The Remedy for Resilience: Every Health Worker’s Request

By Samuel Pimping

With last year’s theme being to Build the Health Workforce Back Better for Health Worker, World Health Worker Week is commemorated with the call to Invest in Health Workers this April. Ravaged, deprived, and fallen into disrepair—the medical community is a home that is in dire need of restoration.

We honor the resilience of our Health Worker, but mere admiration is far from the solution. Are we inadvertently blurring the lines between a celebration of fortitude and the toleration of systemic injustice?

The Delinquency of Nurses’ Blood Money

While the pandemic has taken its toll on the health sector, it is not the root cause of the Health Worker’ downfall. There have already been longstanding, deeply ingrained issues regarding their welfare in the Philippines.

Fair, timely compensation for our health workers has long been overdue. Even before COVID, nurses have taken a stand for more dignified wages that reflect the perils and long hours they face. Frontliners have been demanding the release of their special risk allowances and hazard pay since 2020, and there are 805,000 health workers from the local and national government and private sector with delayed allowances to this day.

This is an astonishing statistic knowing that such special risk allowance is in the meager amount of only ₱5,000 per month.

It was only in 2022 when the demands of nurses for higher entry-level salaries were heeded through the filing of the Salary Increase for Nurses Bill. To mitigate mass migration of health workers abroad where the pay is much more equitable, a minimum monthly salary of ₱50,000 for nurses in government and private hospitals is proposed. This is a stark contrast to the ₱8,000 to ₱13,500 monthly salaries of entry-level nurses in the private sector. According to the president of Filipino Nurses United, salaries of
government nurses can reach ₱35,000 under Salary Grade 15, but this is deceiving because majority of public hospital nurses are contractual and paid much less.

How can we even label our frontline workers as “entitled” given the disproportionate remuneration they receive against substantial risks? Gratitude fills the heart, but it does not feed the family. Hospitals are still understaffed, and we cannot blame health workers for migrating to other countries in search of better, sustainable living wages.

The government has proposed other solutions to keep more of the labor force within the country for the meantime. For instance, the Commission on Higher Education (CHED) recently proposed the implementation of shorter nursing certificate programs that allow graduates to join the profession after only one to three years. However, this misses the point. Prospective workers would still be discouraged from working within the country due to unjust wages. Expedited certifications are only a band-aid solution, and the program can negatively impact the quality of healthcare in the long run.

Understaffing within institutions and workforce shortage are not the same. Truth be told, there is no shortage of nurses in the Philippines. This is acknowledged both by advocates and even CHED, with Chairman De Vera stating that there are “enough number of licensed nurses, but majority are either not practicing or migrant workers.” Hospitals are only understaffed because plenty of nursing graduates simply chose not to practice the profession locally. To support their families, breadwinners prefer to pursue more lucrative employment opportunities either domestically within other fields (such as the Business Process Outsourcing industry) or within the profession but outside the country.

Unreasonable, untimely pay is the biggest concern for Filipino health workers, but there are more complications to be addressed in reinvigorating the health workforce.

Rebuilding through Policy Recommendations

Aside from the financial aspect, there is the matter of employee morale. Unsuitable working conditions further plague health workers in the form of physical or verbal hostility, toxic work culture, gender discrimination, highly centralized health services, and lack of strategic investments in the industry.

Being esteemed as protectors of public health does not preclude our frontliners from being victims of violence. Around 8% to 38% of nurses, paramedics, emergency room staff, and other related workers across the globe have suffered physical aggression at least once in their career from patients or visitors. To reduce the frequency of these incidents, sufficient security personnel must be deployed within medical facilities particularly when it comes to areas where emergency cases are commonly attended to. All staff should be properly trained on the pertinent strategies and procedures in handling violent patients or visitors; this is even more significant in areas with scarce resources. Framework guidelines for addressing workplace violence in the health sector have been developed with the participation of the World Health Organization.

Sexual exploitation and workplace violence have also been prevalent within the field. Women comprise the majority (70%) of health worker worldwide, and 8.2% of women in the workplace have been exposed to dehumanizing acts such as harassment and sexual assault including threats, misogynistic comments, and rape. It should be noted that this is reported data, which means that the actual number of incidents is most likely higher than the statistic due to cases of invisible abuse. Some of victims might stay silent due to fear or duress, or perhaps they either fail to recognize or actively do not acknowledge a related occurrence. Another possible cause is that they no longer have faith in the system and feel that it is disadvantageous for their welfare to expose the perpetrator.

As health workers preserve the health of the public, in the same vein, their health ought to be given just as much importance. The most crucial step in dealing with the abuse of women should be to devote time in making the environment safe for them. Policies and corrective action against gender discrimination must be implemented as strictly as they have been legislated. Controls need to be put in place to allow victims to freely give their testimonies with full confidentiality, and investigative efforts cannot be taken lightly.

Survivors must also be given assistance in coping with trauma as much as possible. It is taxing on both professionals and patients for medical facilities to be highly centralized in Metro Manila. Central hospitals become more congested throughout the years due to the influx of citizens from various regions, and patients from afar have no choice but to expend time, effort, and resources to be within the reach of quality care. Even though state-owned specialty hospitals were assigned a higher budget of ₱7 billion in 2023, all the efforts are concentrated within the city. No substantial funds were designated for the benefit of the provincial areas that need it most.

Many Filipinos perish every day without even getting the chance to seek professional help. Government action in establishing healthcare institutions across the country is urgently needed to accommodate as many citizens as possible. Satellite hospitals with specialized services is a long-term, feasible course of action that supports the welfare of marginalized communities in rural areas untouched by modern medical intervention. While there may be investments every year in the health sector, the problem still lies
within insufficiency and lack of strategy in properly allocating resources to diminish inequality and lifestyle gaps between those in the rural and urban areas.

Braving Future Health Crises

The pandemic served as a grave harbinger—exposing the many weaknesses within our public healthcare system that forewarns our critical susceptibility to future threats. With the multitude of outbreaks in the past such as cholera, smallpox, and the bubonic plague, it should no longer be surprising that another health crisis is inevitable. It is not matter of if; rather, it is matter of when it will happen, whether it be a century, decades, or merely a few years from now.

We must emphasize the people. Regardless of any structural enhancement or regulatory intervention, no progress can be made without investing in our health workers and renovating their confidence in the system. It is only through our professionals that the nation will be able to fend off the imminent dangers to mankind. Global coordination, investments in research and development, and formulation of other strategies should be secondary in nature.

It is time to be proactive instead of reactive. By investing in our health workers’ well-being, we are also preserving public health and the nation’s welfare. In the end, it is in everyone’s best interest to reward resilience not only with gratitude—but also with redress.