When there is no healthcare left to spare

Philip Gabriel Caysido

As progressive as it may seem, a nation that exports millions of nurses worldwide, ironically comes at the expense of its own starving healthcare capacity.

Former Department of Health (DOH) Secretary Ted Herbosa stated that some other countries “look up” to our healthcare system, particularly the Universal Health Care program, suggesting that these measures are considered as models for healthcare reform. 

For them, the success of Filipino nurses abroad reflects the country’s capacity to produce highly competent healthcare workers.

Yet, the question lies not in how well they perform, but why many of them choose to leave a healthcare system that seemingly cannot afford to keep its own best talents. 

A starving system

If a healthcare system cannot retain the very professionals who sustain it, then perhaps its condition is far more overlooked than what the workforce shortages suggest. 

As health reform advocate Dr. Anthony “Tony” Leachon briefly described, the Philippine healthcare system is akin to a patient in the Intensive Care Unit (ICU), it is still alive but in critical condition and requiring urgent intervention. 

In 2023, there was a nationwide shortage of 127,000 nurses. Without interventions, this is projected to double to 250,000 by 2030.

While Filipino nurses are sought around the world, the burden now falls upon those who remain.

Apparently, the World Health Organization (WHO) recommended a benchmark of 44.5 healthcare workers per 10,000 people, and the Philippines has only 21.2.

Within this, as the DOH recommends a ratio of one nurse for every 12 patients (1:12), studies have shown that

• 1:20 is the actual ratio in many hospitals
• 1:50 is the ratio for some understaffed public hospitals

A higher ratio means that one nurse is responsible for more patients than recommended.

And if more patients per nurse mean a heavier workload, then such a shortage contributes to more burnout and exhaustion.

Nevertheless, can one truly blame healthcare workers for pursuing better opportunities when remaining often means enduring low wages and unfulfilled promises? 

Faulting the flight

It may be easy to blame migration amid the country’s worsening healthcare crisis. But doing so ignores the persistent issues starving the system.

Under the Health Emergency Allowance (HEA) program, healthcare workers were guaranteed additional compensation.

However, many Filipino healthcare workers spent years waiting for delayed benefits and allowances that had long been promised to them.

According to studies, it is also evident that compensation disparities remain one of the biggest drivers of migration, especially when Filipino healthcare workers can earn more overseas than domestically. 

“This is a debt we owe them. Our health workers risked their lives during the pandemic, endured longer working hours, and faced serious physical and mental strain. The least we can do is make sure they receive what the law guarantees — and receive it without further delay,” said Albay 3rd District Rep. Raymond Adrian Salceda. 

Not a worthy badge to wear

As institutionalized under the Universal Health Care Act, every Filipino is automatically covered by PhilHealth Insurance, including:

• Universal access to healthcare 
• Local health primary care
• Financial protection

However, concerns regarding the implementation persisted following the controversial transfer of nearly ₱90-billion in PhilHealth funds in 2024. 

While the healthcare reforms have their own share of intentions, legislation alone cannot guarantee accessible and quality healthcare.

Amid healthcare workforce shortages, the Second Congressional Commission on Education (EDCOM II) urged the government to:

• expand scholarships
• improve health professional education and training
• file vacant public health positions
• increase the number of healthcare workers, particularly in underserved areas. 

Indeed, the nation cannot rely solely on producing competent healthcare professionals unless adequate conditions are in place to enable them to remain and serve within the country. 

Mere shortcomings

Because policies alone cannot solve the country’s healthcare crisis, keeping healthcare workers in the country should be the standard.

Otherwise, no amount of international praise can mask the empty promises of our own system.