A comprehensive study reveals systemic barriers preventing healthcare workers from effectively implementing the country's ambitious Universal Health Coverage program

The Philippines' Universal Health Coverage (UHC) Act, enacted in 2019, faces a critical challenge that threatens its foundation: a severe shortage of qualified healthcare workers. A new study by researchers from Ateneo de Manila University has uncovered the complex factors driving healthcare professionals away from the country just when they're needed most.

A System Under Pressure

The Philippines, one of the world's largest exporters of healthcare workers—particularly nurses—is struggling to retain professionals needed to implement its UHC vision. With only 7.92 physicians per 10,000 population (below the ideal ratio of 10 per 10,000) and an estimated shortage of 127,000 nurses, the country faces acute shortages that prevent optimal implementation of health programs.

Three Critical Phases of Crisis

The study, published in Human Resources for Health, identifies problems across healthcare workers' career stages using an Entry-Current Employment-Exit framework:

Entry Barriers

Healthcare graduates face immediate obstacles. Many report feeling unprepared for UHC implementation, lacking training in government procedures and stakeholder management that differs vastly from clinical preparation. Government budget caps limit personnel spending to 45% of local budgets, while restrictive hiring policies requiring civil service eligibility create barriers to filling positions—even for non-patient-facing roles like records officers.

"I finished my MD from one of the best schools in the country," explains a municipal health officer. "But when I worked here, it's an entirely different ballgame. We weren't trained how to deal with local administration and procurement."

Current Employment Challenges

Poor working conditions drive healthcare providers away, compounded by uncompetitive salaries. Private facilities struggle to match government pay scales, while public sector salaries cannot compete with overseas opportunities. Additional barriers include lack of trained personnel for financial management, exorbitant training fees that facilities must pay out-of-pocket, lack of job security for nationally deployed personnel, and inconsistent integration of barangay health workers and community health volunteers across different local governments.

"The nurses we lost are our best nurses," notes a public hospital administrator. "The trained ones are the ones who leave. The ones left with us are either new or very old, because their salary overseas is five times what we pay here."

Exit Factors

Overseas migration remains the primary threat, with healthcare workers earning significantly more abroad. Poor crisis management in government agencies has also accelerated the departure of experienced policy developers.

Promising Solutions

Despite challenges, the study identifies effective practices:

• Scholarship and return service programs: Some facilities use educational scholarships tied to service commitments, ensuring steady workforce pipeline
• Comprehensive benefits: Free tuition for workers' dependents and professional development opportunities
• Specialist training overseas: Government facilities organize international fellowships with return service agreements
• Integrated UHC training: Embedding UHC knowledge in onboarding processes for new personnel

Systemic Reform Required

Researchers argue that addressing these issues requires reforms beyond healthcare, including:

• Revisiting the Local Government Code for workforce investment flexibility
• Integrating health professions education institutions with healthcare facilities
• Implementing reforms in basic, higher, and health education, and civil service
• Revisiting training costs and specialist training programs
• Designing sustainable and equitable bilateral labor agreements

Critical Juncture

The study warns that achieving Universal Health Coverage requires more than policy and financing—it demands creating conditions where healthcare workers want to stay and contribute to their communities' health. Without addressing these fundamental workforce issues, the goal of healthcare for all Filipinos remains at risk.

The research involved 92 participants including policymakers, healthcare providers, and patients across national, regional, and local levels, providing comprehensive insight into UHC implementation challenges.

Read the full article: Pepito, V.C.F., Loreche, A.M., Legaspi, R.S., Guinaran, R.C., Capeding, T.P.J.Z., Ong, M.M., & Dayrit, M.M. (2025). Health workforce issues and recommended practices in the implementation of Universal Health Coverage in the Philippines: a qualitative study. Human Resources for Health, 23, 21. https://doi.org/10.1186/s12960-025-00988-3