An ethnographic reading of the challenges in delivering primary health care in a rural, remote province of the Philippines

Introduction: Primary Care Physicians (PCPs) play a key role in ensuring effective healthcare in rural parts of the Philippines. This study aimed to gain insights into the experiences and perceptions of PCPs delivering primary health care in remote, rural communities.

Method: Long-term ethnographic fieldwork in 18 rural health units in one province (population ~ 632,000 and 44 PCPs): two-week observations and 14 semi-structured interviews with PCPs working in these facilities. Thematic analysis was applied to the ethnographic data.

Results: Four overarching themes emerged: Barriers to healthcare delivery. A stark scarcity of human health resources, a serious lack of physical infrastructure and medicines, high number of patients and competing priorities were significant barriers to good doctor-patient relationships and to delivery of effective primary care.

Multiple roles. The main PCP roles were not solely patient-focused. A wide range of managerial and governance tasks take PCPs away from the consultation room. They do not feel well-supported and often lacked skills to perform some of the non-clinical tasks.
Dealing with local politics around healthcare. PCPs are severely limited in their decision-making and action-taking power under a decentralized health system. PCPs report to the local mayors and most PCPs spend considerable time and energy in liaising with political actors.

Training needs and retention. PCPs working in geographically isolated, rural and underserved areas of the Philippines expressed professional and social isolation, frustration and desperation but also a sense of fulfilment.

Conclusion: Our study has important implications for the training, support and role expectations of PCPs.