of financing and providing continuous, comprehensive,
and coordinated care. These P/CHWS will be composed of municipal and component city-wide health
systems and city health systems in highly urbanized and independent component cities, respectively. A
Special Health Fund7 shall be set up to ensure a pool of resources intended for health services of the
P/CWHS and this shall be managed by the provincial or city health board.
Pushing for “full devolution”
With the implementation of the recent Supreme Court ruling on the Mandanas-Garcia case, a significant
portion of the national government’s budget shall be transferred to the LGUs. This provides an opportunity
for LGUs to fully perform the functions devolved to them under the LGC, including hiring health workers and
providing commensurate salaries and benefits. However, safety nets will have to be installed to ensure that
the DOH budget that will be devolved to the LGUs will be spent on its originally intended purpose––that is,
to ensure access to health.
Making “full devolution” work for Human Resources for Health, towards achieving UHC
Within P/CWHS, a health care provider network (HCPN), composed of health facilities and health care
workers, shall be established to ensure that its catchment population has access to all levels of care8. Each
HCPN shall ensure that adequate health workers are available to provide promotive, preventive, curative,
rehabilitative, and palliative health services.
As such, the P/CWHS shall undertake incremental creation of positions to hire the required health care
professional and health care worker based on the standards set by the DOH9. The P/CWHS shall also
CHAPTER
9
7
Department of Health, Department of Budget and Management, Department of Finance, Department of the Interior and Local
Government, and the Philippine Health Insurance Corporation. (2021). Joint Memorandum Circular 2021-0001: Guidelines on the
Allocation, Utilization, and Monitoring of, and Accountability for, the Special Health Fund. Manila, Philippines.
8
Department of Health. (2020). Administrative Order 2020-0021: Guidelines on Integration of the Local Health Systems into Province-
wide and City-wide Health Systems. Manila, Philippines.
9
Universal Health Care Act Implementing Rules and Regulations. (2019). Retrieved from
https://doh.gov.ph/sites/default/files/basic- page/UHC-IRR-signed.pdf

establish a harmonized competency-based HRH management and development system, and HRH
performance assessment system, including grievance redress mechanisms10.
With these efforts, the country should be able to maximize benefits of devolution as a core element of
primary health care which is “health in the hands of the people,” empowering the community to manage
their health and health service delivery.
Key stakeholders’ low awareness of the existence of the NHRHMP and inadequate
investments for HRH
The first NHRHMP was developed in 2005 to establish a unifying framework and blueprint that will integrate
all efforts in rationalizing the production, mobilization, and utilization of HRH in the Philippines 11. In 2013,
a reformulation of the Plan for 2014-2030 was undertaken. While both Plans had achievements, they were
not widely disseminated and did not generate sufficient buy-in from stakeholders, particularly at the local
level.
To ensure the co-ownership of NHRHMP among key stakeholders, the DOH involved stakeholders from the
beginning or during the conceptualization phase. The Plan was designed to carry broad strategies but with
defined directions, giving room for the implementers to formulate their most innovative, adaptive, and
feasible need-based interventions fit to their local situations and will bring about the intended milestones
and outcomes.
The NHRHMP is an integral part of the UHC; hence, the success in its implementation in LGUs and
Province/City Wide Health Systems would redound to a successful implementation of UHC, and thus,
improved health outcomes.
A need for the co-ownership and co-implementation of the Plan, and for clear
monitoring and accountability measures
Co-ownership and co-implementation of the Plan by both national and local governments, as well as
members of an integrated health system are integral to its institutionalization and success.
The lack of a recognized co-ownership of the first two HRH Master Plans by the stakeholders may have
caused it to be inadequately cascaded to partner agencies/institutions and LGUs. As a result, strategies
were not adopted or integrated into their development or operational plans.
CHAPTER
9
Institutionalization or implementation of plans becomes more difficult when the health system is not
integrated. Lessons must be learned from the country’s current health infrastructure where there is
technical fragmentation of the local health systems––provincial and district facilities are managed and
10
Department of Health. (2020). Administrative Order 2020-0037: Guidelines on Implementation of the Local Health Systems
Maturity Levels. Manila, Philippines.
11
Department of Health. (2005). Human Resources for Health Master Plan 2005-2030. Manila, Philippines.

financed separately from municipal level facilities 12. This has hindered collaborative health activities such
as technical supervision, effective health referral mechanisms, sharing of health information, joint planning,
cost sharing, as well as implementation of national and local priority health programs and policies 6.
The accountability for health care, as held by the local government units, is ineffective, weak, and
confused13. Health has been devolved for almost 30 years now but DOH is still held accountable for the
lack of health facilities, inadequate health workers, and poor access to health services. The DOH initiated
policies and programs for health and the health workforce but because of limitations in jurisdiction,
implementation varies across different LGUs.
The design of health devolution, particularly the appropriate assignment of expenditure accountabilities
across levels of government, and the unambiguous and clear assignment of functions, determine the
success in bringing about efficiency gains expected from decentralization 14. It is therefore important to
revisit Section 17(f) of the LGC, which states that, “The national government or the next higher level of local
government unit may provide or augment the basic services and facilities assigned to a lower level of local
government unit when such services or facilities are not made available, or if made available, are
inadequate to meet the requirements of its inhabitants.” This brings about confusion and weak
accountability between levels of government, and inefficiencies in health service delivery.
Under the UHC Act, the P/CWHS was designed to have jurisdiction between levels of service (between
primary, secondary, and tertiary levels of care). The Health Care Provider Network ensures that there will
be ease of communication and coordination among health facilities and health workers. This provision has
to be considered when reviewing plans for full devolution.
An urgent and great need to support and capacitate the Local Government Units
The weak capacity of health managers in understanding the complexity of the Philippine health system,
both at the national and subnational levels, limits the full realization of the intended impact of health sector
reforms and initiatives. The initial phase of the devolution became difficult because the LGUs were not well-
prepared to take on the heavy responsibilities. Reforms are affected by transition from when local chief
executives (LCEs) have determined their local health needs, gained experience and knowledge from various
technical support, and started to implement programs to improve the health of their community ends their
term to new administration under another LCE. This transition means dealing with a new set of priorities
for the term. In order to address the effects of the periodic change in leadership, mechanisms have to be
in place to effectively and continuously support and capacitate the LGUs.
CHAPTER
9
12
Department of Health. (2001). Local Health Referral Manual. Manila, Philippines.
13
Gorman, D. (2019). Feedback on the Philippine HRH Master Plan Blueprint. Unpublished Report.
14
Singh, A. E. Gonzales, & S. Thomson. (2013). Millennium Development Goals and Community Initiatives in the Asia Pacific.

General Objective
Efficient and effective implementation of the NHRHMP through a collaborative and

participatory approach, while taking into context both the national and local levels
The strategies in institutionalizing and localizing this NHRHMP adopted the roadmap for localizing the
Sustainable Development Goals, and consist of five critical components: (1) awareness-raising, (2)
advocacy, (3) strategy formulation, (4) practical and agile implementation, and (5) monitoring
accountabilities.
Success Measures
Indicators Targets
Adoption of NHRHMP strategies NHRHMP strategies included in NGAs’ development plans and
in national and local development LGUs’ local investment plans for health
plans, as well as established
NHRHMP indicators incorporated in DBM’s oversight and
performance monitoring and
evaluation (M&E) systems performance management system, DILG’s Seal of Good Local
Governance, and other established M&E systems
Partnerships created and Local Government Unit has institutionalized partnerships with
expanded to cover the whole of technical agencies, other government entities (may include other
HRH management and LGUs), non-government implementers, civil society, and potential
development donors
Co-ownership and co- Local HRH plans/programs/policies are co-designed, co-

implementation of local HRH implemented, monitored, and evaluated with national/subnational
plans/programs/ policies bodies and other relevant stakeholders
Local chief executives and local Percent of local chief executives and of local health officers who
health officers capacitated health completed competency development programs on health
leadership and governance leadership and governance as determined by P/CHWS
HRH Management and Percent of the annual local health budget allocated is sufficient to
CHAPTER
development budget fund HRH (hiring, compensation, management, and development)

9

Local stakeholders are aware of the NHRHMP and realize the “power of the health
workforce”
Emerging research shows that investing in health and in the well-being of employees contributes
significantly to productivity and performance, and hence to the achievement of business targets 15. Running
a local government unit is no different from running a business––it is all about ensuring productivity and
performance of the people to achieve economic and social development. Investing in the people’s health
means more productive citizens that collectively contribute to the LGU’s and the country’s growth.
Many local leaders and stakeholders fail to realize that the most cost-efficient way to improve the health
of their people is by investing in its health workforce. If the LGUs will take care of their health workforce,
the health workforce will take care of the health of its people. It is more cost-efficient and sustainable than
providing financial support or dole-outs and conducting regular medical missions. Long-term return on
investments is comparable to, if not greater than, building farm-to-market roads or infrastructures in
increasing citizens’ productivity.
The WHO Global Strategy on Human Resources for Health: Workforce 2030 has emphasized that
investment in HRH can deliver a triple return of improved health outcomes, as well as improve social
welfare, employment creation, and economic growth. There is a bi-directional relationship between health
workforce investments and socio-economic development. The capacity of countries or subnational bodies
to produce health workers is influenced and determined by socio-economic factors such as income levels,
education attainments, migration rates, and availability of health infrastructures 16. On the other hand,
investment in the health workforce can have a major impact on socio-economic development, particularly
in the world’s poorest countries, where it can increase equity, reduce poverty due to ill health, and ultimately
contribute to sustainable development and social justice 17.
Hence, it is critical to make the stakeholders and implementers realize the “power of the health workforce”
and their importance in health system strengthening, and more importantly, in socio- economic
development. Only by securing a sufficient, equitably distributed, adequately supported, and well-
performing and motivated workforce can health goals and targets be met18.
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15
Grossmeier, J. And N. Hudsmith. (2015). Exploring the Value Proposition for Workforce Health: Business Leader Attitudes about
9
the Role of Health as a Driver of Productivity and Performance. Retrieved from:

https://journals.sagepub.com/doi/pdf/10.4278/ajhp.29.6.tahp-2
16
Squires, S., Uyei, J., Beltran-Sanchez, H., & Jones, S. (2016). Examining the Influence of Country Level and Health System Factors
on Nursing and Physician Personnel Production. Retrieved from https://human-resources-
health.biomedcentral.com/articles/10.1186/s12960-016-0145-4
17
Scheil-Adlung, X., Behrendt, T., & Wong, L. (2015). Health Sector Employment: A Tracer Indicator for Universal Health Coverage in
National Social Protection Floors. Retrieved from https://human-resources-health.biomedcentral.com/articles/10.1186/s12960-
015-0056-9
18
Cometto, G., & J. Campbell. (2016). Investing in Human Resources for Health: Beyond Health Outcomes. Retrieved from:
https://human-resources-health.biomedcentral.com/articles/10.1186/s12960-016-0147-2

Local stakeholders play a pivotal role to drive the NHRHMP 2020-2040 from a national vision into a local
reality. The LGUs, their partners, and the local communities, who are the most cognizant of their individual
and collective needs and capacities, are the best partners in realizing the goals of NHRHMP and the UHC.
As such, a key strategy in institutionalizing and localizing the NHRHMP is to ensure the buy-in of relevant
stakeholders and sustain their engagement and participation. The table below lays down the short-,
medium-, and long-term strategies to achieve this.
Table 44. Strategies for Raising Awareness and Buy-in of Local Stakeholders

 Conduct stakeholders’  Integrate NHRHMP  Sustain the participation
analysis/political strategies and targets in of stakeholders
mapping policy frameworks of  Regularly assess the
o Study the feasibility relevant national implementation of local
or viability of creating agencies and HRH strategies and re-
subnational bodies calibrate as needed
a local HRH Network
 Draft a strategic  Create a local multi-
communication and sectoral body within
advocacy plan for the province/ city-wide health
NHRHMP systems (e.g.
o Set clear roles for provincial/city health
national, regional and board) to ensure the
local governments in effective localization and
awareness-raising integration of the HRHMP
campaigns into the local
development agenda
o Take advantage of
through the following:
existing and new
platforms for o Cooperative
dissemination governance
o Ensure that all o Promotion of the the

sectors are NHRHMP
reached o Formulation of a
o Reflect the needs local HRH plan or
and concerns of the integration into local
stakeholders, the health/ development
HRH, and the plans
CHAPTER
citizens o Mobilization of
9
o Promote multi-level stakeholders to

and multi-stakeholder actively participate in
partnerships for better the implementation
collaboration/ of the HRH plan
participation
o Share experiences
and draw out
significant learning

from each other
o Monitor the
implementation and
revise or update
strategies, as needed
Co-ownership and co-implementation of the NHRHMP, with clearly defined roles and
accountabilities for the key players
The gaps in the decentralized set-up, at both national and subnational levels, and the need for a tighter
whole of government approach to health reform, have yet to be fully addressed.
The failure to cascade the previous Plans to the LGUs and other NGAs has been a big deterrent to the
implementation of crucial strategies. National and local health system and health workforce managers
must co-own the NHRHMPN and ensure its implementation by adopting the strategies into their
development and investment plans. Outcome-based measures must also be integrated into these
instruments and other established performance-based assessment systems.
LGUs within the province-wide health system and members of the health care provider networks must
collaborate and co-implement the plan to ensure its success. Equally important is the dynamics between
the national and local governments, with roles and accountabilities clearly defined.
The rules of engagement must be set to determine: (1) who the executive champion and sponsor should
be, (2) who offers the guidance and advice when needed, and (3) who are accountable persons for the
delivery of the local plan for the HRH.
The table below maps out the strategies for integrating the HRHM strategies and success metrics into the
national and local plans, as well as mechanisms to monitor accountabilities.
Table 45. Strategies for Building Co-Ownership and Co-Implementation of the HRHMP

CHAPTER
 Map-out and align  Integrate NHRHMP into  Review and recalibrate
9
NHRHMP strategies with an established the strategies on the

internal and external performance-based mobilization and
stakeholders’ mandates, assessment to promote investment of LGUs in
priorities, and targets compliance (e.g. DILG NHRHMP
 Conduct needs and context Seal of Good Local implementation
assessment to define the Governance for LGUs) o Ensure the sustained
priorities and strategies for  Province-/City-wide participation of multi-

the effective localization of health systems and sectoral stakeholders
the NHRHMP health boards to adopt  Evaluate the impact of
o Identify local and monitor the NHRHMP
challenges, review NHRHMP strategies implementation on the
existing programs/
health outcomes at both
interventions and gaps
national and local levels
o Determine priority
 Advance the HRH agenda
strategies/
interventions at the local level, based
on the evaluation of
 Integrate NHRHMP
outcomes
strategies in local
plans, aligned with
UHC P/CWHS
integration
o Local development
plans and local
investment plans for
health/local HRH
plans should include
the following:
- Baseline diagnosis
(socio- economic
and environmental
context)
- Priorities
- Localized targets
and indicators
- Programs/projects
- Budget/financial
strategies
- Timelines
- Implementation
risks and
contingency plans
CHAPTER
- Cooperative
governance
9
mechanisms
- Monitoring
mechanism
(including
indicators
appropriate for
local context)

 Accelerate/increase
investments in HRH
o Align national and local
budgets with the
priorities identified
Financial and technical support as well as capacity building of subnational bodies provided
for the local implementation of the NHRHMP
Implementing an HRH agenda conducive to the attainment of UHC will require both allocation of additional
resources and their efficient and innovative use. Domestic spending on HRH is lower than is typically
required. Larger investments are necessary and the management of private sector health providers needs
to be improved. In tapping the required external support, the impact of development assistance for HRH
must be maximized through strategic targeting and sustained implementation.
Health workforce development is partly a technical process and, thus, requires expertise in coherent human
resource planning, education, and management. The continuous provision of technical assistance and
capacity building aligned with the priority needs of the lead implementers are key to achieving the NHRHMP
targets and sustaining efforts for the health workforce.
DOH has recently partnered with DILG, through the Local Government Academy, to provide a training
program for local chief executives to increase their capacity in health system management, particularly in
the context of UHC.
Table 46. Strategies for Financial and Technical Support, and Capacity Building of Subnational Bodies
 Establish policies and  Implement performance-  Review outcomes

guidelines for LGUs to based financing and support of the support
access support for the mechanisms provided
NHRHMP implementation o Adopt Special Health CHAPTER
 Identify areas of Fund mechanism
9
convergence/cooperation  Set up a rewards and

NHRHMP implementation, recognition system for LGU
and establish links to align performers in HRH
efforts and synergize development and
various aspects of the HRH
management
(i.e. from production to
retention/ exit). Links  Organize and maximize
should be both vertical, i.e. peer-to-peer learning

multi-level governance, and mechanisms
horizontal, i.e. inter- LGU or  Explore alternative finance
inter-agency cooperation. channels
o Public-private
partnerships
o Pooling of resources by
LGUs/agencies
o Crowdfunding
 Assess capacity of CHDs to  Continue and expand  Provide technical
support the localization of capability building and assistance for HRH
the NHRHMP learning programs local champions to
o Provide capacity-building o Sustain the implementation assess their
interventions to address of Leadership and strategies and
competency gaps Governance for Health refresh them for
programs/courses improved efficacy
o Create positions, as and effectiveness
necessary, to fulfill  Establish mechanism to ease
functions communication between  Regularly evaluate
different levels of government and recalibrate
 Implement Leadership and
(i.e. national, regional, and capacity- building
Governance for Health local) to facilitate quick interventions
programs to strengthen the consultation and timely based on
LGU’s capacity in feedback (e.g. hotlines) outcomes and
implementing health impacts
programs, including HRH
strategies
 Capacitate local
implementers on, but not
limited to, the following
areas:
o HRH data governance
and information
management (including
tracking HRH migration)
o Multi-sectoral
collaboration for HRH
CHAPTER
strategies
o Health workforce
9
assessment
o HRH development and
management
o HRH retention strategies
and welfare promotion

Stakeholder Role/s
1. DOH Centers for Health Development  Policy and program implementation and
monitoring, coordination/liaison between
various regional and local stakeholders,
provision of technical assistance to LGUs
 Spearhead the localization of the NHRHMP
2. Department of Interior and Local  Oversee and strengthen local government

Government capability aimed towards the effective
delivery of basic services to the people
3. Leagues of Cities and Municipalities  Direction-setting on health agenda at the

local level
4. Local Chief Executives
 Management of health workers hired in
LGUs, implementation of local health
initiatives
5. Local health officers  Advise the local chief executive regarding

the direction on health at the local level and
ensure that it is harmonized with national
level directions
 Coordinate/liaise with other government
agencies and non-government organizations
relating to health services/initiatives at the
local level
6. Associations and Federations of Health  Advocate and lobby for the welfare of health
Workers workers and represent their shared interests
 Collaborate with the different stakeholders
of health and make its services important to
their beneficiaries
7. Civil Society  Contribute to the formulation and

implementation of government budget
transparency and accountability
CHAPTER
9

CHAPTER 10
Institutionalization and
Strengthening of the Human
Resources for Health
Network Philippines
CHAPTER TEN
INSTITUTIONALIZATION AND STRENGTHENING OF THE HUMAN
RESOURCES FOR HEALTH NETWORK PHILIPPINES
SITUATION
HRH Governance in the Country
There are multiple national government agencies involved in overseeing the production, regulation,
capacitation, distribution, management, and deployment of HRH—with each of these agencies engaged as
well in developing policies and programs according to their individual mandates. Given this nature of HRH
governance increases the likelihood of gaps, inconsistencies, conflicts, and varying degrees of overlap.
Many of the health system issues and inefficiencies related to fragmentation of health governance are
long-standing problems that stemmed from the devolution of healthcare services as mandated by the Local
Government Code of 1991.
Currently, the lead agencies for various aspects of HRH governance are as follows:
● The CHED is primarily responsible for developing the curriculum for health-related fields and
ensuring the production of quality HRH among the professional health cadres; while TESDA offers
certificate programs for skilled health workers, including community health workers.
● The PRC regulates practice of profession in coordination with specialty societies, and accredited
professional organizations.
● The CSC formulates policies and regulations for administration, maintenance and implementation
of position classification and compensation and sets standards for the establishment, allocation
and reallocation of pay scales, classes and positions for government employees, including health
personnel1.
● The DBM, aligned with its mandate to promote effective and efficient management of government
resources, shares the role of CSC in guiding government agencies (i.e. NGAs, GOCCs and LGUs) in
determining appropriate positions that will comprise their respective staffing pattern 2.
● DOH retains management of recruitment of health workers for DOH hospitals and specialty medical
centers and for HRH deployment programs and is responsible for ensuring quality of training and
health human resource development at all levels of the healthcare system 3.
● Local government units are responsible for HRH management and development at the local levels
including staffing of LGU hospitals and primary health care facilities and other field health
facilities4.
● The private sector, while adhering to health facility standards issued by the DOH, independently
manages their health staff guided by the labor policies, standards, and programs of DOLE.
CHAPTER
1
Executive Order No. 292 s. 1987, “Administrative Code of 1987”- Mandates of the Civil Service Commission
10
2
Republic Act (RA) No. 6758 “An Act Prescribing a Revised Compensation and Position Classification System in the Government and for Other
Purposes”
3
Executive Order No.102 s. 1999 “Redirecting the Functions and Operations of the Department of Health”
4
Republic Act 7160 "Local Government Code of 1991"
Institutionalization and Strengthening of the HRH Network Philippines | 185

● Temporarily or permanently migration of HRH is governed by policies issued by different agencies
(i.e. DFA, BI, CFO, POEA, OWWA).
Human Resources for Health Network Philippines
In 2006, the DOH spearheaded the creation of the HRH Network Philippines, composed of government
agencies and non-government organizations. The HRH Network (HRHN) is designed to harmonize HRH
policy directions and coordinate the actions of its members in developing a globally competent and
sustainable health workforce to provide quality UHC for Filipinos. It has been recognized as the first
collaborative network of its kind for HRH in Asia.
The objective of the HRHN, which is bound by a memorandum of understanding (MOU) signed by its
members, is to ensure that:
● The education and training of HRH is closely aligned with, and responsive to, health system needs;
● The health workforce is well-motivated and able to effectively contribute to the health system;
● The principles of ethical recruitment of international health personnel are promoted and practiced;
● National and international partnerships and networks for the management and development of
HRH are established and maximized;
● HRH planning, and policy monitoring and development are coordinated across different agencies;
and
● The rights of health personnel to decent work, social dialogue, and collective negotiations are
protected and upheld.
The HRH Network meets regularly, at least once every quarter, in order to: collaborate on policy planning,
design, and implementation; address HRH issues and challenges; and disseminate updates on the
country’s health workforce. In 2019, the quarterly meetings focused on the step-by-step formulation of the
National HRH Master Plan, in light of the new UHC Law.
Recognizing the vital role of data collection and information management in carrying out its objectives, the
HRHN has focused on strengthening, expanding, and harmonizing data sharing efforts among its members.
HRH Network Member Agencies
Currently, the HRH Network is composed of eighteen organizations with independent and inter-related
mandates on workforce management and development.
Table 48. List and Categories of HRHN Member Organizations
Government Agencies Private Sector Organizations Academe
▪ Bureau of Immigration (BI) ▪ Association of Deans of ▪ University of the

CHAPTER
Philippines Manila (UP

▪ Civil Service Commission Philippine Colleges of
Manila)
Nursing, Inc. (ADPCN)
10
(CSC)
▪ Association of Philippine
Medical Colleges
186 | Institutionalization and Strengthening of the HRH Network Philippines

▪ Commission on Filipinos Foundation, Inc.
Overseas (CFO) (APMCF)
▪ Commission on Higher ▪ Philippine Nurses

Association, Inc. (PNA)
Education (CHED)
▪ Department of Budget and ▪ Public Services Labor
Independent
Management (DBM)
Confederation (PSLINK)
▪ Department of Health
(DOH)
▪ Department of Labor and
Employment (DOLE)
▪ Department of Interior and
Local Government (DILG)
▪ National Economic and
Development Authority
(NEDA)
▪ Overseas Workers
Welfare Administration
(OWWA)
▪ Philippine Overseas
Employment
▪ Professional Regulation
Commission (PRC)
▪ Technical Education and
Skills Development
Authority (TESDA)
The HRH Network has three technical working committees (TWCs), which are the:
● TWC on Entry, focusing on the planning, education, and recruitment of HRH;

● TWC on Workforce, focusing on supervision, compensation, retention, support systems, and
lifelong learning and development; and
● TWC on Exit and Re-entry, focusing on career tracks and opportunities, health and safety, migration
and retirement, and reintegration of returning migrant workers and others into the Philippine
healthcare system.
Recognizing the importance of the HRH Network as a multi-sectoral platform for collaboration on HRH
management, the network continues to expand its membership to include stakeholder participation from
the private sector (including foundations, industry associations, and NGOs), academic and research
institutions, local governments (municipal, city, provincial and regional), and government information units.
CHAPTER
10

Figure 30. Current HRH Network Philippines Structure
While the Department of Foreign Affairs was earlier designated to chair the TWC for Exit and Re-entry, this
was not formalized in the 2016 MOU of the HRH Network. Instead the agency has since manifested that
they can be tapped as a technical resource for the TWC issues and concerns especially on matters relating
to migration and foreign policy.
HRH Network Initiatives
Since its inception, the HRH Network Philippines has helped to shape national policies, programs, systems,
and initiatives towards realizing the Philippines’ HRH Master Plan and related international and national
plans and commitments. Altogether, these serve as the anchoring schema to respond to workforce
requirements and standards, production, training, recruitment, distribution, and compensation. Among its
several initiatives and accomplishments, the HRH Network has:
● Developed two HRH information systems: National Database for HRH Information System
(NDHRHIS) which provides statistical information on HRH distribution by geographical location,
sex, gender, age, type of facility ownership (private/government); and the Integrated Database
CHAPTER
System for HRH Information System (IDSHRHIS) which captures processes, and stores and reports
information on HRH, from production to deployment to migration, re-entry, and retirement. The
10
implementation of the IDSHRHIS was not sustained but the NDHRHIS is currently being assessed

if feasible to develop further for the National Health Workforce Registry as mandated by the UHC
Act.
● Engaged in developing bilateral and multilateral labor agreements, as well as participated in
meetings of the ASEAN Coordinating Committee on Services, which reports to the ASEAN
Economic Ministers through the Senior Economic Officials Meeting, on MRAs and other economic
cooperation agreements with HRH implications. Chapter 8 specifies several of these international
agreements.
● Guided the development of research initiatives on HRH and multi-sectoral workforce policies in line
with the goals of UHC. Amongst the latest policies developed by the HRH Network are the DOH-
PRC Joint Administrative Order (JAO) No. 2015-01, “Policies and Guidelines on the Conduct of
Medical Residency and Fellowship Training Program for Foreign Medical Professionals in the
Philippines;” the DOH-PRC JAO No. 2020-01, “Guidelines on the Certification of Primary Care
Workers for Universal Health Care;” DOH-PRC JAO No. 2021-01, “Guidelines on the Establishment,
Utilization, and Maintenance of the National Health Workforce Registry.” DOH-CHED-PRC-TESDA-
DOST JAO No. 2021-0001, “Guidelines for Expanding Health Professional and Health Worker
Scholarships and RSA for UHC”, and the DOH-CHED-PRC JAO No. 2021-0001, ‘Guidelines for the
Reorientation of Health Professions Education Curricula and Training Programs to Primary Health
Care”.
● Organized seven HRH-related policy fora. The last forum was held in 2017 in time with its
10th year anniversary, with the theme: “Keeping Momentum: Accelerating Progress
towards Sustainable Human Resources for Health for National Development and
Universal Health Care”, wherein several milestones were also presented.
● Produced multi-stakeholder country reports, every three years (since 2012), on the
implementation of the WHO Global Code of Practice on the International Recruitment of
Health Personnel.
● Collaborated with the USAID HRH2030 Philippines; and with WHO for the development
and implementation of the National Health Workforce Accounts, Workload Indicators of
Staffing Needs, Health Labor Market Analysis, and the National HRH Master Plan 2020-
2040.
HRH Network Challenges
The HRH Network has taken note of challenges and bottlenecks that have held up the realization of its
goals, including:
● Inconsistent representation of permanent and alternate members

● Inactive participation of key agencies, such as DILG, CSC, DBM, NRCO
● Non-participation of LGU leagues and associations
● Limited participation of key decision makers and weak follow-through on intersessional HRH
Network commitments
● Lack of established accountability mechanisms
● Lack of funding dedicated to sustain HRH programs initiated by the Network
CHAPTER
10

Efforts to Institutionalize the HRH Network
In line with efforts to institutionalize the HRH Network Philippines, the following legislations have been
proposed:
● House Bill No. 06514. An Act Institutionalizing the Philippine Human Resources for Health Network
was filed by Congressman Felix William B. Fuentebella. This was referred to the Committee on
Health on June 6, 2016.
● House Bill No. 05608. An Act Institutionalizing Human Resource for Health Network Philippines
was introduced by Congressman Eufranio C. Eriguel. This was read on the First Reading and
referred to the Committee on Health on March 18, 2015.
● Senate Bill No. 695. An Act Institutionalizing the Human Resources for Health Network as a
Structure to Support Human Resources for Health Development in the Philippines was introduced
by Sen. Loren B. Legarda. After the first reading, this was referred to the Committee(s) on Health
and Demography, and Finance on August 7, 2013.
● A Substitute Bill entitled “Institutionalizing the Philippine Human Resources for Health Network”
was drafted and introduced.
These bills gained little mileage within Congress, on the premise that the existing MOU was enough to
enable the HRHN to function. However, the HRH Network recognizes that legislative support for its
institutionalization would address some of the challenges mentioned above as it would mandate the active
participation of its members and define clear roles and responsibilities as well as accountabilities in
meeting the targets set for the HRH. A legislation will also provide a basis for allocation of funds to ensure
the sustainability of programs initiated by the HRH Network, such as integrating health information systems
and to have dedicated staff for its Secretariat.
Fragmented HRH governance with unclear or overlapping accountabilities
It is unclear to what extent individual agencies’ policies overlap, and how this has impacted on inter- agency
policies and programs. In the absence of common goals and directions to work on and strategic framework
to guide the development of harmonized policies, fragmented HRH governance may impede the
achievement of HRH development goals.
For instance, there is inconsistency and incoherence in strategies linking education and labor policies as
levers for achieving UHC and national development goals. HRH production is geared towards hospital-
based services instead of strengthening primary care; and responding to global demand instead of local
health needs.
There are substantial amounts of HRH-related information and data in the public and private sectors remain
disparate, but attempts to collect, store, and analyze these through integrated databases have not made
CHAPTER
significant progress making it difficult to form a clear picture of the evolving HRH landscape, in order to
inform decision making.
10

The devolution of health services has meant that priorities for HRH, including the recruitment and
management at the local levels, are dependent on the political will, or that lack thereof, of local officials
appointed in each election cycle. Political and bureaucratic interference in HRH processes and
management is a recurring complaint raised at various national and regional conferences. National and
local policies for HRH are not often not aligned, and implementation widely varies across LGUs.
Competency gaps in developing, implementing, and monitoring plans and policies
A shortage of competent technical and administrative staff to produce plans, policies, and programs is
counterproductive to nationwide HRH management. National agencies like the DOH have frequently had to
rely on technical assistance from international and development partners to provide the needed expertise
in strategic planning, research implementation, and evidence generation, among others.
It is recommended that the existing staff, not only of the DOH central and regional offices, but the HRH
Network as a whole, be capacitated based on identified gaps in implementing the National HRH Master
Plan.
General Objective
Harmonized and strengthened inter-sectoral governance for HRH
Consultations with various offices and agencies have pinpointed that siloed work is still prevalent among
national agencies; this has resulted in the duplication of efforts and incongruent action plans. The problem
needs to be addressed through a multi-sectoral networked approach to orchestrate actions and goals.
The HRH Network can be optimized as a venue to innovate in terms of connecting, learning, leading, and
working for our health workforce -- to seek new ways to improve and ensure a sustainable health workforce,
and add value to both the HRH and their clients.
Connect. The HRH Network needs to re-enforce its collaboration and expand partnerships to connect with
all key actors and bring in diverse yet synergistic expertise and experiences in developing and managing
the health workforce.
Co-learn. The HRH Network shall serve as a platform to bring ideas together through co-learning and
dialogues; spread knowledge; and ensure the translation of these ideas into practice. Opportunities for
capacity development among its members should also be provided to effectively and efficiently fulfill roles.
Co-lead. The HRH Network should work on the premise of shared responsibility, wherein individual
agencies and institutions play lead roles according to their expertise and mandates, while ensuring
harmonized and synergistic efforts, and building on the principles of accountable governance and agile
CHAPTER
management.
10
Co-create. The HRH Network should continuously work together and seek new ways to drive workforce
transformation to ensure responsiveness to current and future situations.

Success Measures
Indicators Targets
HRHN Institutionalization One (1) legislation passed to support HRHN institutionalization
Staff of HRHN agencies At least % of HRHN agency staff capacitated based on HRH
capacitated based on identified management and development competency gaps
competency gaps
Institutionalized national mechanism for HRH governance and dialogue to broaden

ownership of the NHRHMP and harmonize HRH strategies and policies
As mandated by the UHC Act, Implementing Rules and Regulations Sec. 23.1, the DOH shall lead and
institutionalize a multi-sectoral HRH Network composed of both public and private organizations and
agencies to formulate and oversee the sustainable implementation, monitoring, and periodic evaluation,
and reformulation of the HRH Master Plan. Institutionalizing the HRH Network would establish
accountabilities among lead agencies and provide needed resources for efficient implementation.
Changes in agency leadership and key officials, and a pervasive low level of awareness on the HRH Network
among the technical staff of member agencies, call for a review of the original MOU, to define, more
precisely, roles and responsibilities, and to recalibrate its structure.
The creation of a TWC for HRH Data and Information will help address the lack of accurate, up-to-date HRH
information for evidence-based planning and policy formulation (see Figure 31 for the proposed HRHN
structure).
Table 50. Strategies for Institutionalizing National Mechanism for HRH Governance and Dialogue
▪ Expand HRH Network ▪ Establish and maintain a ▪ Assess and sustain HRH
membership to engage central repository of HRH Network performance
the private sector, CSOs, information, tools, resources,
NGOs, academe, experiences at national and
research; and to create local levels
an additional technical ▪ Institutionalize the HRH
working group for HRH Network through an
data and information appropriate legislative
CHAPTER
▪ Include the measure

10
institutionalization of ▪ Monitor and recalibrate the

the HRH Network in the NHRHMP implementation,
Health Legislative as necessary, to ensure:

Agenda o Adequacy of HRH
▪ Formulate policy to management structure
legitimize the HRH o Financing and other
Network and resource needs
generate resources o Technical assistance
for its efficient provision
implementation and o Data and knowledge
oversight management
▪ Set up accountabilities o Stakeholder
for NHRHMP
engagement
implementation of
priorities and strategies
o International and
development partner
support
Strong technical and management capacity of the DOH and other agencies/sectors to plan,
develop, implement, and monitor HRH policies and programs
The institutionalization of the National HRH Master Plan would place an enormous responsibility on the
HRH Network, especially the DOH, as it will lead the implementation of HRH strategies across all levels of
care. A thorough assessment of current management capacities, technical competencies has to be done;
and staff weaknesses and limitations need to be addressed prior to implementation. A strong governance
body equipped with the necessary competencies is crucial for achieving the goals of the Master Plan.
Table 51. Strategies for Capacity Building of DOH and other Agencies for NHRHMP Implementation
▪ Conduct a baseline ▪ Implement and ▪ Update Learning and

assessment and monitor learning and Development Plans, as
identification of gaps in development necessary
competencies on HRH interventions for the ▪ Create a talent pool for
management and HRH Network continuous learning and
development, and an capacity building of new
▪ Provide opportunities
assessment on the members and staff.
for co-learning
implementation of HRH
policies and programs ▪ Provide opportunities to
tighten working
▪ Prepare a learning and relationship among
development plan for the HRHN members
HRH Network
CHAPTER
10

Stakeholder Role/s
1. Legislators (Health Committee in the Senate ▪ Creation of enabling laws for HRH
and HOR) management and development, including
the institutionalization of the HRH Network
2. HRH Network Philippines member ▪ Co-developer and co-implementer of the

agencies/institutions National HRH Master Plan
▪ Advocate for HRH management and
development
Proposed Governance Structure of the National HRH Master Plan
This reformulated Master Plan underlines a whole of society, whole of government approach and works on
the premise of shared leadership and accountability. The table below shows the proposed governance
structure for the implementation of the National HRH Master Plan.
Table 53. Proposed HRHN Committee Functions
Stakeholder Role/s
Oversight Committee ▪ Shall function as the decision-making body of the

HRH Network Philippines. It shall review and act
upon the recommendations of the different TWCs.
It can create and/or remove committees as the
need arises.
TWC on Entry ▪ Shall focus on the planning, education, and

recruitment of HRH.
TWC on Workforce ▪ Shall focus on supervision, compensation,

retention, system supports, welfare and safety, and
lifelong learning and development.
TWC on Exit and Re-entry ▪ Shall focus on migration and retirement, and
reintegration of HRH into the Philippine healthcare
system.
CHAPTER
TWC on HRH Data and Information ▪ Shall provide and maintain HRH data and
information and function as the core body
10
operationalizing the NHWR/NHWA.

Figure 31. Proposed Management Structure of the HRH Network for the NHRHMP Implementation
The proposed TWC on HRH Data and Information will spearhead the harmonization and optimization of
HRH data and HRH information systems, including the National Health Workforce Registry. It identified the
HRH Network member agencies to contribute data for four areas which are: Production, Workforce, Exit
and Re-entry, and Population Health Needs. Some agencies that are not yet members of the HRH Network
(i.e. DICT, DOST, PSA, and DFA, PHIC, and NNC) shall also be included in the TWC.
CHAPTER
10
Figure 32. Proposed Structure and Members of the Technical Working Committee on HRH Data and
Information

CHAPTER 11
Call to Action
CHAPTER ELEVEN
CALL TO ACTION
Our vision for the Filipino HRH:
“By 2040, Filipinos will have access to responsive and quality health services, anchored on
primary care practices and a networked approach, provided by an adequate and equitably
distributed competent and committed health workers, who, with their decent and supportive work
environment, enjoy the dignity of their work.”
This is our dream and aspiration for the Human Resources for Health––one of our most important
resources that influences access, quality, and effective delivery of health services. However, this will remain
a dream unless we move in unison to bring it to fruition.
Tales of the difficulties that our health workers face in their day-to-day work have reached our ears, but this
COVID-19 pandemic has brought us closer to the realities of their plights. Our health workers bravely stand
on the frontline to battle against the deadly disease, only to see some of their own fall one by one. This
underscores the need for us to care for them as much as they care for us.
With all these challenges, the National HRH Master Plan was developed primarily to formulate the
multisectoral goals, targets, and strategies to improve HRH planning, management, and development, as it
also aims to contribute to the aspirations of Universal Health Care. It is a long-term plan that provides a
strategic roadmap to help us navigate towards our desired future for our HRH, regardless of sector and
affiliation, and that is for them to:
● Have decent jobs. Permanent positions are secured, with adequate financing. The HRH are
developed with clear career paths that allow continuous growth and serve their best interests. They
work in a safe and protected working environment, free from any harm or violence.
● Be adequately and equitably distributed. HRH are located and practicing in areas where they are
needed, such as geographically isolated areas and lower-income class municipalities. Health
facilities in all levels of care are adequately staffed by motivated and energized HRH performing to
their full potential.
● Be competent and compassionate. The HRH provides quality health services anchored on primary
care practices. They are not only recognized for their competence, but also for showing malasakit
at kalinga [concern and care] at pagiging makabayan [being patriotic].
The Department of Health, even with its mandates and resources, cannot and will never be able to do it
alone. The knobs in navigating the road are in the hands of multiple owners. As such, we enjoin you––
lawmakers, members of the HRH Network, other key national agencies and regulatory bodies, the local
government unit leaders, the private sector, international partners and the Filipino health workers––to
share this vision. We shall fuel this journey with shared responsibility, accountability, and inclusivity.
We stress that as we all endeavor to gather, sit down, and brainstorm to develop implementable plans,
frameworks, and policies, the battle does not end in the printed materials, but in the doing. Actions should
be felt by no less than our HRH on the ground and on the forefront. The NHRHMP intends to help us write
CHAPTER
Call to Action | 199

11
stories of evident, felt, and sustained care for our HRH, as it also translates to their invaluable services for
the health of our fellow Filipinos.
Our ultimate measure of success will always be the comfort and well-being of our FIlipino HRH, as well as
their trust and belief that they are valued, wherever they may be.
This is the NHRHMP, and this is OUR plan!
“Ang malasakit para sa health workers ay kalinga para sa sambayanang Pilipino.”
In the next twenty-four (24) months, concerted action is needed to jumpstart the implementation of the
NHRHMP through the following key components:
HRH Network Strengthening
As the key multi-stakeholder advisory body for HRH development in the country, the HRH Network will take
the lead in HRH planning and implementation of strategies. Its immediate tasks will include intensive
communication to engage key stakeholders to actively take their roles in the NHRHMP implementation. It
also needs to undertake catalytic actions such as operations research and assessment, policy scoping,
and a thorough review of the HRH data and IT systems of the network, in conjunction with reviews of the
databases and data sharing agreements of member agencies to start-up the series of strategic reforms.
These immediate tasks are expected to result in:
● An expanded, detailed mandate for the HRH Network.

● Lead stakeholders gaining a strong sense of ownership of the NHRHMP and assuming roles and
accountabilities in advancing HRHMP in their agencies and with the other stakeholder groups in
the HRH Network.
● A needs assessment that lists priorities in order of urgency and concrete plans of intervention and
execution
● More streamlined sharing and improved integration of accurate and updated quality data and
information for decision-making
● The most pressing operational gaps and weaknesses addressed while eliminating duplication and
inefficient use of energy, time, and resources
● The addition of dedicated and capacitated key personnel equipped to carry out the expanded
mandate.
● Expanded membership of the HRH Network to include data and information units and more private
sector stakeholder groups including those from the health-related academia.
More importantly, the HRH Network member agencies must be committed to providing substantive support
to the network by:
● Working actively on cross-agency data and information gathering, harmonization, processing, and
access.
● Supporting capacity-building for Secretariat personnel and agency personnel involved in the HRH
Network.
● Identifying and liaising with key external contacts, including partners in the international
community, who could be engaged as stakeholders in HRH, and provide support to the HRH
Network; embedding and aligning their agency priorities with the NHRHMP agenda where possible.
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200 | Call to Action

11
Legislation
An effective roll-out of HRH programs requires a supportive legislative and regulatory framework. Over the
next two years, in conjunction with broader public advocacy efforts, channels of communication should be
opened with both houses of Congress. A legislative agenda agreed upon by stakeholders should be
established, monitored, and updated regularly to facilitate legislative support for HRH initiatives.
The HRH Network should keep lawmakers apprised of key data, program innovations, creative
collaboration, and successes among different HRH constituencies. In order to achieve evidence- informed
and science-based legislative efforts, the HRH Network should promote the conduct of relevant research
and generate data from its partners in the academic and science sectors.
National legislative support should also be coupled with strong regional and international cooperation such
as ASEAN which aims to advance HRH management and development.
Financing and Investment
Multilateral financial institutions recognize that investing in healthcare education and employment is a
strategy for countries at all levels of socioeconomic development to create jobs in the formal sector and
help drive the engine of growth.
In the next two years, the HRH Network should formulate a NHRHMP Investment Plan in close coordination
with key multilateral institutions, international donors, and financing bodies of the government to
encourage earmarking/allotment of financial resources necessary to implement the strategies of the Plan.
Stakeholders Engagement
Mobilization of resources from various sources must be optimized. To this end, the HRH Network shall
focus on boosting stakeholder engagement in the next two years.
It is anticipated that a reinvigorated HRH Network will generate more attention and support from the
broader community of healthcare stakeholders. Such support, which could range from partnership at the
local community level to technical and resource assistance from multilateral agencies and international
donors, should be maximized.
The HRH Network has to carefully plan the allocation of stakeholder resources for HRH (current and future)
available from member agencies, partners from local government, private sector, and non- government
organizations. Systems should be in place for the close coordination, oversight, monitoring, and evaluation
of resource use. All these combined will put HRH squarely in the front and center of the country’s
development.
Public Communication and Advocacy
The HRH Network should endeavor to regularly communicate and provide information on activities and
programs in real-time and suitably packaged for different audiences: member agencies, other stakeholders,
international agencies, and the general public.
CHAPTER

11
In order to engage relevant stakeholders, the advocacy plan and materials have to clearly articulate the
vision and goals of the plan that would allow them to see where they could best position their assistance
and align investments to implement the plan whether at the national or local community level.
Even more importantly, public outreach should inform and encourage all members of the healthcare
workforce—domestic, as well as temporary and permanent migrant workers—to embrace their role as
nation-builders and guardians of the country’s future.
The advocacy program should be designed to make the public aware of the following, among others:
● Well-trained, well-equipped and properly distributed HRH are just as essential as the military and
defense forces in ensuring the country’s long-term security and safety.
● Investing in healthcare education, training, and career development will not just produce quality
HRH, but will also drive economic growth.
● Healthcare workers are always wanted. Skills and experience of healthcare workers, even those
who opted to temporarily permanently migrate to other countries, are valued by the Philippines as
their home country. The Filipino people will always welcome their return should they choose to
serve and stay in the country.
Groundwork for the Key Results Areas
Implementing each KRAs must begin with assessment of current systems, programs, and projects to
determine strengths that could be sustained and weaknesses that must be addressed. Preliminary
activities could be conduct of scoping and gap analysis, development of relevant policies, conduct of
research, generation of realistic and measurable indicators, and identification of stakeholders and
respective roles.
Subsequently, begin program design and planning in close consultation with financing agencies and
partners. It is also very important to ensure transparency and accountability in the program implementation
process.
HRH Data and Information Management
The oversight, planning, and development of HRH hinges on efficient and comprehensive data and
information management systems, as well as the human capacity to operate these systems. In light of the
establishment of the National Health Workforce Registry, there is a need to create a technical working group
on HRH data and information within the HRH Network to ensure coordinated action and sustain its
implementation.
Establishing an HRH data governance framework will guide data management from generation to
utilization, and would define accountabilities of key players. This will serve as the foundation for
implementing strategies aimed at generating a comprehensive HRH data and information systems.
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11
Localization of the HRHMP
Subnational or local contexts must be considered in pursuing the NHRHMP agenda––from goal setting to
finding ways of implementation and identifying indicators for measuring progress.
The importance of the local governments’ buy-in and support cannot be overemphasized, especially with
the devolved set-up of our health system. For the NHRHMP to be successful, it must be embedded in
subnational policies. Its objectives and strategies must be translated into local laws, ordinances,
investment plans and programs that respond to the needs of the people in varied communities. More
importantly, the attainment of the NHRHMP’s vision and objectives, and the implementation of its
strategies must be pursued vigorously by the local leaders, civil society, private organizations, and the
people themselves.
CHAPTER

11
List of Acronyms
ADPCN Association of Deans of Philippine Colleges of Nursing, Inc
AI Artificial Intelligence
APMC Association of Philippine Medical Colleges Foundation, Inc.
APSOM Association of Philippine Schools of Midwifery
ASEAN Association of Southeast Asian Nations
BARMM Bangsamoro Autonomous Region in Muslim Mindanao
BHW Barangay Health Worker
BNS Barangay Nutrition Scholar
BI Bureau of Immigration
BIHC Bureau of International Health Cooperation
BIR Bureau of Internal Revenue
BPO Business Process Outsourcing
CFO Commission on Filipinos Overseas
CHED Commission on Higher Education
CHW Community Health Worker
CHD Center for Health Development
CMCI Cities and Municipalities Competitiveness Index
COS Contract of Service
CSC Civil Service Commission
DBM Department of Budget and Management
DFA Department of Foreign Affairs
DILG Department of Interior and Local Government
DOF Department of Finance
DOH Department of Health
DOLE Department of Labor and Employment
205
DOLE - POLO Department of Labor and Employment -
Philippine Overseas Labor Office
DOST Department of Science and Technology
DOST - SEI Department of Science and Technology Science Education Institute
DTTB Doctor to the Barrios
EO Executive Order
F1+ FOURmula One Plus
FHSIS Field Health Service Information System
FTA Free Trade Agreement
GIDA Geographically Isolated and Disadvantaged Area
GMIS Government Manpower Information System
GNP Gross National Product
GSIS Government Service Insurance System
HCPN Health Care Provider Network
HDMF (Pag-IBIG) Home Development Mutual Fund (otherwise known as Pag-IBIG

“Pagtutulungan sa kinabukasan: Ikaw, Bangko, Industriya at Gobyerno” Fund)
HEI Higher Education Institutions
HHRDB Health Human Resource Development Bureau
HLMA Health Labor Market Analysis
HR Human Resource
HRH Human Resources for Health
HRM Human Resource Management
HRMD Human Resource Management and Development
HRHMP Human Resources for Health Master Plan
HRHN Human Resources for Health Network
HSE Health Sciences Education
ICS Internal Control System
IDSHRHIS Integrated Database System for HRH Information System
206
ILO International Labour Organization
IRR Implementing Rules and Regulations
JAO Joint Administrative Order
JO Job Order
KRA Key Result Area
LERIS Licensure Examination and Registration Information System
LGA Local Government Academy
LGU Local Government Unit
LTO Land Transportation Office
LUCs Local Universities and Colleges
L&D Learning and Development
MRA Mutual Recognition Arrangement
MRC Medical Reserve Corps
NCR National Capital Region
ND Nutritionist-Dietician
NDHRHIS National Database of Selected Human Resources for Health
NEDA National economic and Development Authority
NGO Non-Governmental Organization
NHIP National Health Insurance Program
NHWA National Health Workforce Accounts
NHWR National Health Workforce Registry
NMAT National Medical Admission Test
NRCO National Reintegration Center for OFWs
ORAOHRA Omnibus Rules on Appointments and Other Human Resource Actions
OSH Occupational Safety and Health
OT Occupational Therapist
207
OWWA Overseas Workers Welfare Administration
PAG-IBIG Check HDMF
PESFA Private Education Student Financial Assistance
PJEPA Philippines-Japan Economic Partnership Agreement
PM Performance Management
PMHN Philippine Migrant Health Network
PNHRS Philippine National Health Research System
POEA Philippine Overseas Employment Administration
PPE Personal Protective Equipment
PQF Philippine Qualifications Framework
PRC Professional Regulation Commission
PRIME-HRM Program to Institutionalize Meritocracy and Excellence in Human

Resource Management
PSA Philippine Statistics Authority
PSSP Pre-Service Scholarship Program
PT Physical Therapist
P/CWHS Province- or City-Wide Health Systems
RA Republic Act
R&R Rewards and Recognition
RSP Recruitment, Selection and Placement
RT Radiologic Technician
SCM Service Continuity Management
SDG Sustainable Development Goal
SDN Service Delivery Network
SO Strategic Objective
SSS Social Security System
SUCs State Universities and Colleges
SY School Year
208
TESDA Technical Education Skills Development Authority
TVET Technical and Vocational Education and Training
TWC Technical Working Committees
UHC Universal Health Care
UNIFAST Unified Financial Assistance System for Tertiary Education
UP University of the Philippines
USAID United States Agency for International Development
WHO World Health Organization
WISN Workload Indicators of Staffing Need
209
Annex A
Risk Governance Frameworks and Change Models
Table 1. Existing Risk Governance Frameworks
Name Description Region Sector
SOX Standard for all publicly traded companies in the U.S. USA All sectors
Contains 11 sections, ranging from additional Corporate
Board responsibilities to criminal penalties. Covers issues
such as auditor independence, corporate governance,
internal control assessment, and enhanced financial
disclosure. Has raised the profile and general awareness of
the COBIT® framework, in particular through its application
for identifying IT controls relevant to the SOX section 404.
COSO A U.S. private sector initiative, whose major objective is to USA All sectors
identify the factors that cause fraudulent financial reporting
and to make recommendations to reduce its incidence. Has
established a common definition of internal controls,
standards, and criteria against which companies and
organizations can assess their control systems.
CobiT The Control Objectives for Information and related Worldwide All sectors
Technology (CobiT) is a set of best practices for IT
Management created by ISACA and ITGI. COBIT provides
managers, auditors, and IT users with a set of generally
accepted measures, indicators, processes and best
practices to assist them in maximizing the benefits derived
through the use of information technology and developing
appropriate IT governance and control in a company. It is
largely based on the control concepts of COSO.
European Directive 95/46/EC of the European Parliament and of the Europe All sectors
Data Council of 24 October 1995 formulates regulations on the
Protection protection of individuals with regard to the processing of
Directive personal data and on the free movement of such data.
ISO/IEC ISO/IEC 27002 is an information security standard published Worldwide All sectors
27002 by the ISO and the IEC as ISO/IEC 17799:2005 and
subsequently renumbered ISO/IEC 27002:2005 in July 2007.
It provides best practice recommendations on information
security management for use by those who are responsible
for initiating, implementing or maintaining Information
Security Management Systems.
KonTraG The KonTraG (Gesetz zur Kontrolle und Transparenz im Germany All sectors
Unternehmensbereich - German Act on Control and
Transparency in Business), aims at improving corporate
governance in German companies.
210 | Annex A
Name Description Region Sector
SESTA The Federal Act on Stock Exchanges and Securities Trading Switzerland All sectors
is a directive intended to encourage issuers to make certain
key information relating to corporate governance available
to investors in an appropriate form. Applies to all issuers
whose securities are listed on the SWX.
TransPuG Transparency and publicity law (TransPuG) for the reform of Germany All sectors
the share and balance legislation, which entered into force
on 26 July 2002, is representing a further step in the direction
of a modern European compatible enterprise legislation.
Table 2. Change Models and their Focus
Model Phase Value Focus
Leadership Model: Kotter Enacting Leadership ● Guides implementation of

Leading Change development change
resource ● Top-down model
● Points to capabilities needed
to lead change
Systems Model: Burke- Designing Assessing readiness ● Shows interconnectedness of

Litwin Change Drivers & identifying gaps organizational systems
● Emphasizes situational
analysis and data collection
● Guides gap analysis and
planning
Stakeholder/Skills Enacting/ Communicating & ● Helps in identifying and

Model: Prosci ADKAR Sustaining identifying skills motivating stakeholders
● Promotes communication
and provides skills for
success
● Offers guidance for
sustaining a change
Recovery Model: Kübler- Enacting Managing resistance ● Addresses emotional

Ross Change Curve and facilitating consequences of change
acceptance ● Explains individual reactions,
resistance to change
● Helps in reducing barriers and
resistance to implementation
Annex A | 211
Annex B
Projecting the Requirements for Selected Health Professionals to Achieve

Universal Health Coverage in the Philippines
Developed through the support of Dr. Harvy Joy Liwanag under the DOST-Balik Scientist Program
and Ms. Jhanna Uy and Mr. Michael Ralph Abrigo from PIDS
October 2021
212 | Annex B
BACKGROUND
Successful attainment of Universal Health Coverage (UHC) requires not only adequate financing of health
services but also sufficient human resources for health (HRH) 1 who are competent and motivated to deliver
quality health services to meet population needs. It has long been recognized that HRH comprises one of
the six essential building blocks that make health systems functional2. The question, however, that ought
to be asked is: How much HRH is required to be considered adequate for the successful attainment of
UHC? There are a number of approaches available to address this question as summarized in Table 1.
Table 1. Summary of Approaches for Estimating HRH Requirements
Description Pros and Cons

1) HRH-to-population Based on predetermined - Simple, least amount of data
ratios thresholds of HRH density - Unresponsive to specific health
(e.g. 44.5 per 10,000) needs
2) Service utilization Previous/Current service - Simple to apply, if data is

approach utilization patterns used to complete
approximate future demand - Current utilization not necessarily
equivalent to “meet demand”
3) Health Based on socio-demographic, - Provides a good basis for

needs/demand epidemiological data determining the need
approach - Relies on the availability of
accurate data (e.g. Burden of
Disease, BOD)
4) Workload Indicators Based on the workload - Provides a strong basis for HRH
of Staffing Needs pressure in a given facility needs per facility
(WISN) - Can be too complex and time-
consuming
*No Planning – leave it to market forces
Among the four general approaches listed above, the use of HRH-to-population ratios has often been
utilized because of its simplicity and minimal requirement for data. Ratios also allow for the possibility of
comparing HRH adequacy across different geographic boundaries (e.g. country A vs. country B, or province
X vs. province Y) and assess against a predetermined target threshold of HRH density. While relatively
easier to apply compared to the other approaches, this approach has been criticized for being crude and
1
WHO. WHO | Health workforce requirements for universal health coverage and the Sustainable Development Goals [Internet].
World Health Organization; 2016 [cited 2020 Dec 14]. Available from: http://www.who.int/hrh/resources/health-observer17/en/
2
WHO. WHO | Monitoring the building blocks of health systems: a handbook of indicators and their measurement strategies
[Internet]. World Health Organization; 2010 [cited 2020 Dec 14]. Available from:
https://www.who.int/healthinfo/systems/monitoring/en/
Annex B | 213
unable to account for the dynamic requirements for HRH that may vary across facilities and population
clusters.
The limitations of the HRH-to-population approach can be compensated by the service utilization approach
and the health needs/demand approach. The service utilization approach takes into account previous and
current service utilization patterns to estimate how utilization might look in the future, and subsequently
determine the number of HRH that will be required to meet the anticipated utilization pattern. However, it
must be pointed out that the extent of utilization of any given health service is not necessarily equivalent
to the demand (especially when there is more demand than the extent of health service that can be utilized).
On the other hand, the health needs/demand approach is an improvement of the utilization approach
because it incorporates socio-demographic and epidemiological data (e.g. estimates of Burden of Disease)
to determine the extent of “health needs” to be anticipated in the future, and subsequently, estimate the
number of HRH to meet such needs.
The Workload Indicators of Staffing Need (WISN) approach, details of which are available in a WHO report3,
is the most comprehensive among the general categories of approaches. However, this approach requires
a substantial amount of data, including actual visits to health facilities to examine records and interview
key informants. Nevertheless, WISN allows for a comprehensive and dynamic assessment of the HRH
requirements of a given health facility, taking into account the workload pressure for that particular facility,
and can provide more accurate estimates of the lack or excess of a particular cadre of HRH in a given
facility.
Finally, there is what could be called the fifth approach, which corresponds to no planning at all and letting
market forces determine the supply and demand for HRH. This is, of course, an option, but will be an
abdication of the government’s responsibility to ensure a well-functioning health system for its people.
Objectives
The HRH projections report aims to present an assessment of the current gaps and determine the future
requirements for HRH to accelerate UHC in the country. Specifically, the objectives of this projection study
are:
3
WHO. WHO | Workload Indicators of Staffing Need (WISN) [Internet]. World Health Organization; 2015 [cited 2020 Dec 14].
Available from: http://www.who.int/hrh/resources/wisn_user_manual/en/
214 | Annex B
a. To estimate the current and previous supply of 10 selected health professionals in the Philippines
every year from 2010 until April 2020, and determine the adequacy of the supply based on target
thresholds of HRH densities to achieve UHC (national level);
b. To estimate the future supply of the 10 selected health professionals every five years starting from
2025 until 2050, and determine the adequacy of the supply based on target thresholds of HRH
densities to achieve UHC (national level);
c. To estimate the future demand for the selected health professionals (national level, with option to
calculate for local levels) based on:
- Numbers required for the category of health professional to meet the target density
- Numbers required for the category of health professional to meet the demand projected
based on sociodemographic and epidemiological factors
Noting that no single HRH projection approach is perfect or ideal, each approach will have its set of
advantages and limitations that have to be considered given country-specific realities (i.e. data availability
and accuracy, and the time and resources available to complete the task).
Significance
The report presents the first HRH projection study that covers supply and demand for the 10 cadres of
health professionals, whereas previous studies were only limited to physicians, nurses, midwives and
dentists. The current projection study adopted a combination of using the HRH-to-population approach
and the health needs/demand approach that takes into account sociodemographic and epidemiological
factors. The study also provides estimates for supply and demand at local levels (provincial and highly-
urbanized city), in addition to national-level projections, consistent with the direction towards integrated
province-wide and city-wide health systems.
METHODS
Selected Health Professionals
The following health professionals were prioritized to be included in these projections based on their active
role in the context of UHC attainment in the Philippines:
 Nurses
 Physicians
Annex B | 215
 Midwives
 Dentists
 Medical Technologists
 Radiologic Technologists
 Pharmacists
 Nutritionist-Dieticians
 Physical Therapists
 Occupational Therapists
Data Sources
Determining the most appropriate data source for HRH supply requires a careful consideration of the
various options based on data availability and resources needed for data processing and analysis. For this
projection study, the licensure and health professional registration dataset of the Professional Regulation
Commission (PRC) was used as a surrogate measure of the active supply of the selected health
professionals. The study assumed that health professionals who are currently practicing or have intentions
of practicing their profession in the country will strive to maintain a valid PRC license. Therefore, the number
of valid licenses in any given year was considered as an estimate of the number of actively-practicing health
professionals for that particular cadre. The study recognizes the limitations of the assumption considering
that some health professionals who maintain an active license do not practice their profession or do not
practice in the country. It was maintained as the proxy data source being the most current available
information and based on the presumption that the small proportion of non-practicing health professionals
are relatively small to significantly affect the results of the projections. This presumption was validated
through inquiries with key informants from the professional societies.
Estimating Future Supply using the Leslie Projection Model
The population census data from the Philippines Statistics Authority 4 was used as the basis for estimating
future growth and hazard rates to project future supply of the health professionals following the Leslie
projection model.
The future supply per health profession and broad age groups were projected based on the PRC registration
dataset. The projections were straightforward applications of the Leslie projection model5 based on stable
population theory. The Leslie projection model remains the standard for making population-based
4
Philippine Statistics Authority | Republic of the Philippines [Internet]. [cited 2020 Dec 14]. Available from: https://psa.gov.ph/
5
Kajin M, Almeida P, Vieira M, Cerqueira R. The state of the art of population projection models: from the Leslie matrix to
evolutionary demography. Oecologia Aust. 2012 Mar 1;16:13–22.
216 | Annex B
projection models. The main assumption was that reproduction and attrition by age group for the selected
health professions are both stable over time. The projected number of HRH in the subsequent period was
the combined number of: (a) new entrants (captured by reproduction rate and non-HRH population); and
(b) surviving HRH from previous period, captured by attrition/hazard rate and base stocks. The simplified
model used the total population from the 2010 Census (rather than 2015 Census as this covered only until
2025) instead of the non-HRH population, and this was not expected to affect results as the non-HRH
population was significantly bigger than the HRH population. This model is inherently limited by its
dependence on events during the preceding reference period (2014-2019), particularly for the hazard and
survival rates, which were held constant during the projection horizon. It is therefore important to highlight
that due to this limitation, the projection model is unable to predict sudden major events that might have
an impact on the health system (e.g. COVID-19 pandemic). Hence, the projected numbers presented in this
report would be most accurate for the next 5-10 years, and would lose their accuracy in subsequent years.
To ensure that estimated HRH requirements for the Philippines remain accurate, we recommend that HRH
projections be updated every three years (or at the most every five years) to account for new developments
that have an effect on the health system.
Estimating Demand using Burden of Disease and Socio-Demographic Factors
The demand projections based on the health need approach focused on the primary care level using the
data analysis already performed for the Philippine Health Facility Development Plan (2020-2040) to
estimate the demand for HRH. The prevalence and incidence rates of 23 diseases were projected using
multiple regression models (Table 2). Human capital (i.e. the share of the population with at least
secondary education and per capita income) and technological change variables (i.e. year) were included
as endogenous predictors in the model. Then the prevalence and incidence of cases for 2020-2040 were
estimated by multiplying the projected rates with the projected population. These 23 diseases account for
almost 70% of the total burden of disease in the Philippines. The historical incidence and prevalence of 23
diseases were obtained from the Institute for Health Metrics for Evaluation 6.
The demand for outpatient primary care services was estimated for each disease and for each province
and highly-urbanized city between 2020 to 2040. The probabilities for disease health states were
determined by an epidemiologist through a review of the literature and with reference to validated disease
models. Priority was given to finding studies from the Philippines, then South East Asia, then South Asia,
and lastly Western countries as a last resort when literature was scant. The projected disease burden and
health state probabilities were used to calculate the resource consumptions in terms of outpatient visits
6
IHME. GBD Results Tool | GHDx [Internet]. [cited 2020 Dec 15]. Available from: http://ghdx.healthdata.org/gbd-results-tool
Annex B | 217
and equipment uses. These numbers were then converted to the number of outpatient physicians, inpatient
beds, and machines using the formulas and assumptions available in an HRH calculator.
Table 2. Diseases Considered in the Projections
A Noncommunicable diseases
1 Chronic kidney disease
2 Cerebrovascular Disease (CVA) - Strokes
3 Ischemic heart disease
4 COPD
5 Asthma
6 Breast cancer
7 Lung cancer
8 Diabetes
9 Hypertension
10 Colorectal cancer
B Maternal and child care

11 Pregnant + postpartum + preterm
12 Neonatal disorders (e.g. births, postpartum) + immunization
13 Acute Malnutrition
C Infectious diseases
14 Tuberculosis
15 HIV/AIDS
16 Dengue
17 Community Acquired Pneumonia
18 Diarrhea
D Others
19 Major Depressive Disorder
20 Road / vehicular injuries
21 Low back pain
22 Appendicitis
23 Substance abuse (Drug Use Disorders)
218 | Annex B
Combining Thresholds of HRH Density and Health Demand Approaches
As previously stated, the strategy for these projections was to combine two approaches by estimating the
gap for HRH by comparing supply projections with thresholds of HRH density and with the projected
demand using the demand-based approach. Figure 1 provides a hypothetical example of how it was
intended to be accomplished, while Figure 2 provides a summary of the methodology applied.
Figure 1. Sample Supply Projections for Physicians and Approaches to Determine Future HRH requirements
Figure 2. Overview of Methodology
Annex B | 219
RESULTS AND DISCUSSION
The results of the supply and demand projections are provided below in a series of graphical
representations, divided into three sections: previous and current supply, future supply projections, and
future demand projections.
Previous and Current Supply
Figure 3 presents the supply of nurses in the Philippines every year from 2010 to April 2020 (month of data
retrieval from the PRC). The numbers are disaggregated into the number of already licensed nurses for that
year and the number of nurses who just received their license for that year. The density of nurses is also
described through the nurse-to-population ratios for each year (per 10,000 population). The same data
presentations are applied to the other nine health professionals.
Figure 3. Number of Licensed Nurses Per Year in the Philippines, 2010 - April 2020
Figure 3 suggests that the number of licensed nurses in the country has remained steady in recent years
even with the significant drop in the number of newly-licensed nurses entering the pool. The nurse-to-
population ratio through the years has also remained stable. The slight reduction in April 2020 can be
explained by the suspension of licensure examinations as well as renewal of expiring licenses at the time
of data collection from the PRC due to the COVID-19 pandemic.
220 | Annex B
Figure 4. Number of Licensed Physicians Per Year in the Philippines, 2010 - April 2020
Figure 4 indicates that the number of physicians in the country has remained relatively stable, supported
as well by the stable physician-to-population ratio through the years, despite the increasing number of new
physicians entering the pool in recent years.
Annex B | 221
Figure 5. Number of Licensed Midwives Per Year in the Philippines, 2010 - April 2020
Figure 5 indicates a decline in the number of licensed midwives per year, both in terms of the already-
licensed and those who are newly-licensed midwives. There is also a steady decline in the midwife-to-
population ratio across the years. This decline in the number of midwives, who play a critical role at the
primary care level, should be addressed and prioritized in order to accelerate UHC.
222 | Annex B
Figure 6. Number of Licensed Dentists Per Year in the Philippines, 2010 - April 2020
Figure 6 suggests that the pool of licensed dentists in the country is increasing through the years, bolstered
by the rise in the number of new dentists per year. However, the dentist-to-population ratio shows that
dentist density is in fact slightly decreasing in recent years, indicating that the production of dentists is still
unable to match the growth in the population. Increased investment for the production of dentists would
be an important consideration in this context since oral health services are also an essential component of
primary care.
Annex B | 223
Figure 7. No. of Licensed Medical Technologists Per Year in the Philippines, 2010-April 2020
Figure 7 suggests a steady increase both in the number of medical technologists in recent years, and in the
medical technologist-to-population ratio.
Figure 8. No. Licensed Radiologic Technologists Per Year in the Philippines, 2010-April 2020
224 | Annex B
Figure 8 indicates a steady increase in the number of licensed radiologic technologists, as well as a steady
increase in their density.
Figure 9. Number of Licensed Pharmacists Per Year in the Philippines, 2010 - April 2020
Likewise, in Figure 9, it is observed that there has been a steady increase in the number of pharmacists per
year, as well as in the pharmacists-to-population ratio.
Annex B | 225
Figure 10. No. of Licensed Nutritionist-Dietitians Per Year in the Philippines, 2010-April 2020
Figure 10 also indicates a steady increase in the number of nutritionist-dieticians per year, although the
ratio is observed to be slightly increasing only.
Figure 11. Number of Licensed Physical Therapists Per Year in the Philippines, 2010 - April 2020
226 | Annex B
Figure 11 suggests a slight increase in the number of physical therapists per year; however, the ratio has
remained stable in recent years.
Figure 12. No.Licensed Occupational Therapists Per Year in the Philippines, 2010-April 2020
Finally, Figure 12 indicates a substantial increase in the numbers and ratio of occupational therapists,
although they remain to have the lowest density among the health professionals (in this case presented a
per 50,000 of the population)
Annex B | 227
Figure 13. Composition of Health Professionals with Valid Licenses as of April 2020
A total of 853,253 health professionals have valid licenses as of April 2020. Figure 13 indicates that, among
the 10 health professionals included for these projections, nurses constitute a huge majority at 59%,
followed by physicians (10%), midwives (9%), and pharmacists (6%).
228 | Annex B
Figure 14. Top Five Health Professionals with the Highest Ratios per 10,000 Population, 2010-2019
Figure 14 shows the five health professionals with the highest HRH-to-population ratios. It indicates that
the nurses do have the highest ratios, although it has been decreasing in recent years, together with the
midwives.
Figure 15. Top Five Health Professionals with the Lowest Ratios per 10,000 Population, 2010-2019
Annex B | 229
Figure 15 presents the next five health professions with the lowest ratios. The rise in the ratio for radiologic
technologists in recent years is a positive development. On the other hand, there is indeed an observation
that the ratio for dentists is decreasing.
Do we have enough HRH?
The World Health Organization recommends a threshold of 44.5 “skilled health workers” (i.e. nurses +
physicians + midwives) per 10,000 for a country to achieve UHC.
Figure 16. Ratio of Skilled Health Workers to Achieve UHC, 2010-1029
Figure 16 above indicates that, for the Philippines, the production capacity of professionals can supply HRH
to reach a ratio of 67.9 per 10,000 as of 2019. This, however, does not indicate that the country has an
excess of these cadres, if the ratio is further broken down into its individual cadres. Further, this needs to
be interpreted with caution noting the fact that not all of these health professionals, especially in the case
of nurses, are actually practicing in the Philippine health system.
230 | Annex B
Figure 17. Total Licensed Nurses and Ratio per 10,000 Population, 2010-2019
When looking into nurses alone, Figure 17 suggests that, as expected, the nurse-to-population ratio in the
Philippines exceeds the target density of 27.4. This indicates an apparent surplus in the supply of nurses
at the national level in the Philippines. However, it should be noted that a review of migration data would
reflect that more than 50% of the supply of nurses are working temporarily or have permanently migrated
to other countries.
Annex B | 231
Figure 18. Total Licensed Physicians and Ratio per 10,000 Population, 2010-2019
On the other hand, Figure 18 indicates that the ratio for physicians falls below the desired density
of 14.3, suggesting that even at national level, the country is still lacking physicians. The density
of physicians at subnational levels will be presented in succeeding figures.
232 | Annex B
Figure 19. Total Licensed Midwives and Ratio per 10,000 Population, 2010-2019
Finally, Figure 19 indicates that the ratio of midwives at national level exceeds the target density of 2.8 per
10,000. Here there is a need to interpret once again the findings with caution. A more granular examination
of the ratio at local levels will help in putting these numbers in context.
Figure 20. Licensed Nurses in NCR, 2010-2019
Annex B | 233
For instance, a closer examination of nurses in the National Capital Region (NCR) (Figure 20) indicates that
the supply of nurses far exceeds the recommended ratio of 27.4.
Figure 21. Licensed Physicians in NCR, 2010-2019
Figure 22. Licensed Midwives in NCR, 2010-2019
The same excess over the ratio is likewise observed for physicians (Figure 21) and midwives (Figure 22) in
NCR.
234 | Annex B
Figure 23. Licensed Nurses in Region IVB - MIMAROPA, 2010-2019
Figure 24. Licensed Physicians in Region IVB - MIMAROPA, 2010-2019
Annex B | 235
Figure 25. Licensed Midwives in Region IVB - MIMAROPA, 2010-2019
On the other hand, examining the supply of health professionals in a region like MIMAROPA reveals that
nurses (Figure 23) and physicians (Figure 24) both fall very far below the targeted density for these cadres.
However, it can be noted that the region meets the threshold for midwives (Figure 25) and it implies the
possibility of this cadre filling the void left by the lack of nurses and physicians. Assessing HRH supply in
this manner underscores the limitation of determining HRH adequacy by relying solely on national level
estimates and emphasizes the need for local level estimates to account for the likely variation in local
contexts.
Projecting the Future HRH Supply
The succeeding graphs in this section (Figures 26-35) present the results of the supply projections for the
10 health professions every five years, beginning 2025 until 2050.
236 | Annex B
Figure 26. Total Licensed Nurses (2017-2020) and Projected Every 5 Years (2025-2050)
Figure 27. Total Licensed Physicians (2017-2020) and Projected Every 5 Years (2025-2050)
Annex B | 237
Figure 28. Total Licensed Midwives (2017-2020) and Projected Every 5 Years (2025-2050)
Figure 29. Total Licensed Dentists (2017-2020) and Projected Every 5 Years (2025-2050)
238 | Annex B
Figure 30. Total Licensed Medical Technologists (2017-2020) and Projected Every 5 Years (2025-2050)
Figure 31. Total Licensed Radiologic Technologists (2017-2020) and Projected Every 5 Years (2025-2050)
Annex B | 239
Figure 32. Total Licensed Radiologic Technologists (2017-2020) and Projected Every 5 Years (2025-2050)
Figure 33. Total Licensed Nutritionist-Dietitians (2017-2020) and Projected Every 5 Years (2025-2050)
240 | Annex B
Figure 34. Total Licensed Physical Therapists (2017-2020) and Projected Every 5 Years (2025-2050)
Figure 35. Total Licensed Physical Therapists (2017-2020) and Projected Every 5 Years (2025-2050)
Annex B | 241
There is an observation that there will be a consistent rise in the supply of licensed professionals in all 10
health professions except midwives. This is assuming that the trends of previous years, which became the
basis for our projections, would continue in the absence of sudden disruptive events (e.g. COVID-19). This
indicates the need to prioritize investments for the midwifery profession to mitigate the expected decline
in future supply of midwives who play an important role in the delivery of primary care services.
Furthermore, there is a decline in the HRH-to-population ratio for nurses and dentists despite the continuing
rise in supply. While this may not be an immediate cause of alarm for nurses, the declining ratio is a concern
for dentists since it signals the inability of the rise in the production of dentists to catch up with the
population growth. Therefore, along with the interventions to increase the production of midwives and
physicians, the health sector also needs to actively support the production of dentists to increase their
ratios as oral health services are also essential components of primary care.
Estimating Future Demand
The projection study used a combination of approaches to estimate future demand for HRH. The first and
simplest approach is to refer to the target threshold density for each health profession, and calculate the
required number of HRH to be able to meet the desired density. Figure 36 demonstrates an example of how
this calculation is done for physicians.
Figure 36. Total Licensed Physicians (2017-2020) and Projected Every 5 Years (2025-2050)
242 | Annex B
Based on the projected supply for the year 2025, we calculate that an additional 65,803 physicians should
have been produced for that year if the country should meet the desired ratio for physicians. Such a number
will require a significant amount of investment in scholarships by the government, among other challenges,
and is therefore an unrealistic target considering our present situation and production capacity. This is
where the other approach that is based on burden of disease estimates becomes more useful.
Figure 37 presents a section of the HRH calculator that was developed to project HRH requirements for
primary care in the Philippines.
Figure 37. Section of HRH Demand Calculator Based on Burden of Disease
Using this calculator provides an estimate of the number of HRH required for each of the 10 health
professions to adequately meet the needs at primary care level. For example, Table 38 presents the
estimated minimum number of health professionals required for every year starting 2025 at national level
to meet primary care requirements. The gaps in HRH requirements can be ascertained by subtracting the
current supply, as determined from existing registries, from the projected number of required HRH. This
approach offers a more realistic expectation of what the Philippine government can do to address the gap,
rather than referring to the huge gap previously provided for by the ratios.
Annex B | 243
Table 38. Initial Sample Calculations for Demand at Primary Care Level (National)
The HRH calculator is a useful tool because it enables not only projections of primary care HRH
requirements at national level, but also at local levels. Examples of the results for Davao City (Table 39)
and the province of Palawan (Table 40) are provided below.
Table 39. Initial Sample Calculations for Demand at Primary Care Level (Davao City)
244 | Annex B
Table 40. Initial Sample Calculations for Demand at Primary Care Level (Province of Palawan)
Demand projections for all UHC sites are also included in this study (refer to attachment).
SUMMARY AND CONCLUSION
This projection study was conducted to determine the previous and current supply of HRH based on target
density thresholds, estimate future supply from 2025 to 2050, and project future demand for ten selected
health professions. The two methods used were the ratio-based approach, which was mainly based on the
valid PRC licenses count, and the health needs approach based on the global burden of disease.
The results showed that as of April 2020, five health professions with the highest national ratio (per 10,000
population) were: nurses (52), physicians (8.1), midwives (7.8), medical technologists (5.8), and
pharmacists (5.2) while professions with lowest ratio were dentist (2.97), radiologic technologists (1.79),
physical therapists (1.54), nutritionists (1.03), and occupational therapists (1.15:50,000 popn.).
The supply of professionally active HRH at the national level, assuming they are all practicing in the
Philippine health system, apparently exceeds the WHO recommended threshold level of 44.5 “skilled health
workers” (i.e. physicians, nurses, midwives) per 10,000 population for a country to achieve UHC. The
situation is different when the numbers are presented by individual regions and cadres. For instance,
nurses, physicians, and midwives exceed the target densities in NCR but in regions with low HRH densities,
such as MIMAROPA, nurses and physicians fall far below the target densities.
Most of the cadres have increasing or steady densities as more licensed professionals enter the pool in
recent years (2010-2020). However, the following are key findings on future supply and demand: 1) the
projected doctor to population ratio by 2025 still falls below the recommended 14.3 per 10,000 population
2) there is a decline in the number of midwives both in terms of the newly-licensed and those already
licensed; 3) a decline in nurse to population ratio was also observed but this might not be an immediate
concern since it is still expected to exceed the minimum threshold if the volume of nurses produced
Annex B | 245
annually remains high and the migration rate remains stable; 4) meanwhile, the declining dentists to
population ratio suggests that it still cannot catch up with the population growth despite the production of
dentists; 5) lastly, the supply of physical therapists and occupational therapists are fairly stable but remain
to have the lowest density among the health professions.
RECOMMENDATIONS
To achieve Universal Health Coverage, the following recommendations are proposed to strengthen HRH in
the Philippines.
● Both public and private investments for supporting HRH production should harmonize to prioritize
physicians, midwives, dentists, and occupational therapists as these are the professions observed
and projected to have declining ratios that will widen the gap from the desired densities. These
investments should particularly focus on the production of midwives, the profession noted to have
more significant supply and density declines and yet recognized to play a critical role in the delivery
of primary health care.
● The Department of Health together with its partner government agencies and health professional
organizations should further explore, through a multi-stakeholder approach, opportunities to
provide an enabling regulatory framework to establish mechanisms for “task shifting” wherein
nurses are formally authorized to perform selected physician functions, or selected midwife
functions. This will require an extensive review of the existing professional regulatory laws
governing the practice of professions vis-a-vis the current demands for health services. This
recommendation for task shifting is made in recognition of the significantly higher number of
nurses relative to both physicians and midwives. Policies to establish task shifting mechanisms
must also include consideration of training mechanisms for nurses to assume the skills necessary
to perform the functions to be assumed, as well as the credentialing and quality assurance
frameworks.
● To address the inequitable distribution of HRH in the country, especially by rebalancing the
availability of HRH in favor of rural and disadvantaged settings, and to promote HRH retention,
appropriate policy interventions must be put in place to enhance decent working conditions
(including, but not limited to, competitive salaries, benefits and incentives, career development,
occupational safety, etc.).
● Building on the findings of this projections initiative, subsequent assessments of HRH adequacy
must now go beyond national-level estimates but also ensure inclusion of local-level projected
estimates for a more granular appreciation of need across a wide range of settings. Local-level
projections provide the opportunity to implement HRH interventions that are more responsive and
246 | Annex B
geographically-specific to actual needs. The HRH demand calculator developed for this initiative
that takes into account the estimated burden of disease as well as other factors may be updated
for continuing monitoring of the demand for HRH across the country in the near- to medium-term.
● To address data limitations, there should be increased investments and policy support to collect
accurate and up-to-date information on the number of HRH practicing in the Philippine health
system and the location of their practice. The number of professionally active HRH is only
indicative of production capacity and does not reflect the actual health workforce stock of the
country.
● Finally, there is a need to strengthen and institutionalize capacity for undertaking HRH projections
as a core function of government to ensure sustainability. Projecting future HRH requirements is
not a one-time endeavor but will require continuous updating and scenario building to consider the
dynamic events that affect HRH supply and demand, including unpredictable events with severe
consequences (such as the COVID-19 pandemic). Projection efforts would be best to be integrated
into the updating timeline of the National HRH Master Plan.
Annex B | 247
Attachment. Regional Demand Projections for UHC Integration Sites
National Capital Region
248 | Annex B
Annex B | 249
250 | Annex B
Annex B | 251
CORDILLERA ADMINISTRATIVE REGION (CAR)
252 | Annex B
Annex B | 253
BANGSAMORO AUTONOMOUS REGION IN MUSLIM MINDANAO (BARMM)
254 | Annex B
Annex B | 255
Region I
256 | Annex B
Region II
Annex B | 257
258 | Annex B
Region III
Annex B | 259
260 | Annex B
Region IV-A (CALABARZON)
Annex B | 261
262 | Annex B
Region IV-B (MIMAROPA)
Annex B | 263
264 | Annex B
Region V
Annex B | 265
266 | Annex B
Region VI
Annex B | 267
268 | Annex B
Region VII
Annex B | 269
270 | Annex B
Region VIII
Annex B | 271
272 | Annex B
Region IX
Annex B | 273
274 | Annex B
Region X
Annex B | 275
276 | Annex B
Region XI
Annex B | 277
278 | Annex B
Region XII
Annex B | 279
Region XIII (CARAGA)
280 | Annex B
Annex B | 281
282 | Annex B
Annex C
Assessing Workload and Human Resources for Health Requirement

through the Workload Indicators of Staffing Need
Developed through the support of USAID HRH2030 Philippines Project
October 2021
Annex C | 283
Background
The Universal Health Care (UHC) Act, which was recently passed into law, emphasizes the need for
evidence-based planning for human resources for health (HRH) and primary care provider networks in
province-wide and city-wide health systems. In order to be more responsive to the demands of UHC, the
approach which is based on the 1980 general workforce projections for primary care needs to be updated.
Hence, it is important to have a scientific approach for a rational methodology for determining HRH
requirements that take into consideration the workload of the facility especially in primary care facilities.
Improved workforce projections, beyond the usual staff to population ratios, are needed as a more accurate
basis for hiring needed staff as well as for calculations of training costs, compensation, and benefits.
This National Human Resources for Health Master Plan recommends the application of the World Health
Organization (WHO) Workload Indicators of Staffing Need (WISN) method/tool for assessing the workload
and HRH requirement for health cadres at each level of health facility within a Healthcare Provider Network
to deliver essential health care services towards achieving Universal Health Care for all Filipinos. The WISN
method is used to (1) determine how many health workers of a particular type or cadre are required to cope
with the workload of a given health facility, and (2) assess the workload pressure of the health workers in
the facility. The method takes into account both the health service and non-health service activities that are
conducted by health workers using actual service statistics from the facility. WISN also takes into account
differences in services provided and in complexity of care in different facilities. The calculation of staff
requirements is based on the same professional standards in all similar facilities. The WISN method is
simple to operate using already collected, available service statistics in each health facility being analyzed.
It is translated and computed in the WISN software which produces reports per facility and by cadre in web
archive transformation (WAT) file for further analysis to identify applicable staffing decisions at all health
service levels.
The WISN method provides two types of results – differences and ratios. The difference between the actual
(existing) and calculated (required) number of health workers shows the level of staff shortage or surplus
for the particular staff category (or cadre) and health facility type, in consideration of the workload of the
health facility under study. The ratio of the actual to the required number of staff is a measure of the
workload pressure with which the staff is coping in their daily work in a health facility.
284 | Annex C
Limitations
To assess workloads, WISN relies on the accuracy of the annual service statistics that a health facility
maintains. The analysis is based on detailed statistics to arrive at precise WISN calculations for the
different services that are delivered and the staff who performed the services. The WISN calculation is
retrospective as it uses the previous years’ service statistics. There will, however, be a noticeable surge in
workload in cases of pandemic and public health emergencies. A percentage correction can be made in
these uncommon situations. Finally, the WISN calculation does not consider other influences on workload,
e.g. unavailability of medicines and supply shortages, which can affect the workload of the health facility.
Thus, it is critical to contextualize the WISN analysis and reports taking into account other health system
factors and health events such as, but not limited to, extraordinary circumstances.
Annex C | 285
Sample WISN Full Report
286 | Annex C
Uses of WISN Results
Careful calculation using the WISN method and analysis of the results can aid in making better
human resource management decisions. WISN results can1:
1. Improve distribution of current staff and reduce workload pressure by comparing the
results between similar types of health facilities, several different types of health facilities
in the same administrative area or within units of a large health facility. Allocation of new
staff or staff movement/transfer to understaffed health facilities are some ways to
improve unbalanced staffing situations.
2. Review and align allocation of tasks between and among cadres to equally distribute the
workload. Task shifting to less-highly trained health workers is an alternative approach.
3. Increase quality of current health services by examining the workload pressure that the
staff is coping with.
4. Plan future staffing of health services to respond to new trends in scope of professional
practice, medical interventions, and technology.
It is worth to note that due diligence is a primordial and critical element to manage the impact of
every staffing decision that will be implemented.
Efforts to Promote the Use of WISN
In 2018, the Department of Health, in partnership with USAID HRH2030/Philippines, implemented

the WISN methodology to assess the workload pressure and Human Resources for Health
requirement (for four (4) priority cadres - physicians, nurses, midwives and medical technologists)
at primary health care facilities in 18 provinces from nine selected regions.
The implementation of the tool involved the orientation and training of Technical Taskforce (TTF)
members (n=99) from various regions who will be the WISN implementers at the national and
subnational levels. The implementation, which has to be closely coordinated with and
participated by local health facilities, will include collection of data on the health worker’s available
working time, workload components per workload group, activity standards, annual workload data and
1
World Health Organization (2010). Workload Indicators of Staffing Need User’s Manual. Retrieved from
https://www.who.int/workforcealliance/knowledge/toolkit/17_1.pdf?ua=1
Annex C | 287
current staffing, validation of quality of the data collected and development of a staffing norm based on
the results.
In 2019, Expert Working Groups (EWG) in the Philippines were convened. The groups consisted of
experienced health workers from all levels of care from both public and private facilities and underwent a
three-day training on the WISN methodology, to determine the workload components and activity standards
for each cadre based on acceptable professional standards for each cadre. Representatives from the
professional associations, regulatory councils and representatives from the health training institutions
from the same cadre then validated their work. The tables below on workload components and activity
standards form part of the key components to calculate staffing.
In an ideal setting and under normal workload pressure, a health worker allots 85% of his/her available
working time to provide health services, 15% for support activities or non-health service activities, and 5%
for additional activities which are functions attributed to specific individuals in a staff grouping.
WISN results indicated that none of the Rural Health Units (RHUs) were operating at normal levels, with
85% indicating staff underutilization in terms of direct health service provision. Only 15% of RHUs/CHOs
had significant shortages. Differences in the provision of service were noted, indicating a lack of standards
in service delivery. Further, analysis of workload and activity standards at the RHUs seemed to indicate
inefficient distribution of tasks among RHU staff. For example, an RHU midwife used only 2.8 hours (21%)
of her daily working time to perform health services for family planning, antenatal and child welfare clinic,
and immunization. Four hours (52%) were consumed for barangay/home visits and housekeeping of their
assigned Barangay Health Station. Finally, she spent 1.2 hours (27%) on report writing, supervision,
conduct/attending meetings and transit.
The 2019 WISN report in the Philippines shows that there are differences in services offered at the various
Barangay Health Stations and Rural Health Units, indicating a need for establishing a standard package of
services for levels of care to respond to UHC. These WISN assessment findings will form part of the
recommendations to support the implementation of the Universal Health Care Law through updating of
staffing standards, promoting rational distribution of HRH, and optimizing HRH and services within health
care provider network operation among others. In other countries, WISN studies have been used to inform
revision of the services offered at various levels of care.
To know more about WISN, the user manual and software manual can be downloaded via
https://www.who.int/workforcealliance/knowledge/toolkit/17/en/
288 | Annex C
References:
Department of Health. (2018). National objectives for health Philippines 2017-2022. Manila, Philippines:
Department of Health.
World Health Organization. (2016). HRH Observer Series No. 15. WISN: Selected Country Implementation
Experiences.
USAID HRH2030 Philippines. “Determining Staffing Levels for Primary Health Care Services Using Workload
Indicator for Staffing Need in Selected Regions of the Philippines.” Draft report. April 2019.
Annex C | 289
WISN ACTIVITY STANDARDS
FOR HEALTH CADRES IN
PRIMARY HEALTH CARE SETTING
290 | Annex C
Workload Components and Activity Standards for Physicians
Workload Group 1: Health Service Activities

Workload Component Activity Standard
Consultations 16minutes/patient
Minor surgical procedures 30 minutes/patient
Referrals 9 minutes/patient
Family planning - bilateral tubal ligation (BTL) 30 minutes/patient
Family planning - vasectomy 30 minutes/patient
Workload Group 2: Support Activities

Health education 2 hours/month
Departmental meetings 2 hours/month
Continuing professional development 8 days/year
Outreach program (medical mission) 8 hours/month
Issuance of documents and medico-legal management 8 hours/month
Workload Group 3: Additional Activities

Staff supervision 30 minutes/day
Trainee supervision 2 hours/week
Administrative functions 1 hour/week
Interpretation and action on surveillance 2 hours/week
Annex C | 291
Workload Components and Activity Standards for Nurses

Patient assessment 13 minutes/patient
Nursing diagnosis and management 34 minutes/patient
Minor surgical procedures 37 minutes/patient
Wound care 30 minutes/patient
Administration of medication 20 minutes/patient
Immunization 12 minutes/patient
External referral with escort 142 minutes/patient
Internal referral/external referral without escort 12 minutes/patient

Health teachings 30 minutes/day
Home visits 8 hours/week
Reporting patient census 30 minutes/day
Staff meetings 1 hour/month
Community outreach programs 8 hours/month
Group counselling 2 hours/month
Continuing professional development 2 hours/month

Activity Activity Standard
Disease surveillance 1 hour/month
Supervision of staff 1 hour/day
Staff scheduling 1 hour/week
Mentoring of students 1 hour/week
Management meetings 2 hours/month
292 | Annex C
Supervisor’s monthly reports 1 hour/month
Performance evaluation 2 hours/year
Nursing audit 2 hours/month
Committee work 3 hours/month
Workload Components and Activity Standards for Midwives

Antenatal visits 39 minutes/client
Family planning - male condoms 24 minutes/client
Family planning - injectables 23 minutes/client
Family planning - intrauterine device (IUD) 53 minutes/client
Family planning - natural 33 minutes/client
Family planning - implants 44 minutes/client
Family planning - pills 12 minutes/client
Normal spontaneous delivery 99 minutes/patient
Newborn care 120 minutes/patient
Labor management 168 minutes/patient
Post-natal care 35 minutes/patient
Childcare/well baby clinic 18 minutes/patient
Integrated management of childhood illness 22 minutes/patient
Visual inspection with acetic acid (VIA) 25 minutes/patient
Pap smear 20 minutes/patient
Rehabilitation of malnourished children 20 minutes/patient
Caesarean section (pre-operative care) 14minutes/patient
Annex C | 293
Health education 30 minutes/day
Home visits 8 hours/month
Staff meetings 2 hours/month
Continuing professional development 48 hours/year
Medical missions 16 hours/month
Housekeeping (5S) practice 40 minutes/day
Mentoring of students 12 hours/week

Supervision of BHWs 1I hour/day
Management meetings I1 hour/month
Mass circumcision 8 hours/year
Workload Components and Activity Standards for Medical Technologists

Complete blood count - automated 9 minutes/sample
Complete blood count - manual 25 minutes/sample
ABO and Rh blood typing 10 minutes/sample
Fasting blood sugar 33 minutes/sample
Oral glucose tolerance test (OGTT) 123 minutes/sample
Cholesterol 9 minutes/sample
Creatinine (serum/urine) 9 minutes/sample
Lipid profile 9 minutes/sample
Triglycerides 9 minutes/sample
294 | Annex C
Dengue rapid 10 minutes/sample
Hepatitis B antigen rapid 10 minutes/sample
Hepatitis B (AHBS) - automated 9 minutes/sample
Hepatitis BHBc - automated 9 minutes/sample
Hepatitis B IgG 9 minutes/sample
HIV - automated 29 minutes/sample
HIV rapid 31 minutes/sample
Rapid syphilis 10 minutes/sample
Pap smear staining 33 minutes/sample
Acid fast bacilli 29 minutes/sample
Urinalysis - automated 4 minutes/sample
Urinalysis - manual 8 minutes/sample
Fecalysis 23 minutes/sample

Internal quality control (IQC) 30 minutes/day
Calibration of laboratory equipment 20 minutes/day
Inventory management 1 hour/month
Technical evaluation of new equipment 3 hours/year
Validation of test parameters 8 hours/year
Advocacy lecture 2 hours/week
Mobile blood collection 6 hours/year
External quality control 1 hour/month
Departmental meetings 2 hours/month
Annex C | 295
Registration of health certificates 1 hour/day
Management meetings and review 4 hours/month
Supervision of staff 30 minutes/day
Orientation of new staff 2 hours/year
Documentary requirements for license to operate 30 minutes/year
Monthly reports 1 hour/month
Billing forms 30 minutes/month
Quality manual review 2 hours/year
Research 2 hours/month
Workload Components and Activity Standards for Dentists

Oral prophylaxis (manual) 56 minutes/patient
Oral prophylaxis (ultrasonic) 41 minutes/patient
Fluoride therapy / treatment 21 minutes/patient
Tooth extraction (anterior) 21 minutes/patient
Tooth extraction (posterior) 26 minutes/patient

Community dental health education 20 hours/year
Quarterly meetings 16 hours/year
School-based dental services 40 hours/year
Physical inventory of supplies 1 hour/month
296 | Annex C
Administrative function (e.g. drafting of WFP) 2 hours/year
Monitoring and supervision 1 hour/month
Dental missions 8 hours/month
Consolidation of monthly reports 2 hours/month
Consolidation of quarterly reports 2 hours/year
Consolidation of semi annual reports 2 hours/year
Consolidation of annual reports 1 hour/year
Workload Components and Activity Standards for Pharmacists 2

Dispensing of regulated medicines 10 minutes/patient
Dispensing of prescription medicines 15 minutes/patient
Dispensing of antiretroviral medicines 15 minutes/patient
Dispensing of maintenance medicines 23 minutes/patient
Dispensing of biological products (Vaccines) 14 minutes/patient
Compounding 20 minutes/patient
Antimicrobial stewardship program 30 minutes/patient
Workload Group 2: Support Activities 3

Health promotion and education in Barangay 8 hours/year
Pharmacy staff meeting 2 hours/month
2
Workload Group 1 for Pharmacists is derived from EWG outputs, and thus needs further validation as practiced in the Primary Health Care
facilities
3
No continuing professional development component as per last EWG meeting
Annex C | 297
Physical inventory and monitoring 8 hours/month
Pharmacovigilance 4 hour/year

Attending external meetings to DOH 4 hours/month
Attending external meetings to PDEA 4 hours/year
Attending external meetings to Provincial Capitol 16 hours/year
Attending internal meetings 8 hours/month
Supervision of staff pharmacist 20 hours/month
Administrative function (preparation of Annual Procurement

Program and purchases of medicines and medical supplies) 8 hours/year
Preparation and consolidation of monthly reports 1 hour/month
Orientation of new pharmacy interns 4 hours/year
Mentoring of new pharmacy interns 90 minutes/week
Workload Components and Activity Standards for Nutritionist-Dietitians

Nutrition consultation 48 minutes/patient
Nutrition/Dietary counseling 33 minutes/patient
Follow-up and monitoring of clients/patients 11 minutes/patient

Nutrition education/promotion 1 hour/week
Supervision of Barangay Nutrition Scholars (BNS) 90 minutes/week
Community visit 3 hours/week
298 | Annex C
Documentation/Report writing 8 hours/month
Meetings 8 hours/year

Nutrition logistics management 1 hour/month
Preparation/ Project proposal or concept paper of nutrition project 90 minutes/year
Training and development plan 1 hour/year
Orientation of newly hired personnel 1 hour/year
Serve as resource person to conferences/seminars/fora 5 days/year
Meetings 1 hour/year
Workload Components and Activity Standards for Radiologic Technologist

X-ray imaging - simple procedures 20 minutes/patient
X-ray imaging - complex procedures 79 minutes/patient

Medical missions C8 hours/year
Calibration of equipment 20 minutes/day
Monthly staff meetings 24 hours/year

Supervision of staff 24 hours/year
Annex C | 299
Continuing professional development 16 hours/year
Inventory of supplies and materials 1 hour/month
Requisition of supplies and materials 20 minutes/month
Preparation of monthly reports 1 hour/month
300 | Annex C
Annex D
NHRHMP Legislative Agenda
This Legislative Agenda was formulated to support the key result areas of the National HRH Master Plan
and address important and timely concerns in HRH management. The following areas will be advocated
for legislation to set out unifying frameworks that will guide relevant stakeholders in implementing the HRH-
related initiatives.
The following agenda will be pursued within the Plan period:
KRA 2: Health Education Strengthening and Regulation

Description/Rationale Scope Relevant Agencies
Review of Professional Acts

To come up with health professional laws Health Professionals ● CHED
responsive to the changing needs of the ● PRC
population, health care system and workforce ● DOH
demand. ● Professional
Societies
● Review/update/inclusion of:
○ Scope of practice (to include
interprofessional education and
practice, and advances in
technology)
○ Regulatory approaches
○ Career pathways/progression
○ Flexibility in scopes of practice
for building resilient health
systems for UHC, especially
during public health
emergencies
KRA 3: HRH Welfare, Protection, and Career Development

Review of RA No. 7305, “Magna Carta of Public Health Workers”

To come up with a Magna Carta for all health Health workers in ● DOH
workers covering public and private sectors; public and private ● Professional
and provisions applicable for normal working sectors, regardless Associations
conditions and during public health of type employment, ● Hospital
emergencies. engaged in health Associations
● Review/update/inclusion of: and health-related ● DILG
○ Coverage (based on type of work ● DBM
employment and health
Annex D | 301
facility/industry where health Shall cover benefits
services is performed) and incentives
○ Salary (including actions to during normal
respond to the limitations on PS working conditions
Cap) and public health
○ Compensation and benefits emergencies
○ Occupational safety and health
○ Career development
○ Creation and institutionalization
of monitoring and regulation
system of LGU performance
○ Sanctions for
individuals/institutions violating
the law
Recentralization of Public Health Workers
To recentralize the public health workers in Health workers in ● DOH

order to address issues in the management the national and ● DBM
and development of health workers in the local government ● CSC
currently devolved health system. offices ● DILG
● DOF
● Review/inclusion of: ● NEDA
○ Mechanism to address the
discrepancy in salary rates
between LGU-hired and
national-hired health personnel
○ Standardization of benefits
○ Management of HRH during
public health emergencies
Salary Standardization for HRH in both Public and Private, National and Local Health Sectors
To establish mechanisms and safeguards to Health workers in ● DOH

address the wage imbalance among HRH at both public and
the national and local levels, and between the private sectors,
● DOLE
public and private healthcare industries, in national and local ● DBM

order to ensure sustainable HRH for all social health sectors ● CSC
sectors and across geographic regions.
● Inclusion of:
○ Standardize wage and benefits
among HRH at the national and
local levels, public and private
sectors
302 | Annex D
○ Mechanisms to implement
salary standardization
Amendment of RA No. 7883, “Barangay Health Workers’ Benefits and Incentives Act”
To amend RA No. 7883 to establish standard All barangay health ● DILG

qualifications and scopes of work that would workers ● DOH
rationalize the status and roles of the BHWs ● LGU
as part of the health workforce. ● BHW
Association/
● Review/inclusion of: Federation
○ Type of engagement (hired vs ● Local
volunteer) Government
○ Standard qualifications Leagues
○ Compensation and benefits ● PHO/CHO/ MHO
○ Scopes of work
○ Security of tenure
○ Training/development
opportunities
KRA 4: HRH Migration and Reintegration

Review of Mission Critical Skills provisions for Management of Health Worker Migration during State
of Public Health Emergency
To come up with a national framework and Health professionals ● DOLE
mechanism to manage health workers and health-related ● POEA
during public health emergencies, occupations under the ● DOH
particularly the inclusion in Mission Critical MCS category ● DFA
Skills (MCS) to protect national public ● Professional
health interest. Associations
● PRC
● Inclusion of: ● Health Facilities
○ Mechanism in determining
skills/cadres to be under MCS
○ Decision pathways in coming
up with MCS
○ Management of HRH under
MCS
Annex D | 303
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NATIONAL

HUMAN RESOURCES FOR HEALTH

Updated 12 November 2021

© Department of Health 2021

Editorial Team and Lay-out:

Health Human Resource Development Bureau

An electronic copy of this publication can be downloaded at http://bit.ly/NHRHMP

List of Tables and Figures .................. iv.

Chapter 10 Institutionalization and Strengthening of the Human Resources for

List of Acronyms ....................... 205

The management of health in the country is

Our experiences with COVID-19 pandemic have

Recognizing the value of our health workers, the

Ang malasakit para sa health workers ay kalinga para sa sambayanang Pilipino.

FRANCISCO T. DUQUE III, MD, MSc

From early 2020 to 2021, the world’s healthcare system was

MARIO C. VILLAVERDE, MD, MPH, MPM, CESO I

The Universal Health Care (UHC) Act of 2019 galvanized the

Thank you and God bless!

Kenneth G. Ronquillo, MD, MPHM, CESO III

Health Sector Policy Reforms

Challenges of the Philippine Health Workforce

1. Lack of accurate HRH information to guide planning and policy;

3. Fragmented HRH governance and unclear accountabilities; and

These core problems have resulted to:

1. Inadequate number of health workers in the health sector; and

National HRH Master Plan Overall Framework

The Philippine Development Plan 2017-

With the aim to address the multifarious

Following the adoption of F1+ strategy, the

Figure 2. FOURmula One Plus for Health Strategy Map

Health Labor Market Analysis for UHC

Figure 3. Health Labor Market Framework for UHC

National HRH Master Plan Formulation

Intended Users and Use of the National HRH Master Plan

Table 1. HRH Management and Development Stakeholders

● Health Human Resource Development Bureau (HHRDB)

The Personnel Administration Division, under the Administrative Service,

Educators Curriculum developers and implementers responsible for the formation of

Health Care Providers and Consumers

Limitations in planning activities conducted

HRH Situation, Results

Where are we now?

Access to Health Care: A Persistent Problem

HRH Situation, Results Framework, and Strategies | 17

Access to Human Resources for Health

Inadequate Human Resources for Health

4 Department of Health. (2019). Number of Deployed HRH from 2010-2019.

18 | HRH Situation, Results Framework, and Strategies

Figure 5. Licensed Health Professionals per Cadre, 20208

HRH Situation, Results Framework, and Strategies | 19

20 | HRH Situation, Results Framework, and Strategies

Inequitable distribution of HRH

HRH Situation, Results Framework, and Strategies | 21

22 | HRH Situation, Results Framework, and Strategies

Distribution is further skewed towards hospitals

Among doctors, 87% work in clinical facilities

HRH Situation, Results Framework, and Strategies | 23

72% of doctors, nurses, midwives, and dentists are