The Philippine HRH Master Plan

(2005-2030)

F. Marilyn E. Lorenzo DrPHCollege of Public Health

University of the Philippines, Manila

First GHWA Conference Kampala, Uganda

March 5,2008

2

HRH Master Plan Goal

Develop and install HHRMD systems that will support Philippine health sector reforms to improve health outcomes

3

II. Situational Analysis

3. Lack of

Operations Research to rationalize HR standards

National HHRD Plan

of 1994 not implemented

1. No integrated policies on HHR

2. Weak HRH info

system to support other HR systems (eg. health facilities, HRH stock and needs)

Functions of organizations with HR roles are not integrated(DOH, PRC. CHED, DBM, POEA, DOLE, DILG, TESDA, Private Hospitals)

Inadequate HRH Management Systems

10 Inadequacy in Budgeted

Items for HRHresource in government and private facilities at the provincial

and municipal levels

HR Standards

outdated or inappropriate

Variable cost of health sciences education

Proliferation of substandard schools (eg. nursing schools)

Inequitable

distribution of health professionals

Other health

professionals going into nursing

Increased Migration

of Health

LowProductivit

y of Health Profession

al Dissatisfaction

Weak Health System

Inappropriate or outdated skill and skill mix

Low Quality

HR Standards

outdated or inappropriate

7. No rational basis for

opening of health science schools

11. Inequitable distribution of health professionals

5. Other health professionals going into nursing

Increased Migration of Health

professionals

Lack of integrated HRH systems in general: Information system, HRH development, compensation/ benefits/ incentives, production,regulation, deployment/ placement, utilization, monitoring/ evaluation, policy and standard development, HRH planning

6.Poor Working Conditions;

Limited Career Progression Opportunities; Unfavorable terns of

employment

4.Compensation: Low; Large

gap exists between salaries of government and private based

health workers

Lack of system for local recruitment and deployment

LowProductivity

of Health Profession

al Dissatisfaction

Salaries of resident doctors and nurses pale in

comparison to professionals in other sectors

Low Quality

4

Situational Analysis Summary: Strengths / Opportunities

1. Presence of Organizations with HRH functions and existence of informal ties

2. DOH: Ability to solve HRH problems that surface

3. New emphasis on HRH globally and nationally

4. Competitiveness of Health Sciences Professions; Popularity of Health Sciences programs over other

professional programs

5

Situational Analysis Summary:Weaknesses and Threats

• Government organizations have fragmented HRH functions

• Non- integrated organizational policies

• No evidence-based staffing standards–politicized, limited

and outdated

• Contractualization of HRH: Job Order, Labor List

• Lack of Functional HRH systems in general

• Inequitable distribution of HRH

• Inadequately budgeted items for HRH

6

Framework for Human Resource Framework for Human Resource

for Healthfor Health

External Environment

Socio-economic Planning, Health Planning, Disease Conditions,

Government Pressures and Regulation,Market Conditions,Union pressures,

Stage of country’s Development and Culture, HHR Needs and Resources

Internal Environment

Health Services, Sectoral Strategy,

Job Technology, HR Characteristics

HR Outcomes

•Competence

•Congruence

•Commitment

•Org Effectiveness

•Cost Effectiveness

•Productivity

•Readiness for

Change and innovation

Long Term

Consequences

•Individual Well Being

•Organizational Effectiveness

•Societal Well Being

•Quality Work life

Feedback system for control

Multiple Interests

(Values) of

the Key Stakeholders

Health

Workers

Community

Unions

Health

Facilities

NGOs

Federation of

Health Prof

Orgs

LGUs

Development

of HHR

Systems

Figure 1: National Health Human Resource Development Framework

HR PlanPRC, DOH, CHED

-Policy and Standard Development

-Monitoring and Evaluation of Policies-Information System

-Research

HR Productionand RegulationAcademe, PRC,

CHED,TESDA

HR Management and StrategiesDOH, Prof. Association, CSC

Recruitment, Deployment/Placement

Orientation, Supervisory System

Production Stds, Non-labor Inputs, Career Pathways

HR Development

PRC, DOH, CHED, Specialty Boards

Academe/ Institutions-Continuing Education

-Training

7

Planning Bases

• Medium Term Development Plan NEDA 2005-2010

• UN Millennium Development Goals

• Devolution

– Inter-local Health Zones

• Health Sector Reform

• Health Needs (Disease Patterns; Triple burden of Disease)

• Health financing (Philhealth, commercial, community)

• Domestic HRH demand based on socio-demographic trends

• Foreign HRH demand based on known demand trends

• Regulatory standards e.g. AO 70, AO 147

• National Health Plan 1994-2020

8

Planning Assumptions

• Implementation of HSRA until 2030

• Workforce plans based on following requirements:

– population

– equitable distribution based on needs, geographic characteristics and

socio-economic factors

– Regulatory standards

• Phased HRHD planning feasible

– 12 HRH categories covered in first phase

– 11 HRH categories covered in second phase

• Each HRH category is assumed to have possible multiple roles as clinicians, educators and

researchers

• EO 366 is implemented

17,5414,9652,3202,64511,5371,039Midwives

1,2828413934480441

Pharmacist

s

9718413934480130OT

9578413934480116PT

4,1028413934482,296965MedTech

4,4238413934482,2961,286Dentists

65,90051,445

24,04

0

27,40

52,29612,159Nurses

22,87313,6766,3917,2852,2966,901Doctors

TotalPrivatePublicTotal

Positions in HospitalsNo. of

RHUs/MHCs/

BHS

Existing

DOH/NGAs

positions

Number of Positions

Professions

Available Positions in the government and hospitals for various health professional groups

10

Assumptions:

8. Tertiary care medical centers assumed to have 15 dept

7. Tertiary care hospitals assumed to have 7 dept

6. Secondary care hospitals assumed to have 4 dept

5. Admin positions (chiefs, supervisors) taken into account for doctors and nurses

4. Medtech, OT, PT, Pharm to hospital bed ratio assumed to be 1 per hospital except for birthing homes and infirmary

3. HW to hospital bed ratio based on AO. 70

2. RHUs/MHCs require only one health worker per type of profession

1. Distribution of HW based on distribution of public (53.27%) and private (46.73%) hospital beds

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26,75124,51322,46920,60318,89717,338Midwives

33,32230,52727,97625,64623,51821,572Pharmacists

16,618 15,218 13,940 12,774 11,713 10,769 OT

23,58421,14419,08817,31415,67514,313PT

7,7797,5537,0336,6336,3936,386MedTech

12,80211,73510,7619,87115,9548,629Dentists

263,244241,166221,010202,603185,788170,423Nurses

47,15143,19639,58636,28933,27730,525Doctors

203020252020201520102005

Projected Workforce RequirementsProfessions

Workforce projections for various health professional groups, 2005-2030

122,50016,3982,29315,045Midwives

7,20916,3086,61314,959Pharmacists

4,7416,9724,3596,410Occupational Therapists

6,4379,2385,8788,435Physical Therapists

6125,7806125,774Medical Technologists

1,41814,5367677,862Dentists

67,775118,01362,170108,253Nurses

9,29823,9798,52921,996Doctors

PrivatePublicPrivatePublic

20102005

Projected Workforce Requirements

Professions

Distribution of projected workforce to public and private sectors for various health professional groups,

2005-2010

13

-1,17716,39817615,04515,221Midwives

-15,41916,308-14,07014,959889Pharmacists

-2,8353,413-2,5683,146578OT

-3,9414,505-3,5834,147564PT

-2,0715,780-2,0655,7743,709MedTech

-10,50614,536-3,8327,8624,030Dentists

-76,153118,013-66,393108,25341,860Nurses

-7,49723,979-5,51421,99616,482Doctors

Difference

(A-C)

Projections

(C)

Difference

(A-B)

Projections

(B)

20102005

Projected Workforce RequirementsExisting positions in public

sector (A)

Professions

Difference between projected workforce for the public sector and existing

positions for various health professional groups, 2005-2010

14

-1,17716,39817615,04515,221Midwives

-15,41916,308-14,07014,959889Pharmacists

-6,3946,972-5,8326,410578OT

-8,6749,238-7,8718,435564PT

-2,0715,780-2,0655,7743,709MedTech

-10,50614,536-3,8327,8624,030Dentists

-76,153118,013-66,393108,25341,860Nurses

-7,49723,979-5,51421,99616,482Doctors

Differe

nce (A-

C)

Projections

(C)

Difference

(A-B)

Projections

(B)

20102005

Projected Workforce Requirements

Existing

positions

in public

sector (A)Professions

Difference between projected workforce for the public sector andexisting positions for various health professional groups,

2005-2010

15

Salary costs of projected workforce to public and private sectors for various health professional groups, 2005-2010, in Billions PhP

0.835.461.087.10Midwives

2.315.232.144.84Pharmacists

0.731.070.110.17OT

2.052.950.440.63PT

0.444.140.403.73MedTech

0.444.520.383.94Dentists

25.344.0024.542.6Nurses

3.138.064.0910.54Doctors

PrivatePublicPrivatePublic

20102005

Projected Workforce Requirements

Professions

16

Cost projections (Training) for various health profession

groups for 2021-2030 Philippines (in Billions Php)

879.84235.7874.7730.0313.594.41Total

48.0225.6113.657.283.880.08OT

17.249.194.902.611.390.74PT

3.012.051.390.950.640.44MT

4.032.151.150.610.330.17Pharm

1.280.540.230.160.110.07MW

5.653.842.621.781.210.82DMD

35.0218.9710.324.121.610.79RNs

765.61173.4340.5112.524.411.28MDs

203020252020201520102005

YearsProfessions

17

Cost projections (Salaries) for various health profession

groups for 2005-2030 Philippines (in Billions Php)

321.99242.31175.91132.00107.12106.65Total

18.8512.938.865.781.790.28OT

7.104.923.332.251.521.09PT

7.826.785.905.174.584.12MT

23.2316.8612.479.577.536.98Pharm

5.484.364.425.106.298.18MW

8.857.656.615.724.964.32DMD

214.60157.72113.2782.6769.2667.04RNs

36.0731.0921.0415.7311.1914.63MDs

203020252020201520102005

YearsProfessions

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Assumptions for workforce projections (Nurses)

Regions

1747353002337RN Graduation Patterns

0.2200.330Geographic Weight

0.170.170.330Cultural Weight

0.1100.220SES Weight

70,694 104,230 120,409 127,383 Current Cost to train RN

Student

301,104 301,104 285,138 301,104 Current Salary Costs/RN

1.56%1.39%1.90%1.19%Annual Population

Growth Rate

3,087,476 4,491,386 1,560,867 11,240,743 Current Population

4.17%0.00%7.32%11.76%RN Attrition Rate

14,28512,6696,22032,603Number of RNs at

beginning of year

1.581.581.581.58Preferred Nurses to

Population Ratio

IIICARNCRAssumptions

19

Assumptions for workforce projections (Doctors)

Regions

1910891559MD Graduation Patterns

0.2200.330Geographic Weight

0.170.170.330Cultural Weight

0.1100.220SES Weight

550,000 550,000 550,000 550,000 Current Cost to train MD

Student

285,138 285,138 285,138 285,138 Current Salary Costs/MD

1.56%1.39%1.90%1.19%Annual Population

Growth Rate

3,087,476 4,491,386 1,560,867 11,240,743 Current Population

7.14%57.89%1.41%30.30%MD Attrition Rate

2,7641,8691,68014,391Number of MDs at

beginning of year

0.283 0.283 0.283 0.283Preferred Doctors to

Population Ratio

IIICARNCRAssumptions

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General Assumptions

6. Adjusted for socio-economic, cultural, and geographic indices

7. Increased graduation patterns by 10% starting 2006 for all regions except for NCR

5. Attrition rate assumed to be the same as that for government HWs

4. Distribution of HWs across regions assumed to be the same as distribution of government HWs

3. Stock of HW derived from licensees (PRC data) adjusted for unemployment (11.4%) and migration (per category of HW)

2. Wages from government rates (entry level)

1. NSO population projections using medium assumptions

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The Proposed HRH The Proposed HRH

Implementing Implementing

OrganizationOrganization

Support & coordinating

agencies

Planning, Resource Mgmt, Coordination ,

ChampionDOH

BLHD, HHRDB,,IMS,

HPDPB, BIHC, BHFS, NCFHD

PartnersProposed

Implementers of the

Plan

DOF NGOs

Funding

PHIC/

International

Donors like

WHO

CSCNEDA

Data

source:

LGU’s

DTI

DILGRetention,

Compensa-

tion & Career

Dev’tDBM, PHA &

LGUs

Production

Academe &

Accredited

Professional Organizations

RegulationPRC,

Professional Regulatory

Boards,

CHED, TESDA & PHIC

Domestic

Deployment

DOLE &

League of

Municipalities

and Cities

Int’l

Deployment

POEA, DFA

& OWWA

POPCOM PITAC

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Monitoring the HRHMP: Comp. I

Establishment : HRH Implementing Org.

Formulation: Evaluation scheme for 7 HRH systems

Program Development: domestic and international deployment

Competency-Based Job Analysis Interventions

Career Development Management Systems Interventions

Establishment: HRH units and HRHIS

Pilot: Staffing Plan, 15 Pilot ILHZs

Workforce planning in local levels

Finalization of HRH Master Plan

201020092008200720062005

Year (2005-2010)

HRHMP Outputs Phase I

HRHMP Time Frame (Phase I)HRHMP Time Frame (Phase I)

23

Monitoring of the HRHMP

Conferences between private and public sectors

Maintenance of HRHIO

Staffing Components Implementation: 46 ILHZs

Maintenance of HRHIS

HRHIS expansion: 46 ILHZs

Programs implementation: Quality health science schools

CDMS Implementation: expansion areas

Deployment Projections: medium and long terms

2020201920182017201620152014201320122011

Year (2011-2020)HRHMP OutputsPhase II

HRHMP Time Frame (Phase II)HRHMP Time Frame (Phase II)

24

HRHMP Time Frame (Phase III)HRHMP Time Frame (Phase III)

Planning for the next master plan

Revision of HRH programs based on monitoring and evaluation

Review of Master Plan

Monitoring of Staff Performance and Satisfaction

Evaluation of HR management Systems and HRHMP

Implementation of 7 Management Systems Continued

CDMS Implementation (entire public sector)

2020201920182017201620152014201320122011

Year (2011-2020)

HRHMP Activities/ Outputs Phase III

Thank you!