PHILIPPINE POLICIES ON MATERNAL, NEWBORN,

AND CHILD HEALTH AND NUTRITION

Most recent government surveys reveal the following state of MNCHN in the
Philippines:

1. Fertility Trends

The current fertility rate, according to the National Demographic Health Survey (NDHS) 2008
preliminary results, is at 3.3. The NDHS 2008 also reports that fertility levels in the Philippines
declined gradually in the last 15 years. The declines in the fertility rates of women ages 25 to 34
have continued to be more noticeable. The fertility rates of women ages 15-19 and 45-49 have
remained almost unchanged in the last 15 years while the rate of birth remains higher among
women aged 25 to 29.


2. Maternal Mortality Trends

According to the 2006 Family Planning Survey (FPS), the maternal mortality ratio for the seven-
year period prior to the survey was 162 deaths per 100,000 births. This implies a slight decline
from the level of about 172 estimated from the 1998 NDHS. However, because of the 95 percent
confidence intervals around the point estimates of the two surveys, the apparent decline cannot
be considered statistically significant. The 2008 NDHS did not collect maternal mortality data.

3. I nfant and Child Mortality Trends

Preliminary results of the 2008 NDHS show that there has been a decline in under-five mortality
rate in 15 years, from 54 deaths per 1,000 live births during the period 1988-1992 to 34 deaths
per 1,000 live births in the period 2003-2007. The infant mortality rate has declined, from 34
deaths per 1,000 live births to 25 deaths per 1,000 live births.

Facts on maternal; and neonatal health in the Philippines:

- 160 women for every 100,000 births die.
- Roughly over 11 women die every day.
- 7 out of 10 deaths occur at child birth or within a day after delivery.
- 4 out of 10 deaths are due to complications and widespread infections.
- For every death, 40 more women get sick.
- 8 out of 10 births in rural areas are delivered outside a health facility.

4. I mmunization of Children

The 2008 NDHS preliminary report shows that overall, 80 percent of children ages 12-23 months
have received all of the recommended vaccinations. Immunization coverage is generally high for
each type of vaccine: 94 percent of children have received the BCG vaccination, 93 percent have
received the first DPT dose, and 92 percent have received the first polio dose. Coverage against
measles is 84 percent. Only 6 percent of children have not received any immunization, a
decrease from 8 percent of children not immunized in 2003.

5. Nutritional Status of Infant and Children

The 6th National Nutrition Survey 2008 initial results show that among children under age five,
27.6 percent are underweight and 1.4 percent are overweight. Among pregnant and lactating
women, 26.6 percent and 11.7 percent, respectively, are underweight. The prevalence of anemia
among 6 months to below 1 year, and 1 year and 11 months old children, is at 66 percent and 53
percent, respectively. The prevalence of anemia among pregnant and lactating women is at 43.9
percent and 42.2 percent, respectively.

The 2008 NDHS results show that 8 percent of infants under two months old are not breastfed.
Furthermore, only 34 percent of infants under 6 months old are being exclusively breastfed, most
are mixed fed with other milk or plain water or given complementary feeding. By age 6-9
months, only 63 percent of infants are being breastfed with 58 percent receiving complementary
food. Eighty percent of households (mothers) claim they are aware of iodized salt, but only 38
percent actually use iodized salt. The proportion of households whose salt tested positive for
iodine is 56.4 percent.

6. Childhood I llness

Acute respiratory illness (ARI), malaria, and dehydration from diarrhea are the major causes of
childhood mortality. In the 2008 NDHS, mothers were asked whether each child under age five
had experienced cough with short, rapid breathing (symptoms of ARI), fever (symptom of
malaria), or diarrhea in the two weeks prior to the survey and the treatment given to those who
experienced the symptom. The survey results show that treatment was sought from a health
facility or health provider for 50 percent of children with symptoms of ARI in the two weeks
before the survey. The survey results also show that treatment was sought for 34 percent of
children under age five who are reported to have had diarrhea in the two weeks prior to the
survey, and 47 percent were given solutions prepared from packets of oral rehydration salts
(ORS). Fifty-nine percent of children with diarrhea were given oral rehydration therapy (ORT),
which includes solution prepared from ORS and recommended homemade fluids.

The Philippines, together with the rest of the other nations, is a signatory to international
conventions which recognize these rights such as the International Covenant on Economic,
Social and Cultural Rights in 1976, the Convention on the Elimination of All Forms of
Discrimination Against Women (CEDAW) in 1979, the Convention on the Rights of the Child
(CRC) in 1989, the International Conference on Population and Development (ICPD) in 1994,
the Beijing Declaration, Platform of Action during the Fourth World Conference on Women
(WCW) in 1995, and the Millennium Development Goals in 2000, among others. Most of these
international conventions were ratified by the Philippine Congress/ Senate and, therefore, the
country is bound to implement and report progress in achieving them.

Effect of Health Policies and Regulations
Issues surrounding health care are often complex, involving the fields of medicine and
economics, and affecting individuals' rights as well as access to health care. Consumers are
concerned about quality, and corporations and individual providers are concerned about
economic survival.
Two major trends will have a significant impact on health care delivery. First, there will be an
increase in state and federal regulation as costs rise and managed care continues to expand.
Along with regulation, there will be attempts to shift to less expensive settings and apply market
forces to restrain costs.
Second, shared responsibility for the health program and the shift to managed care has resulted in
an increased oversight role for the states. States must define, measure, and assess quality, and
serve as contractors for corporate entities while enforcing accountability of managed care
organizations. Both new regulation and devolution have serious implications for health care
delivery and the practice of nursing.
Devolution of health services in the Philippines
One of the most significant laws that radically changed the landscape of health care
delivery system in the country is RA 7160 or more commonly known as the Local Government
Code. The Code aims to: transform local government units into self-reliant communities and
active partners in the attainment of national goals through a more responsive and accountable
local government structure instituted through a system of decentralization.
In 1993, health services were devolved or transferred from DOH to local government unit- all
provincial, district and municipal hospitals to the provincial government and RHUs and barangay
health stations (BHSs) to the municipal government.
The shift in the leadership in health care from the national government to the LGUs has resulted
in both the improvement and deterioration of health care delivery. There are LGUs that are
committed to health and are innovative while there are those that are just interested in the
purchase of supplies and medicines. Some LGUs have the financial capability to support their
own health care system while others do not have adequate financial resources. It has been
established that an LGUs financial capability, a dynamic and responsive political leadership and
community empowerment are the important ingredients of an effective local health system.
Physical and social empowerments have been promoted in the inter-related sub-sectors of health,
nutrition, and population development. Towards this end, direct and indirect interventions have
been achieved through program expansion, greater outreach to clientele, more emphasis on
preventive measures, and advocacy.
Other notable recent accomplishments in the area of policy development are the continued
facilitation of the implementation of the Magna Carta for public health workers, capability
building for devolved local government unit (LGUS) health personnel, and the publication of the
1995 Field Health Information System statistics. The improvement of occupational safety and
health (OSH), particularly in small and medium enterprises (SME's), has been pursued. The
labour department conducted several trainings for government employees, industrial supervisors
and workers. A total of 659 Work Environment Measurements (WEMS) were conducted to
improve indoor environments of 16,049 workers in 56 companies. Industry Tripartite Councils
(ITCs), which have been tasked to monitor compliance with all existing labour laws and social
legislations, were established in 13 industries.
Global Shortage of Healthcare Workforce
Manpower shortage is prevalent, expressed in shortages and maldistribution of health
workers geographically and professionally. This has globally affected the affordability and
accessibility of health services. If these health care providers are inadequate, prevention and
treatment of disease and advances in health care cannot reach those in need.
The World Health Organization's 2006 World Health report estimated the global health
workforce to be around 59 million people. Though there are 39.5 million health service providers
and 19.5 million management and support workers, WHO estimates a global health worker
shortage of more than 4 million doctors, midwives, nurses, pharmacists, dentists and support
workers (Abano, 2008).
Geographical variation needs to be addressed, with large disparities in the workforce
between and also within countries (Bangdiwala, et al., 2010).
Most high-income countries such as America do not have enough locally-trained
healthcare professionals to provide care to those in need. Moreover, most of them also have an
existing ageing workforce. To solve this manpower shortage, developed countries search for
skilled health workers such as nurses and doctors from developing countries. Unfortunately as a
result, the lack of workforce (caused by migration of their health workers) in developing
countries further aggravates their health care system.
To reduce the occurrence of migration of health workers, destination/receiving countries
should minimize their dependency on health workers abroad by improving the training of their
local health workers and maximizing the capacity of their present workforce. In addition,
destination countries should also advocate responsible recruitment policies and ensure fair
treatment of migrant workers (World Health Organization, 2010).
Migration of Health Care Workers
The Current Nursing Shortage in the Philippines
As a result of the global manpower crisis, especially in first-world countries,
opportunities for health workers from developing countries to work abroad continue to rise. In
addition, other reasons such as economic condition and poor working state are factors for their
departure. Despite the efforts of these countries to train adequately-skilled health workers, the
brain drain still continues.
Nurses from the Philippines (110,000) and doctors from India (56,000) account for the
largest share of migrant health workforce in OECD countries. However, countries with smaller
populations than India and the Philippines may suffer from a larger impact in terms of
expatriation rates. Over 50% of highly-trained health workers leave for better job opportunities
abroad in some low-income countries (World Health Organization, 2010).
The Philippines is the primary exporter of nurses employed overseas. The Philippine
government actually supports migration of the nurses by training a surplus of nurses to be
employed outside of Philippine borders. According to International Labor Organization (2006),
the labor migration was intended to serve as temporary procedure to ease domestic labor market
in Philippines thus to stabilize the countrys balance-of-payments position. However, this has
not come to be, because of the increase in dependence on labor migration and change in
demographic in agricultural economy to largely service-driven economy (International Labor
Organization, 2006).
In the Philippines, an estimated number of 15,000 Filipino health workers leave the
country every year (Abano, 2008). In the past decade, 2,000 nurses and 250 physicians leave the
country each year. Philippines is cited as the number one exporter of nurses worldwide with 85
percent of Filipino nurses working in some 50 countries and the number 2 exporter of doctors,
next to India, with 68 percent of Filipino doctors working external (Dabu, 2012).
A 2008 report by Erlinda Castro-Palaganas, citing NIH data revealed that the United
States of America, United Kingdom, Saudi Arabia, Ireland and Singapore are the top five
destinations of Filipino nurses as of 2004. Europe, especially the UK, The Netherlands, and high-
income Asia were reported as new markets and Japan as an emerging destination for migrating
Filipino nurses. The report also revealed that more than 9,000 doctors have already left as
nurses from 2002 to 2005 while around 80 percent of public health physicians have taken up or
are enrolled in nursing (Dabu, 2012).
Health care professionals working abroad have several reasons for leaving their country. The
economic factor is one of the main causes of departure. Health care workers seek for better-
paying jobs which can give them a living wage one large enough to support a family
(Callaway, 2008). In the Philippines, the average salary of a nurse in the provinces is about
US$150 a month, sometimes lower. In contrast, a Filipino nurse in the U.S. could earn between
$3,500 and $5,000 a month. In a number of middle-income countries and those with good
medical education systems, such as Fiji, Jamaica, Mauritius and the Philippines, a significant
portion of students, especially in nursing school, start their education with the intention of
migrating, usually in search of a good income (Abano, 2008).
Likewise, the poor working conditions often motivate nurses to seek employment abroad (Dabu,
2012). They look for jobs with a better management quality. Due to scarce resources for essential
supplies and equipment and inadequate infrastructures, the institutions where they come from are
often unable to meet even the most basic standards for clinical operations (Callaway, 2008).
Socio-political factors that cause them to leave include corruption, political instability, war and
threat of violence in the workplace. Some migrate due to their diminishing interest in the nursing
profession (Dabu, 2012).
And finally, there are more opportunities for career advancement abroad. Some health care
professionals desire to receive more advanced clinical training that is not available in their
country. Unfortunately, once they have, many are reluctant to return (Callaway, 2008).
When significant numbers of doctors and nurses leave, the countries that financed their
education lose the return on their investment. Financial loss is not the most damaging outcome,
however. When a country has a fragile health system, the loss of its health workforce can bring
the whole system close to collapse, with the consequences measured in lives lost (World Health
Organization, 2010).
Health worker migration has further lowered the standard of care in hospitals. Since 2006, there
has been a 10 to 55 percent decrease in enrollment in medical schools and a 50 percent decrease
in applicants for medical residency positions to become specialists in the Philippines. In 2003 to
2005, some 200 hospitals were completely closed, 800 partially closed for lack of nurses and
doctors. Also, since 2003, about 50 percent of nurses employed in specialty hospitals like the
Philippine Health Center, the National Kidney and Transplant Institute, the Lung Center of the
Philippines and the Philippine Childrens Medical Center went abroad (Dabu, 2012). The
Philippine population has now increased to nearly 90 million and possibly 150 million by 2050.
The health of millions of people in the Philippines alone is at risk from health care worker
shortage (Abano, 2008).
On the contrary, migration of health professionals to developed countries has also produced
positive effects. Migration generates billions of dollars in remittances to low-income countries
(migrants home countries) and has been linked with a decline in poverty. Health care
professionals who come back can also share their skills and expertise back to their home
countries (World Health Organization, 2010).
To address the increasing number of migrants, developing countries should promote better health
workforce retention, especially in rural and remote areas. They should protect and ensure fairer
treatment of health workers, who may face difficult and often dangerous working conditions and
poor pay. They should also improve domestic training of health workers. Lastly, they should
develop policies that facilitate the return of migrants (World Health Organization, 2010).