Wednesday, November 14, 2012
Philippines - Deploying Filipino village doctors
What has happened to the “Doctors to the Barrios” (DTTB) programme? Not much has been heard of the government project that then Philippines' Health Secretary Juan Flavier pioneered in 1993, which encouraged medical graduates to consider spending a couple of years or so of their professional practice in some of the country’s poorest and most remote barrios (villages), where healthcare needs are at their direst.
Flavier launched the DTTB after the Department of Health discovered that some 271 towns in the country had had no municipal physician for 10 years or more. The programme, according to current Health Secretary Enrique Ona, aimed to address this gap by providing “equitable healthcare services to all areas of the country by deploying competent, committed, community-oriented and dedicated physicians to serve inaccessible areas”.
Flavier’s common-sense programme was much lauded in its time. Not only did it pinpoint, and seek to remedy, a critical weakness in the healthcare environment, one that affected the most economically deprived and vulnerable sectors of the population; it also made urgent Flavier’s call, one that he had practiced himself for much of his career, for doctors—especially those from the University of the Philippines (UP) and other state colleges whose education is subsidised by the citizenry—to “give back” to the country by rendering service in places where they’re needed most.
The government is said to subsidise about 80 per cent of a student’s education in UP; unfortunately, according to a GMA-7 report last year, “data from the UP College of Medicine showed that more than 80 per cent of their graduates eventually leave the country to practice medicine overseas, and the number has been increasing in the past 10 years.”
This has led to a new university policy, called the Return Service Programme, in which incoming freshmen to medical colleges in UP schools are required to sign a commitment saying that after they graduate, they will stay and serve the country for a specific number of years—three for those under the medicine programme, two for students from allied disciplines such as dentistry, nursing, pharmacy, public health and health sciences.
Not all of them will find employment, of course, in city-based hospitals and medical institutions. So they may well consider the DTTB programme, which, nearly 20 years after Flavier sounded the call, turns out to have grown very significantly.
Last week, Ona announced that the Philippines would no longer have “doctorless” municipalities by the end of the year, with 32 “doctorless” and “very poor” municipalities in Abra, Ilocos Sur, Cagayan in the north and Palawan, Tawi-Tawi and Basilan in the south finally about to have their own physician by December through the DTTB programme.
How did the DOH do it? By assiduous recruitment, apparently, resulting this year in 114 new recruits, on top of the 72 doctors already deployed to various fifth- or sixth-class municipalities all over the country since last year that cannot afford to hire their own doctor.
“Since 1993, 553 physicians have served in 390 municipalities all over the Philippines,” said Ona. “Presently, our doctors are serving in 68 municipalities in 38 provinces and 16 regions across the country.”
Ona’s address at the recent commencement exercises of the new doctors didn’t skip the caveats. “The road will not be easy,” Ona said, the difficulty stemming right off from the sheer weight of the job. DTTB doctors could serve up to 50,000 people, or more than double the doctor-to-population ratio of 1:20,000 set by the World Health Organisation, he said. For young doctors, two years of such crushing work may be daunting.
“But the journey has its rewards,” Ona added. “No doubt, your communities will adopt you as one of their own and pamper you in their little way, in their humble way. Experiences, both good and bad, will give colour to your tours of duty. You will find fulfillment, however, in every patient you treat, comfort, and hopefully heal.”
The government is doing its bit to sweeten the deal not only with incentives such as clothing, subsistence, laundry and hazard allowances, but also with postgraduate study opportunities for the young doctors.
Of the new batch of 114 DTTB doctors, 92 are said to have already been dispatched to various areas. The communities they serve—and the larger nation whose well-being benefits from their heroic work—will no doubt be grateful. DOH’s next goal must be to deploy more than one of these physicians to a target community, to decrease the doctor-to-population ratio. In other words, may their tribe increase, indeed.