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Addressing Health Worker Satisfaction and Retention in Philippine Primary Care

By Carla Marie L. Asis, Leonila F. Dans

SUMMARY

The Philippines paradoxically faces a severe shortage of healthcare professionals while simultaneously being a major exporter of these workers. This economic reliance on healthcare worker (HCW) emigration, without addressing domestic workforce retention, undermines healthcare services in underserved areas. Given the challenges of providing equitable healthcare access, improving HCW satisfaction and retention is paramount to building a robust and effective primary care system in the country. A study conducted by the Philippine Primary Care Studies (PPCS) revealed that HCWs in different settings (urban, rural, and remote) face unique challenges that can be best addressed by context-specific interventions. This policy brief provides recommendations to address the Philippine health workforce crisis based on real-world experience in urban, rural, and remote primary care settings.

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THE PHILIPPINE HEALTH WORKFORCE CRISIS

A nation’s capacity to achieve its health targets is strongly influenced by the competence, motivation, and strategic deployment of its health workforce. Research demonstrates a strong correlation between sufficient numbers of HCWs and positive population health outcomes [1,2]. However, many countries face serious health workforce shortages due to factors like inadequate training capacity, internal and international migration of health professionals, skill mismatches, and demographic disparities.

The Philippines faces a critical shortage of HCWs, falling far below the World Health Organization’s recommended skilled health worker to population ratio of 4.45:1000. A deficit of 60,000 doctors, 121,000 nurses, and 109,000 midwives has been reported in public facilities alone. This deficit disproportionately impacts the poorest communities, who rely heavily on understaffed government-funded community health stations. Despite this, the Philippines is a major exporter of healthcare professionals, particularly nurses. This outward migration, without addressing domestic shortages, severely hinders healthcare access in underserved areas. Improving HCW job satisfaction and retention is therefore crucial for strengthening primary care, reducing health inequities, and achieving better health outcomes.

CHALLENGES AND GEOGRAPHIC DISPARITIES

A study was conducted as part of the PPCS program to examine the effects of primary care system interventions on healthcare worker satisfaction.[3] These interventions included improved HCW training, implementation of electronic health records, and performance-based financial incentives. The study used HCW job satisfaction as one of the key indicators to evaluate the success of the PPCS model. The study revealed the following:

  • Inadequate Compensation and Benefits: Despite incentives, the perceived fairness of compensation remained The low base salaries and infrequent or delayed bonus payments are insufficient to offset the challenges and risks associated with working in remote areas.
  • Poor Infrastructure and Supply Accessibility: Despite interventions, remote areas experienced a decline in overall healthcare worker satisfaction and retention. Limited supply accessibility, unreliable communication, job insecurity, and a lack of motivation contributed to this These inadequacies compromised the quality of care HCWs can provide, leading to frustration and low morale.
  • Disparities in Turnover Intention: While urban areas showed no change in turnover intention, rural areas showed an increase in intention to stay and remote areas a significant decline post- intervention. This underscores the disproportionate impact of challenges on retention in remote
  • Administrative Challenges: Bureaucratic processes, including delays in payments, further exacerbate the difficulties faced by HCWs in remote areas.

OPTIMIZING HEALTHCARE WORKER CONDITIONS

Compensation Strategies

Competitive salary and benefit packages should be developed and specifically tailored for healthcare workers in remote areas. This should include not only a substantial increase in base salary but also tangible and relevant benefits.

Infrastructure Development and Supply Chain Management

Prioritize investment in upgrading infrastructure in remote healthcare facilities, including access to reliable electricity, internet, and transportation. Address supply chain issues, especially in rural and remote areas, to increase the availability of essential medical supplies and equipment.

Improve Support Systems

Strengthen support systems, especially for remote HCWs, including:

    • Regular supervision and
    • Access to professional development
    • Build workforce capacity by ensuring that primary care providers have access to updated evidence- based clinical decision support (CDS) tools.
    • Effective communication channels with central health

Context-Specific Interventions

Develop context-specific strategies to address the unique challenges faced by health workers in different settings. A one-size-fits-all approach is ineffective.

Address Administrative Challenges

Streamline administrative processes to ensure timely payment of salaries and incentives. Establish a system for regularly monitoring HCW satisfaction and retention, enabling timely adjustments to policies and programs.

THE PATH FORWARD

The exodus of HCWs from remote Philippine communities is unsustainable and threatens to worsen existing health inequities. Addressing this critical issue requires a comprehensive, multi-pronged strategy that tackles compensation, infrastructure, support systems, and improved governance. The proposed recommendations, if implemented effectively, can significantly contribute to improving HCW retention and ensuring equitable access to healthcare for all Filipinos.

 

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Citation

  1. Anand, S., & Bärnighausen, T. (2007). Health workers and vaccination coverage in developing countries: an econometric analysis. Lancet (London, England), 369(9569), 1277–1285. https://doi.org/10.1016/S0140-6736(07)60599-6
  2. Speybroeck, N., Kinfu, Y., Poz, M.R., & Evans, D. (2006). Reassessing the Relationship Between Human Resources for Health, Intervention Coverage and Health Outcomes.
  3. De Mesa, Y. H., Marfori, J. R. A., Fabian, N. M. C., Camiling-Alfonso, R., Javelosa, M. A. U., Bernal- Sundiang, N., Dans, L. F., Calderon, Y. T., Celeste, J. A., Sanchez, J. T., Rey, M. P., Galingana, C. L.T., Paterno, R. P. P., Catabui, J. T., Lopez, J. F. E., Aquino, M. R. N., & Dans, A. M. L. (2023). Experiences from the Philippine grassroots: impact of strengthening primary care systems on health worker satisfaction and intention to stay. BMC health services research, 23(1), 117. https://doi.org/10.1186/s12913-022-08799-1