Health workforce issues and recommended practices in the implementation of Universal Health Coverage in the Philippines: a qualitative study

BACKGROUND: The transition towards Universal Health Coverage (UHC) in a devolved healthcare system such as the Philippines is beset by health workforce issues considering that it is among the world's leading source countries for health workers. This study aims to document health workforce issues and recommended practices in the implementation of UHC in the Philippines. METHODS: We conducted focus group discussions and key informant interviews with health policymakers and UHC implementers in the national, regional, and local levels. Participants included local chief executives, healthcare facility administrators, and healthcare providers at tertiary, secondary, and primary levels, as well as patients. We transcribed and translated the focus group discussions and key informant interviews and analyzed it thematically. RESULTS: Workforce factors at entry, current employment, and exit hinder the implementation of UHC. Factors at entry include: poor preparation of graduates in school for implementing UHC; difficulty in recruitment due to restrictive government hiring policies; and government budget caps for personnel services. Factors at the current employment include: poor working conditions; uncompetitive salaries; lack of trained personnel for financial management; exorbitant fees for trainings; lack of job security for nationally deployed personnel; and lack of integration of some barangay health workers and community health volunteers. Factors at exit include the pull of migration overseas and poor crisis management. Some recommended practices to recruit and retain health workforce include scholarships and return service programs; free tuition for dependents of health workers; opportunities for postgraduate degrees and specialist training overseas, and onboarding UHC training for new hires. CONCLUSIONS: To address the health workforce issues hindering the effective implementation of UHC in the Philippines, there is a need for reforms in the country's healthcare sector and beyond. Specifically, there is a need to revisit the country's Local Government Code, integrate further health professions education institutions and healthcare facilities, implement reforms in its basic, higher, and health education, and the civil service, revisit training costs, and training programs for specialists, and design and implement more sustainable and equitable bilateral labor agreements to keep health workforce in the Philippines and engage them as partners for optimal implementation of UHC in the country.