EXPLAINER | Expanding prescriptive protections

The Philippines is navigating the transition to the ‘new normal,’ grappling with the domino effects of the COVID-19 pandemic across various sectors. While the global health emergency has officially ended, critical issues started to get light shed on them. Inadequate pay, literal broken promises, job insecurity, and the need for enhanced trainings and opportunities continue to challenge our once-heroes. 

This all brings to clarity the importance of addressing these concerns and protecting health workers’ rights as part of the nation's recovery and ongoing efforts toward a more resilient healthcare system.

In a speech delivered at the Senate plenary on September 25, Senator Christopher “Bong” Go, chairperson of the Senate Committee on Health and Demography, he urged fellow solons and the president to grant the long-standing calls to pass laws for Barangay Health Workers (BHWs).

“Sila po ang tumutulong sa panggagamot ng ating mga kababayan, lalung-lalo na sa mga komunidad na walang doktor … As such, they are only entitled to meager incentives and benefits. Moreover, they are not given ample compensation that befits the level of commitment necessitated by the role that BHWs play,” Go asserted.

“Mr. President, it is only imperative for us to listen to their needs at kung paano po tayo makakagawa ng paraan upang mabigyan sila ng karampatang kompensasyon. It is for this reason, Mr. President, that we filed a measure that would provide just compensation to our BHWs,” the senator added.

The legislative measure Go highlighted was Senate Bill No. 2838, also known as the Magna Carta of Barangay Health Workers (BHWs), a proposal seeking to strengthen protections and provide benefits to BHWs, also recognizing their vital role in the continuous delivery of healthcare services in barangays.

By law, a barangay health worker (BHW) refers to people who have undergone training under accredited government and non-government organizations, and voluntarily renders primary healthcare services in the community after having been accredited to function as such by the local health board in accordance with the Department of Health (DOH).

In 2022, recent data combined from the DOH Centers for Health and Development and Ministry of Health Bangsamoro Autonomous Region for Muslim Mindanao showed stability in the number of active BHWs at 225,123 in 2021, and 224,886 by 2022, this slight decrease suggests potential challenges surrounding policies for BHWs

One magna carta proposal for BHWs recommends that each barangay shall at least have one BHW for every 20 households. However, in reality, BHWs take upon excessive amounts of work, typically dealing with 200 to 300 households. 

A study in 2023 conducted interviews towards BHWs concluded that if these workers are either undervalued or underpaid for the essential care they deliver, this creates vulnerabilities for both the recruitment and retention of BHWs and health systems. 

“As resources are leveraged in the push toward UHC in the Philippines and other contexts, resource allocation should reflect the important role of BHWs within the broader health system,” they added.

Before the pandemic, these health care workers had long been behind the scenes. On regular days, the primary duties of BHWs were to disseminate information, assist in nutrition drives and immunization programs for children, and organize health events for the barangays.

Because BHWs are only considered volunteers and not regular workers, they recieve meagre financial compensation ranging from PHP 800 to PHP 1,300 in the form of honoraria, not salaries.

In March 2020, the Philippines was tested of its capability to have a fast and responsive healthcare sector, more than ever, to combat a then-brewing COVID-19 virus pandemic. At the onset of the community quarantine, BHWs were among the first to be tapped and mobilized by the government to keep the virus at bay.

Most vulnerable to contracting the virus were public health workers in hospitals. And when community transmissions were being reported, these BHWs, with many increasing in volunteers, joined and then fought in frontlines against COVID-19. 

In actuality, there already exists a law granting rights and protection to public health workers. Republic Act No. 7305, also known as the Magna Carta of Public Health Workers Act of 1992 ensures fair compensation, benefits such as hazard pay, and protection against unjust dismissal for public health workers (PHWs), also setting standards for working conditions.

Pursuant to the law, ‘health workers’ shall mean 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.”

However, then and now, a divide seems to be present upon the employed and full-time hospital workers and the volunteering community health workers. Since the 1990s, when RA 7305 rolled out, many BHWs have called and recommended for enhanced training processes, more equitable benefits, and most especially: explicit definitions of their role in the community.

These BHWs will not replace established hospital workers or employed health professionals but rather connect communities to the services they require even in rural or unreached by hospitals in urgency. 

It was with Republic Act No. 7883 or the Barangay Health Workers’ Benefits and Incentives Act of 1995 that the government actually gave highlight to BHWs in terms of their accreditation as official health workers in the community.

Under the law, BHWs were entitled to various incentives such as hazard pay, subsistence allowance, and access to more training programs to strengthen and advance their services.

However, in Section 7, the following clause states: “Every incentive or benefit for barangay health workers requiring the expenditure of local funds shall be reviewed and approved by the local health board to ensure that only the deserving barangay health workers get the same.”

The scope of the implementation of the act to give incentives to BHWs thus depends on the financial capacity and political will of the local government units (LGUs). This led to experiences of inconsistent application of the law across different regions, with many not receiving incentives at all.

It was then in the 19th Congress, just two years after the global COVID-19 pandemic started, that talks on considering amending RA 7305 to increase health workers’ particularly to BHWs’ benefits and compensation, resurfaced. 

Senator Robinhood Padilla filed Senate Bill 232 or the Magna Carta for Barangay Health Workers (BHWs), which recognizes the roles of BHWs in communities and granting them a strengthened legislative measure for their protection

“With the huge role that our BHWs perform in our health sector, it is only proper that the State likewise protect those who protect our people by giving them just compensation and other benefits and incentives that they rightfully deserve,” Padilla said in his bill. 

Multiple other solons, like Padilla, have since then filed measures to create a law solely for BHWs and their recognition, protection, and compensation.

The largest step took yet to establish a BHW magna carta was with the recent filing of Senate Bill No. 2838, known also as Magna Carta of Barangay Health Workers. The bill is currently in the second reading and is recommended for approval by the Committees on Health and Demography, Local Government, Ways and Means, and Finance in the Senate plenary.

The bill took into consideration a total of 17 previous, similar legislative measures and was signed by 16 senators, for the sake of establishing a landmark piece of both labor and social legislation finally prioritizing the rights and privileges of these community health workers.

Under the current proposal for BHWs magna carta, these workers shall garner benefits such as strengthened accreditation, better training programs, inclusion to regular service, various incentives and subsidies, organized associations and federations, and a “BHW Day” in all barangays.

According to the bill, a National BHW Information System shall be established and maintain by the health department to provide real-time data on BHWs, including their profiles and areas of assignment. In connection, to “further professionalize … BHWs in rendering primary health care,” the bill states that a duly registered BHW shall undergo certification by the local health board.

Another scope of the bill is to institutionalize a continuing competency-based education and training curriculum all BHWs with guidance of the DOH, the Technical Education and Skills Development Authority, and the Commission on Higher Education. This curriculum shall equip BHWs to serve as primary health care providers, health educators, community organizers, and record keepers, incorporating web-based and mobile applications in the training process.

Abiding calls of many BHWs towards accreditation and inclusion to regular government service, the magna carta will establish position classifications and explicit salary grades for BHWs in the Index of Occupational Standards upon accordance with the Department of Budget and Management and the Civil Service Commission.

A chapter in the bill highlights the various incentive of BHWs, including a minimum monthly honorarium of not less than PHP 3,000, transportation and subsistence allowances, hazard pay, insurance coverage. It also includes special allowances during public health emergencies, legal services, and preferential access to government livelihood programs. Additionally, low-income municipalities will receive subsidies to support the deployment and compensation of BHWs in underserved areas.

The bill will also mandate the formation of BHW associations at the municipal and city levels and federations at provincial, regional, sub-national, and national levels. These associations and federations will altogether address the issues, propose policies, and support BHWs in delivering primary health care services.

 

While the sacrifice of safety and the vital frontlining done by these barangay workers are recognized, other matters also had to be attended to--particularly their future in the new normal. After all, the government promised them sorts of financial compensation, and issues arise from unattended appeals and the slow processing of the disbursement of funds. 

The DOH's BHW Pocket Handbook encouraged BHWs to be dedicated “despite difficulties … and lack of financial support.”

 

In 2022, Republic Act No. 11712 or the Public Health Emergency Benefits and Allowances for Health Care Workers Act had supposedly secured a health emergency allowance (HEA) for health workers as compensation for every month of service during a state of public health crisis.

Myrna Gaite, President of the Barangay Health Workers Federation (National Capital Region), said in a statement this August that many BHWs across the country have not received and are awaiting their HEAs from the pandemic.

“Many of our colleagues have already passed away without receiving anything. What’s even more painful is that some BHWs were excluded by their LGUs from the list of HEA beneficiaries despite having served during the crisis. We served our communities, where is the compensation for our service?” Gaite asked officials.

Budget constraints were the usual suspects for the initial slow and incomplete disbursement of funds since there was only a specified amount allotted for the HEA yearly under the health department’s programmed appropriation.

In Sept. 21, the DOH stated that the total HEA obligation of PHP 103.5 billion was now 90 percent paid, following the urgent decision for the Department of Budget and Management to fully fund the remaining PHP 27.3 billion in arrears this year--which is also two-thirds done in reimbursement. 

On top of financial compensation issues, politics now influenced BHWs and their futures.

As new winning barangay officials assumed posts after the Oct. 30 elections in 2023, some of them unduly terminated BHWs that had been appointed by previous officials. Reports surfaced and estimated 80,000 barangay health workers found themselves suddenly out of work with no notice.

Barangay Health Wellness (BHW) Party list Rep. Angelica Natasha Co in a statement asserted that the unjust dismissal of the BHWs “weakened the country’s primary health-care front lines” and compromised national public health and safety, also urging the new chiefs to reinstate them.

“Given the shortage of barangay health workers, the barangays should be adding barangay health workers, not removing the registered and accredited [ones], on whose training and service capability upgrades the DOH has spent billions of pesos over the years,” Co said. 

The DOH’s Bureau of Local Health Systems Development has since then ordered its regional health offices in “protecting all registered and accredited (barangay health workers) against unjust removal in (their) respective regions” and “resolve the disputes arising from it.”