MANILA, Philippines — Close to 40 percent of the poorest municipalities in the country are “doctorless,” a government health official told senators on Friday, noting that most doctors are “discouraged” to serve in low-income class areas due to wage disparities.
During a Senate local government committee hearing, Department of Health (DOH) Undersecretary for Administration and Financial Management Roger Tong-An said 38.46 percent of 6th class municipalities in the Philippines do not have doctors.
He added that in the Bangsamoro Autonomous Region in Muslim Mindanao alone, 36 of its municipalities are “doctorless.”
“A doctor hired by the local government unit (LGU) of a 6th class municipality is entitled to receive only 65 percent of what an equivalent doctor working for the national government receives,” Tong-An pointed out.
“This has discouraged doctors to serve in low-income class municipalities or the geographically isolated and disadvantaged areas,” he added.
The health official said that among the reasons why LGUs of rural areas “may find themselves limited in paying their doctors sufficiently” are because of two existing laws. Tong-An cited Section 325 of the Local Government Code, which caps the total appropriation of LGUs for personal services at 45 to 55 percent.
“This limits the number of doctors that can be hired and even [the] appropriation of their benefits,” he said.
He also pointed to Section 10 of Republic Act No. 6758, or the Compensation and Position Classification Act of 1989, which defines the rates for pay in LGUs depending on their class and financial capability.
Currently, 372 doctors are deployed under the DOH’s “Doctors to the Barrios” (DTTB) program, with more than half serving in 4th to 6th class municipalities, Tong-An said.
The committee was tackling, among others, Senate Bill No. 446 which seeks to grant incentives and other benefits to rural doctors.
“The DOH appreciates the intent of the bill to accord benefits to doctors serving in rural areas. Their service to the Filipino people deserves recognition and recompense from the state,” Tong-An said.
“The provision of benefits may attract doctors to serving in underserved areas. So the department recognizes that the intent of the bill comes from the disparities in pay and benefits between doctors in different cities’ income classes,” he added.
According to Union of Local Authorities of the Philippines (ULAP) president Quirino Governor Dakila “Dax” Cua, LGUs struggle to compete with the salary rates offered in national government hospitals.
“Ang nagyayari, yung mga doktor na—minsan pinapadala ng DOH, minsan nagha-hire kami ng mga doktor, ng nurses, lahat ng health workers—isang matinding issue ay ang layo kasi ng mga sweldo,” Cua said.
(What really happens, the doctors–either they were sent by the DOH or LGUs hire doctors, nurses, health workers–a major issue is that the salary gap is really wide.)
“Ang sweldo ng mga national government hospital or DOH hospitals is much higher than the salaries that are prescribed under the local government. Kaya yang mga doctors and nurses kapag nagtaas ng sweldo na naman ang DOH…nahahatak nila yung mga doktor, yung mga nurses. There’s really an issue there,” he added.
(The salary offered in a national government hospital or a DOH hospital is much higher than the salaries that are prescribed under the local government. That’s why the doctors and nurses, when the DOH increases salaries, they are encouraged to work there. There’s really an issue there).
“Yun ang isang rason, that is not the entire reason for the problem but that is one major problem that the LGUs are facing regarding the health personnel,” he further added.
(That is one of the reason, that is not the entire reason for the problem but that is one major problem that the LGUs are facing regarding the health personnel.)
Cua said he and the DOH have had several dialogues on the matter.
“Di naman namin sinasabing wag kayong magtaas, pero siguro kung pwede niyo kaming matulungan din dahil ‘di kaya ng LGUs na makipagsabayan sa national government or sa DOH pag nagtaasan na nga mga sahod ang national government,” the governor said.
(We are not saying that they should not increase the salary they offer to health professionals, but maybe they could also help because the LGUs can’t really afford to be at par with the national government or the DOH in terms of pay rate.)
Senator Francis Tolentino, who presided over the hearing as chair of the Senate local government panel, then suggested that funds from the national government can be “downloaded” to concerned LGUs.
Cua agreed with the senator’s proposal.
“Tama po yung nasabi niyo. Kung puwedeng magkaron ng mekanismo na magkaroon ng subsidy ang DOH for the LGUs to maintain or augment the resources or subsidize or i-provide na lang yun salary,” he said.
(You are correct. Maybe there could be a mechanism where the DOH could give subsidies to the LGUs to maintain or augment the resources or subsidize or provide for the salary).
“Hindi lang po dahil kulang ang pera dahil minsan po yung 45, 55 personal cap according to the Local Government Code isa ring nagiging issue yan,” he added.
(It’s not only the lack of funds but another issue is the 45 to 55 percent cap provided under the Local Government Code.)
Meanwhile, national president of the Association of Municipal Health Officers in the Philippines Dr. Clemencia Dilag-Bondoc said that doctors serving in rural areas should ideally receive P80,000 to 90,000 in monthly salary.
However, she noted that the majority of rural doctors are still receiving P50,000 and below
“As most stay at home, and keep safe during this global pandemic, here we are rural health doctors fighting the unseen enemy and yet not even enough protection,” Dilag-Bondoc further said.