National Human Resources for Health Master Plan 2020-2040

FINAL | JUNE 30, 2020 Human Resources for Health Philippine Masterplan 2020-2040

ACKNOWLEDGEMENTS The National Health Human Resource Master Plan was developed with support from the United States Agency for International Development (USAID) through the HRH2030 Program, and the World Health Organization (WHO).

Cover photo: Dr. Redentor Rabino, one of the first doctors to the barrios in Bongao, Tawi-tawi, conducts the Snellen’s test to one of his patients. (Credit: Blue Motus, USAID HRH2030/Philippines)

June 30, 2020

Contents

Contents ........................................................................................................................................................................................ ii List of Tables .................................................................................................................................................................... ii List of Figures ................................................................................................................................................................... ii Acronyms ..................................................................................................................................................................................... iii Executive Summary .................................................................................................................................................................... vi Philippine Context ....................................................................................................................................................................... 1 Country profile ................................................................................................................................................................ 1 Philippine Health Workforce ........................................................................................................................................ 1 Philippine HRH Challenges ............................................................................................................................................ 1 National HRH Masterplan .......................................................................................................................................................... 3 Background and Methodology ...................................................................................................................................... 3 Vision, Mission, Goals of the Masterplan.................................................................................................................... 4 Guiding Principles ............................................................................................................................................................ 5 Theory of Change and Results Framework ............................................................................................................... 5 Short term plan (2020-2022) ........................................................................................................................................ 7 A. Short term risk-based scenario descriptions ............................................................................................................ 7 B. Strategic focus in the short term ................................................................................................................................. 7 C. Strategies in the short term ......................................................................................................................................... 7 D. Implementation plan....................................................................................................................................................... 8 E. Budget/Resources .......................................................................................................................................................... 17 F. Monitoring and evaluation ........................................................................................................................................... 20 Medium term plan (2023-2028) ................................................................................................................................. 22 A. Medium term risk-based scenario descriptions ..................................................................................................... 22 B. Strategic focus in the medium term .......................................................................................................................... 22 C. Strategies in the medium term .................................................................................................................................. 23 D. Budget/Resources ......................................................................................................................................................... 24 E. Monitoring and evaluation ........................................................................................................................................... 24 Long term plan (2029-2040) ....................................................................................................................................... 26 A. Long term risk-based scenario descriptions ........................................................................................................... 26 B. Strategic focus in the long term ................................................................................................................................. 26 C. Strategies in the long term ......................................................................................................................................... 26 D. Budget/Resources ......................................................................................................................................................... 27 E. Monitoring and evaluation ........................................................................................................................................... 27 Governance and Accountability ................................................................................................................................. 28

Policy environment and support ................................................................................................................................ 32 Communications plan ................................................................................................................................................... 37 Monitoring and evaluation ........................................................................................................................................... 40 End Notes.................................................................................................................................................................................... 44 Appendices .................................................................................................................................................................................. 46 Appendix A. Logical Framework Matrix for Short-term Strategies ................................................................... 47 Appendix B. Assessing strategies to localize the national HRH Masterplan ..................................................... 88 Appendix C. Cost Assumptions for Short-term Strategies .................................................................................. 90 Appendix D. Costing matrices for Short-term Strategies .................................................................................... 93 Appendix E. About the HRH Network .................................................................................................................... 99 Accompanying Documents ................................................................................................................................................... 100

List of Tables Table 1. Timeline of preparatory activities of the HRH Masterplan .............................................................................................. 10 Table 2. Proposed implementation schedule of short-term strategies ......................................................................................... 11 Table 3. Summary of estimated cost, Strategic Objective 1 ............................................................................................................ 17 Table 4. Summary of estimated cost, Strategic Objective 2 ............................................................................................................ 18 Table 5. Summary of estimated cost, Strategic Objective 3 ............................................................................................................ 18 Table 6. Summary of estimated cost, Strategic Objective 5 ............................................................................................................ 19 Table 7. Summary of estimated cost, Strategic Objective 7 ............................................................................................................ 19 Table 8. Technical Working Committees of the HRH Network ................................................................................................... 29 Table 9. Proposed Technical Working Committees for the HRH Masterplan 2020-2040 implementation ......................... 29 Table 10. Legislations and policies with provisions supportive of each strategic objectives .................................................... 34 Table 11. Proposed policy agenda ......................................................................................................................................................... 36 Table 12. Key elements of the communications plan ........................................................................................................................ 37 Table 13. Balanced scorecard indicators of the HRH Masterplan .................................................................................................. 41 Table 14. Timetable for Evaluation Activities ..................................................................................................................................... 43

List of Figures Figure 1. Process Diagram on Developing HRH Masterplan .............................................................................................................. 3 Figure 2. Theory of change of the HRH Masterplan ............................................................................................................................ 6 Figure 3. HRH Masterplan 2020-2040 results framework .................................................................................................................. 6 Figure 4. Implementation framework .................................................................................................................................................. 16 Figure 5. Proposed governance and management system of the HRHMP 2020-2040 ............................................................... 30 Figure 6. Accountability framework of the HRHMP 2020-2040 ..................................................................................................... 32 Figure 7. Policy support to identified HRH strategies per Strategic Objectives ......................................................................... 33

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Acronyms

AO Administrative order BHERT Barangay Health Emergency Response Team BHS Barangay health stations BHW Barangay health worker BNS Barangay nutrition scholar BSC Balanced scorecard CHED Commission on Higher Education CFO Commission on Filipinos Overseas CHD Center for Health Development CHEEG CPD High Commission on Health Worker employment and Economic Growth Continuing Professional Development CPG Clinical practice guidelines CSC Civil Service Commission DBM Department of Budget and Management DFA Department of Foreign Affairs DICT Department of Information and Communications Technology DILG Department of Interior and Local Government DND Department of National Defense DOF Department of Finance DOH Department of Health DOLE Department of Labor and Employment DOST Department of Science and Technology FHSIS Field Health Services Information System FLO Flexible learning option GIDA Geographically isolated and disadvantaged areas HCPN Health care provider network HEI Higher Education Institution HFDP HHRDB Health Facility Development Plan Health Human Resource Development Bureau HRH Human resources for health HRHMP Human Resources for Health Masterplan IACEH Inter-Agency Committee on Environmental Health IRR Implementing rules and regulation

LCE LFA Local chief executives Logical framework approach LGC Local Government Code LGU Local government unit LIPH Local Investment Plan for Health M&E Monitoring and evaluation MDG Millenium Development Goal NCD Non-communicable diseases NDHRHIS National Database of Selected Human Resources for Health Information System NEDA National Economic and Development Authority NGO Non-government organization NHWA National Health Workforce Account NHWR National Health Workforce Registry NOH National Objectives for Health OSH Occupational safety and health OWWA Overseas Workers Welfare Administration PDP Philippine Development Plan PGH Philippine General Hospital PHB Provincial Health Board PHC Primary health care POEA Philippine Overseas Employment Administration PPE Personal protective equipment PRC Professional Regulation Commission PS Personal services PSA Philippine Statistics Authority QA Quality assurance RA Republic Act RSA Return service agreements SA Situation analysis SDG Sustainable development goals SGLG Seal of Good Local Governance SO Strategic objective SUC State universities and colleges TESDA Technical Education and Skills Development Authority TWC Technical working committee

UHC Universal Health Care UP University of the Philippines USAID United States Agency for International Development WHO World Health Organization WISN Workload indicators of staffing needs

Executive Summary Inspired by the passage of the Universal Health Care (UHC) Act in 2019, the 2020-2040 Human Resources for Health (HRH) Masterplan will serve as a long-term strategic plan for the management and development of HRH. The development of this overarching document is guided by the whole of society and whole of government approach to meet the desired HRH outcomes stipulated in b-- UHC Act. The Masterplan shall address “outcomes pertaining to sustainable production, appropriate skill mix retention in the health sector, equitable distribution and practice-ready training and education for HRH” and contribute to the achievement of universal health care and the improvement of the country’s health outcomes. The law further stipulates that the HRH MasterPlan will be implemented through a multi-stakeholder Human Resources for Health (HRH) Network, composed of both public and private organizations and agencies, to formulate and oversee the sustainable implementation, monitoring, periodic evaluation, and reformulation of the National Health Human Resource Master Plan.
Consistent with the UHC Act, the goal of the 2020-2040 HRH Masterplan is to provide policies and strategies for the appropriate generation, recruitment, retraining, regulation, retention, and reassessment of the health workforce based on population health needs. The HRH Masterplan defines the current situation of HRH in the Philippines, the strategies that will address the issues that impact on the performance of the HRH and the health sector, the governance and accountability mechanism among the HRH stakeholders, the monitoring and evaluation mechanism that will track the progress of its implementation, and the communication plan to guide its dissemination. The Masterplan will be progressive, technically, economically feasible and sustainable document with sufficient details for implementation and operationalization to guide the health sector to achieve better HRH management and development. As a key initiative that will address the prevailing issues that confront HRH and simultaneously address current critical health issues such as COVID19, the HRH Masterplan posits that: if fit for practice and fit for work HRH with rural background are provided scholarships and developed near their places of origin; provided decent work, learning and development opportunities, and improved working conditions with their protection and well-being in mind; then HRH in the Philippines will contribute to the improvement of the health system performance and to the improvement of individual and population health outcomes. This is the theory of change that underlies the HRH Masterplan. The 2020-2040 HRH Masterplan is composed of three sub-plans. Each sub-plan defines the scenarios that need to be addressed, strategic foci of the HRH management and development interventions to address the identified HRH issues, resource requirements, and monitoring and evaluation considerations.
Short-term Plan The short-term plan (2020 to 2022) is defined based on the current health scenarios that the Philippine health system must respond to. The short-term plan includes an implementation plan defining the activities, schedule, budget and resource requirements, and the monitoring and evaluation considerations. The strategic foci for the first 2 years of implementing the HRH Masterplan are to: • Produce adequate number of quality HRH to support national and local health system needs
• Recruit and retain sufficient number of HRH towards attaining equitable distribution of HRH at all levels of the health care system
• Promote decent work and protection for HRH • Build HRH capacities to deal with triple disease burden, prevent and control emerging & re-emerging diseases, and respond to health emergencies • Establish HRH systems to support strategic health system goals (e.g., HRH governance, information systems, health technologies, etc.) • Engage policy makers and key stakeholders, at national and local levels, to substantially invest in the health workforce • Engage communities to participate in providing health promotive and disease preventive care for families (by raising awareness and capacity building) Strategic objectives and corresponding strategies have been determined and aligned with the abovementioned strategic foci: Strategic objective 1 (SO 1) Install systems that will improve recruitment of HRH fit for practice and fit for work to sustainably produce and deploy HRH and to promote greater HRH retention in the health sector leading to adequate and equitable HRH distribution vis-à-vis local health needs SO 1 comprise of four production strategies in the short-term that embeds retention in order to produce adequate number of HRH and reduce inequitable HRH distribution. The strategies address where future HRH should be educated, the admission guidelines of

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HEIs, providing scholarships linked to return service agreements (RSAs), and re-orienting current curricula to emphasize primary health care, exposure and immersion to rural topics and practice, and the use of technology. The development of a new range of skill sets, particularly in the delivery of health services using technology, has been incorporated in the strategy on re-orienting curricula. This is vital in public health emergencies such as the ongoing pandemic. Strategic objective 2 (SO 2) Create and sustain systems for developing HRH competencies and the careers of health workers to improve productivity and responsiveness, and to promote greater HRH retention Part of the workforce strategies in the short-term, SO 2 focuses on a) improving HRH competencies by enabling them to engage in learning and development through traditional and alternative learning methods including the use of technology, and providing coaching, mentoring, and supportive supervision; and, b) developing the careers of volunteer and professional health workers. The strategies will improve HRH productivity and responsiveness in the workplace and promote greater retention.
Strategic objective 3 (SO 3) Raise HRH productivity and responsiveness by promoting job satisfaction and motivation at all levels and improve greater HRH retention SO 3 comprises of short-term strategies on the creation of permanent positions in response to health sector needs and standardizing positions, compensation, benefits, and incentives. The creation of permanent positions will respond to the issue of inadequate HRH in the sector and both strategies will improve job satisfaction and motivation. Three other strategies that will promote job satisfaction and motivation are: ensure the well-being of HRH including their protection, ensure compliance with occupational safety and health standards and infection and prevention control initiatives to improve conditions in the work setting (e.g. telehealth, telemedicine), and ensure that health facilities have the appropriate skills mix. These three strategies will also enable a better response to public health emergencies such as the current pandemic that is COVID19. Strategic objective 5 (SO 5) Strengthen information systems/data on HRH for monitoring, informing decision making, and ensuring accountability SO 5 includes short-term strategies on improvement of HRH information systems to ensure up-to-date and accurate information, and the carrying out of HRH-related research. These speaks to the need for evidence that will regularly inform decision-making and accountability. Strategic objective 7 (SO 7) Increase investments in HRH and align investments with current and future population health needs and of health systems SO 7 comprises of strategies in the short term that aim to increase investments in HRH and HRH systems and build fiscal capacity in order to respond to current and future population health needs and of health systems. Medium-term Plan The medium-term plan (2023 to 2028) shall focus on strategies that will:
• Sustain production of practice-ready health workforce
• Promote recruitment, and equitable distribution of quality HRH working in underserved areas • Retain appropriate skill mix in national and submational health systems • Support career development an advancement of HRH in the health sector • Enhance HRH competencies to deal with triple disease burden and to prevent and control emerging & re-emering diseases, including strengthening health emergency response teams. • Improve working conditions to motivate health workers to practice in underserved areas • Optimize existing health workforce • Increase health literacy The corresponding strategic objectives and strategies are as follows: Strategic objective 1 Install systems that will improve recruitment of HRH fit for practice and fit for work to sustainably produce and deploy HRH and to promote greater HRH retention in the health sector leading to adequate and equitable HRH distribution vis-à-vis local health needs

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Production strategies under SO 1 launched in the short-term will be sustained, while introducing two more strategies: a) establish inter-profession education (IPE) and training in universities and institutions, and b) provide incentives to HEIs (e.g., tax breaks and subsidies) to ensure quality graduates and provide scholarship grants. Strategic objective 3 (SO 3) Raise HRH productivity and responsiveness by promoting job satisfaction and motivation at all levels and improve greater HRH retention In the medium term, strategies launched in the short-term will be sustained, while sustaining improved health outcomes through standardize care via the implementation of national Clinical Practice Guidelines (CPGs) for priority health conditions. Strategic objective 4 (SO 4) Foster sustained intersectoral collaboration/co-development to develop responsive and coherent plans and policies among health and non-health agencies and organizations to generate shared goals, synergize functions, and produce collective impact Implemented in the medium term, SO 4 focuses on health worker migration policies and programs that should factor in the population health needs of the country, strengthen meaningful private sector regulation particularly in HRH production and employment, and align policies on production, employment, and migration. The nature of these strategies requires close and sustained collaboration and co-development in order to achieve shared goals. Strategic objective 6 (SO 6) Build the capacity of institutions for effective public policy stewardship, leadership, and governance In the medium-term, the HRH Network will be strengthened by expanding its membership and improving representation from a wide array of HRH stakeholders. Other short-term cross-cutting strategies such as on investments in HRH, HRH systems, and technology, improving fiscal capacity, and conducting research will also be continued to ensure that gains are sustained. Long-term Plan The long-term plan (2029-2040) shall focus on strategies that will: • Develop highly competent and motivated HRH who are responsive to individual and population health needs • Retain HRH for the needs of the health system at national and local levels • Institutionalize governance, financing, regulation and information systems for HRH management and development • Support progressive investments for HRH
• Provide sufficient resources and srong legislative or policy support to HRH rights, benefits and welfare • Ensure that Filipinos share accountability for their individual, family and community health outcomes The strategic objectives and strategies for the long term include:
Strategic objective 2 (SO 2) Create and sustain systems for developing HRH competencies and the careers of health workers to improve productivity and responsiveness, and to promote greater HRH retention In the long-term plan, institutionalizing the short-term and medium-term plan strategies are vital. It is also important to identify and implement appropriate activities to facilitate cooperation and support among health workers across HCPNs and the development of professional and health worker networks. This will reduce of professional isolation, promote learning among health workers, and encourage communities of practice. Strategic objective 3 (SO 3) Raise HRH productivity and responsiveness by promoting job satisfaction and motivation at all levels and improve greater HRH retention In the long term, strategies launched in the short-term and medium term should be sustained, while introducing, facilitating and regulating an enhanced and more aligned scopes of practice to health workers’ function and population health needs. Strategic objective 6 (SO 6) Build the capacity of institutions for effective public policy stewardship, leadership, and governance In the long term, strategies began in the medium term will be sustained. Additionally, the following strategies will be introduced: building HRH development and management capacity at all levels of the health sector; and establishing, and strengthening where present, quality assurance (QA)/ accountability mechanisms in health facilities. These will build capacity in public policy stewardship and improve leadership and governance.

Implementation plan There are necessary preparatory activities for the short-term plan that should be carried out prior to the implementation of the Masterplan strategies. These relate in particular to the Masterplan’s governance and management, establishing collaboration mechanisms, determining the extent of policy support for the strategies, addressing barriers (e.g. funding, time, people) identified during the consultations, disseminating the Masterplan and obtaining buy-in among different stakeholders, creating localized plans, and developing a monitoring and evaluation system. These are proposed to be done in 2020. A priority in the Masterplan implementation are workforce strategies that will help contain the COVID19 pandemic and protect and ensure the well-being of HRH during this public health emergency and other like it in the future. In the proposed implementation schedule, workforce strategies targeted for 2020 are those that offer alternative learning development approaches, ensure well-being of health workers including compliance with occupational safety and health (OSH) standards and exploring digital health, and ensuring the presence of appropriate skills mix in health facilities. The strategies on creating permanent positions and standardizing positions, competitive compensations, benefits, and incentives will be implemented in the medium-term. However, the strategy is included in the short-term as certain activities need to be started right away. For instance, activities such as broadcasting widely unfilled government and private HRH positions, reviewing existing policies relevant to the creation of positions, etc. are expected to start in the next two years. Initiating activities in the short-term can help ensure its achievement in the medium-term. The implementation of cross cutting strategies on investments and HRH information systems are targeted for 2021. It is necessary to implement these soonest as the cross-cutting strategies will help improve the successful implementation of the production and other workforce strategies. This is particularly true regarding the timely availability of resources, and access to accurate and up-to-date HRH information. Indicative cost of the Masterplan The indicative cost in implementing eighteen strategies under the five strategic objectives covered by the short-term plan is estimated at PHP 8.3 Billion. Of the estimated total indicative cost, 15% of the cost estimate is for production strategies, 82% is for workforce strategies, and 3% is for cross-cutting strategies. This was derived based on cost drivers for activities of each strategy under the strategic objectives for production, workforce and cross-cutting concerns. The main cost drivers identified for each activity are remuneration and operational cost. Remuneration refers to the amount allocated for labor work to carry out an activity, while operational cost is the amount allocated for direct cost (except labor) to implement an activity. This cost estimate does not yet include the cost of projected staffing needs for the short-term. Governance and accountability To implement the Masterplan, the current organizational structure of the HRH Network structure (three technical working committees (TWCs) with the themes of HRH Entry, HRH Workforce, and HRH Exit and Re-entry and an Oversight Committee) is proposed to be reconfigured and assume the functions necessary to implement the Masterplan. The Masterplan’s strategies can be categorized consistent with the foci of the TWCs: production, workforce, and exit and re-entry. Due to the similar nature of committees and the strategies, each TWC can assume the broad functions of coordination, monitoring and evaluation of the strategies’ implementation. The implementation of cross cutting strategies can be taken on by another committee which will be formed for this specific purpose with the same broad functions as the other TWCs. Membership in each TWC will be unique to avoid unduly creating confusion, and additional and/or overlapping workloads for members. However, reconfiguring the TWCs and their functions will entail revisiting the memorandum of understanding among the members of the HRH Network. The Masterplan adapts the WHO’s three components in its accountability framework: governance, results-based management, and an assurance mechanism. Governance of the HRH Masterplan takes place at the national and local levels and spans across planning, implementation, and reporting. The HRH Network and HHRDB will work closely together to manage and coordinate the implementation at the national level while the implementation of the Masterplan at local levels will be led by Provincial/City Health Boards (P/CHBs). The HRH Network and HHRDB will work closely with P/CHBs in the implementation of the Masterplan. Results- based management is embedded in the Masterplan through its logical framework approach (LFA) matrix that has been developed for all strategies across the strategic objectives. For each strategy, activities, outputs, and outcomes have been identified with corresponding indicators. In addition, the stakeholders that will be critical to the attainment of the strategies have been identified. The LFA can become a binding document if the stakeholders formally recognize it as such. The Masterplan is a collaborative endeavor where its successful implementation relies on mutual accountability and responsibility. The last component, quality assurance, can be found in the accountability mechanisms (e.g. Seal of Good Local Governance, DOH Scorecard, Primary Care Scorecard) that have been identified. In addition to scorecards, the P/CPHBs have a key role to play in the accountability framework. Integral to their functions is the exercise of technical and administrative supervision over HRH within their respective territorial jurisdiction. This reinforces the role of local health boards as outlined in the 1991 LGC which is to propose annual budgetary allocations for the operation and maintenance of health facilities and services; and, create committees which shall advise local health agencies on matters such as personnel selection and promotion, grievance and complaints, personnel discipline, operations review, and similar functions.

A critical input to the three components of the accountability framework is the data that will be produced by the Masterplan’s monitoring and evaluation system. Besides informing national and local level planning and implementation of the Masterplan, the data will be a critical input into reports about the HRH components of the 2018 UHC law, NOH 2017-2022, the 2017-2022 PDP, and Goal 3 of the SDGs. Communications plan To facilitate soliciting inputs and the commitment of a wide range of HRH stakeholders who need to be involved in the Masterplan, a communications plan was developed. The communications plan aims to widely disseminate the Masterplan among stakeholders and the general public, obtain support for the implementation of the Masterplan, and ensure the appropriate implementation especially at the national and local levels. These will be achieved by shaping and delivering key messages using various communication channels and materials that are known to work, and tailoring the messages to resonate with the targeted audience and bring about desired changes. Monitoring and evaluation To determine to what extent the theory of change is achieved and to establish its validity, monitoring and evaluation activities will be made integral to the Masterplan. A balanced scorecard (BSC), a widely accepted approach to monitoring and evaluation (M&E), has been crafted for the HRH Masterplan. The BSC includes a set of high-level quantitative indicators across five dimensions and for each of the strategic objectives of the Masterplan that have been identified. These high-level indicators will show the progress towards the accomplishment of the mission and goals of the Masterplan and have been used in the development of indicators for each strategy in the logical framework approach (LFA) matrix.

1 Philippine Context Country profile1 The Republic of the Philippines, an archipelago situated in Southeast Asia, consists of more than 7,600 islands that are broadly categorized into three geographical divisions: Luzon, Visayas, Mindanao. Over 80% of the population are Catholics and the rest comprise of Muslims, other Christian denominations, Buddhism and other religions. The country’s gross domestic product, which was $355.5 billion in 2019,2 is expected to decline due to COVID19, the first contraction in two decades.3 In 2020, the estimated population is 109.9 million, of which 54.7% live in rural areas.4 5 Literacy rates stand at 98.3%, one of the highest in Southeast Asia.6 7 In October 2019, the unemployment rate was at 4.5%.8 The proportion of the population living below the poverty threshold of PhP10,727 was at 16.6% or 17.6 million Filipinos in 2018.9 Filipinos are living longer, from 67 years in 2000 to a projected 72 years in 2020.10 Non-communicable (NCDs) and communicable diseases were the top 10 causes of mortality in 2016 in the Philippines. NCDs include ischemic heart disease, neoplasms or cancer, cerebrovascular diseases or stroke, hypertensive diseases, diabetes and other heart diseases, and communicable diseases like pneumonia, respiratory tuberculosis and chronic lower respiratory infections. On the other hand, the leading causes of morbidity in 2016 were all communicable diseases such respiratory infection, acute lower respiratory tract infection and pneumonia, except for hypertension. Filipinos bear a triple burden of disease with the high prevalence of communicable disease, increasing NCDs, and from injuries and accidents.11

Philippine Health Workforce The number of HRH who renewed their professional identification cards with the Professional Regulation Commission (PRC) data was 861,89112 in 2020 suggesting that the health sciences education sector produces enough health workers for the Philippine health system. However, data from National Database of Selected Human Resources for Health Information System (NDHRHIS), Field Health Service Information System (FHSIS), and the Department of Health (DOH) Deployment Program as of 2019 indicate that there are 189,204 HRH or 28% of the total, representing 13 cadres in the health system.13 The remaining 672,687 HRH or 72% that renewed their PRC ID have unspecified practice. There are many indicators of the demand for HRH in the local health system. Data from the DOH-Personnel Administration Division (PAD) as of December 2019 show that there are 5,405 unfilled positions in the Department, covering the Central Office, Centers for Health Development retained hospitals and treatment and rehabilitation centers.14 An estimated 25% of all barangays in the Philippines do not have any health workers.15 When compared to the World Health Organization (WHO) estimate of 44.5 per 10,000 population needed to achieve coverage of sustainable development goals (SDGs), there is a gap of about 25 HRH per 10,000 population in 2018 in the Philippines. The workload indicators of staffing needs (WISN) study in 2019 estimated requirement of 240,780 physicians, nurses, midwives, and medical technologists in all rural health units (RHUs) and 12,950 nurses and midwives in barangay health stations (BHS) to strengthen primary care services.16 In response to the COVID19 pandemic, provincial targets established by the DOH include at least: one epidemiology and surveillance officer for every 100,000 population, one contact tracing personnel for every 800 population, Barangay Health Emergency Response Teams (BHERT) for every 1,000 population, and 10 trained testing staff. Health care services in the Philippines is delivered by a composite of public and private health facilities. Funded mainly by a tax-based budgeting system, PhilHealth capitation, and user fees, the public sector delivers health care through national and local government health facilities. At the national level, the DOH supervises the government retained corporate hospitals, specialty, regional hospitals, and selected primary hospitals, while the Department of National Defense (DND) operates the military hospitals and the University of the Philippines (UP) Manila is in charge of the Philippine General Hospital. Beginning with the devolution of health services in 1991, the provincial governments operate the district and provincial hospitals, and municipal governments provide primary care through rural health units, health centers, and barangay health stations. Highly urbanized cities provide hospital and primary care services through city health centers. The private sector exacts user fees for health care at the point of service.17 In 2019, there were 1,198 public and private hospitals, 22,613 barangay health stations, 2,596 rural health units, 253 primary care facilities, 674 infirmaries, and 1,906 birthing homes.18

Philippine HRH Challenges There are standalone reports and studies that serve as the basis in the preparation of the HRH Masterplan. These include a Situation Analysis Report, a Strategy Paper, the HLMA Report, and the Policy Omnibus Review Report. From the situation analysis (SA) of the HRH Masterplan, the core problem identified was the lack of fully functional integrated HRH systems including information systems, production and deployment planning, professional development, attractive compensation packages, management and regulation, and

sustainable deployment. Two of its major effects (i.e. inadequate number and inequitable HRH distribution) and four key causes of the core problem will be addressed by the Masterplan.  Inadequate number of health workers in the health sector. This caused in part by fewer number of graduates in the health sciences due to high attrition rates; the limited number of decent jobs in the health sector; unclear career paths of health workers; the inadequate support for health workers’ health, safety, and well-being; and the increasing demand for Filipino health workers in destination developed countries.  Inequitable distribution of HRH. Factors affecting maldistribution include the inadequate remuneration in low income class municipalities; disparities in salary between private and public sectors, and national and local levels; and the inability of some local government units (LGUs) to absorb health workers such as those who are deployed. In addition, the poor working conditions and the characteristics of the place of assignment that increase their personal risks can affect retention adversely.  Lack of accurate HRH information to guide planning and policy. The currently available data on the number of health workers in the country is not up to date, comes from disparate information systems, and does not accurately reflect the actual numbers. There is no data on health workers that are out of work or unemployed nor data on number of migrants and those who return from working abroad. There is no single integrated source of HRH related data and information.  Limited collaboration among stakeholders with multiple roles in the HRH sector. Many of the HRH stakeholders operate independently. The HRH Network was established in order to act as an integrating mechanism for discussing issues, policy making and carrying out collaborative decision making, data sharing, and policy implementation, among others. But its effectiveness can still be improved.
 Fragmented HRH governance and unclear accountabilities. The DOH is responsible for the recruitment of health workers at the national level, the Deployment Program, and for DOH retained hospitals. On the other hand, LGUs have the responsibility of staffing field health facilities. Locally recruited HRH are not always adequately compensated, provided benefits or given security of tenure, which can be traced to policy issues such as the personnel services (PS) cap mandated in the 1991 Local Government Code (LGC), and the income of municipalities and provinces. The private sector, while guided by the policies, standards, and programs established by the DOH, operates independently and are not necessarily aligned to DOH directions.  Lack and poor implementation of policies. There are several policy gaps and issues such as on competency standards and skills mix, effective deployment of HRH, strengthening health leadership and performance management systems, among others. Additionally, there are policy gaps in the development of HRH information systems. There is poor implementation of HRH policies. There is a lack of consistency and strategic coherence in linking critical policies between health, education, labor, and other sectors. Policies emanating from non-health sectors especially the economic and financial sector also impact the HRH sector.

National HRH Masterplan Background and Methodology The passage of the Universal Health Care (UHC) Law in 2019 is the legal basis that underpins the crafting of the Human Resources for Health Master Plan (HRHMP) 2020-2040. It will serve as an overarching document that guides the whole of society and whole of government to meet the human resources for health (HRH) component of the UHC goals. The HRHMP addresses the need to improve the country’s health outcomes and achieve UHC. To do so, it is critical to have a sufficient number of ‘appropriately skilled and motivated, equitably distributed and well supported health workers in the system.19 20
The HRHMP is aligned with the vision of Filipinos to be among the healthiest people in Asia by 2040 as presented in AmBisyon Natin 2040. It is also consistent with the strategic goals of the National Objectives for Health (NOH) 2017-2022 and the Philippine Development Plan 2017-2022, particularly in improving health outcomes, and improved responsiveness of the health system to Filipinos’ health needs. The preparation of the HRH Masterplan involved several major activities: conduct of a situation analysis, strategy development, drafting a blueprint, an omnibus policy review, preparing a communication plan, developing a balanced scorecard and a logical framework approach, formulating an accountability framework, and estimating the indicative costs of the activities of the short-term strategies (Figure 1). Through all this, the HRHMP development was designed to be a co-development endeavor primarily with the DOH-Health Human Resource Development Bureau (HHRDB) and secondarily with the HRH network. Consultations and validation meetings were conducted with the DOH, the HRH network and other stakeholders to derive a consensus on plan inclusions.
Figure 1. Process Diagram on Developing HRH Masterplan

There are several elements in the HRHMP 2020-2040 that distinguishes it from the previous masterplans:
 scenarios that included the impact of public health emergencies and crises for the short, medium, and long term were identified;  developed assessment criteria that will facilitate the implementation and adaptation of the Masterplan strategies to reflect local situations by local government units (LGUs);  designed short term, medium term and long-term strategies that align with UHC Act defined structures to improve primary health care delivery through health care provider networks (HCPNs);  incorporated a strategic communications plan;  established an accountability framework between and among HRH stakeholders to ensure effective monitoring and evaluation of HRHMP implementation; and,

 it is proposed to be included in the National Economic and Development Authority’s (NEDA) medium-term Philippine Development Plan.

Limitations In developing the HRH Masterplan, the following constraints were encountered: 1. Variance in available data In the preparation of the situation analysis, HRH data for 13 cadres was available only for 2018. However, historical data from
1990 to 2018 were available for physicians, nurses, midwives, and medical technologists because this was the scope of USAID’s HRH2030 Philippines.
2. Consultations to validate findings of situation analysis and strategies The results of the situation analysis and the strategies to address key issues determined in the situation analysis were validated with regional representatives (e.g. health workers from LGUs and barangay health workers (BHWs) representing the grassroots) and the HRH Network through a series of consultations. However, there was limited representation of high level officials from LGUs and the private sector in the consultations. 3. Scenario building For the short term, an HRH situation analysis helped define the scenarios. Additional strategies were identified to take into account the impact of projected scenarios of COVID19. For the medium and long-term, assumptions were made such as certain conditions will not have been resolved in the short-term (e.g. triple burden of Filipinos will continue to be an issue). Scenario building was based on the results of a limited review of available literature and existing documents. 4. Omnibus policy review  The content assessment used in the policy review did not consider whether policies are still in effect or are implemented in the country  International and regional policy instruments, like ASEAN declaration or commitments, that may have influence on the policy environment of Universal Health Care in the country were not included in the policy inventory.
 Any law or policy that may have HRH provisions but are not available online are not included in this review since the main source of the database search was conducted online.
5. Costing of HRH Masterplan activities  Assumptions used in the indicative costing only covered the minimum requirement in managing and monitoring the short- term activities identified in the logical framework approach (LFA) matrix.
 Estimating the cost for remuneration of regular staff and consultant considered the minimum staff composition to manage and monitor each activity. Rates used for costing remuneration requirements is based on National Budget Circular 579 issued on January 2020 implementing the first tranche of the modified salary schedule for civilian personnel in the National Government  Estimating the operational cost considered the cost items critical to manage and monitor the activity. Cost of at least 1 critical intervention for each activity was also included.  Cost of interventions for production and workforce strategies only considered 4 cadres (doctor, nurse, midwife, medical technologist) due to limitation on data available as basis for cost assumptions  Costing of the projected staffing needed to carry out UHC implementation is not included in this report.
Vision, Mission, Goals of the Masterplan As stated in the UHC Law, the goal of the national 2020-2040 HRH Master Plan is to provide policies and strategies for the appropriate generation, recruitment, retraining, regulation, retention, and reassessment of the health workforce based on population health needs. The HRH Masterplan provides a picture of the current situation of the HRH sector in the Philippines, strategies that will address the issues that impact on the performance of the HRH and health sectors, an accountability mechanism among the HRH stakeholders, and a monitoring and evaluation system that will track the progress of the Masterplan’s implementation. The Masterplan development will be progressive, technically, economically feasible and sustainable, and will have sufficient details for implementation and operationalization to guide the health and health related sectors to achieve better HRH management.

Vision By 2040, all Filipinos shall have access to quality health services, provided by adequate number of competent, highly motivated, people- centered, and compassionate HRH who are enjoying decent work and competitive salaries, in a supportive environment without the need to work overseas.

Mission Ensure adequate/equitable and sustainable number of compassionate and responsive HRH at all levels to deliver health care through the continuum of promotive, preventive, curative, rehabilitative health interventions. Goals for HRH Management and Development  Develop highly skilled and highly motivated health workers  Ensure adequate and equitable distribution of health workers across the Philippines  Contribute in improving population health outcomes Guiding Principles The HRHMP will espouse the following principles in support of the national initiative towards provision of primary health care (PHC) for all Filipinos. The principles will be embedded in the strategic objectives and strategies of the Masterplan.  UHC principles including universality, equity, accountability, sustainability, participation, social solidarity, individual and mutual responsibility, transparency, and progressive realization.  Primary health care principles including equitable distribution, community participation, intersectoral coordination, and appropriate technology.  Ensuring a healthy, sustainable and productive workforce to improve positive patient experience towards improving population health and reducing cost of care.  Alignment of strategic directions. The Masterplan is aligned with HRH components of national and international goals and commitments thereby contributing to achieving better health outcomes.  Continuous monitoring and learning. Feedback is provided and lessons are learned from continuous review and evaluation of the quality, efficiency and effectiveness of the Masterplan’s strategies and activities, and the achievement of results in order to improve and strengthen performance. Theory of Change and Results Framework As a key initiative that will address the prevailing issues that confront HRH and simultaneously address current critical health issues such as COVID19, the HRH Masterplan posits that: if fit for practice and fit for work HRH with rural background are provided scholarships and developed near their places of origin; provided decent work, learning and development opportunities, and improved working conditions with their protection and well-being in mind; then HRH in the Philippines will contribute to the improvement of the health system performance and to the improvement of individual and population health outcomes (Figure 2). This is the theory of change that underlies the HRH Masterplan. A theory of change is a model of how and why interventions or initiatives are supposed to work or lead to change.21 22 23 24 Another way of looking at the theory of change is through the results framework (Figure 3). The Masterplan’s strategies are summarized according to the four dimensions of the balanced scorecard which are commonly used when applied to the private sector: customer, internal processes, financing, learning and growth or organizational capacity. Since the strategies are for the country’s HRH, partnership and collaboration as a dimension has been added, due to the sector’s multi-sectoral nature. Investments, collaborations (e.g. establishing information systems, conducting research, coherent policies among others), and fostering learning and growth among HRH will facilitate the necessary processes (i.e. recruitment and retention, sustainable HRH production, improved productivity and responsiveness) that will lead to adequate and equitable distribution of HRH. This will in turn impact positively on the stakeholders of the HRH sector ultimately leading to improved health outcomes.

Figure 2. Theory of change of the HRH Masterplan

Figure 3. HRH Masterplan 2020-2040 results framework

Source: Based on DOH Balanced Scorecard, AmbisyonNatin 2040 and the Philippine Development Plan 2017-2022

Short term plan (2020-2022) A. Short term risk-based scenario descriptions From the HRH situation analysis and a review of COVID-19 related reports, five major scenarios are identified that need to be addressed in the short term of the HRH Masterplan.

Filipinos have a triple disease burden: (1) a high prevalence of communicable disease, (2) increasing non-communicable diseases (NCDs), and (3) emerging rates of injuries and accidents.25 Communicable diseases such as acute respiratory infection, influenza, bronchitis, TB etc., remain dominant as the top leading causes of morbidity in the Philippines. On the other hand, NCDs such as ischemic heart disease, cerebrovascular disease, diabetes, etc. are the leading causes of mortality in the country. Based on data from the Philippine Statistics Authority, the number of road crash related deaths has been showing a year-on-year increase from 2006 to 2015, averaging 4% per year.26 The Philippines ranks third in the world in terms of exposure to disaster risks and thousands have died from disasters due mostly to trauma, drowning or crush-related injuries.27
Greater effort should be given to expand the health system capacity.28 29 30 There is a need to scale up hiring of HRH31 to deal with the triple burden of disease and to prevent and control emerging & re-emerging diseases and health crises, especially at the LGU level. The COVID19 pandemic has highlighted the inadequacies of the Philippine health system particularly in public health emergencies. Recently completed studies has recommended the expansion of the health system capacity including the scaling up of HRH recruitment at the national, regional, provincial and LGU levels. In support of the health system expansion to better respond to COVID19 and without ignoring the triple disease burden of Filipinos, it is critical to respond to the next two scenarios.

Use technology where available and feasible32 to prevent and control emerging & re-emerging diseases and health emergencies. 4. Better information systems yielding substantial data including research, which is key to better decision making and policies, are needed.33 34 5. COVID19’s major economic impact is the disruption in the production of goods and services in the country. NEDA estimates zero growth for the economy and possibly a decline due to stoppage in many business operations.35

B. Strategic focus in the short term In response to the current health scenarios that the Philippine health system must respond to, the following strategic foci is being proposed in the short term of the Masterplan:  Produce adequate number of quality HRH to support national and local health system needs
 Recruit and retain sufficient number of HRH towards attaining equitable distribution of HRH at all levels of the health care system
 Promote decent work and protection for HRH  Build HRH capacities to deal with triple disease burden, prevent and control emerging & re-emering diseases, and respond to health emergencies  Establish HRH systems to support strategic health system goals (e.g., HRH governance, information systems, health technologies, etc.)  Engage policy makers and key stakeholders, at national and local levels, to substantially invest in the health workforce  Engage community to participate in providing health promotive and disease preventive care for families (by raising awareness and capacity building)

C. Strategies in the short term Production strategies embed approaches to improving training and retaining future HRH.  Establish targeted admission practices in higher education institutions (HEIs)  Educate and train future HRH in or near their places of origin  Expand scholarships with enforceable return service agreement (RSA) that also offers incentives  Re-orient curriculum to PHC and integrate public health, rural health courses/ topics, rural exposure/immersion, and use of technology to deliver health services so that health science graduates are responsive to population needs

Workforce strategies focus on improving competencies and professional development, providing competitive salaries and benefits, improving work conditions including the use of technology to deliver health services, and ensuring the well-being of HRH  Create adequate permanent positions for HRH (including Barangay Health Workers [BHWs] & Barangay Nutrition Scholar [BNS]) in response to health sector needs

 Standardize health workers’ positions and competitive compensation, benefits and incentives such as supporting career progression, standardized, decent compensation and benefits, recognition and rewards system to improve job satisfaction and motivation (public and private sectors; national and local)  Ensure well-being of health workers including protection from emerging and re-emerging diseases (e.g. wellness programs, mental health, etc.)  Ensure compliance with minimum work environment standards by implementing occupational safety and health (OSH) standards and infection and prevention control initiatives  Ensure appropriate skills mix and roles/functions present in health facilities  Develop and implement career paths of health workers across the public and private sector from national to local levels (including recognition and award mechanisms)  Support career development of volunteer health workers (e.g. BHW, BNS, etc.)  Enable health workers to obtain appropriate skills, knowledge and attitudes through learning and in-service staff development methods  Enforce/strengthen the provision of coaching, mentoring, and supportive supervision to health workers

Cross cutting strategies cover improving HRH information systems and conducting research, and increasing investments in HRH and improving fiscal capacity  Generate resources for HRH from various sources (domestic, international, and other sources)  Invest in HR systems (education and training, recruitment, deployment and retention, etc.) to meet national and subnational needs  Develop fiscal capacity to absorb and utilize effectively and transparently both domestic and international resources for HRH systems in the public and private sector  Strengthen and integrate information systems to ensure up-to-date HRH data and data sharing across the HRH sector e.g. National Health Workforce Registry (NHWR), National Health Workforce Account (NHWA)  Undertake robust HRH research (including operations and evaluation research and analysis of health labor markets)

D. Implementation plan This section presents the different components in implementing the short-term plan of the HRH Masterplan that was derived using the logical framework analysis (LFA). LFA was combined with the Balanced Score Card Tool to derive measures and indicators of key strategies.

Strategic objective 1 (SO 1) Install systems that will improve recruitment of HRH fit for practice and fit for work to sustainably produce and deploy HRH and to promote greater HRH retention in the health sector leading to adequate and equitable HRH distribution vis-à-vis local health needs SO 1 comprises four production strategies in the short-term that embeds retention in order to produce adequate number of HRH and reduce inequitable HRH distribution. The strategies address where future HRH should be educated, the admission guidelines of HEIs, providing scholarships linked to RSAs, and re-orienting the current curricula to emphasize primary health care, exposure and immersion to rural topics and practice, and the use of technology. The development of a new range of skill sets, particularly in the delivery of health services using technology, has been incorporated in the strategy on re-orienting curricula. This is vital in public health emergencies such as the ongoing pandemic. Stakeholders involved in these set of strategies include Commission on Higher Education (CHED), PRC, HEIs, LGUs, the Congress, professional societies, student groups, and private and public health facilities.

Strategic objective 2 (SO 2) Create and sustain systems for developing HRH competencies and the careers of health workers to improve productivity and responsiveness, and to promote greater HRH retention Part of the workforce strategies in the short-term, SO 2 focuses on a) improving HRH competencies by enabling them to engage in learning and development through traditional and alternative learning methods including the use of technology, and providing coaching, mentoring, and supportive supervision; and, b) developing the careers of volunteer and professional health workers. The strategies will improve HRH productivity and responsiveness to population needs, in the workplace and promote greater retention.

Stakeholders involved include the DOH, Technical Education and Skills Development Authority (TESDA), PRC, Philippine Statistics Authority (PSA), Department of Interior and Local Government (DILG), LGUs, academe, health facilities, professional associations, public and private health facilities, and other agencies/ institutions that offer programs for volunteer health workers.

Strategic objective 3 (SO 3) Raise HRH productivity and responsiveness by promoting job satisfaction and motivation at all levels and improve greater HRH retention SO 3 is composed of short-term strategies on the creation of permanent positions in response to health sector needs and standardizing positions, compensation, benefits, and incentives. The creation of permanent positions will respond to the issue of inadequate HRH in the sector and both strategies will improve job satisfaction and motivation. Three other strategies that will promote job satisfaction and motivation are: ensure the well-being of HRH including their protection, ensure compliance with occupational safety and health standards and infection and prevention control initiatives to improve conditions in the work setting (e.g. telehealth, telemedicine), and ensure that health facilities have the appropriate skills mix. These three strategies will also enable a better response to public health emergencies such as the current pandemic that is COVID19. Stakeholders involved in these strategies include the DOH, DILG, LGUs, Department of Budget and Management (DBM), Department of Labor and Employment (DOLE), Civil Service Commission (CSC), PSA, HRH Network, Inter-Agency Committee on Environmental Health (IACEH) - Occupational Health Sector and Toxic and Hazardous Substances Sector, University of the Philippines (UP) College of Public Health, UP-Philippine General Hospital (PGH) National Poison Management, province/city-wide health care provider network, professional organizations, and civil society organizations

Strategic objective 5 (SO 5) Strengthen information systems/data on HRH for monitoring, informing decision making, and ensuring accountability SO 5 includes short-term strategies on information systems development to ensure up-to-date and accurate information, and the carrying out of HRH-related research. These speak to the need for evidence that will regularly inform decision-making and accountability. Stakeholders that will be involved include CHED, PRC, DOH, Philippine Overseas Employment Administration (POEA), Commission on Filipinos Oversease (CFO), Department of Information and Communications Technology (DICT), Department of Science and Technology (DOST), LGUs, HRH Network, HEIs, research stakeholders, and the private sector.

Strategic objective 7 (SO 7) Increase investments in HRH and align investments with current and future population health needs and of health systems SO 7 comprises strategies in the short term that aim to increase investments in HRH and HRH systems and build fiscal capacity in order to respond to current and future population health needs and of health systems. Stakeholders that will be involved are the Department of Finance (DOF), DBM, DOH, NEDA, PSA, HRH Network, LGUs, the private sector, and international development partners.

LOCALIZING THE MASTERPLAN Based on evidence drawn from a literature review and validated through national and regional consultations, the strategic objectives and national level strategies were identified for the Masterplan. However, the national strategies cannot be uniformly implemented across the regions and provinces as there are wide variations in local conditions. For instance, many areas in highly urbanized cities have higher access to health services compared with GIDA that have low access and where there are instances when some HRH cadres (e.g. physicians) are not present. In order to address this imbalance, it is proposed that LGUs ‘localize’ the Masterplan. This can be done by assessing the relevance and feasibility of the Masterplan strategies at the local level. The assessments can be carried out through consultation workshops by the Provincial Health Board with the participation of the HRH Network and HHRDB using a set of criteria (Appendix B). Results of the assessment will inform how the national Masterplan strategies can be adapted best to benefit the health of individuals and local populations.

IMPLEMENTATION SCHEDULE OF MASTERPLAN STRATEGIES There are necessary preparatory activities for the short-term plan that should be carried out prior to the implementation of the Masterplan strategies. These relate in particular to the Masterplan’s governance and management, and its monitoring and evaluation system.  Establishing governance and management structures including a secretariat. A review of the current Memorandum of Agreement is needed and a formal agreement among the HRH Network members should be reached to establish the Network as the implementing unit. The roles of the technical working committees (TWCs) and the Oversight Committee on Masterplan Management and its relationship with the DOH should be clearly defined. Focal persons in each agency / stakeholder must be made available to ensure continuity and consistency.  Establishing mechanisms and implementing arrangements for stakeholders to work together in implementing and monitoring the Masterplan. Many of the indicators for the outputs and outcomes of the Masterplan strategies are multi-sectoral. The stakeholders’ commitment to these will include incorporating HRH in their workplans and budgets and assigning persons to the relevant TWC and actively participating.  Identifying champions to further the HRH agenda in each HRHN organization. Champions have a clear role to play in ensuring that the Masterplan’s short-term strategies are supported by high level stakeholders.  Determine extent of policy support present for the strategies. The policy omnibus review indicates support for most strategies but unclear to what extent this goes since policy implementation was not included in the omnibus review.  Refining and establishing the proposed accountability framework (discussed below) and obtaining buy-in from HRH stakeholders.  Disseminating the Masterplan to different audiences which will be guided by a communications plan.  Creating localized plans. The Masterplan’s strategies were developed for the whole country which does not capture specific local conditions (e.g. health burdens, adequacy of health workers, etc.). Developing several ‘local’ plans can serve as examples or templates that other provinces can follow.  Addressing barriers identified during consultations. During the regional and national consultations, the most common barriers raised were availability of funding, time, and people. The above activities are expected to be implemented in 2020 ( Table 1).

Table 1. Timeline of preparatory activities of the HRH Masterplan Year Preparatory activities Purpose 2020  Review existing Memorandum of Understanding among members of the HRH Network and establish a formal agreement among the HRH Network members including

The Network is the implementing unit of the HRH Masterplan

Reconfiguring structures such as TWCs and their functions

Establishment of a full-time secretariat that will be in charge of the Masterplan’s daily implementation and monitoring

Agreement on an accountability framework  Establish governance and management structures  Facilitate the accomplishment of strategies and monitoring of multi- sectoral indicators  Create mechanisms and implementing arrangements including identification of

Point/focal persons for each agency per strategy

Decision making, communication and other processes

Unique membership in each TWC  Facilitate the processes of collaboration among agencies  Identify champions to push the HRH agenda  Ensuring transparent governance, availability of resources, and high- level support for strategies  Identify gaps in policy including extent of implementation  Ensure a supportive policy environment for the HRH Masterplan

Year Preparatory activities Purpose  Implement a communications plan  Disseminate HRH Masterplan and raise support for its implementation  Develop local HRH plans  Reflect local conditions and ensure implementability at the provincial/city/municipal levels  Identify financial resources for

setting up and operating the governance and management structures of the Masterplan

implementing the Masterplan strategies  Ensure timely and appropriate implementation of the Masterplan by securing resources that support its implementation

A priority in the Masterplan implementation are workforce strategies that will help contain the COVID19 pandemic and protect and ensure the well-being of HRH during this public health emergency and other like it in the future. In the proposed implementation schedule ( Table 2), workforce strategies targeted for 2020 are those that offer alternative learning development approaches, ensure well-being of health workers including compliance with occupational safety and health (OSH) standards and exploring digital health, and ensuring the presence of appropriate skills mix in health facilities. Note that the creation of permanent positions will be implemented in the medium-term. However, the strategy is included in the short-term as certain activities need to be started right away. For instance, activities such as broadcasting widely unfilled government and private HRH positions, reviewing existing policies relevant to the creation of positions, etc. are expected to start in the next two years. Similarly, the strategy on standardizing positions, competitive compensations, benefits, and incentives will take place in the medium-term. Nevertheless, it is included in the short-term since activities will be initiated to help ensure its achievement in the medium-term. The implementation of cross cutting strategies on investments and HRH information systems are targeted for 2021. It is necessary to implement these soonest as the cross-cutting strategies will help improve the successful implementation of the production and other workforce strategies. This is particularly true regarding the timely availability of resources, and access to accurate and up-to-date HRH information.

Table 2. Proposed implementation schedule of short-term strategies Year Strategy Activities Workforce Strategies 2020 Enable health workers to obtain appropriate skills, knowledge and attitudes through learning and in-service staff development methods [SO 2] Develop more alternative modes of learning (e.g., e- learning, webinars) on Primary Care in DOH e- Learning platform with CPD units Provide access to available face-to-face learning and development programs and providers while earning CPD units 2020 Ensure well-being of health workers including protection from emerging and re- emerging diseases (e.g., wellness programs, mental health, etc.) [SO 3] Develop health, wellness, and infection prevention and control programs (e.g., mental health, physical health, etc.) for health workers Craft policy on health care worker protection (e.g., stigma, bullying), and infection prevention and control measures for emerging and re-emerging diseases 2020 Ensure compliance with minimum work environment standards by implementing occupational safety and health (OSH) standards and infection and prevention control initiatives [SO 3] Review existing OHS standards and its implementation Explore use of available technology to deliver health care services Identify alternative work arrangements in cases of public health emergencies

Year Strategy Activities Review and implement minimum work environment standards (e.g., hazard pay, personal protective equipment (PPEs), short-term accommodations) to prevent and control emerging and re-emerging diseases to protect health workers 2020 Ensure appropriate skills mix and roles/functions present in health facilities [SO 3] Review current minimum staffing (composition and number) for health service delivery, including needs for workload and public health emergencies, outbreaks, etc. Implement WISN findings specifying the ranges for staffing standards based on actual computed workload Craft policy on minimum staffing (composition and number) for health facilities for public health emergencies, outbreaks, etc. Develop guidelines on HRH standards to ensure optimal response to public health emergencies, outbreaks, etc. 2021
Create adequate permanent positions for HRH (all cadres including Barangay Health Workers & Barangay Nutrition Scholar) in response to health sector needs [SO 3] Broadcast widely unfilled government and private HRH positions Collaborate between the national and local governments to source funds and recruit local HRH to fill necessary vacant positions Advocate to LGUs to create positions for HRH Review existing policies 2022 Support career development of all health workers including volunteer health workers (e.g., BHW, BNS, etc.) [SO 2] Review existing capacity building programs for volunteer health workers Craft career development paths for volunteer health workers Define needed competencies based on roles and functions of job description of volunteer health workers using the competency-assessment tool developed by USAID’s HRH2030 Philippines Review of roles and responsibilities of BHWs and other health volunteers Explore new initiatives such as micro credentialing to be able to provide home-/community-based services Strengthen implementation of national certification program (e.g., Barangay Health Services Certification (NCII) under TESDA) for volunteer health workers 2022 Enforce/strengthen the provision of coaching, mentoring, and supportive supervision to health workers [SO 2] Determine competencies of workplace coaches and mentors and capacitate them as necessary Include coaching and mentoring in the learning and development programs Design mentoring and coaching programs aligned with area or program needs as needed

Year Strategy Activities 2022 Develop and implement career paths of health workers across the public and private sector from national to local levels [SO 2] Design harmonized career progression paths of HRH in government and private sector Provide information on careers in the health sector for potential health workers 2022 Standardize health workers’ positions and competitive compensation, benefits and incentives such as supporting career progression, standardized, decent compensation and benefits, recognition and rewards system to improve job satisfaction and motivation (public and private sectors; national and local) [SO 3] Advocate and capacitate LGUs to allocate sufficient budgets for HRH in accordance with staffing standards Request exemption from PS cap and LGU income class-dependent rates for health workers Enforce full implementation of Magna Carta for Public Health Workers across national and local levels Review/amend provisions under existing laws on compensation and benefits of health workers (e.g., PS limit and Magna Carta to cover private sector HRH) Identify compensation packages, benefits and incentives for professional and non-professional health workers that are motivating
Review of existing benefits and incentives for the public and private sector Review of positions classification and job descriptions of public health workers Cross-cutting Strategies 2021 Strengthen and integrate information systems to ensure up-to-date HRH data and data sharing across the HRH sector (e.g., National Health Workforce Registry, National Health Workforce Account) [SO 5] Conduct data mapping to identify data gaps and sources, frequency of data collection, and overlaps, if any Utilize the NHWA system as the national repository of HRH data and information Identify specific NHWA data modules to be contributed by HRH stakeholders consistent with their mandates
Provide updated health worker information aligned with agency process (e.g. PRC licensing, POEA exit information, etc.) Include a NHWA system of data collection in the processes of agencies collecting HRH data 2021 Conduct HRH research (including operations and evaluation research and analysis of health labor markets) [SO 5] Formulate HRH research agenda and identify lead groups in the medium term Harmonize/integrate HRH development and management research agenda of national agencies 2021 Generate resources for HRH from various sources (domestic, international, and other sources) [SO 7] Explore co-financing mechanisms between national and local governments Funding for local HRH needs (development and management) provided by LGUs and supported, if necessary, by national government with private sector participation

Year Strategy Activities Explore government subsidies (conditional transfer) for private sector health worker development and management to expand access to health care
2021 Invest in HR systems (education and training, recruitment, deployment and retention, etc.) to meet national and subnational needs [SO 7] Allocate resources to support HRH in the Local Investment Plan for Health (LIPH) Identify sources for funds in areas that are under invested at appropriate levels to support primary health care Identify areas in training and education, recruitment, deployment and retention at national and local levels requiring (additional) investments 2021 Develop fiscal capacity to absorb and utilize effectively and transparently both domestic and international resources for HRH systems in the public and private sector [SO 7] Build capacities of HRH Network and HHRDB for planning, resource management (fiscal management) and analysis Develop a system for co-managing resources, such that management directions will be provided by national agencies, and implementation of specific plan of actions will be handled by local government units Production Strategies 2022 Educate and train future HRH in or near their places of origin [SO 1] Identify and support SUCs or high quality HEIs which offer health sciences education in every region Determine training hospitals for internship of 12 cadres in all regions Reorient health professional curricula to produce responsive health workers equipped with primary care competencies for the region 2022 Establish targeted admission practices in HEIs [SO 1] Revise admission guidelines in HEIs per region to target indigenous people and local students with rural background who are willing to serve as health workers in their localities Promote enrolment of local students including indigenous people who are willing to serve locally for at least 5 years 2022 Expand scholarships that would support the production of needed cadres of health care professionals and health care workers with enforceable RSA that also offers incentives [SO 1] Use WISN results as basis for providing scholarships in rural areas Harmonize public and private scholarships from all sources to boost health sciences program enrolment and produce needed cadres of health workers in rural and GIDA areas Strengthen implementation of RSA for HRH (monitoring, non-compliance, identify incentives) 2022 Re-orient curricula to PHC and integrate public health, rural health courses/ topics, Intensify pre-service education and training on PHC, public health, rural exposure/immersion, and use of technology to deliver health services

Year Strategy Activities rural exposure/immersion, and use of technology to deliver health services [SO 1] Advocate for the inclusion of PHC, public health, and rural health topics/ immersion, and use of technology in public and private HEIs Utilize flexible learning options (FLOs) in pre-service training of health professionals
Form a functioning interagency working group to introduce changes to curricula

IMPROVING THE IMPLEMENTATION OF THE MASTERPLAN As a process, the Masterplan’s implementation is expected to follow a logical framework (Figure 4). Implementing the Masterplan requires:  An operational governance and management body  Inputs consisting of –
o Indicative estimates of funding needed for the activities of short-term strategies (PhP8.3 Billion) o Additional staffing needed, including its cost, is currently being forecasted
o Policy support is available as presented elsewhere in the report. For instance, the Magna Carta for Health Workers enacted in 1995 has provisions supportive of 5 out of 7 strategic objectives (see Table 10 for details)
o Even as the development of a Masterplan has legal standing, it is necessary to derive political will and stakeholder buy-in. This will be assisted by the Masterplan communications plan and advocacy.
o Technical working committees of the HRH Network will be one of the key mechanisms of collaboration. Reporting and accountability systems are integral to the Masterplan’s monitoring and evaluation system. The above inputs are fundamental in order to operationalize production, workforce, and cross cutting strategies in the short term. As the strategies are made operational, these are expected to produce outputs which will in time lead to outcomes. For instance, production strategies are expected, with revised HEI admission guidelines, to have a higher proportion of local students who are trained and educated near their place of origin, benefit from the revised curricula, graduate, stay and practice locally. Hence, outcomes will be produced such as improved retention and sustainably produced HRH that can provide primary care. While the processes of generating outputs and outcomes from the inputs and strategies may seem straightforward, in actuality, there are many factors that will affect the creation of desired outputs and outcomes and should be addressed. By no means a complete list, these are the timely availability of the necessary resources for the Masterplan implementation, having excellent communication and coordination among HRH stakeholders at the national and local levels and across HCPNs and P/CWHS, stakeholder commitment and support, understanding and agreement with strategic objectives among stakeholders, functioning mechanisms for collaborations, and the minimum impact of constraints that are beyond the control of the implementers.36 37 As shown in Figure 4, most of these impact in the input and strategies stage of the implementation of the Masterplan. Some of these match the barriers identified during the national and regional consultations when the strategies were first proposed and those identified in the LFA. For instance, the need for funding, buy-in particularly from decision makers e.g. local chief executives (LCEs), knowing about the Masterplan, and for collaboration among many stakeholders.

Figure 4. Implementation framework

Governance and management body

E. Budget/Resources This section presents the estimated indicative cost for implementing, managing and monitoring the eighteen short-term strategies identified covering Year 2020 to Year 2022 implementation of the HRH Masterplan. The indicative cost was identified based on cost drivers for activities of each strategy under the strategic objectives for production, workforce and cross-cutting concerns covered in the short-term plan. The main cost drivers, or factors that trigger change in the cost, identified for each activity are remuneration and operational cost. Remuneration refers to the amount allocated for labor work to carry out an activity, while operational cost is the amount allocated for direct cost (except labor) to implement an activity. Appendix C lists the cost assumptions that underlie the budget estimates. The indicative cost in implementing eighteen strategies under the five strategic objectives covered by the short-term plan is estimated at PHP 8.3 Billion. Of the estimated total indicative cost, 15% of the cost estimate is for production strategies, 82% is for workforce strategies, and 3% is for cross-cutting strategies.

PRODUCTION STRATEGIES There are four short-term strategies under Strategic Objective 1 (Install systems that will improve recruitment of HRH fit for practice and fit for work to sustainably produce and deploy HRH and to promote greater HRH retention in the health sector leading to adequate and equitable HRH distribution vis-à-vis local health needs) that targets HRH production. Table 3 shows the summary of estimated cost per strategy. Table 3. Summary of estimated cost, Strategic Objective 1 Strategy Estimated Cost (in PHP) 1 Educate and train future HRH in or near their places of origin 37,907,742.00 2 Establish targeted admission practices in HEIs 7,933,967.00 3 Expand scholarships that would support the production of needed cadres of health care professionals and health care workers with enforceable RSA that also offers incentives 1,128,948,460.40 4 Re-orient curriculum to PHC and integrate public health, rural health courses/topics, rural exposure/immersion, and use of technology to deliver health services 35,039,294.00 TOTAL 1,209,829,463.40

Cost estimates presented in Table 3 considers staff remuneration and operational cost (e.g., events/meetings, transportation, communication, office supplies, etc.) for implementing identified activities for each strategy at the national and regional levels. Large cost drivers in implementing strategies under Strategic Objective 1 are the conduct of conferences or workshops to support HEIs in the region and the scholarship program.

WORKFORCE STRATEGIES Nine short-term strategies under two strategic objectives were included in the short-term plan to support the health workers as they serve as member of the health workforce. Table 4 shows the estimated cost for strategies under Strategic Objective 2 (Create systems for developing HRH competencies and the careers of health workers to improve productivity and responsiveness, and to promote greater HRH retention), while Table 5 presents the estimated cost for strategies identified for Strategic Objective 3 (Raise HRH productivity and responsiveness by promoting job satisfaction and motivation at all levels and improve greater HRH retention). In total, the estimated cost for all workforce strategies identified in the short-term plan amounted to PHP 6.86 Billion.

Table 4. Summary of estimated cost, Strategic Objective 2 Strategy Estimated Cost (in PHP) 5 Support career development of volunteer health workers (e.g., BHW, BNS, etc.) 12,473,100.00 6 Enable health workers to obtain appropriate skills, knowledge and attitudes through learning and in-service staff development methods 6,723,747,156.50 7 Enforce/strengthen the provision of coaching, mentoring, and supportive supervision to health workers 25,096,262.00 8 Develop and implement career paths of health workers across the public and private sectors from national to local levels 28,974,578.00 TOTAL 6,790,291,096.50

Cost estimates presented in Table 4 considers staff remuneration and operational cost (e.g., events/meetings, transportation, communication, office supplies, etc.) for implementing identified activities for each strategy at the national and regional levels. Large cost drivers in implementing strategies under Strategic Objective 2 are the conduct of researches and feasibility studies, cost of face- to-face trainings for health workers, cost of e-learning module development, and maintenance cost for the e-learning platform.

Table 5. Summary of estimated cost, Strategic Objective 3 Strategy Estimated Cost (in PHP) 9 Create adequate permanent positions for HRH (all cadres including including Barangay Health Workers & Barangay Nutrition Scholar) in response to health sector needs 12,289,598.00 10 Standardize health workers’ positions and competitive compensation, benefits and incentives such as supporting career progression, standardized, decent compensation and benefits, recognition and rewards system to improve job satisfaction and motivation (public and private sectors; national and local) 23,187,327.00 11 Ensure well-being of health workers including protection from emerging and re-emerging diseases (e.g., wellness programs, mental health, etc.) 3,518,864.00 12 Ensure compliance with minimum work environment standards by implementing occupational safety and health (OSH) standards and infection and prevention control initiatives 10,852,570.00 13 Ensure appropriate skills mix and roles/functions present in health facilities 18,747,659.00 TOTAL 68,596,018.00

Cost estimates presented in Table 5 considers the staff remuneration and operational cost (e.g., events/meetings, transportation, communication, office supplies, etc.) for implementing identified activities for each strategy at the national and regional levels. However, the cost estimate in this table does not yet include costs of salary and compensation of health workers for Strategy 10, which should be computed based on the result of the staffing projection still being done by the DOH.

CROSS-CUTTING STRATEGIES Five cross-cutting strategies under two strategic objectives were included in the short-term plan to strengthen the health workforce environment. Table 6 shows the estimated cost for strategies under Strategic Objective 5 (Strengthen information systems/data on HRH for monitoring, informing decision making, and ensuring accountability), while Table 7 presents estimated cost for strategies identified for Strategic Objective 7 (Increase investments in HRH and align investments with current and future population health needs and of health systems). In total, the estimated cost for all workforce strategies identified in the short-term plan amounted to PHP 257.87 Million.

Table 6. Summary of estimated cost, Strategic Objective 5 Strategy Estimated Cost (in PHP) 14 Strengthen and integrate information systems to ensure up-to-date HRH data and data sharing across the HRH sector (e.g., National Health Workforce Registry, National Health Workforce Accounts) 31,679,852.00 15 Conduct HRH research (including operations and evaluation research and analysis of health labor markets) 163,340,135.00 TOTAL 195,019,987.00

Cost estimates presented in Table 6 considers the staff remuneration and operational cost (e.g., events/meetings, transportation, communication, office supplies, etc.) for implementing identified activities for each strategy at the national and regional levels. Large cost drivers in implementing strategies under Strategic Objective 5 are the conduct of researches and evaluations and the systems development and maintenance of interoperable HRH information systems.

Table 7. Summary of estimated cost, Strategic Objective 7 Strategy Estimated Cost (in PHP) 16 Generate resources for HRH from various sources (domestic, international and other sources) 3,611,308.50 17 Invest in HR systems (education and training, recruitment, deployment and retention, etc.) to meet national and subnational needs 45,806,477.00 18 Develop fiscal capacity to absorb and utilize effectively and transparently both domestic and international resources for HRH systems in the public and private sector 13,429,201.00 TOTAL 62,846,986.50

Cost estimates presented in Table 7 considers the staff remuneration and operational cost (e.g., events/meetings, transportation, communication, office supplies, etc.) for implementing identified activities for each strategy at the national and regional levels. Large cost drivers in implementing strategies under Strategic Objective 7 are the conduct of regional assessments for training, education, recruitment, deployment requirements, and e-learning module development of resource/fiscal management capacity building.

F. Monitoring and evaluation In the short term, there will be 17 production, workforce, and crosscutting strategies that will be implemented. Monitoring activities will focus on collecting data for indicators of these short-term strategies and ensuring feedback to strategic and program development to make sure that strategy implementation is on track. PRODUCTION Strategic Objective 1: Install systems that will improve recruitment of HRH fit for practice and fit for work to sustainably produce and deploy HRH and to promote greater HRH retention in the health sector leading to adequate and equitable HRH distribution vis-à-vis local health needs Strategy Measure Establish targeted admission practices in HEIs Increased number of graduates of students from local areas Educate and train future HRH in or near their places of origin
Proportion of health facilities with graduates of SUCs and high quality HEIs that are responsive to the local needs and practice locally

Proportion of health facilities that provide holistic/ comprehensive health services

Reduced patient readmission rates

Expand scholarships with enforceable RSA that also offers incentives
Amount of funding for scholarships per region Sources of scholarships Number of scholars per cadre funded Coverage of scholarships (e.g., tuition fee, miscellaneous fees, living allowance) Re-orient curriculum to PHC and integrate public health, rural health courses/ topics, rural exposure/immersion, and use of technology to deliver health services Proportion of health sciences HEIs that have re-oriented curricula to PHC and integrate public health, rural health courses/topics, rural exposure/immersion, and use of technology to deliver health services by CHED region by professional cadre Proportion of health sciences HEIs that produce primary care workers who are practice ready after graduation by region and by cadre

WORKFORCE Strategic Objective 2: Create and sustain systems for developing HRH competencies and the careers of health workers to improve productivity and responsiveness, and to promote greater HRH retention Strategy Measure Support career development of all health workers includeing volunteer health workers (e.g, BHW, BNS, etc.) Defined health worker career paths by cadre including volunteer health worker
Enable health workers to obtain appropriate skills, knowledge and attitudes through learning and in-service staff development methods Proportion of responsive and highly skilled HRH providing health services Reduced re-admission rates in primary care facilities Reduced referral rates in primary care facilities Provide or expand implementation of coaching, mentoring, and supportive supervision to health workers Proportion of health facilities with health workers exhibiting enhanced competencies that provide improved health services

Strategy Measure Develop and implement career paths of health workers across the public and private sector from national to local levels Proportion of health workers in the appropriate positions of their career paths based on their competencies and experience

Strategic Objective 3: Raise HRH productivity and responsiveness by promoting job satisfaction and motivation at all levels and improve greater HRH retention Strategy Measure Create adequate permanent positions for HRH (all cadres including Barangay Health Workers [BHWs] & Barangay Nutrition Scholar [BNS]) in response to health sector needs
Proportion of health facilities and health care provider network that fulfilled the staffing standards Increased number of HRH employed in health sector with permanent positions especially in rural areas/GIDA Increase in funding (Contribution of stakeholders for HRH investment) Standardize health workers’ positions and competitive compensation, benefits and incentives such as supporting career progression, standardized, decent compensation and benefits, recognition and rewards system to improve job satisfaction and motivation (public and private sectors; national and local) Satisfaction (rating) of public and private health workers on employment terms Stable facility HRH complements Satisfaction of health workers over competitive compensation, benefits, and incentives received
Ensure well-being of health workers including protection from emerging and re-emerging diseases (e.g. wellness programs, mental health, etc.)
Reduced health worker turnover due to work-related health and illness issues Health compensation package for health workers implemented Ensure compliance with minimum work environment standards by implementing occupational safety and health (OSH) standards and infection and prevention control initiatives Satisfaction (rating) of public and private health workers on work environment Health worker productivity measures (e.g., reduced absences, infections, etc.) Ensure appropriate skills mix and roles/functions present in health facilities Proportion of health facilities that provide proactive and responsive health services Reduced patient readmission rates

CROSS-CUTTING
Strategic Objective 5: Strengthen information systems/data on HRH for monitoring, informing decision making, and ensuring accountability Strategy Measure Strengthen and integrate information systems to ensure up-to-date HRH data and data sharing across the HRH sector e.g. National Health Workforce Registry (NHWR), National Health Workforce Account (NHWA) Number of Functioning information/ intelligence center for HRH established implementing NHWA and the registry Presence of tools for decision makers

Strategy Measure Utilization of information by the decision-makers
Undertake robust HRH research (including operations and evaluation research and analysis of health labor markets) Implemented effective solutions to HRH problems

Strategic Objective 7: Increase investments in HRH and align investments with current and future population health needs and of health systems Strategy Measure Generate resources for HRH from various sources (domestic, international, and other sources) Fully supported HRH and HRH systems Invest in HR systems (education and training, recruitment, deployment and retention, etc.) to meet national and subnational needs Disbursement of funds allocated for investments on education and training, recruitment, deployment and retention of health workers Develop fiscal capacity to absorb and utilize effectively and transparently both domestic and international resources for HRH systems in the public and private sector Efficiency measures (use existing DOH indicators) Cost-utility/ effectiveness (use existing DOH indicators)

Medium term plan (2023-2028) The medium-term plan is broadly presented in this document because of the evolving strategic environment that cannot be forecasted accurately. The scenarios and strategic foci are drawn from a combination of the available long-term national plans, such as AmBisyon Natin 2040, Philippine Development Plan, and the need to be better prepared for current population health needs and for emerging and re-emerging diseases and public health emergencies.

A. Medium term risk-based scenario descriptions Health issues or scenarios identified in the short-term (2020-2022) are not expected to be resolved over two years, which means that the health system will continue to face the following: 1. Filipinos having a triple burden of disease due to continuing increase of NCDs including mental health issues, declining prevalence of communicable disease, and increasing injuries and accidents, and addressing the aging population. 2. The Philippine health system capacity should be enhanced by scaling up hiring of HRH (NEDA 2020) to deal with the continuing issue of triple burden of disease and to prevent and control emerging & re-emerging diseases and health emergencies, especially at LGU level. 3. Use of technology should be developed and expanded to prevent and control emerging & re-emerging diseases and health emergencies, especially at LGU level. 4. Research capabilities should be expanded to locally develop new health solutions needed by the Filipino population to deal with emerging and re-emerging diseases and inform decision making and policies. 5. Climate change and loss of environmental habitat increases the risk of zoonotic diseases incidence38 and natural disasters.

B. Strategic focus in the medium term • Sustain production of practice-ready health workforce
• Promote recruitment, and equitable distribution of quality HRH working in underserved areas • Retain appropriate skill mix in national and submational health systems • Support career development an advancement of HRH in the health sector

• Enhance HRH competencies to deal with triple disease burden and to prevent and control emerging & re-emering diseases, including strengthening health emergency response teams • Improve working conditions to motivate health workers to practice in underserved areas • Optimize existing health workforce • Increase health literacy of all Filipinos

C. Strategies in the medium term STRATEGIC OBJECTIVE 1 (SO 1) Install systems that will improve recruitment of HRH fit for practice and fit for work to sustainably produce and deploy HRH and to promote greater HRH retention in the health sector leading to adequate and equitable HRH distribution vis-à-vis local health needs SO 1 comprise of two production strategies in the medium-term that also embeds retention in order to produce adequate number of HRH and reduce inequitable HRH distribution. In the medium term, strategies launched in the short-term will be sustained, while introducing the following strategies:  Establish inter-profession education (IPE) and training in universities and institutions  Provide incentives to HEIs (e.g., tax breaks) to ensure quality graduates and provide scholarship grants Stakeholders involved in these set of strategies include CHED, PRC, DBM, DOF, HEIs, LGUs, the Congress, professional societies, student groups, and private and public health facilities. STRATEGIC OBJECTIVE 3 (SO 3) Raise HRH productivity and responsiveness by promoting job satisfaction and motivation at all levels and improve greater HRH retention In the medium term, an additional strategy will be implemented along with sustaining the implementation of strategies launched in the short-term. Creating adequate permanent positions and standardizing health workers’ positions, compensation, benefits, and incentives, started in the short-term, will continue to be implemented. • Create adequate permanent positions for HRH (all cadres including BHWs and BNS) in response to health sector needs • Standardize health workers’ positions and competitive compensation, benefits and incentives such as supporting career progression, standardized, decent compensation and benefits, recognition and rewards system to improve job satisfaction and motivation (public and private sectors; national and local) • Sustain improved health outcomes through standardized care through the implementation of national Clinical Practice Guidelines (CPGs) for priority health conditions. Stakeholders involved in these strategies include the DOH, professional organizations, and private and public health facilities. STRATEGIC OBJECTIVE 4 (SO 4) Foster sustained intersectoral collaboration/co-development to develop responsive and coherent plans and policies among health and non-health agencies and organizations to generate shared goals, synergize functions, and produce collective impact SO 4 focuses on health worker migration policies and programs that should factor in the population health needs of the country, strengthen meaningful private sector regulation particularly in HRH production and employment, and align policies on production, employment, and migration. The nature of these strategies requires close and sustained collaboration and co-development in order to achieve shared goals. Identified strategies are as follows: • Ensure implementation of health worker migration policies and programs with consideration of the Philippine population health needs • Strengthen meaningful private sector regulation in HRH production and employment • Align policies on production, employment and migration involving the education, health, labor, and other relevant sectors

Stakeholders involved in these strategies are HRH Network, CHED, PRC, DOLE, DBM, DILG, CSC, DFA, POEA, OWWA, private and public HEIs and health facilities, professional societies. STRATEGIC OBJECTIVE 6 (SO 6) Build the capacity of institutions for effective public policy stewardship, leadership, and governance In the medium-term, the HRH Network will be strengthened by expanding its membership and improving representation from a wide array of HRH stakeholders. Other short-term cross-cutting strategies on investments in HRH, HRH systems, and technology, improving fiscal capacity, and conducting research will also be continued to ensure that gains are sustained. Stakeholders involved include the HRH Network, DOH- Centers for Health Development (CHD), regional and provincial HRH offices, LGUs, development partners (e.g., academe, training institutions), and public and private health facilities.

D. Budget/Resources The budget and resources needed for implementing, managing and monitoring the activities and strategies in the medium-term plan should consider its remuneration and operational cost requirement along with the cost requirement to continue implementing and monitoring the short-term strategies. As of the time of its writing, the Masterplan includes two production strategies, one workforce strategy, and one cross-cutting strategy identified to be initiated between Year 2023 and Year 2028. Like what was done in the short-term plan, it is recommended to identify the activities that will be implemented in the medium-term plan and estimate the indicative cost requirement prior to implementation. More specific costing can be done during annual planning retreats when current costing parameters can be updated.

E. Monitoring and evaluation In the medium term, monitoring activities initiated in order to collect data for indicators of short-term strategies will be sustained. In addition, monitoring data for indicators of the following medium-term strategies will be included: PRODUCTION Strategic Objective 1: Install systems that will improve recruitment of HRH fit for practice and fit for work to sustainably produce and deploy HRH and to promote greater HRH retention in the health sector leading to adequate and equitable HRH distribution vis-à-vis local health needs Strategy Measure Establish inter-profession education (IPE) and training in universities and institutions Proportion of program outcomes exhibited by new graduates Proportion of all health sciences HEIs utilizing IPE approach to education by cadre, by region Assessment scores on performance of new professionals indicate positive patient experience Provide incentives to HEIs (e.g., tax breaks) to ensure quality graduates Proportion of high performing HEIs

WORKFORCE Strategic Objective 3: Raise HRH productivity and responsiveness by promoting job satisfaction and motivation at all levels and improve greater HRH retention Strategy Measure Create adequate permanent positions for HRH (all cadres including BHWs and BNS) in response to health sector needs Proportion of health workers with permanent positions by cadre by region.
Standardize health workers’ positions and competitive compensation, benefits and incentives such as supporting career progression, standardized, decent compensation and benefits, recognition and rewards system to improve job satisfaction and motivation (public and private sectors; national and local) Measures of variance of salaries, benefits and other incentives across LGUs/ HCPNs by region/province Sustain improved health outcomes through standardize care through the implementation of national Clinical Practice Guidelines (CPGs) for priority health conditions Trend of health outcomes over the medium term (7-year period) such as reduced mortality rates, increased life expectancy, etc. Consistently and evenly implement incentives to improve job satisfaction and motivation such as supporting career progression, standardized, decent compenstion and benefits, recognition and rewards system Turn over rates of health workers per facility per cadre monitored every quarter

EXIT AND RE-ENTRY Strategic Objective 4: Foster sustained intersectoral collaboration/co-development to develop responsive and coherent plans and policies among health and non-health agencies and organizations to generate shared goals, synergize functions, and produce collective impact Strategy Measure Ensure implementation of the health worker migration policies and programs in consideration of the Philippine population health needs Adequate number of HRH for population health needs
Compliance with staffing standards per facility type and HPCN

CROSS-CUTTING Strategic Objective 4: Foster sustained intersectoral collaboration/co-development to develop responsive and coherent plans and policies among health and non-health agencies and organizations to generate shared goals, synergize functions, and produce collective impact Strategy Measure Strengthen meaningful private sector regulation in HRH production and employment Changes in private sector production and employment practices (e.g., reduction in class size, higher HRH salaries) Align policies on production, employment and migration involving the education, health, labor, and other relevant sectors Proportion of aligned implementable policies to total number of HRH-related policies crafted

Strategic Objective 6: Build the capacity of institutions for effective public policy stewardship, leadership, and governance Strategy Measure Strengthen HRH Network as an organization to improve effectiveness and performance Measures of HRH Network effectiveness (stakeholder satisfaction, extent to which goals are achieved, resource mobilization capacity) and productivity (implementation of policies and programs)

Long term plan (2029-2040) The long-term plan, which will take place nine years from now is broadly presented because of the evolving strategic environment that cannot be forecasted accurately. The scenarios and strategic foci are drawn from a combination of available long-term national plans, such as AmBisyon Natin 2040, and the need to be better prepared for current population health needs and for emerging and re- emerging diseases and public health emergencies.

A. Long term risk-based scenario descriptions 1. Filipinos have long and healthy lives with access to affordable and good quality healthcare. Health and wellness services are available including primary, secondary, and tertiary care and other products and services (AmBisyon Natin 2040, NEDA). 2. Filipinos are health literate, provided with healthy living conditions, and protected from hazards and risks that could affect their health (UHC Law)

B. Strategic focus in the long term  Develop highly competent and motivated HRH who are responsive to individual and population health needs  Retain HRH for the needs of the health system at national and local levels  Institutionalize governance, financing, regulation and information systems for HRH management and development  Support progressive investments for HRH
 Provide sufficient resources and srong legislative or policy support to HRH rights, benefits and welfare  Ensure that Filipinos share accountability for their individual, family and community health outcomes

C. Strategies in the long term STRATEGIC OBJECTIVE 2 (SO 2) Create and sustain systems for developing HRH competencies and the careers of health workers to improve productivity and responsiveness, and to promote greater HRH retention In the long-term plan, institutionalizing the short-term and medium-term plan strategies are vital. It is also important to identify and implement appropriate activities to facilitate cooperation among health workers across HCPNs and the development of professional and health worker networks. This strategy will facilitate establishment of community of practice to strengthen coordination/interaction and sharing of information among health workers. Stakeholders involved include the DOH, LGUs, CHDs, public and private health facilities, professional societies, and health workers and health worker organizations STRATEGIC OBJECTIVE 3(SO 3) Raise HRH productivity and responsiveness by promoting job satisfaction and motivation at all levels and improve greater HRH retention In the long term, strategies launched in the short-term and medium term should be sustained, while introducing, facilitating and regulating an enhanced and more aligned scopes of practice to health workers’ function and population health needs.

Stakeholders involved in these strategies include the DOH, LGU, Congress, professional and community-based health worker organizations, civil society organizations, public and private health facilities
STRATEGIC OBJECTIVE 6 (SO 6) Build the capacity of institutions for effective public policy stewardship, leadership, and governance In the long term, strategies began in the medium term will be sustained. Additionally, the following strategies will be introduced: building HRH development and management capacity at all levels of the health sector; and establishing, and strengthening where present, quality assurance (QA)/ accountability mechanisms in health facilities. These will build capacity in public policy stewardship and improve leadership and governance.
Stakeholders involved include the HRH Network, DOH-CHDs, regional and provincial HRH offices, LGUs, development partners (e.g., academe, training institutions), and public and private health facilities.

D. Budget/Resources The budget and resources needed for implementing, managing and monitoring the activities and strategies in the long-term plan should consider its remuneration and operational cost requirement along with the cost requirement to continue implementing and monitoring the short-term strategies. As of the time of its writing, the masterplan includes two workforce strategies, one exit and re-entry strategy, and four cross-cutting strategies identified to be initiated between Year 2029 and Year 2040. Like what was done in the short-term plan, it is recommended to identify the activities that will be implemented in the long-term plan and estimate the indicative cost requirement prior to implementation.

E. Monitoring and evaluation In the long-term, monitoring activities initiated in order to collect data for indicators of short- and medium-term strategies will be sustained. In addition, monitoring data for indicators of the following long-term strategies will be included: WORKFORCE Strategic Objective 2: Create and sustain systems for developing HRH competencies and the careers of health workers to improve productivity and responsiveness, and to promote greater HRH retention Strategy Measure Identify and implement appropriate collaboration activities to facilitate cooperation among health workers across HCPNs and the development of professional and health worker networks Number of coalitions, networks, alliances or groups that are functional among health workers in HCPNs Number and type of interactions among health workers in HCPN that provide opportunities for learning and support Functional referral system

Strategic Objective 3: Raise HRH productivity and responsiveness by promoting job satisfaction and motivation at all levels and to improve HRH retention Strategy Measure Introduce, facilitate and regulate aligned and enhanced scopes of practice of health workers i.e. task shifting Improved health worker productivity (efficiency and accomplishments) and satisfaction

Strategic Objective 6: Build the capacity of institutions for effective public policy stewardship, leadership, and governance Strategy Measure Build HRH development and management capacity at all levels of the health sector covering public and private health facilities Proportion of LGUs with improved HRH development and management systems Establish/strengthen quality assurance (QA)/ accountability mechanisms in health facilities Facility performance measures (e.g., referral rates, death rates, recovery rates, etc.) Quality assurance certification of health facilities (e.g. ISO)

Governance and Accountability

Proposed governance and management structure At the national level, the HRH Network is proposed to be the implementing unit of the HRH Masterplan and will assume the necessary governance and management functions. Its membership consists of three professional associations, one higher education institution, and 15 government agencies.
At present the goal of the Network is to harmonize the policies and coordinate the action of different agencies, accredited professional organizations, academic institutions, and non-government organizations (NGOs) in the production, welfare, and development of HRH to deliver quality health for Filipinos. Specifically, its objectives are to:  Ensure that the education and training of HRH is linked to health system needs;  Ensure that HRH are well motivated and effectively contribute to the health system;  Ensure that the principles of ethical recruitment of international health personnel are promoted and practiced;  Engage in national and international partnerships and networks for the management and development of HRH;  Ensure that HRH planning, and policy monitoring and development are coordinated across different agencies; and  Protect and upholds the rights of HRH to decent work, social dialogue, and collective negotiations.

The HRH Network organizational structure lends itself well to the implementation of the Masterplan. There are three technical working committees (TWCs) with the themes of HRH Entry, HRH Workforce, and HRH Exit and Re-entry based on the WHO Working Lifespan Strategies (Table 8). These can be reconfigured and assume the functions necessary to implement the Masterplan (Table 9). However, re-arrangement of the working committees will also entail revisiting of MOU among the members of the HRH Network. The Masterplan’s strategies can be categorized consistent with the foci of the TWCs: production, workforce, and exit and re-entry. Due to the similar nature of committees and the strategies, each TWC can assume the broad functions of coordination, monitoring and evaluation of the strategies’ implementation. The implementation of cross cutting strategies can be taken on by another committee which will be formed for this specific purpose. This committee will have the same functions as the other TWCs. Membership in each TWC will be unique to avoid unduly creating confusion, and additional and/or overlapping workloads for members.

Table 8. Technical Working Committees of the HRH Network Committee Theme Composition TWC on Entry Planning, education, and recruitment One permanent and one alternate member representing each of the designated member government agencies and NGOs TWC on Workforce Supervision, compensation, retention, system supports, and lifelong learning and development TWC on Exit and Re-entry Career choice, health and safety, migration and retirement, and reintegration of HRH in the healthcare system Oversight Committee Decision making body Composed of heads or designates of all member government agencies and NGOs

The Oversight Committee on the Masterplan Management will be composed of the heads or designates of all member government agencies and NGOs of the HRH Network. It will function as the decision-making body and provide oversight function to the Network. It will review and act on the recommendations of Technical Working Committees (TWCs) and can create and/or remove committees as necessary. However, it is imperative that the Oversight Committee will be supported by fully functioning secretariat composed of full-time staff as they will act as primary boundary spanners across network members. Table 9. Proposed Technical Working Committees for the HRH Masterplan 2020-2040 implementation Committee Theme/Purpose Composition Oversight Committee on HRH Masterplan Management Decision making body; provide coordination and oversight; review and act upon recommendation of other TWCs  Composed of heads of core members of the HRH Network all members  Will have a dedicated full-time secretariat TWC on Entry HRH pre-service strategies i.e. on education and training Responsible for production strategies  Will have one subcommittee on curricular revisions, scholarships; and RSA; and, another on admissions policies and practices. Membership will be similar to current TWC Entry of the Network. TWC on Workforce All strategies that cover HRH management and development once HRH are in the health workforce Responsible for workforce strategies  Will have one subcommittee on competencies and professional development and another on work conditions (including occupational and mental health)
 Membership will be similar to TWC Workforce of the HRH Network TWC on Exit and Re-entry HRH strategies on attrition including retirement, migration, re-integration and ethical recruitment Responsible for exit and re-entry strategies  Will have subcommittee on migration  Membership will be similar to TWC Exit and Re-entry of the HRH Network TWC on Cross-cutting concerns HRH strategies on information systems, collaboration, policies, investments, and building institutional capacities Responsible for cross cutting strategies  Will have one subcommittee on information systems and research, and collaboration; and, another on investments and institutional capacity  Membership will come from HRH Network members that represent cross cutting issues (e.g. information systems, migration, etc.)

As discussed above, there will be five committees that will comprise the governance and management structure for the implementation of the Masterplan. The structure will not be hierarchical but collegial; committees will be on equal footing to reflect the multi-sectoral nature of HRH development and management (Figure 5). The committees will not work in silos and the Oversight Committee on HRH Masterplan Management will coordinate, provide oversight, and make decisions. The Oversight Committee will regularly report to HHRDB and the Office of the DOH Secretary. It will also work with LGUs through Provincial/City Health Boards and with the proposed Technical Management Committees as they are tasked with HRH development.39 The committees will play a critical role as mechanisms for collaboration among the many HRH stakeholders.

Figure 5. Proposed governance and management system of the HRHMP 2020-2040

Establishing accountabilities Accountability is an obligation to be answerable for delivering results that were determined through a clear and transparent assignment of responsibility, subject to the availability of resources and constraints posed by external factors.40 WHO identifies three components in its accountability framework: governance, which is providing strategic direction and leadership for successful accountability; results- based management to deliver on agreed-upon results and operational accountability; and, an assurance mechanism that comprise of enhanced accountability, transparency, and effective management through the provision of integrated assurance mechanisms.41 The HRHMP accountability framework (Figure 6) illustrates the three components of accountability. Governance of the HRH Masterplan takes place at the national and local levels and spans across planning, implementation, and reporting. The HRH Network and HHRDB will work closely together to manage and coordinate the implementation at the national level while the implementation of the Masterplan at local levels will be led by Provincial/City Health Boards (P/CHBs). The HRH Network and HHRDB will work closely with P/CHBs in the implementation of the Masterplan. In addition to advocacy work and awareness raising that will be done as

part of the communications plan to gain buy-in from the P/CHBs and other local stakeholders, a policy is proposed to be issued in order to formalize the implementation arrangement between the national and local levels. At the planning stage, the national HRH Masterplan will be adapted to reflect local conditions and incorporated in local investment plans for health e.g. through the addition of budget lines for HRH. Led by TWCs of the HRH Network, national agencies, LGUs, and other stakeholders will be involved in the implementation and monitoring, and reporting of the strategies and activities, making the accomplishment of pre-determined indicators a multi-sectoral effort. Results-based management is embedded in the implementation of the Masterplan. A logical framework approach (LFA) matrix (Appendix A) has been developed for all strategies across five strategic objectives of the Masterplan. For each strategy, activities, outputs, and outcomes have been identified with corresponding indicators. The indicators are aligned with the Balanced Scorecard indicators that have been devised earlier for the Master Plan. In addition, the stakeholders that will be critical to the attainment of the strategies have been identified. It is necessary to get agreements with and commitments to the results (i.e. indicators) among these stakeholders as the strategies are rolled out. Stakeholders who agreed to the multisectoral performance indicators of the outputs and outcomes per strategy as embodied in the LFA must answer to the governing and management structure (i.e. the HRH Network) of the Masterplan. The Masterplan is a collaborative endeavor where its successful implementation relies on mutual accountability and responsibility. The quality assurance component of the Masterplan’s is evident in the feedback loop of the accountability framework as well as the accountability mechanisms (e.g. Seal of Good Local Governance, DOH Scorecard, Primary Care Scorecard) that have been identified. With the involvement of P/CHBs, the feedback loop will provide evidence that informs the future planning of the Masterplan as well as its implementation. On the other hand, accountability mechanisms will be established between and among HRH Network, regions, and other stakeholders such as LGUs to ensure that HRH are appropriately recruited, developed and managed to provide primary care to the local population. In Figure 6, the mechanisms are represented by scorecards, linked potentially by incentives and sanctions or penalties. The scorecard can be realized and backed by RA 11292 or the Seal of Good Local Governance (SGLG) Act of 2019. The SGLG Act creates a Council where the DOH is a member and will participate in the development of performance indicators for LGUs. An HRH focused performance indicator can be proposed to the Council. An LGU that complies, qualifies, and passes the assessment criteria will be awarded the SGLG and granted the corresponding financial incentive.42 In addition to scorecards, the P/CPHBs have a key role to play in the accountability framework. Besides their existing functions, they will exercise technical and administrative supervision over HRH within their respective territorial jurisdiction. This reinforces the role of local health boards as outlined in the 1991 LGC which is to propose annual budgetary allocations for the operation and maintenance of health facilities and services; and, create committees which shall advise local health agencies on matters such as personnel selection and promotion, grievance and complaints, personnel discipline, operations review, and similar functions. These will be in accordance with technical and administrative standards and criteria set by the DOH.43 In addition, the LFA can become a binding document if the stakeholders formally recognize it as such.
A critical input to the three components of the accountability framework is reporting of the data that will be produced by the Masterplan’s M&E system. Besides informing national and local level planning and implementation of the Masterplan, the data will provide on how the Masterplan has responded to the HRH components of the 2018 UHC law, NOH 2017-2022, the 2017-2022 PDP, and Goal 3 of the SDGs. This process involves reporting to its national and local stakeholders, and to external development partners.

Figure 6. Accountability framework of the HRHMP 2020-2040

Policy environment and support For the 2020-2040 HRH Masterplan formulation, it was necessary to define the policy environment that will affect its implementation. The HRH Masterplan must respond to the policy frameworks articulated in international commitments and national goals. These will contribute to the re-shaping of the Masterplan, especially in identifying strategies, activities and targets that it should contain to ensure that there are “appropriately skilled and motivated, equitably distributed and well supported” health workers supporting the health system to improve health outcomes and achieve UHC for Filipinos.44 45
The Philippines commited to achieve desired health outcomes articulated in international agreements like the Millenium Development Goals (MDG) and the Sustainable Development Goals (SDG). In particular, SDG 3, which is specific on health, considers the HRH- related sub-outcome of substantially increasing the health financing and the recruitment, development, training and retention of the health workforce. Furthermore, as a WHO member state, the country is expected to uphold the WHO Global Code of Practice on the International Recruitment of Health Personnel, and consider the WHO Global Workforce Strategy in its planning and policy- making “to improve health, social and economic development outcomes by ensuring universal availability, accessibility, acceptability, coverage and quality of the health workforce”. The Philippines is committed to attain certain health outcomes by 2030. With its signing up to fulfill the High Commission on Health Worker employment and Economic Growth (CHEEG) provisions, the Philippines has professed to increase investments in health workforce employment to contribute to national economic growth.

On the national front, the HRH Masterplan is aligned to the vision of “Filipinos having long and healthy lives by 2040” as stated in AmBisyon Natin 2040. The NOH 2017-2022 also articulated this similarly by envisioning that Filipinos be among the healthiest in Southeast Asia by 2022 and the healthiest among Asians by 2040. Exisiting medium-term plans such as the Philippine Development Plan (PDP) 2017-2022 and the Health Facility Development Plan (HFDP) of the DOH also articulate components supportive of HRH, to which the HRH Masterplan 2020-2040 should be aligned.
The existing policy environment that affects identified HRHMP strategies to address persistent and emerging issues being faced by HRH was observed to be generally supportive.

Figure 7 summarizes the extent of current policy support for the identified strategic objectives of the HRHMP 2020-2040

Figure 7. Policy support to identified HRH strategies per Strategic Objectives

It is important to note that there are 10 short-term, one medium-term, and four long-term strategies across the seven strategic objectives identified in the HRHMasterplan explicitly supported by the UHC Act and its IRR and are likewise supported by policy issuances from the several agencies in the executive branch of the government. There are four strategies not currently covered by provisions of the UHC Act and its IRR, which includes a long-term strategy (i.e., Enhancing health workers migration policies to consider the country’s population health needs) and three short-term strategies (i.e., Support career development of all health workers including Volunteer Health Workers; Enforce/strengthen the provision of coaching, mentoring, and supportive supervision to health workers; and, Develop career paths of health workers).

Table 10. Legislations and policies with provisions supportive of each strategic objectives Strategic Objective Supportive legislation and policy Strategic Objective 1 Install systems that will improve recruitment of HRH fit for practice and fit for work to sustainably produce and deploy HRH and to promote greater HRH retention in the health sector leading to adequate and equitable HRH distribution vis-à-vis local health needs

• Republic Act 11223 (UHC Act) and IRR • Republic Act 10650 (Open Distance Learning Act) • DOH Administrative Order 2018-0022 • DOH Administrative Order 2006-0014 • CSC Memorandum Circular 1996-26 • DOH Administrative Order 2015-0042 • DOH Administrative Order 2018-0022 • CHED Memorandum Order 2017-15 Strategic Objective 2 Create and sustain systems for developing HRH competencies and the careers of health workers to improve productivity and responsiveness, and to promote greater HRH retention • Republic Act 11223 (UHC Act) and IRR • Republic Act 7883 (Barangay Health Worker Incentives Act) • Republic Act 10912 (Continuing Professional Development Act) • Republic Act 10767 (Comprehensive Tuberculosis Elimination Plan Act) • Republic Act 7305 (Magna Carta for Public Health Workers) • Republic Act 8792 (Electronic Commerce Act) • DOH Administrative Order 2006-0014 • DOH Administrative Order 2014-0042 • Executive Order 1999-102
• CSC Memorandum Circular 2012-6 Strategic Objective 3 Raise HRH productivity and responsiveness by promoting job satisfaction and motivation at all levels and improve greater HRH retention • Republic Act 11223 (UHC Act) and IRR • Republic Act 7883 (Barangay Health Worker Incentives Act) • Republic Act 7305 (Magna Carta for Public Health Workers) • Republic Act 11058 (Occupational Safety and Health Standards Act) • Republic Act 2382 (Medical Law) • Republic Acts 7164 and 9173 (Nursing Laws) • Republic Act 10862 (Nutrition and Dietetics Law) • Exectuive Order 2016-201

Strategic Objective Supportive legislation and policy • DOH-DBM Joint Circular 2013-1 • DOH-DBM Joint Circular 2014-1 • DOH Administrative Order 2012-0020 • DBM Administrative Order 2011-25 • CSC Memorandum Circular 1997-33 • DOLE Department Order 2018-198 Strategic Objective 4 Foster sustained intersectoral collaboration/co-development to develop responsive and coherent plans and policies among health and non-health agencies and organizations to generate shared goals, synergize functions, and produce collective impact • Republic Act 11223 (UHC Act) and IRR • Republic Act 7305 (Magna Carta for Public Health Workers) • Republic Acts 8042 and 10022 (Migrant Workers and Overseas Filipinos Act) • CHED Memorandum Order 2012-46 • CHED Memorandum Order 2017-15 Strategic Objective 5 Strengthen information systems/data on HRH for monitoring, informing decision making, and ensuring accountability • Republic Act 11223 (UHC Act) and IRR • Republic Acts 8042 and 10022 (Migrant Workers and Overseas Filipinos Act) • Republic Act 10844 (Department of Information, Communication and Technology Act) • Republic Act 10175 (Cybercrime Prevention Act) • Republic Act 10173 (Data Privacy Act) • Presidential Decree 442 (Labor Code) • Executive Order 1982-797 • DOH-DOST-Philhealth Joint Administrative Order 2016-2 • DOH Administrative Order 2015-17 Strategic Objective 6 Build the capacity of institutions for effective public policy stewardship, leadership, and governance • Republic Act 11223 (UHC Act) and IRR • Republic Act 7305 (Magna Carta for Public Health Workers) Strategic Objective 7 Increase investments in HRH and align investments with current and future population health needs and of health systems • Republic Act 11223 (UHC Act) and IRR • Republic Act 7305 (Magna Carta for Public Health Workers) • Republic Act 10354 (Responsible Parenthood and Reproductive Health Law) • Republic Act 10912 (Continuing Professional Development Act)

Strategic Objective Supportive legislation and policy • Republic Act 10767 (Comprehensive Tuberculosis Elimination Plan Act) • Republic Act 7883 (Barangay Health Worker Incentives Act) • DOH Administrative Order 2007-34

Given the current policy environment, the translation of provisions from the UHC Act and its IRR to implementation policies and operational guidelines is limited. Some HRH strategies were found to have weak or unclear policy support. Furthermore, existing policies need to be reviewed to ensure that they are aligned to the provisions of the UHC Act and its IRR.
An omnibus policy review was conducted to determine policies that impact HRH development and management that have overlapping and/or opposing intentions and provisions that can affect the successful implementation of the UHC Act. The review showed that there is a growing body of evidence about the policy environment in terms of the health system in the Philippines especially when the dialogue on UHC started. However, there are persisting policy issues that need to be resolved (e.g., institutionalizing interprofessional education, barriers to competitive salaries for health workers, rationalizing staffing standards, revisiting accountability mechanisms, harmonizing governance, etc.). A proposed policy agenda (Table 11) was generated from the review that will facilitate resolution the major issues that spans the working lifespan of health workers, from pre- and in-service training and education, workforce, to exit and re-entry. Table 11. Proposed policy agenda Issues Policy agenda HRH Production

Expanding and adjusting inter-professional education (IPE) to the needs for HCPNs and PCPNs Craft a national policy on IPE to guide collaborative pedagogical approach.

HRH entry, exit & re-entry

Need to overcome policy barriers in providing competitive salaries and enabling work environment to the health workforce Identify national policy that will address Section 325 of the 1991 LGC code which sets the limit on appropriations for personal services

Extend policy provisions that provide competitive salaries and improved working conditions for health workers in the public sector to those in the private sector
Need to provide incentives to encourage re-entry of HRH into the health labor force Craft policies to support the re-entry of HRH into the health labor force Need to operationalize task shifting and task sharing to facilitate teamwork in primary care Craft policies on task shifting and task sharing of health workers in order to fully optimize the delivery of health services within HCPNs and PCPNs especially those in areas with inadequate HRH and high inefficiencies Need to rationalize staffing patterns and standards based on needs Establish appropriate and evidence-based HRH planning and management mechanism that will ensure adequate and responsive health workforce

Institutionalize HRH staff Cross cutting

Determine whether DOH has the mandate and accountability mechanisms for managing and developing Filipino HRH Develop accountability mechanisms among national government agencies, the LGUs, and the private sector to ensure a standard set of core functions of HRH policy, planning and governance, data management, and reporting

Issues Policy agenda Transitioning HRH governance synchronized with UHC provisions Develop national and sub-national policies that will articulate HRH strategies that support the shift from vertical programming to a people-oriented approach focusing on the delivery of primary health care services Need to harmonize institutional governance for HRH with their data systems and make them inter-operable Establish policies to harmonize the different systems of institutional governance for HRH data systems and standards among LGUs and between the national and local governments thereby improving current practices on data systems, and maximizing the use of data in policymaking. Need to go beyond Gender and Development (GAD) compliance Develop policies that includes integration of gender and rights-based concerns in the pre- and in-service training of HRH, gender competencies in the health workforce, and a gender sensitive work environment.

Communications plan A communications plan is critical to the effective implementation of the Masterplan. It will facilitate obtaining inputs and commitment of a wide range of HRH stakeholders who need to be involved in the Masterplan. The communication plan aims to:  Widely disseminate the Masterplan among stakeholders and the general public  Obtain support for the implementation of the Masterplan  Ensure the appropriate implementation especially at the national and LGU levels The objectives will be accomplished by defining key messages, using various communication channels and materials that are known to work from the experience of HRH2030 in the Philippines, and tailoring these as befits the targeted audience to bring about desired changes (Table 12). Table 12. Key elements of the communications plan Audience Key message Communication channels Desired change/action Individuals
 With an aging population and emerging and re- emerging diseases, community and personal involvement in improving public health should be encouraged.

 The HRH Masterplan will contribute in ensuring that Filipinos will have access to consistent optimal treatment and holistic care.

 Adequate number and better quality of health workers mean more and better health services that Filipinos can access to keep and become healthy.

 There is no health care without health workers  Mass media channels

Radio, community billboards, posters, press release  Social Media platforms
Facebook, Instagram, YouTube
Prepare social media messages for key stakeholders to share on their personal platforms to repost and thus further amplify messages.  Website
HRH network website and in collaboration with partner agencies and stakeholders  Interpersonal channels
Verbal relay of information among individuals

Awareness building  The first step in an awareness campaign is to understand the knowledge, attitudes and practices of the various user groups.  To influence the behavior of the community, there should be changes in their attitudes, perceptions and behavior.  Awareness-raising campaigns tend to be more successful and have a greater impact when they are conducted by a network  Individuals take responsibility on their health and their family and practice health seeking behavior

Heath care providers  Health facilities can ensure that HRH management is  Healthcare workers Intranet

Internal newsletters Behavior change

Audience Key message Communication channels Desired change/action structured that it complements and strengthens hospital initiatives and the work of staff.  Health facilities should recognize that well managed and developed HRH contribute to personal and societal health and well-being as well as improving the patient experience.  Performance management should be based on a minimum standardized set of competencies that respond to community needs.  Health workers are essential links between the health facilities and the community, strengthening relationships, building trust and supporting health care improvements.

Central location for resources
Departmental sites
Staff directory  Social Media platforms
Facebook group chat  Interpersonal channels
Verbal relay of information among individuals

The passage of time is necessary for innovations to be adopted; they are rarely adopted instantaneously.

The message must be widely adopted in order to self-sustain.

Health facility management practice supportive roles to health care providers’ career growth and employ recognition system Policy and decision makers (national and subnational levels)  The HRH Masterplan supports the Philippine Government to create a strategic plan to plan, finance, and implement solutions to address its human resources for health challenges.
 The government should strategically invest in HRH as a foundation of an optimal health system that is accessible, accountable, affordable, and reliable.
 Ensure effective and robust monitoring and evaluation throughout the policy and implementation of the HRH Masterplan.  In the Philippines, only about 10 percent of the country’s health workers serve in rural areas, resulting in maldistribution of HRH and inequities in health services and outcomes in underserved areas.  Government office channels

Communication network between government offices such as e-mails and memos.  Meetings and conferences
Strategic planning
Brainstorming
Policy making

Behavior change

Government use policy instruments to institute change and provide evidence for information campaigns.
Societal support is needed to achieve change i.e. demand for more and competent HRH
Policy and decision-makers promoted enabling policy environment and strategic investments

Audience Key message Communication channels Desired change/action  Investing in health workers saves lives

Health System/ facility managers  Ensure effective and robust monitoring and evaluation throughout the policy and implementation of the HRH Masterplan.  Health facilities can ensure that HRH management is structured that it complements and strengthens hospital initiatives and the work of staff.  Health facilities should recognize that well managed and developed HRH contribute to personal and societal health and well-being as well as improving the patient experience.  Performance management should be based on a minimum standardized set of competencies that respond to community needs.  Health workers are essential links between the health facilities and the community, strengthening relationships, building trust and supporting health care improvements.  Government office channels

Communication network between government offices such as e-mails and memos.  Meetings and conferences  Healthcare workers Intranet
Internal newsletters
Central location for resources
Departmental sites
Staff directory  Social Media platforms
Facebook group chat  Interpersonal channels
Verbal relay of information among individuals Awareness building
The first step in an awareness campaign is to understand the knowledge, attitudes and practices of the various user groups.
To influence the behavior of the community, there should be changes in their attitudes, perceptions and behavior.
Awareness-raising campaigns tend to be more successful and have a greater impact when they are conducted by a network Behavior change
Health facility management practice supportive roles to health care providers’ career growth and employ recognition system General public  The commitment to ensuring universal access to essential health care is, therefore, not only central to the social and economic development of a community but also an important aspect of social equity.  Building an operational partnership with the community, with the goal of improving the health status of the population, is a step beyond participation and involvement.  Mass media channels
Radio, community billboards, posters, press release  Social Media platforms
Facebook, Instagram, YouTube, Vimeo
Prepare social media messages for key stakeholders to share on their personal platforms to repost and thus further amplify messages.  Website
HRH network website and in collaboration with partner agencies and stakeholders  Interpersonal channels
Verbal relay of information among individuals

Awareness building

The first step in an awareness campaign is to understand the knowledge, attitudes and practices of the various user groups.
To influence the behavior of the community, there should be changes in their attitudes, perceptions and behavior.
Awareness-raising campaigns tend to be more successful and have a greater impact when they are conducted by a network

Audience Key message Communication channels Desired change/action International partners and stakeholders  HRH stakeholders should strategically invest in HRH as a foundation of an optimal health system that is accessible, accountable, affordable, and reliable.
 HRH stakeholders will introduce and adopt innovative ways to produce, manage and develop human resources for health to sustain a fit- for-purpose-and-practice health workforce.  Partnership opportunities abound and governments must work with healthcare institutions to encourage and facilitate collaboration between the community and the public sector.  Public-private partnerships establish and recognize the collaboration of the private health sector with services of public utility and can foster respecting basic standards of service delivery.  Building strong partnerships between health professionals provides an opportunity to maximize talents and expertise, while focusing on health care delivery.  Promote integrated and collaborative HRH initiatives (not in silos)

 International network

Partner countries (MHO/DOH)
ASEAN, INGOs, NGOs, Agencies  International news media  Websites

HRH network website and in collaboration with partner agencies and stakeholders  Social media platforms

Facebook, Instagram, YouTube, Vimeo
Prepare social media messages for key stakeholders to share on their personal platforms to repost and thus further amplify messages.

Adoption of messages and assist in its dissemination

Deep involvement (buy-in) in the process by a variety of stakeholders tend to generate better outcomes and a greater sense of ownership.

Actively involve partners and stakeholders in the process.

Stakeholders involved in strategic planning will have more interest and investment in the plan’s
success.

Include representatives of stakeholder groups in discussions for strategic planning to the greatest extent possible

Involve middle level managerial and operational levels in addition to the top level of management In planning and monitoring of HRHMP implementation

Monitoring and evaluation To determine to what extent the theory of change (see Figure 2) is achieved and to establish its validity, monitoring and evaluation activities will be made integral to the Masterplan. Monitoring is the ongoing process of systematically collecting and analyzing data or feedback on the progress being made towards achieving stated goals and objectives.46 47 Evaluation is a systematic, rigorous and independent assessment of ongoing or completed activities, programs or policies, compared to a set of standards, to determine the extent to which objectives are being achieved as a mean to contributing to decision making e.g. improvement of a program or policy. 48 49 50 A balanced scorecard (BSC), a widely accepted approach to monitoring and evaluation (M&E), is a carefully selected set of quantifiable measures derived from strategies organized around financial, customer (people), internal processes (activities), and learning and growth perspectives.51 A BSC has been crafted for the HRH Masterplan and due to the not for profit nature of human resources for health, partnership and collaboration have been included as additional dimensions. A set of high-level quantitative indicators across five

dimensions of the BSC and for the each of the strategic objectives of the Masterplan have been identified (Table 13). These high-level indicators will show the progress towards the accomplishment of the mission and goals of the Masterplan and have been used in the development of indicators for each strategy in the LFA. Table 13. Balanced scorecard indicators of the HRH Masterplan Perspective Strategic Objectives Measure People Adequate and equitable HRH distribution vis-à-vis local health needs (SO1) Responsiveness:

provision of proactive health services
reduced readmission rates  Customer value Satisfied end users of health system Productivity:
increase in availability of health services
reduction in patients going to secondary/tertiary -level of care Health system end user (customer) satisfaction  Satisfaction and/or retention Collegial collaboration among national agencies and other stakeholders Types and frequency of collaborations Mechanisms for collaboration Satisfied and cooperative owners and managers of health facilities Health worker satisfaction (on employment) Reduction of vacancies / duration of vacancy Satisfied and cooperative owners and managers of HEIs Increased # of graduates per cadre and practicing locally Improved completion rates (# of graduates/ # of enrolment) Proportion of compliant HEIs (# of compliant HEIs/total HEIs in the region) Process Improve recruitment of HRH fit for practice and fit for work to sustainably produce and deploy HRH and to promote greater HRH retention in the health sector (SO1) Increased number of graduates of students from local areas Efficiency: Improved retention of local health workers in local health facilities Quality: Profile of graduates of SUCs and high quality HEIs are responsive to the needs and practice locally
Quality: Increased/sustained availability of health services including public health in local health facilities Improved HRH productivity and responsiveness (SO3) Staffing standards fulfilled at the facility and health care provider network level Increased HRH employed in health sector with permanent positions especially in rural areas/GIDA Low employment turnover; reduced JOs, contractual employment Health facilities have appropriate number of permanent positions and filled vacancies Proportion of health worker who are aware about HRHMP Job satisfaction of public and private health workers
Financial Fully supported HRH and HRH systems

Perspective Strategic Objectives Measure  Financial performance  Effective resource use (Funding source, cost of service, overhead costs) Increased HRH-related investments which are appropriately managed (SO7) Increase in funding (Contribution of stakeholders for HRH investment) Efficiency measures (existing DOH indicators) Cost-utility/ effectiveness (existing DOH indicators) Compliance to public financial management system Learning and growth Enhanced competencies and careers of health workers (SO2) Employee satisfaction (career development) Defined volunteer health worker career paths
 Human capital

Health workers are in the appropriate positions of their career paths based on their competencies and experience Improved provision of health services because of enhanced competencies  Culture / Community

Responsive and highly skilled HRH providing culturally appropriate health services

Improved public health outcomes  Infrastructure & technology Functional and integrated HRH information systems (SO5) Access to up to date and accurate information  Governance Strengthened institutional capacity (SO6) Improved institutional planning and management capacities Proportions of national agencies and LGUs with institutionalized HR management for HRH Partnership and collaboration Sustained intersectoral collaboration/co-development of plans and policies (SO4)
Harmonized HRH related policies (personnel services limit in LGUs, financing)

Monitoring activities will be done regularly and focus on data collection for the pre-determined indicators in the LFA and BSC. If and when possible, it will be done in conjunction with the data collection activities and tools that are being done and used by the DOH.
Data for the LFA indicators will largely come from national and regional agencies, LGUs, and public and private HEIs and health facilities. These will be summarized and inform the high-level indicators in the BSC, which will indicate the progress of the Masterplan implementation. There are common evaluation activities that are carried at various stages of an intervention: formative or ex-ante, mid-term or process, and summative or ex-post evaluation. Formative evaluation (monitoring) is usually carried out in the development or implementation stages of an intervention or initiative while summative evaluation (outcome or impact)is done at the end of the intervention or initiative and usually focuses on outcomes.52 However the nature of an evaluation can be focused on its purpose such as on implementation, improvement-oriented, outcome/impact, and developmental.53 While monitoring will be undertaken from the beginning of the implementation of the Masterplan until its completion, evaluation activities are proposed to take place as follows:

Table 14. Timetable for Evaluation Activities Activity Coverage Stage of implementation Time/Year Process evaluation Short term plan Semi annual and during the short-term plan period 2021 to 2022 Outcome evaluation Short term plan Beginning of mid-term Early 2023 Process evaluation Mid-term plan Mid-implementation End of 2025 Outcome/impact evaluation Short and mid-term plans At the end of mid-term End of 2028

End Notes 1 Country Profile: Philippines (). Philippines | Institute for Health Metrics and Evaluation at http://www.healthdata.org/philippines accessed 18 May 2020 2 Trading Economics (2019). Philippines GDP 1960-2019 at https://tradingeconomics.com/philippines/gdp accessed 23 May 2020 3 CNBC (2020). Philippine 2020 GDP could decline more than previously forecast. 13 May 2020 at https://www.cnbc.com/2020/05/13/philippine-2020-gdp-could-decline-more-than-previously-forecast.html accessed 23 May 2020 4 Philippine Statistics Authority (2018). Technical Notes. Updating Population Projections based on 2015 Census of Population at https://psa.gov.ph/sites/default/files/attachments/hsd/pressrelease/Annex%20A%20-%20Technical%20Notes.pdf accessed 21 May 2020 5 Philippine Statistics Authority (2013). Urban-Rural Classification at https://psa.gov.ph/tags/urban-rural-classification accessed 22 May 2020 6 Philippine Statistics Authority (2020). National Quickstat for 2020 at https://psa.gov.ph/statistics/quickstat/national-quickstat/all/%2A accessed 23 May 2020 [PSA Quickstat 2020] 7 Philstar (2019). National Literacy Month: UN ranks Filipinos as most literate in Southeast Asia. September 27, 2019 at https://www.philstar.com/lifestyle/on-the-radar/2019/09/27/1955462/national-literacy-month-un-ranks-filipinos-most-literate- southeast-asia accessed 23 May 2020 8 PSA Quickstat 2020 supra 9 Philippine Statistics Authority (2019). Proportion of Poor Filipinos was Estimated at 16.6 Percent in 2018. At
https://psa.gov.ph/poverty-press-releases/nid/144752 accessed 22 May 2020
10 Department of Health (2017). National Objectives for Health Philippines 2017-2022 [NOH 2017-2022] 11 Ibid 12 Professional Regulation Commission (2020). Health professionals with valid licences as of April 2020
13 Data from NDHRHIS, FHSIS and DOH Deployment Program 14 Department of Health- Personnel Administration Division, March 2018. Powerpoint presentation. 2nd_Dr. Christine Co_HHRDB Presentation Sept 19 AM (09.19.18)_Unedited 15 Ibid 16 Data on the WISN recommended staffing came from “Technical Briefer on Facility Based Staffing Standards for Primary Care in the Philippines” USAID HRH2030 Philippines (2020) and the number of RHUs and BHS from Department of Health (2017). National Objectives for Health Philippines 2017-2022 17 Dayrit MM, Lagrada LP, Picazo OF, Pons MC, Villaverde MC. The Philippines Health System Review. Vol. 8 No. 2. New Delhi: World Health Organization, Regional Office for South- East Asia; 2018 18 Department of Health (2020). Philippine Health Facility Development Plan 2020-2040. Draft report 19 World Health Organization (2006). Working together for health. The World Health Report 2006. Geneva, Switzerland
20 World Health Organization (2010). Increasing access to health workers in remote and rural areas through improved retention. Global policy recommendations. The World Health Report 2010. Geneva, Switzerland 21 Mayne, John (2015). Useful Theory of Change Models. Canadian Journal of Program Evaluation. 30.2 (Fall), 119-142 22 Stein, Danielle, Valters, Craig (2012). Understanding “Theory of Change” in International Development: A Review of Existing Knowledge. Justice and Security Research Programme, International Development Department, London School of Economics 23 James, Cathy (2011). Theory of Change Review. A report commissioned by Comic Relief.
24 Vogel, Isabel (2012). ‘Theory of Change’ in international development. Review report. UK Department for International Development April 2012 25 NOH 2017-2020 supra 26 Sy, Kimiko (2017). In Numbers: Road crash incidents in the Philippines. Rappler. April 12, 2017 27 NOH 2017-2022 supra

28 Mission Report. Visit of the Anti-epidemic Medical Expert Team from the People’s Republic of China to the Philippines. 5-19 April 2020 29 NEDA (2020). Addressing the social and economic impact of the COVID19 pandemic [NEDA 2020] 30 Imperial College COVID-19 Response team (2020). Report 9: Impact of non-pharmaceutical interventions (NPIs) to reduce COVID-19 mortality and health care demand at https://www.imperial.ac.uk/media/imperial-college/medicine/mrc-gida/2020- 03-16-COVID19-Report-9.pdf accessed 4 May 2020 31 David, Guido, Rye, Singh Ranjit, Agbulos, Ma Patricia. (2020). Forecast Report No.5 Covid-19 Forecasts in the Philippines: Sub- National Models for NCR and other Selected Areas. UP–OCTA research. April 29, 2020 32 Ibid 33 Ibid 34 HRH2030 (2019). Human Resources for Health Masterplan Situation Analysis. Pasig 35 Inter-Agency Task Force Technical Working Group for Anticipatory and Forward Planning (2020). We Recover as One 36 Hogwood, Briand and Lewis Gunn (1998). “Why ‘perfect implementation’ is unattainable”, The Policy Process A reader, ed. by Michael Hill, London: Prentice Hall 37 Pal, Leslie (2014), Beyond Policy Analysis – Public Issue Management in Turbulent Times, Fifth Edition, Nelson Education, Toronto 38 Naughton, John (2020). “When Covid-19 has done with us, what will be the new normal?” The Guardian. 18 April 2020. At https://www.theguardian.com/commentisfree/2020/apr/18/when-covid-19-has-done-with-us-what-will-be-the-new-normal accessed 4 May 2020 39 Department of Health (2020). Guidelines on Integration of the Local Health Systems into Province-wide and City-wide Health Systems (P/CWHS). Administrative Order No. 2020-0021. May 22, 2020 40 World Health Organization (2015). WHO Accountability Framework 41 Ibid 42 Philippine Congress (2018). An Act Establishing and Institutionalizing the Seal of Good Local Governance for Local Government Units, and Allocating for this Purpose the Seal of Good Local Governance Fund. Quezon City 43 Philippine Congress (1991). An Act providing for a Local Government Code of 1991. Quezon City 44 WHO (2006) Working together for health. The World Health Report 2006. Geneva, Switzerland
45 World Health Organization (2010). Increasing access to health workers in remote and rural areas through improved retention. Global policy recommendations. The World Health Report 2010. Geneva, Switzerland 46 United Nations Development Programme (2009). Handbook on Planning, Monitoring and Evaluating for Development Results. UNDP New York [UNDP 2009] 47 Shapiro, Jane (2003). Monitoring and Evaluation. CIVICUS at http://www.civicus.org/view/media/Monitoring%20and%20Evaluation.pdf accessed 8 June 2020 48 Ibid 49 Shackman, Gene (1998). What is program Evaluation? A beginner’s guide. The Global Social Change Research Project 50 Patton MQ (1997). Utilization-focused evaluation 3rd edition. Thousand Oaks: Sage Publications 51 Niven, Paul R (2003). Balanced Scorecard Step by Step for Government and Nonprofit Agencies. New Jersey: John Wily & Sons Inc. 52 Bowen, Sarah (2012). A Guide to Evaluation in Health Research. Canadian Institutes of Health Research. Ottawa at https://cihr- irsc.gc.ca/e/45336.html
53 Ibid

Appendices

Appendix A. Logical Framework Matrix for Short, Medium and Long -term Strategies

Production Strategies

Project Summary Measure Baseline Target Means of Verification Existing DOH Initiatives Stakeholder Timelines Assumptions/ Risks Estimated Cost (in PHP)

Goal 1Educate and train future HRH in or near their places of origin
Proportion of health facilities with graduates of SUCs and high quality HEIs that are responsive to the local needs and practice locally
No data

Health facility employment records

Congress, CHED, regional HEIs, professional societies, employers: LGUs and private health facilities 2024 - onwards

Funds for establishing health sciences programs in SUCs and campuses are available
There is policy/political support (Congress, CHED, LGU/LCE)

Proportion of health facilities that provide holistic/ comprehensive
health services No data

Health Facility data

Availability of schools, training hospitals and affiliation facilities in the area

Reduced patient readmission rates
No data

Health Facility data

Availability of competent faculty who are willing to teach in GIDAs/rural areas or where they are needed

Outcomes Locally produce highly motivated and responsive HRH who will continue to serve for at least 5 years in their locality  increased # of graduates per cadre and practicing locally 189,787 HRH

Data Source: 2018 HHRDB Data From forecasting results Graduation records (CHED) 2024 - onwards -Alternative learning is accessible

 Proportion of regions with available supply of local HRH

Project Summary Measure Baseline Target Means of Verification Existing DOH Initiatives Stakeholder Timelines Assumptions/ Risks Estimated Cost (in PHP)

Outputs Local students are enrolled in SUCs or high quality SUCs Improved completion rates (# of graduates/ # of enrolment) Enrollees as of 2017

Nursing: 46,310
Midwifery: 11,132
Medicine: 23,763
Medtech: 32,466

Graduates as of 2017

Nursing: 12,267
Midwifery: 3,720
Medicine: 4,542
Medtech: 7,307

Source: 2017 CHED data from HLMA dataset From forecasting results Graduation and Enrolment records (CHED) 2023

Accredited internship/clinical practice programs for 12 cadres established per region

of interns/trainees by cadre

No data 1 internship/clinical practice program per cadre per region 2023

Health science courses for 12 cadres offered per region Proportion of regions with health science courses for 12 cadres Nursing: All regions Midwifery: All regions Medicine: Except Region 12, CARAGA and MIMAROPA Medtech: All regions

Source: 2017 CHED data from HLMA dataset

2023

Activities & inputs Identify and support SUCs or high quality HEIs which offer health sciences education in every region Proportion of regions with HEI having health sciences education present 109 SUCs (min 1 per region but not for all cadres) All SUCs have responsive curricula for 12 cadres National and CHED policies and registration 2022

37,907,742.00

Determine training hospitals for internship of 12 cadres in all regions Proportion of regions with internship/clinical practice program per cadre in place No data

CHED data 2022

Project Summary Measure Baseline Target Means of Verification Existing DOH Initiatives Stakeholder Timelines Assumptions/ Risks Estimated Cost (in PHP)

Reorient health professional curricula
to produce responsive health workers equipped with primary care competencies for the region Proportion of HEIs with responsive curriculum development No data

2022

Goal 2Establish targeted admission practices in HEIs Increased number of graduates of students from local areas No data

(Data source: DOH Scholarship program data)

Admission practices; CHED/HEI issuances

CHED, DOH, regional HEIs 2024 - onwards

Private schools adjust their admissions guidelines.

Outcomes SUCs and HEIs prioritize admissions of IP and students with rural background Proportion of compliant HEIs (# of compliant HEIs/total HEIs in the region) No data

CHED/HEI monitoring of issuances 2024 - onwards

Public and private schools can be readily regulated

Outputs Increase enrolment of rural and IP students Proportion of rural and IP students to total enrolment No data

(Data source: DOH Scholarship program data) at least 50% Enrolment records (CHED) 2023

Coordinate with school officials and family

Activities & inputs Revise admission guidelines in HEIs per region to target indigenous people and local students with rural background Proportion of SUCs/HEIs with admission guidelines target indigenous people and local students with rural background No data

(Data source: DOH Scholarship program data)

2022

Policies in place for SUCs and HEIs to prioritize admissions 7,933,967.00

Promote enrolment of local students including indigenous people who are willing to serve locally for at least 5 years Proportion of SUCs/HEIs with campaigns to promote enrolment of local students No data

2022

Goal 3Expand scholarships that would support the production of needed cadres of health care professionals and health care workers with enforceable RSA that also offers incentives
Amount of funding of for scholarships per region

No data

Scholarship program data and reports

HRH Network, UNIFAST, DOH, DOST, PRC, CHED, HEIs 2024 - onwards

There are policies on health sciences program scholarships & RSA with rigorous instruments i.e. incentives and penalties

Sources of scholarships No data

Scholarship program data and reports

Number of scholars per cadre funded No data

Scholarship program data and reports

Coverage of scholarships (e.g., tuition fee, miscellaneous fees, living allowance) No data

Scholarship program data and reports

Project Summary Measure Baseline Target Means of Verification Existing DOH Initiatives Stakeholder Timelines Assumptions/ Risks Estimated Cost (in PHP)

Outcomes High utilization of health science program scholarships that address HRH gaps in underserved areas Proportion of graduates with RSAs serving in underserved areas No data

HW Registry, PRC 2024 - onwards

There is budget for scholarships

Outputs Available health sciences program scholarships with RSA for students from underserved areas Increased number of health sciences program scholarships in underserved areas Medicine program (for 8 SUCs including UPM and UP-SHS) Nursing program (UPM and UP-SHS) Dentistry (UPM) Midwifery (UP- SHS) Pharmacy (UPM) PT (UPM) OT (UPM) Medtech [Public Health] (UPM)

Source: CHED- DBM JMC 2018-1, UPM RSA IRR

Scholarship records 2023

Students are amenable to longer RSAs.

Activities & inputs Use WISN results as basis for providing scholarships in rural areas Availability of an institutionalized national system of providing scholarship grants in rural areas using WISN results No institutionalized national system of provising scholarship grants

2022

WISN is regularly carried out 1,128,948,460.40

Harmonize public and private scholarships from all sources to boost health sciences program enrolment and produce needed cadres of health workers in rural and GIDA areas
Equitable distribution and comprehensive coverage of health sciences program scholarships in rural and GIDA areas No data

2022

Strengthen implementation of RSA for HRH (monitoring, non- compliance, identify incentives) Proportion of regions implementing and monitoring of an enhanced policy on RSA CHED-DBM JMC 2018-1, UHC IRR as of 2019

2022

Goal 4Re-orient curriculum to PHC and integrate public health, rural health courses/ topics, rural exposure/immersion, and use of technology to deliver health services Proportion of health sciences HEIs that have re-oriented curricula to PHC and integrate public health, rural health courses/topics, rural exposure/immersion, and use of technology to deliver health No data

CHED issuances, health sciences program curricula

CHED, PRC, private sector, HEIs, associations e.g. ADMC, ADPCN 2024 - onwards

Political will/support is present to introduce and implement revisions in curricula

Project Summary Measure Baseline Target Means of Verification Existing DOH Initiatives Stakeholder Timelines Assumptions/ Risks Estimated Cost (in PHP)

services by CHED region by professional cadre Proportion of health sciences HEIs that produce primary care workers who are practice ready after graduation by region and by cadre

There is budget available for revising curricula.

Outcomes HRH graduates have strengthened PHC and public orientation and serving in underserved areas Proportion of HRH with strengthened PHC and public health orientation serving in underserved areas No data

List of HEIs with graduates who are products of the re-oriented curriculum 2024 - onwards

The necessary structure for the revision and implementation of curricula is present.

Outputs Implementation of revised curricula in HEIs/SUCs Proportion of HEIs/SUCs with revised curricula No data

HEI records 2023

HEIs are compliant with curricular revision policies.

Activities & inputs Intensify pre-service education and training on PHC, public health, rural exposure/immersion, and use of technology to deliver health services Proportion of HEIs/SUCs integrating PHC, public health, rural health topics/immersion, and use of technology to deliver health services in curriculum of all health sciences program No data

2022

The necessary policies are in place and enforceable. 35,039,294.00

Proportion of HEIs/SUCs producing graduates with new skillset, especially in the application and use of technology in service delivery

Advocate for the inclusion of PHC, public health, and rural health topics/ immersion in public and private HEIs Increased percentage of public health/primary health care related questions in board examinations of health-related courses No data

2022

Utilize flexible learning options (FLOs) in pre-service training of health professionals
Number of HEIs using modular, blended learning and e-learning modalities in pre-service training of health professionals No data

HEI reports, CHED policies 2022

Project Summary Measure Baseline Target Means of Verification Existing DOH Initiatives Stakeholder Timelines Assumptions/ Risks Estimated Cost (in PHP)

Form a functioning interagency working group to introduce changes to curricula Enacted agreement (or any binding document) establishing the interagency working group No data

2022

Primary health/ public health care included in OBE No data

Minimum time of rural exposure/immersion defined in OBE No data

Workforce Strategies

Strategic Objective 2 Create and sustain systems for developing HRH competencies and the careers of health workers to improve productivity and responsiveness, and to promote greater HRH retention

Project Summary Measure Baseline Target Means of Verification Existing DOH Initiatives Stakeholder Timelines Assumptions/ Risks Estimated Cost (in PHP)

Goal 5 Support career development of volunteer health workers (e.g, BHW, BNS, etc.)
Defined volunteer health worker career paths
No volunteer health worker career path Adoption of career paths of volunteer health workers by LGUs
Job descriptions/rol es and responsibilities for volunteer health workers

Career map for volunteer health workers Competency assessment DOH, TESDA, LGUs, DILG, other agencies/ institutions that offer programs for volunteer health workers 2024 - onwards

There is a policy that supports the career development of volunteer health workers

Outcomes Volunteer health workers have career paths in the health sector Career program for volunteer health workers No career program for volunteer health workers

Program design 2024 - onwards

The budget is available for their career development.

Proportions of national agencies and LGUs with institutionalized HR management for HRH No data

LCEs will support the career path of volunteer health workers

Volunteer health workers will no longer be co-terminus with LCEs.
Proportion of volunteer health workers appointed beyond the LCE term
No data

List of volunteer health workers 2024 - onwards

Structures/processes are in place to support volunteer health workers career development.

Project Summary Measure Baseline Target Means of Verification Existing DOH Initiatives Stakeholder Timelines Assumptions/ Risks Estimated Cost (in PHP)

Outputs Adoption of certification program for volunteer health workers by LGUs Proportion of LGUs employing volunteer health workers with certification
No data

List of certified volunteer health workers, TESDA certication program 2023

LGUs will support the accreditation of volunteer health workers and include them in local priorities.

Adoption of career development paths for volunteer health workers Proportion of LGUs implementing career development paths 0 LGUs

List of LGUs implementing career development paths, LGU annual reports 2023

Activities & inputs Review exisiting capacity building programs for volunteer health workers Availability of a range of capacity building programs for volunteer health workers No data

Reports 2022

12,473,100.00

Craft career development paths for volunteer health workers Availability of a feasible career development paths available for volunteer health workers No career development paths available for volunteer health workers

Career development path for volunteer health worker report 2022

Explore new initiatives such as micro credentialing to be able to provide home-/community-based services Established appropriate certifications (e.g., National Certification Program) for volunteer health workers

2022

Strengthen implementation of national certification program for volunteer health workers No data

TESDA Report 2022

Goal 6 Enable health workers to obtain appropriate skills, knowledge and attitudes through learning and in- service staff development methods Proportion of responsive and highly skilled HRH providing health services No data

end user (patient and facility) satisfaction e-learning, competency assessment, LDIMS PRC, DOH, TESDA, academe, other agencies, health facilities 2022 - onwards

HRH are allowed time to access learning and development activities.
Support from LCEs to access learning and development activities without incuring absences
The cost of learning and development activities (e.g. conventions) is made affordable with

Project Summary Measure Baseline Target Means of Verification Existing DOH Initiatives Stakeholder Timelines Assumptions/ Risks Estimated Cost (in PHP)

sponsorship of health facilities.

There is policy supporting the acquisition of knowledge and skills through various learning and development activities.

Reduced re-admission rates No data

facility statistics

Reduced referral rates No data

facility statistics

Outcomes HRH have up-to-date knowledge, skills and attitudes that is the foundation of high quality practice Proportion of HRH with improved competencies No baseline data

Performance evaluation reports, post- training evaluation scores 2022 - onwards

HRH have access to learning and development activities and opportunities to earn continuing professional development (CPD) units.

Proportions of national agencies and LGUs with institutionalized HR management for HRH No data

Outputs HRH regularly access face-to-face accredited learning and development programs or alternative modes of learning while earning CPD units Increased proportion of HRH with completed trainings and accessing alternative modes like eLearning No data

list of HRH with completed trainings per year and per region 2021

There is internet access for quality online learning.

Increased investment in training/ competency improvement No data

LIPH, AOP 2021

There is a single process that assesses learning and development needs of HRH and oversees learning and development activities attended

Number and types of learning and development activities accessed No data

List of trainings, Training information management 2021

Project Summary Measure Baseline Target Means of Verification Existing DOH Initiatives Stakeholder Timelines Assumptions/ Risks Estimated Cost (in PHP)

database in LDIMS Activities & inputs Develop more alternative modes of learning (e.g., e-learning, webinars) on Primary Care in DOH e-Learning platform with CPD units Presence of Database of alternative modes of learning accessible in DOH e-Learning platform and other learning platforms No data

2020

6,723,747,156.50

Provide access to available face-to- face learning and development programs and providers while earning CPD units Presence of Database of CPD Programs and list of learners per region
No data

Training information management database in LDIMS 2020

Goal 7 Enforce/ strengthen the provision of coaching, mentoring, and supportive supervision to health workers Proportion of health facilities with health workers exhibiting enhanced competencies that provide improved health services No data

end user satisfaction CMSS DOH, health facilities, professional associations 2024 - onwards

All health facilities will integrate CMSS in theeir performance development plans

Outcomes HRH have improved knowledge and skills through CMSS Improved scores in performance management and CMSS tools
No data

Performance evaluation reports, assessment tools

2024 - onwards

Designate supervisors to participate in CMSS

Proportions of national agencies and LGUs with institutionalized HR management for HRH No data

Outputs HRH have CMSS in public and private sectors at local and national governments Proportion of HRH with CMSS No data

list of HRH with CMSS

2023

There are existing tools that may be used in CMSS

Time spent for CMSS activities No data

reports

Types of CMSS activities No data

reports

Activities & inputs Determine competencies of coaches and mentors and capacitate them as necessary Availability of Capacity building programs for coaches and mentors No data

reports, NHWA

2022

25,096,262.00

Proportion of coaches and mentors capacitated No data

2022

Include coaching and mentoring in the learning and development programs Proportion of Coaching and mentoring programs accredited for CPD units No data

reports, NHWA

2022

Design mentoring and coaching programs aligned with area or program needs as needed Presence of established coaching and mentoring programs, especially in the public sector No data

reports, NHWA

2022

Project Summary Measure Baseline Target Means of Verification Existing DOH Initiatives Stakeholder Timelines Assumptions/ Risks Estimated Cost (in PHP)

Goal 8 Develop and implement career paths of health workers across the public and private sector from national to local levels Proportion of health workers in the appropriate positions of their career paths based on their competencies and experience
No data

Job descriptions/rol es and responsibilities, Career map

DOH, DILG, LGUs, professional organizations, health facilities, CHED, academic partners 2024 - onwards

The LGUs and the private sector have career progression and specialization programs

Outcomes HRH are in appropriate career programs Proportion of HRH with career paths No data

HR records, NHWA 2024 - onwards

There is a policy that supports the development of career paths of HRH

Proportions of national agencies and LGUs with institutionalized HR management for HRH No data

Outputs Implementation of career progression programs in national and local governments, private and public sectors Number of institutions in private and public sector adopting career progression programs No data

reports, NHWA 2023

LCEs and health facility management support the development of career paths of HRH.

Activities & inputs Design harmonized career progression paths of HRH in government and private sector Presence of Career progression programs for all health professionals

reports, NHWA 2022

The income class of the LGUs does not affect the need for development of career paths of HRH.
28,974,578.00

Provide information on careers in the health sector for potential health workers Proportion of health workers aware of careers in the health sector

Survey 2022

Strategic Objective 3 Raise HRH productivity and responsiveness by promoting job satisfaction and motivation at all levels and improve greater HRH retention

Project Summary Measure Baseline Target Means of Verification Existing DOH Initiatives Stakeholder Timelines Assumptions/ Risks Estimated Cost (in PHP)

Goal 9 Create adequate permanent positions for HRH (all cadres including Barangay Health Workers [BHWs] & Barangay Nutrition Scholar [BNS]) in response to health sector needs
Proportion of health facilities and health care provider network that fulfilled the staffing standards No data

Staffing list vis- à-vis required staffing per WISN results per facility and health care provider network level WISN DOH, DILG, LGUs, CSC, DBM, DOLE, professional organizations, CSOs 2023 - onwards

There is policy support for the creation of permanent positions.
The budget is available for the creation of permanent positions.
Staffing standards widely disseminated
WISN results available and used basis for creating positions

Increased number of HRH employed in Phil health sector with permanent positions especially in rural areas/GIDA No data

There is political support for creating permanent positions

Increase in funding (Contribution of stakeholders for HRH investment) No data

NHWA is functional

Outcomes Sufficient HRH with permanent positions receiving competetive salaries and benefits Proportion of health facilities with appropriate number of permanent positions and filled vacancies 9311 vacant positions (count of vacant positions of DOH-CO, regional offices and DOH retained hospitals)

Source: Feb 2017 data, DOH-HHRDB

Staffing structure with employment status, salaries and benefits 2023 - onwards

Health facility websites are functional and capable of disseminating vacancies widely

Proportions of national agencies and LGUs with institutionalized HR management for HRH No data (Permanent positions in DOH and DOH retained hospitals might be available)

DOH and LGUs widely disseminate vacancies

Outputs Adequate permanent positions with competitive salaries and benefits created for HRH Increased number of permanent positions in health sector vis-a-vis health sector needs No data

Staffing records, NHWA 2022

Decrease in number of health facility personnel occupying job order and/or casual positions No data

Staffing records, NHWA

Project Summary Measure Baseline Target Means of Verification Existing DOH Initiatives Stakeholder Timelines Assumptions/ Risks Estimated Cost (in PHP)

Activities & inputs Broadcast widely unfilled government and private HRH positions Proportion of health worker positions filled vis-à-vis the health sector needs 9311 vacant positions (count of vacant positions of DOH-CO, regional offices and DOH retained hospitals)

Source: Feb 2017 data, DOH-HHRDB

National database of government (and private) positions for health workers, NHWA 2021

12,289,598.00

Collaborate between the national and local governments to source funds and recruit local HRH to fill necessary vacant positions 2021

Advocate to LGUs to create positions for HRH 2021

Review existing policies 2021

Goal 10 Standardize health workers’ positions and competitive compensation, benefits and incentives such as supporting career progression, standardized, decent compenstion and benefits, recognition and rewards system to improve job satisfaction and motivation (public and private sectors; national and local)
Satisfaction (rating) of public and private health workers on employment terms No data

Staff Satisfaction survey

DOH, DBM, DILG, DOLE, CSC 2024 - onwards

There are funds to provide benefits under the Magna Carta Law

Stable facility HRH complements No data

2024 - onwards

There is political support e.g. LCEs may not want to spend more for HRH.

Satisfaction of health workers over competitive compensation, benefits, and incentives received
No data

Survey 2024 - onwards

There are policies to support standardization.

Outcomes Consistent implementation of standardized positions, compensation, benefits and incentives across sectors and between local and national governments Low employment turnover rate; reduced number of health workers occupying job order positions or engaged in contractual employment No data

List of vacancies/filled positions, NHWA 2024 - onwards

The private sector will support standardization.

Proportions of national agencies and LGUs with institutionalized HR management for HRH No data

2024 - onwards

Private sector supports expansion of Magna Carta to cover Private sector-hired HRH

Outputs Standards for positions, compensations, benefits and incentives that are acceptable, feasible and implementable across national and local governments and private sector Change in standardized positions, compensation and benefits across sectors and between local and national governments No data

Staffing records, compensations and benefits issuances 2023

Too many players in the Private sector

Project Summary Measure Baseline Target Means of Verification Existing DOH Initiatives Stakeholder Timelines Assumptions/ Risks Estimated Cost (in PHP)

Activities & inputs Advocate and capacitate LGUs to allocate sufficient budgets for HRH in accordance with staffing standards Proportion of LGUs enacting budgets supportive of HRH development and management No data

Local budget, AOP 2022

There is sufficient technical expertise and funds to conduct high quality reviews and craft standards 23,187,327.00

Proportion of capacitated LCEs No data

Program(s) similar to HLGP

Request exemption from PS cap and LGU income class-dependent rates for health workers Enacted policy/ies that will allow exemption from restrictions of PS Cap and LGU income class- dependent rates No available policy that will allow exemption from restrictions of PS Cap and LGU income class- dependent rates Policy exempting restrictions of PS Cap and LGU income class- dependent rates Revised policy 2022

Harmonized HRH related policies (PS cap, financing) No data

Explore expansion of Magna Carta to cover private sector HRH Revision of Magna Carta to cover private sector Magna Carta does not cover private sector health workers

Revised policy 2022

Enforce full implementation of Magna Carta for Public Health Workers across national and local levels Proportion of compliant health facilities and local governments that implement the Magna Carta provisions No data

List of health facilities and local governments that provides Magna Carta benefits 2022

Review/amend provisions under existing laws on compensation and benefits of health workers (e.g., PS limit and Magna Carta to cover private sector HRH ) List of proposed provisions in selected policies that supports health workers No data

Policy reviews, reports 2022

Identify compensation packages,
benefits and incentives for professional and non-professional health workers that are motivating
Availability of competitive compensation packages, benefits and incentives
No data

Staffing structure showing compensation and benefits per facility and health care provider network 2022

Review of existing benefits and incentives for the public and private sector Identified variations in benefits and incentives No data

Report 2022

Project Summary Measure Baseline Target Means of Verification Existing DOH Initiatives Stakeholder Timelines Assumptions/ Risks Estimated Cost (in PHP)

Review of positions classification and job descriptions of public health workers Identified variations in positions and job descriptions No data

Report 2022

Goal 11 Ensure well-being of health workers including protection from emerging and re-emerging diseases (e.g. wellness programs, mental health, etc.) - (from long term) Reduced health worker turnover due to work-related health and illness issues No data

health facility reports, agency reports, prevalence/incid ence studies, HRH information system statistics

DOLE, DOH, health facilities, HRH Network, C/P-Wide health care provider network 2022 - onwards

Health workers take advantage of the health, wellness, and infection prevention and control programs

Outcomes Improved health and well-being of health workers Reduced incidence and prevalence of work-related illnesses among health workers No data

health facility reports, agency reports, prevalence/incid ence studies, HRH information system statistics 2022 - onwards

Health facilities have resources for health, wellness, and infection prevention and control programs

Outputs Implementation of health and wellness programs for health workers within city-wide and province-wide healthcare provider networks Proportion of city-wide and province-wide healthcare provider networks implementing health and wellness programs for all health workers No data

health facility reports, agency reports 2021

Political will of decision- makers to implement policies on health care worker protection, and infection prevention and control in public and private sector

Implementation of policies on health care worker protection, and infection prevention and control standards in public and private sector health facilities Proportion of health facilities implementing policies on health care worker protection, and infection prevention and control in public and private sector No data

health facility reports, agency reports 2021

Health facilities and decision makers are willing to introduce health and wellness programs for health workers

Activities & inputs Develop health, wellness, and infection prevention and control programs (e.g., mental health, physical health, etc.) for health workers Documented functional health and wellness programs, and infection prevention and control programs No data

health facility reports, agency reports 2020

3,518,864.00

Craft policy on health care worker protection (e.g., stigma, bullying), and infection prevention and control measures for emerging and re- emerging decisions Enacted policies on health care worker protection, and infection prevention and control measures
No data

Policy documents 2020

Project Summary Measure Baseline Target Means of Verification Existing DOH Initiatives Stakeholder Timelines Assumptions/ Risks Estimated Cost (in PHP)

Goal 12 Ensure compliance with minimum work environment standards by implementing Occupational safety and health (OSH) standards and infection and prevention control initiatives
Satisfaction (rating) of public and private health workers on work environment No data

Routinely collected information on satisfaction

DOH, DOLE, Health Professional societies, health facilities, Inter- Agency Committee on Environmental Health (IACEH) - Occupational Health Sector and Toxic and Hazardous Substances Sector, CSC, UP College of Public Health, UP-PGH National Poison Management
2022 - onwards

Supporting mechanisms (payment, accreditation) in place

Health worker productivity measures (e.g., reduced absences, infections, etc.)

HRIS statistics, NHWA

Policy supportive to telehealth/telemedicine, alternative work arrangements in place

Outcomes Optimal patient load of health workers in health facilities Proportion of health facilities with optimal patient load considering patient acuity and nature of cases (e.g., infectious, non-infectious, long term, etc. No data

health facility data, HRIS statistics, NHWA 2022 - onwards

Decision makers support changes in alternative work arrangements

Reduced likelihood of health worker exposure to nosocomial and other infections, as well as other health risks Proportion of health facilities with reduced infections and other health risks among health workers No data

health facility data, HRIS statistics, NHWA 2022 - onwards

Capacity building to explore and use available technology

Outputs Introduce changes in existing OHS standards based on the results of implementation review, and to cover public health emergency scenarios
Proportion of health facilities implementing revised OHS standards
No data

health facility report, agency reports 2021

Use of telehealth and telemedicine in public and private sector Proportion of health facilities using telehealth and telemedicine in service delivery No data

health facility and agency reports 2021

Introduce changes in work shifts or working time of health workers in public and private sector Proportion of health facilities implementing changed work shifts for health workers No data

health facility and agency reports 2021

Activities & inputs Review existing OHS Standards and its implementation Gaps from OHS standards implementation review No data

report 2020

10,852,570.00

Explore use of available technology to deliver health care services
Enacted guidelines on using available technology to deliver health care services
No data

Policy documents 2020

Identify alternative work arrangements in cases of public health emergencies Enacted guidelines for alternative work arrangements No data

Policy documents 2020

Project Summary Measure Baseline Target Means of Verification Existing DOH Initiatives Stakeholder Timelines Assumptions/ Risks Estimated Cost (in PHP)

Review and implement minimum work environment standards (e.g., hazard pay, PPEs, short-term accommodations) to prevent and control emerging and re-emerging diseases to protect health workers Available minimum work environment standards on disease prevention and control for emerging and re-emerging diseases No data

Policy documents 2020

Goal 13 Ensure appropriate skills mix and roles/functions present in health facilities Proportion of health facilities that provide proactive and responsive health services No data

Health Facility data WISN DOH, health facilities, professional organizations, PSA, PHO, C/P- Wide HCPN 2022 - onwards

Available HRH to be recruited in C/P-Wide

Reduced patient readmission rates
No data

Health Facility data

Resources are available to introduce new staffing composition and number for health service delivery

Outcomes Improved workload distribution among health workers within health facilities in consideration of emerging and re-emerging diseases Proportion of health facilities with improved workload distribution among health workers No data

Health Facility data 2022 - onwards

Decision makers are supportive of implementing guidelines on HRH standards

Establishment of new health worker cadre/s or roles/functions needed to respond to future health needs including emerging and re-emerging diseases Improved population and individual health outcomes No data

Health Facility data, PSA, PHO data 2022 - onwards

Decision-makers use WISN results in developing guidelines on HRH response and policies on minimum staffing composition and number

Outputs Introduce new staffing composition and number for health service delivery, including staffing appropriate for regular workload and public health emergencies, outbreaks, etc. Proportion of health facilities implementing policy on health worker minimum staffing (composition and number) No data

health facility report 2021

Implementation of guidelines on HRH standards to ensure optimal response to public health emergencies, outbreaks, etc. Proportion of health facilities implementing guidelines on HRH standards to ensure optimal response to public health emergencies, outbreaks, etc. No data

health facility report 2021

Availability of pool of health workers to respond to emerging and re-emerging diseases No data

Provincial health worker list, HRIS statistics, NHWA

Project Summary Measure Baseline Target Means of Verification Existing DOH Initiatives Stakeholder Timelines Assumptions/ Risks Estimated Cost (in PHP)

Activities & inputs Implement WISN findings specifying the ranges for staffing standards based on actual computed workload
Proportion of regions implementing staffing based on WISN calculations of workload for all cadres No data

Health facility report, CHD reports 2020

18,747,659.00

Review current minimum staffing (composition and number) for health service delivery, including needs for workload and public health emergencies, outbreaks, etc. Gaps on current minimum staffing (composition and number) for health service delivery, including needs for workload and public health emergencies, outbreaks, etc. No data

Report 2020

Craft policy on minimum staffing (composition and number) for health facilities in HCPN/SDN for regular health service delivery, public health emergencies, outbreaks, etc. Enacted policy on minimum staffing (composition and number) for health facilities in HCPN/SDN for regular health service delivery, public health emergencies, outbreaks No data

Policy documents 2020

Develop guidelines on HRH standards to ensure optimal response of HCPN/SDN during regular health service delivery, public health emergencies, outbreaks, etc. HRH standards available for response of HCPN/SDN during regular health service delivery, public health emergencies, outbreaks No data

Policy documents 2020

Cross-cutting Strategies

Strategic Objective 5 Strengthen information systems/data on HRH for monitoring, informing decision making, and ensuring accountability

Project Summary Measure Baseline Target Means of Verification Existing DOH Initiatives Stakeholder Timelines Assumptions/ Risks Estimated Cost (in PHP)

Goal 14 Strengthen and integrate information systems to ensure up-to- date HRH data and data sharing across the HRH sector e.g. National Health Workforce Registry (NHWR), National Health Workforce Account (NHWA) Number of Functioning information/ intelligence center for HRH established implementing NHWA and the registry 2 (NDHRHIS, IDHRHIS)

Annual reports Tools utilization, national health workforce profile NHWA CHED, PRC, DOH, POEA, CFO, DICT, LGUs, CHED private sector, HRH Network 2023 - onwards

The provisions of Data Privacy Act is well understood by HRH stakeholders and Data Privacy Act will not pose problem for data collection and sharing.

Project Summary Measure Baseline Target Means of Verification Existing DOH Initiatives Stakeholder Timelines Assumptions/ Risks Estimated Cost (in PHP)

There is budget to set up and operate HRH information systems

Presence of Tools for decision- makers No data

Annual reports Tools utilization, national health workforce profile

Utilization of information by the
decision-makers
No data

Policies, policy briefs and reports

There is political support for setting up the HRH information systems.

Outcomes Updated HRH information/data informs decisions and policies No. and type of HRH process (e.g., recruitment, compensation, etc.) covered of data-informed decisions and policies
0 modules 18 priority NHWA modules briefs, advisories, policy issuances 2023 - onwards

A policy will mandate DOH to be the data repository ogHRH information

Outputs Functional, integrated and interoperable HRH information systems Presence of Functional National Health Workforce Registry 0 registry

Reports generated, HRH country profile 2022 - Provide a standard schedule of updating/releasing of data

Presence of Functional National Health Workforce Account NHWA not yet implemented

Reports generated, HRH country profile 2022

Availability of HRH country profile Yes (2018 c/o USAID HRH2030)

Reports generated, HRH country profile 2022

Activities & inputs Conduct data mapping to identify data gaps and sources, frequency of data collection, and overlaps, if any Presence and implementation of a joint agreement among agencies collecting HRH data No data

NHWA 2021
31,679,852.00

Utilize the NHWA system as the national repository of HRH data and information Presence of an Interoperable information system across HRH Network and key stakeholders No data

NHWA 2021

Identify specific NHWA data modules to be contributed consistent with their mandates
Proportion of relevant stakeholders timely sharing data sets for NHWA No data

NHWA 2021

Provide updated health worker information aligned with agency process (e.g. PRC licensing, POEA exit information, etc.) Presence of Routinely updated health worker information No data

NHWA 2021

Include a NHWA system of data collection in the processes of agencies collecting HRH data Complete data collection aligned with relevant NHWA modules No data

NHWA 2021

Project Summary Measure Baseline Target Means of Verification Existing DOH Initiatives Stakeholder Timelines Assumptions/ Risks Estimated Cost (in PHP)

Goal 15 Conduct HRH research (including operations and evaluation research and analysis of health labor markets) Implemented effective solutions to HRH problems No research agenda for HRH

Policy/program and corresponding reports HLMA, deployment program research, omnibus policy review, health research agenda DOH, DOST, HRH Network, private sector, HEIs, research stakeholders 2023 - onwards

The cost of research is budgeted
There is policy supporting the conduct of research.
Research activites are incorporated in health workers' job descriptions.
Health facilities and institutions are held accountable in producing appropriate HRH researches
Time for research is routinely allocated both at the facility and national level
Completed research is widely disseminated and available online

Outcomes Understand causes of problems in HRH component of the health system Number of Identified effective solutions to HRH problems No data

Programs, reports, policy briefs, advisories 2023 - onwards

A "culture of research" will be promoted.

Determine the progress of HRH development and management and its contribution to achievement of health outcomes Status and progress of HRH development and management at different levels (?) No data

Programs, reports, policy briefs, advisories 2023 - onwards

Outputs Develop appropriate HRH research themes for the period (short-, medium-, long-term) Presence of Research themes for the short-, medium- and long- term No data

reports 2022 - The number of individuals and research facilities engaged in research will increase.

Activities & inputs Formulate medium term HRH research agenda and identify lead groups Presence of a National research agenda for HRH development and management No data

reports 2021 - There is capacity among stakeholders to do research. 163,340,135.00

Harmonize/integrate HRH development and management research agenda of national agencies 2021

Strategic Objective 7 Increase investments in HRH and align investments with current and future population health needs and of health systems

Project Summary Measure Baseline Target Means of Verification Existing DOH Initiatives Stakeholder Timelines Assumptions/ Risks Estimated Cost (in PHP)

Goal 16 Generate resources for HRH from various sources (domestic, international, and other sources) Fully supported HRH and HRH systems 2018 PhP: Salaries & benefits: 33.9B Deployment program: 9.6B

government annual and financial reports

Program reports

DOF, DBM, DOH, LGUs, NEDA, international development partners, HRH network 2023 - onwards

There is a policy supporting the generation of resources for HRH from various sources.

Outcomes International and other sources complement available resources for
HRH systems investment
Increase in HRH funding (Contribution of stakeholders for HRH investment) No data

Budget allocation and funding support from external sources 2023 - onwards

There is HR line item budget in the LIPH

Outputs Resources for HRH and HRH systems made available by national and local governments Presence of Agreements between national and local government regarding fund sharing No data

Agreements, LIPH, Annual operations plan 2022

There is sufficient budget allocated for HR at national and local levels

Inclusion of HRH in workplan and budget of national and local governments Yes (Budget)

Agreements, LIPH, Annual operations plan 2022

Private sector health facilities contribute directly to population health outcome

Activities & inputs Explore co-financing mechanisms between national and local governments Presence of established financing mechanisms
No data

Agreements, reports 2021

3,611,308.50

Funding for local HRH needs (development and management) provided by LGUs and supported, if necessary, by National government Proportion of LIPH with integrated local HRH investments
No data

LIPH 2021

Explore government subsidies (conditional transfer) for private sector health worker development and management to expand access to health care
Increased recruitment and retention rates of private health care facility
No data

budget and accomplishment reports 2021

Goal 17 Invest in HR systems (education and training, recruitment, deployment and retention, etc.) to meet national and subnational needs Disbursement of funds allocated for investments on education and training, recruitment, deployment and retention of health workers No data

government financial/disburse ment reports

DOF, DBM, DOH, CHED, LGUs, private sector (e.g., health facility managers), PSA, HRH Network 2023 - onwards There will be a specific amount allotted to HRH development and management in the LIPH

Outcomes Investment plan of HRHMP aligned with national and subnational needs Presence of Portfolio of investments No data

Investment plan, LIPH 2023 - onwards

LCEs will prioritize investments HRH

Project Summary Measure Baseline Target Means of Verification Existing DOH Initiatives Stakeholder Timelines Assumptions/ Risks Estimated Cost (in PHP)

Investments made produce highest possible contributions to health outcomes Improved public health outcomes (use existing measures for public health outcomes) No data

2023 - onwards development and management in this area

Cost effectiveness ratios (incremental cost-effectiveness ratio) No data

investment analysis reports, quarterly health reports, PSA data and report 2023 - onwards

Outputs Investment decision produce the greatest HR system benefits Cost-utility analysis ratios
Economic rate of return Return of investment No data

investment analysis reports 2022

Capacity to accomplish economic and financila valuation analysis

Establish annual investment priorities and initiatives that include strong HRH systems support Number of initiatives financed and supported by key stakeholders Annual list of investments No data

LIPH, Annual operations plan, General appropriations 2022

The policy environment is supportive of HRH investment

Activities & inputs Allocate resources to support HRH in the LIPH HR support budget line item in LIPH No data

LIPH 2021

Competent governance structure in place to implement investment decisions 45,806,477.00

Organize advocacy activities and campaigns to engage key stakeholders in investing and supporting HRH development and management initiatives

and types of advocacy

Number of stakeholders reached No data

Reports, Communication materials targeting HRH stakeholders 2021

Identify sources for funds in areas that are under invested at appropriate levels to support primary health care Available sources of funds No data

LIPH, General appropriations 2021

Identify areas in training and education, recruitment, deployment and retention at national and local levels requiring (additional) investments Gaps in investments No data

Report 2021

Project Summary Measure Baseline Target Means of Verification Existing DOH Initiatives Stakeholder Timelines Assumptions/ Risks Estimated Cost (in PHP)

Goal 18 Develop fiscal capacity to absorb and utilize effectively and transparently both domestic and international resources for HRH systems in the public and private sector Efficiency measures (use existing DOH indicators)

Cost-utility/ effectiveness (use existing DOH indicators) No data

DOH PGS/ government reports (all levels)

DOF, DBM, DOH, LGUs, private sector (health facilities) 2023 - onwards

There are policies that support:
- development of fiscal management capacities
- establishing budget coordination mechanisms across public and private sectors, and national and local levels
- co-managing resources across public and private sectors, and national and local levels

Outcomes Available resources are maximized for HRH systems in the public and private sector HRH systems objectives achieved No data

HRH system reports (all levels) 2023 - onwards

Outputs Plan, manage and analyze resource utilization routinely (every quarter and annual) in the public and private sectors Timely utilization (rate) of resources allocated No data

budget vs. expenditure report, budget utilization report 2022

If quarter utilization of allocated resources is accomplished, annual utilization will be high

Establish national and local fiscal system coordination
Presence of Functional coordination mechanism in place between DBM and LGU financial units No data

evaluation report of coordination mechanism accomplishments 2022

Activities & inputs Build capacities of HRH Network and HHRDB for planning, resource management (Fiscal fiscal mManagement) and analysis Proportion of Personnel (private and public sector) trained on planning, resource management, financial/economic analysis No data

HR records, organization file 2021

There is available learning and development interventions provided to HRH managers at all levels to do planning, resource management, analysis and coordination of financial resources 13,429,201.00

Develop a system for co-managing resources, such that management directions will be provided by national agencies, and implementation of specific plan of actions will be handled by local government units Presence of Guidelines on co- managing resources, with clear roles and responsibilities of each actor in the public and private sector No data

Policy guidelines 2021

MEDIUM-TERM PLAN

Production Strategies

Project Summary Measure Means of Verification Stakeholder Assumptions/ Risks

Goal 1 Establish inter-profession education (IPE) and training in universities and institutions Proportion of program outcomes exhibited by new graduates HEI data, annual reports, PRC data PRC (data), HEIs, CHED, professional societies, student groups, training hospital/facility (place of assignment)

Policy support

Assessment scores on performance of new professionals indicate positive patient experience Assessment scores and reports

Assessment tools developed by HRH2030 or other stakeholders will be used

Outcomes Health sciences graduates are trained to collaborate with various cadres in delivering health care Proportion of graduates interprofessionally trained HEI data, annual reports

HEIs are willing to implement IPE

Outputs Implementation of IPE guidelines based on needs of HCPNs and PCPNs
Proportion of HEIs implementing IPE guidelines CHED compliance report?

Resources (including funds) are available

Project Summary Measure Means of Verification Stakeholder Assumptions/ Risks

Implementation curricula integrating IPE based on assessment results Proportion of HEIs implementing health sciences program with revised curricula integrating IPE HEI report

Expertise available to develop IPE curricula

Activities & inputs Develop guidelines for IPE implementation Available IPE guidelines CHED Guidelines, policy issuance

Develop curricula integrating IPE Proportion of health sciences programs with revised curricula integrating IPE Health sciences program curricula

Assess relevance, acceptability and feasibility of IPE in existing health sciences education Gaps in IPE on existing health sciences education
Report

Goal 2 Provide incentives to HEIs (e.g., tax breaks) to ensure quality graduates Proportion of high performing HEIs
HEI annual reports, CHED data CHED, PRC, DBM, DOF, LGUs, HEIs,

Adapt CHED criteria for high performing HEIs

Outcomes Improved quality of graduates Performance of graduates as health professionals based on competency assessment Competency assessment scores, NHWA data

Performance standards for professionals by cadre are developed and available

Improved board passing rates PRC data

Improved performance of HEIs offering health sciences program Improved completion rates comparable to ASEAN standards CHED data, HEI data

HEIs are willing to improve quality of graduates

Outputs Implement effective financial or non-financial incentive packages for HEIs Available financial or non-financial incentive packages for HEIs HEI annual reports, CHED report

Project Summary Measure Means of Verification Stakeholder Assumptions/ Risks

Proportion of HEIs granted appropriate incentives HEI report

Activities & inputs Identify appropriate financial or non-financial packages for HEIs to ensure quality Proposed evidence-based effective incentives and incentive mechanisms for HEIs HRH Network-TWC Entry Report

Funds and other resources are available

Explore implementation of HEI incentive mechanisms and good practices from other countries

Review existing incentives and incentive mechanisms for HEIs (including SUCs)
Policy support

Workforce Strategies

Strategic Objective 3 Raise HRH productivity and responsiveness by promoting job satisfaction and motivation at all levels and improve greater HRH retention

Project Summary Measure Means of Verification Stakeholder Assumptions/ Risks

Goal 3 Create adequate permanent positions for HRH (all cadres including Barangay Health Workers [BHWs] & Barangay Nutrition Scholar [BNS]) in response to health sector needs
Proportion of health facilities and health care provider network that fulfilled the staffing standards Staffing list vis-à-vis required staffing per WISN results per facility and health care provider network level DOH, DILG, LGUs, CSC, DBM, DOLE, professional organizations, CSOs

There is policy support for the creation of permanent positions.
The budget is available for the creation of permanent positions.

Project Summary Measure Means of Verification Stakeholder Assumptions/ Risks

Staffing standards widely disseminated
WISN results available and used basis for creating positions

Increased number of HRH employed in Phil health sector with permanent positions especially in rural areas/GIDA NHWA

There is political support for creating permanent positions

Increase in funding (Contribution of stakeholders for HRH investment) LIPH, agency annual plans and reports

NHWA is functional

Outcomes Sufficient HRH with permanent positions receiving competetive salaries and benefits Proportion of health facilities with appropriate number of permanent positions and filled vacancies Staffing structure with employment status, salaries and benefits

Health facility websites are functional and capable of disseminating vacancies widely

Proportions of national agencies and LGUs with institutionalized HR management for HRH Agency and LGU reports

DOH and LGUs widely disseminate vacancies

Outputs Adequate permanent positions with competitive salaries and benefits created for HRH Increased number of permanent positions in health sector vis-a-vis health sector needs Staffing records, NHWA

Project Summary Measure Means of Verification Stakeholder Assumptions/ Risks

Decrease in number of health facility personnel occupying job order and/or casual positions Staffing records, NHWA

Activities & inputs Revise outdated policies, and those with gaps, and develop new policies, as needed
Amended and new policies supporting the creation of new permanent positions Policies

Identify sources of funding of new permanent positions
Inventory/list of funding sources and mechanisms for permanent positions LIPH, agency reports

Advocate to LGUs and key stakeholders to create permanent positions for HRH

and types of advocacy

Number of stakeholders reached Communication materials targeting HRH stakeholders

Goal 4 Standardize health workers’ positions and competitive compensation, benefits and incentives (public and private sectors; national and local) Satisfaction (rating) of public and private health workers on employment terms Job satisfaction ratings/ surveys DOH, DBM, DILG, DOLE, CSC

There are funds to provide benefits under the Magna Carta Law

Stable facility HRH complements Employment records, list of vacancies

There is political support e.g. LCEs may not want to spend more for HRH.

Satisfaction of health workers over competitive compensation, benefits, and incentives received
Job satisfaction ratings/ surveys

There are policies to support standardization.

Project Summary Measure Means of Verification Stakeholder Assumptions/ Risks

The private sector will support standardization.

Proportions of national agencies and LGUs with institutionalized HR management for HRH LGU, CHD, DOH reports

Private sector supports expansion of Magna Carta to cover Private sector-hired HRH

Too many players in the Private sector

Activities & inputs Advocate for amendment of existing government issuances and existing laws affecting compensation and benefits of health workers Amended issuances and laws affecting compensation and benefits of health workers Policy

There is sufficient technical expertise and funds to conduct high quality reviews and craft standards

Advocate passage of a Magna Carta covering private sector HRH Revision of Magna Carta to cover private sector Policy

Goal 5 Sustain improved health outcomes through standardize care through the implementation of national Clinical Practice Guidelines (CPGs) for priority health conditions Trend of health outcomes in a 7- year period (e.g., reduced mortality rates, increased life expectancy) health statistics, PSA data Professional organizations, health facilities, PSA, DOH

Buy-in of professional societies in developing and updating CPGs and clinical pathways of priority health conditions

Project Summary Measure Means of Verification Stakeholder Assumptions/ Risks

Outcomes Improve health outcomes related to CPG and clinical pathway compliance Proportion of health facilities and health professional cadres compliant with CPGs and clinical pathways for priority health conditions DOH data

Political support from WHO, DOH and professional societies

Outputs Ensure feasibility and acceptability of CPGs and clinical pathways for priority health conditions Proportion of health facilities that adopt and sustain the use of CPGs and clinical pathways for priority health conditions Health facility reports to DOH, professional organization data,

Resources available from professional societies in developing and updating CPGs and clinical pathways per cadre

Adoption of new and updated CPGs and clinical pathways for priority health conditions

Additional resources from development partners and DOH

Activities & inputs Advocate adoption of new and updated CPGs and clinical pathways for priority health conditions Levels of awareness and adoption CPG and clinical pathway utilization survey results

Disseminate widely the new and updated CPGs and clinical pathways for priority health conditions

Develop (where none) and update (if outdated) CPGs and clinical pathways for the priority health conditions based on HTA results Percentage of health conditions with new and updated evidence based CPGs and clinical pathways HTA reports and professional organization publication of CPGs

Project Summary Measure Means of Verification Stakeholder Assumptions/ Risks

Review of existing national CPGs and clinical pathways implemented in the country for priority health conditions (comminicable, non-communicable, emerging/re-emerging diseases) Inventory of CPGs and clinical pathways for priority health conditions

Use of digital health worker decision support accessible via mobile devices

Entry and re-entry, and Cross-cutting Strategies

Strategic Objective 4 Foster sustained intersectoral collaboration/co-development to develop responsive and coherent plans and policies among health and non-health agencies and organizations to generate shared goals, synergize functions, and produce collective impact

Project Summary Indicators Means of Verification Stakeholder Assumptions/ Risks

Goal 6 Ensure implementation of the health worker migration policies and programs consider the Philippine population health needs Adequate number of HRH for population health needs National statistics, PSA, NHWA POEA, DFA, OWWA, DOH, LGUs, professional societies, private sector (recruitment agencies, hospital association), development partners, destination country representative

Political support and agency stakeholder buy-in

Outcomes Sustainable migration of HRH to strengthen the capacity of the health system Proportion of active Filipino health worker migrants to total active health workforce
Facility-based statistics, HCPN data, NHWA

Resources in reviewing BLAs and ASEAN MRAs provisions, and other international commitments, and monitoring compliance

Outputs BLAs and ASEAN MRAs provisions, and other international commitments more Proportion of BLAs/ international commitments with provisions Reports

Low likelihood of health worker pushback

Project Summary Indicators Means of Verification Stakeholder Assumptions/ Risks

beneficial to Philippine interest (e.g., more economic opportunities, student exchange or scholarship opportunities) aligned with meeting population health needs Implementation of new policies and programs, and enhanced migration policies Proportion of cadres complying to enhanced migration policies Reports

Activities & inputs Advocate for individual health workers to cooperate with changes in migration policies and program that will manage migration to sustainable levels Number of health workers reached through advocacy activities Reports

Develop new policies or programs, when necessary, that will bridge the identified gaps in current migration policies and programs to manage migration to sustainable levels New policies or programs Congress archives, DOH- HPDPB reports

Strengthen existing migration policies (set conditions for migration, monitoring, compliance, penalties/incentives) to manage migration to sustainable levels Revised policies Congress archives, DOH- HPDPB reports

Review implementation and impact of bilateral agreements (BLAs), ASEAN MRAs, commitments in WHO ethical recruitment and other commitments to manage migration to sustainable levels Gaps and potential benefits to the country Reports

Goal 7 Strengthen meaningful private sector regulation in HRH production and employment Changes in private sector production and employment practices (e.g., reduction in class size, higher salaries) Reports Private sector HEIs and health facilities, PRC, DOH, CHED, DOLE,
professional societies

Private sector and stakeholder buy-in regarding regulation

Project Summary Indicators Means of Verification Stakeholder Assumptions/ Risks

Outcomes Encourage outcome-based (e.g., sustainable migration) self-regulation in the private sector Proportion of private sector health facilities participating in self-regulation Statistics, PSA, NHWA

Resources available to review current system of regulation, provide incentives and monitor compliance

Outputs Implement enhanced private sector regulation system and incentives/penalties Available self-regulation mechanisms Reports

Policy support available

Activities & inputs Identify incentives/penalties for private sector to achieve rational and quality HRH production and employment Set of incentives/penalties package Policies and programs

Review current system of private sector regulation i.e. identify areas where private sector regulation is needed Gaps in private sector regulation Reports

Goal 8 Align policies on production, employment and migration involving the education, health, labor, and other relevant sectors Proportion of aligned implementable policies to total number of HRH-related policies crafted Reports, NHWA, Reports from policy units of collaborating agencies HRH Network, CHED, PRC, DOLE, private and publlic HEIs and health facilities, professional societies, DBM, DILG, CSC, DFA, POEA, OWWA

Buy in from stakeholders to review and align policies and guidelines

Outcomes Produce HRH required by health, labor, and other relevant sectors Proportion of regions with adequate HRH based on needs Regional reports (DMO generated)

Resources for review process, implementation and monitoring of aligned policy and guidelines

Outputs Effectively implement aligned policies on production, employment and migration involving the education, health, labor, and other relevant sectors at the regional and provincial level Proportion of regions and provinces complying with aligned policies and guidelines promulgated Reports, NHWA, Reports from policy units of collaborating agencies

Political support in implementing policies and guidelines

Project Summary Indicators Means of Verification Stakeholder Assumptions/ Risks

Activities & inputs Craft policy agenda and implementation guidelines that aligns production, employment and migration involving the education, health, labor, and other relevant sectors Number of aligned policies and guidelines promulgated NHWA, HPDPB reports, reports from the policy units of collaborating agencies

Form a national and regional functioning interagency working group to align policies on production, employment and migration involving the education, health labor, and other relevant sectors Organogram, reports showing the agency collaboration working groups

Review implementation of existing policies on production, employment and migration involving the education, health, labor, and other relevant sectors Gaps in policy implementation reports

Strategic Objective 6 Build the capacity of institutions for effective public policy stewardship, leadership, and governance

Project Summary Indicators Means of Verification Stakeholder Assumptions/ Risks

Goal 9 Strengthen HRH Network as an organization to improve effectiveness and performance Measures of HRH Network effectiveness (stakeholder satisfaction, extent to which goals are achieved, resource mobilization capacity) and productivity (implementation of policies and programs) HRH Network reports, HRH Network members' annual reports HRH Network, HRH Network members, LGUs, grassroots organizations, private sector, non- government organizations, professional societies

Policy support to legitimize organizational development and build organizational capacity of HRH Network

Outcomes HRH Network has more active role in leading HRH development and management Increased number of HRH Network driven policy issuances and decisions Joint issuances, HRH Network issuances and agreements

Sharing of resources encouraged

Expand membership of the HRH Network to include involvement of diverse set of stakeholders Harmonized HRH related policies (PS cap, financing) Joint issuances, HRH Network issuances and agreements

Resources are available

Outputs Better representation of HRH stakeholders due to broader membership Proportion of member organizations participating in policy development, decision- making and resource mobilization Agency reports

Stakeholder (including grassroots organizations and LGUs) buy-in

Activities & inputs Advocate for more active participation of HRH Network core members
Attendance to HRH Network activities Attendance sheets

Project Summary Indicators Means of Verification Stakeholder Assumptions/ Risks

Advocate active participation of grassroots organizations and LGUs

Identify gaps in stakeholder involvement to maximize HRH Network governance and management Gaps in stakeholder involvement Report

LONG-TERM PLAN

Workforce Strategies

Strategic Objective 2 Create and sustain systems for developing HRH competencies and the careers of health workers to improve productivity and responsiveness, and to promote greater HRH retention

Project Summary Measure Means of Verification Stakeholder Assumptions/ Risks

Goal 1 Identify and implement appropriate collaboration activities to facilitate cooperation among health workers across HCPNs and the development of professional and health worker networks Number of coalitions, networks, alliances or groups that are functional among health workers in HCPNs Reports from professional and health worker groups, studies DOH, public and private health facilities, LGU, professional societies, health workers, HCPNs, Development management officers (regional and provincial)

Resources available for organizing and sustaining outreach activities

Number and type of interactions among health workers in HCPN that provide opportunities for
Reports from professional and health worker groups, studies

Functional referral system Health facility reports

Outcomes Establish community of practice (COP) among HRH
Proportion of regions with established COP Profesional association and other reports

Policy support to organize outreach activities available

Outputs Establish monitoring system of outreach indicators Monitoring data available routinely Reports

Implement technologies that will strengthen interaction and coordination among HRH, especially in GIDA Proportion of regions implementing technologies in strengthening interaction and coordination of HRH Reports, health facility reports

Reliable and stable connectivity (internet and mobile) available, especially in GIDA

Project Summary Measure Means of Verification Stakeholder Assumptions/ Risks

Organize inter-professional groups/network, health worker networks and other outreach activities, especially in GIDA Proportion of HRH participating inter-professional outreach activities Profesional association and other reports

Buy-in of stakeholders (including community-based health worker groups and professional societies)

Activities & inputs Develop effective outreach coordination among health workers across HPCNs Indicators of effectiveness and efficiency of outreach coordination Profesional association and other reports

Explore technologies that can facilitate coordination, networking and interaction among health workers, especially in GIDA Functional digital platform Reports, health facility reports

Determine and design appropriate activities that facilitates cooperation and learning among health workers, especially those in GIDA
Number of collaborative activities organized Profesional association and other reports

Strategic Objective 3 Raise HRH productivity and responsiveness by promoting job satisfaction and motivation at all levels and to improve HRH retention

Project Summary Measure Means of Verification Stakeholder Assumptions/ Risks

Goal 2 Introduce, facilitate and regulate aligned and enhanced scopes of practice of health workers i.e. task shifting Improved health worker productivity (efficiency and accomplishments) and satisfaction
Facility performance measures DOH, professional and community based health worker organizations, Congress, civil society organizations, LGU and private health facilities

Stakeholder buy-in on enhancing scope of practice

Outcomes Increase HRH job satisfaction and motivation Decreased HRH turnover Health facility records

Political support and endorsement to changes in scopes of practice

Effective delivery of primary care by improving HRH teamwork Reduced workload pressures Patient experience assessment scores (HRH, patient and institution satisfaction measures)

Relationships among health worker groups/organization is congenial

Outputs Implement new and aligned health professional laws reflecting enhanced scopes of practice Proportion of health workers practicing enhanced scope of practice Survey results of implemented enhanced scopes of practice

Major conflicts among health care professional groups addressed

Activities & inputs Update scopes of practice of professional and community-based HRH cadres
Proportion of professional laws with updated scope of practice Updated scopes of practice and omnibus HRH practice act

Resources available to conduct review of health worker functions and responsibilities

Review functions and responsibilities of health workers per facility and per cadre Report

Cross cutting Strategies

Strategic Objective 6 Build the capacity of institutions for effective public policy stewardship, leadership, and governance

Project Summary Indicators Means of Verification Stakeholder Assumptions/ Risks

Goal 3 Build HRH development and management capacity at all levels of the health sector covering public and private health facilities Proportion of LGUs with improved HRH development and management systems NHWA, HHRDB/HRH Network reports HRH Network, LGUs, development partners (e.g., academe, training institutions), public and private health facilities, DOH-CHDs, regional and provincial HRH offices

Political support to institutionalize HR management especially at LGU level

Outcomes LGUs and other stakeholders capacitated in HRH development and management Proportion of LGUs with enhanced capacity for HRH development and management
NHWA, HHRDB/HRH Network reports

Buy in from stakeholders to improve HRH development and management capacities

Outputs Improved HRH development and management capacity
Proportion of LGUs with LIPH considerations responding to province-wide and city-wide HRH needs
Local investment plans for health

Contextualized HRH development and management to be responsive to province- wide and city-wide HRH needs

Available expertise to provide capacity building in HRH development and management

Implement HR plan (including HR/personnel chart, job description of all positions, HR systems, HRIS, competency level and qualification, succession planning) Proportion of LGUs at the provincial and city level formulating and implementing HR plan Reports

Funding and manpower to implement HR plan

Project Summary Indicators Means of Verification Stakeholder Assumptions/ Risks

Activities & inputs Design and implement capacity building activities
Number of LGU that participated in capacity building activities
Capacity building reports

Resources to assess, implement and monitor capacity building in HRH development and management

Review HRH development and management capacity of LGUs and other stakeholders Gaps in LGU and stakeholder HRH development and management capacity LGU and stakeholder reports

HRH development and management office is present at the regional and provincial level

Support transition of programmatic HRH management to province-wide and city-wide HRH management systems Available integrated HRH development and management in city-wide and province-wide health systems HHRDB and regional reports

Assess HRH management and development maturity level LGU HRH management and development maturity level
Reports

Expertise on assessing HRH management and development maturoty levels

Goal 4 Establish/strengthen quality assurance (QA)/ accountability mechanisms in health facilities Facility performance measures (e.g., referral rates, death rates, recovery rates, etc) Statistics, PSA, health and nutrition survey DOH (HHRDB, HFSRB), professional societies, public and private health facilities, HRH Network, PhilHealth

Policy support for establishing national QA system for facilities

Quality assurance certification of health facilities (e.g., ISO) Reports

Project Summary Indicators Means of Verification Stakeholder Assumptions/ Risks

Outcomes Improved quality of care and enhanced patient experience Reduced readmission rates Statistics, PSA, health and nutrition survey

Resources to review, implement and monitor strengthened QA

Patient experience assessment score Results from patient experience assessment

Patient experience framework is implemented

Outputs Implement updated and revised standards of care Compliance with standards of care Health facility reports

Stakeholder buy-in and participation to implement QA interventions in the LGU and health facilities

Activities & inputs Develop mechanisms for health service delivery quality assurance focusing on HRH and patient accountability per cadre, per health facility, and at HCPN level Available QA and accountability mechanisms per cadre, per health facility, and at HCPN level HRH Network TWC Reports

Review existing standards of care to determine gaps and impact on health outcomes by cadre Gaps in standards of care and impact on health outcomes by cadre HRH Network TWC Reports

TWGs will be formed to review and recommend updates on existing standards of care

88 Appendix B. Assessing strategies to localize the national HRH Masterplan Rationale Based on evidence drawn from a literature review and validated through national and regional consultations, national level strategies were identified for the Masterplan. However, the national strategies cannot be uniformly implemented across the regions and provinces as there are wide variations in local conditions. For instance, highly urbanized cities have higher access to health services compared with GIDA that have low access and where there are instances when some HRH cadres (e.g. physicians) are not present. In order to address this imbalance, it is proposed that LGUs ‘localize’ the Masterplan through consultation workshops.

Objectives 1. To present the national Masterplan strategies that addresses key HRH issues 2. To determine the relevance and feasibility of the national strategies to address key HRH issues in local areas/regions

Outputs 1. National Masterplan strategies adapted to address local health issues; and
2. Consensus on the localized Masterplan

Stakeholder participation Group Expected contribution HRH Network, HHRDB ▪ Co-lead the organization of the consultations ▪ Co-facilitate discussions with stakeholders ▪ Co-documenter of the consultations DOH Regional Offices (ROs)
 Participate in the discussion of issues and strategies  Assist in organizing consultations Provincial Health Boards ▪ Participate in the discussion of issues and strategies ▪ Determine the relevance and feasibility of the national strategies to local health and socio-economic conditions Representatives of health facilities and local population ▪ Participate in the discussion of issues and strategies ▪ Provide inputs on relevance and feasibility of the national strategies to local health and socio-economic conditions

Methodology There will be two activities in each of the consultation workshops: (a) a short presentation of the Masterplan, and (b) small group discussion. The presentation will highlight the key HRH issues at the national level and the strategies that will address these. It is important to remind participants that while the major HRH issues are presented, each comprise of smaller issues. The small group discussion will provide a venue for discussion of local HRH issues. The relevance and feasibility in the context of local health issues and socio-economic conditions will be determined.
Participants will be divided into groups. Each group will respond to the following questions:

Are the national strategies relevant and feasible?
Are there other HRH issues that should be addressed? What strategies should address these other issues?

To elicit inputs and provide structure to the discussions, the following criteria will be applied as each strategy is discussed.

A plenary session will be conducted after the small group work to share the results of discussions as well as solicit feedback and insights.

Criteria Definition Scale Used Relevance The strategy can effectively address HRH issues in our municipality/ province/region. 1 = Low 2 = High Feasibility (acceptability) Capable of being carried out by different factors below:

Has time
Budget
People
Policies
Structures
Cultural/political factors

Note: Presumes that strategy is acceptable if feasibility is being explored. Acceptability shall mean sufficient to serve the purpose 1 = Low feasibility (has 1-3 factors) 2 = Highly feasible (has 4-6 factors)

Appendix C. Cost Assumptions for Short-term Strategies 1. Production strategies Key assumptions used to estimate the cost indicated in Table 7 are as follows: Remuneration requirements a. There will be a designated team to manage and monitor implementation of activities (at national and regional level) consisting of 1 manager (SG 22), 1 technical staff (SG 18) and 1 support staff (SG 14). Monthly cost is approximated using government rate and based on the identified salary grade. b. Activities to be implemented at the national level will have a one regional staff (SG 18) as counterpart to cascade and monitor activities in the regions. Monthly cost is approximated using government rate using the same salary grade as that of a technical staff c. Some activities have identified engagement of consultant/expert as additional human resource for some activities identified. Monthly cost is approximated using government rate at SG 26. Operational cost considerations a. Cost for implementing activities include meeting costs, transportation costs, communication costs and costs for office supplies needed by the implementation team to cover each activity’s approximated duration
ii. Meeting cost per person for both internal and external stakeholder meetings approximated using the meal rate indicated in Executive Order no. 77 s. 2019 iii. Communication cost approximated cost for local calls1, cell cards and mail/courier service2
iv. Transportation cost estimates cost for land trips for site visits, trips for meetings outside office, and other local land trips v. Office supplies approximated a standard monthly budget allocation b. Cost for a 2-day conference per region is included to cover possibility of convening higher education institutions in the regions. Costing considers the costs for meal per person, venue rental and conference kits c. Scholarship program is one of the key interventions included in the costing assumption for production strategies. It covers 4 cadres (medicine, nursing, midwifery, medical technology)3 computed based on the following assumptions: i. WISN results used to compute for the total number of health workers delivering primary care in rural health units and barangay health stations ii. 100% of vacancies in rural health units and barangay health stations based on attrition4 as the basis for number of scholars d. Cost of feasibility studies exploring at least one flexible learning option for pre-service education per cadre was estimated at PHP 2,000,000.00 per study

Workforce strategies Key assumptions used to estimate the cost indicated in Table 8 and Table 9 are as follows: Remuneration requirements a. There will be a designated team to manage and monitor implementation of activities (at national and regional level) consisting of 1 manager (SG 22), 1 technical staff (SG 18) and 1 support staff (SG 14). Monthly cost is approximated using government rate and based on the identified salary grade. b. Activities to be implemented at the national level will have a one regional staff (SG 18) as counterpart to cascade and monitor activities in the regions. Monthly cost is approximated using government rate using the same salary grade as that of a technical staff c. Some activities have identified engagement of consultant/expert as additional human resource for some activities identified. Monthly cost is approximated using government rate at SG 26

1 Using published rates from PLDT, one of the major telecommunications companies in the Philippines 2 Using published rates from LBC, one of the major courier service providers in the Philippines 3 Only these four cadres were covered by available WISN study covering rural health unit and barangay health stations in the country. The cost requirement to cover the scholarship program for the remaining eight cadres will still need to be computed. 4 Attrition rate for doctors, midwives and nurses is based on estimated total annual attrition rate for doctors, midwives and nurses (maximum estimate) from middle income countries from a 2017 study by Castro Lopes et al. Attrition rate for Medical Technologist is based on rate declared in the HRH Masterplan 2005-2030 and the Philippine HRH country profile published by WHO in 2013

d. This costing does not include computation of total salary and compensation cost of health workers needed based on staffing projection
Operational cost considerations a. Cost for implementing activities include meeting costs, transportation costs, communication costs and costs for office supplies needed by the implementation team to cover each activity’s approximated duration
ii. Meeting cost per person for both internal and external stakeholder meetings approximated using the meal rate indicated in Executive Order no. 77 s. 2019 iii. Communication cost approximated cost for local calls5, cell cards and mail/courier service6
iv. Transportation cost estimates cost for land trips for site visits, trips for meetings outside office, and other local land trips v. Office supplies approximated a standard monthly budget allocation b. Cost in developing e-learning modules considered the following assumptions: i. Estimated cost of e-learning module development based on HRH2030’s experience in engaging private sector partners in developing e-learning modules (with an average of PHP400,000.00 per module which includes script, storyboard and final production) ii. E-learning module development for the following:

Health worker capacity building per health program: 4 e-learning modules7 will be developed for each health program8

E-learning modules for developing coaching and mentoring competencies: 2 modules for mentoring and 2 modules for coaching c. Cost for e-learning platform maintenance for 1 year (including updates and systems maintenance, staff training) approximated at PHP 500,000 per month d. Cost for conducting feasibility study for alternative modes of learning and development program (aside from face-to-face training and e-learning) where cost is approximated at PHP 2,000,000.00 per study e. Cost for conducting career path development studies for the 12 cadres9 is approximated at PHP 2,000,000.00 per study f. Approximated cost of face-to-face training covering 4 cadres (medicine, nursing, midwifery, medical technology) computed based on the following assumptions: i. WISN results used to compute for the total number of health workers delivering primary care in RHU and BHS ii. Cost of training per person is estimated based on sum of training cost from government and private training providers per person with each person having access to two 3-day trainings per year10

Cross cutting strategies Key assumptions used to estimate the cost indicated in Table 10 and Table 11 are as follows: Remuneration requirements a. There will be a designated team to manage and monitor implementation of activities (at national and regional level) consisting of 1 manager (SG 22), 1 technical staff (SG 18) and 1 support staff (SG 14). Monthly cost is approximated using government rate and based on the identified salary grade. b. Activities to be implemented at the national level will have a one regional staff (SG 18) as counterpart to cascade and monitor activities in the regions. Monthly cost is approximated using government rate using the same salary grade as that of a technical staff c. Some activities have identified engagement of consultant/expert as additional human resource for some activities identified. Monthly cost is approximated using government rate at SG 26

5 Using published rates from PLDT, one of the major telecommunications companies in the Philippines 6 Using published rates from LBC, one of the major courier service providers in the Philippines 7 1 module each for doctor, nurse, midwife and medical technologist 8 There are 50 health programs published in the DOH website 9 12 cadres of health workers: doctor, nurse, midwife, medical technologist, physical therapist, occupational therapist, respiratory therapist, radiology technologist, nutritionist-dietician, pharmacist, dentist, optometrist 10 Derived from PSA's Annual Training Cost by Employment Size and Training Provider, Philippines: 2013

Operational cost considerations11 a. Cost for implementing activities include meeting costs, transportation costs, communication costs and costs for office supplies needed by the implementation team to cover each activity’s approximated duration
iii. Meeting cost per person for both internal and external stakeholder meetings approximated using the meal rate indicated in Executive Order no. 77 s. 2019 iv. Communication cost approximated cost for local calls12, cell cards and mail/courier service13
v. Transportation cost estimates cost for land trips for site visits, trips for meetings outside office, and other local land trips vi. Office supplies approximated a standard monthly budget allocation b. Cost for software development and deployment of an interoperable information system for NHWA was estimated based on industry standard for developing HR software cost14 c. Cost for information system maintenance for 1 year (including updates and systems maintenance, staff training) approximated at PHP 500,000 per month d. Cost to fund conduct of HRH-related research for at least 10 operations researches, 5 evaluation researches and 1 labor market research approximated to be PHP5,000,000 per research e. Cost of conducting HRH policy related research, where it is assumed that each member agency/organization of the HRH Network15 will have at least 1 operations research and 1 evaluation research, was estimated to be PHP 2,000,000.00 per research f. Cost for conduct of regional assessments (at least once a year) on training and education, recruitment, deployment and retention were approximated at PHP 500,000.00 per assessment

11 Subsidy for private sector health worker development and management is an identified intervention. However, cost is not yet identified because of limited information on how cost can be approximated 12 Using published rates from PLDT, one of the major telecommunications companies in the Philippines 13 Using published rates from LBC, one of the major courier service providers in the Philippines 14 Industry standard cost from https://existek.com/blog/how-much-does-custom-hr-software-development-cost/
15 Currently have 20 member institutions per 2016 MOA

Appendix D. Costing matrices for Short-term Strategies

PRODUCTION STRATEGIES

Activity Description Cost considerations Subtotal Strategic Objective Strategy Activity Remuneration Operational cost

Strategic Objective 1 Install systems that will improve recruitment of HRH fit for practice and fit for work to sustainably produce and deploy HRH and to promote greater HRH retention in the health sector leading to adequate and equitable HRH distribution vis-à-vis local health needs 1 Educate and train future HRH in or near their places of origin
Identify and support SUCs or high quality HEIs which offer health sciences education in every region 10,208,925.00
11,162,336.00
21,371,261.00
Determine training hospitals for internship of 12 cadres in all regions 3,402,975.00
1,494,232.00
4,897,207.00
Reorient health professional curricula to produce responsive health workers equipped with primary care competencies for the region 11,157,858.00
481,416.00
11,639,274.00
2 Establish targeted admission practices in HEIs Revise admission guidelines in HEIs per region to target indigenous people and local students with rural background 3,163,384.50
808,112.00
3,971,496.50
Promote enrolment of local students including indigenous people who are willing to serve locally for at least 5 years 2,669,558.50
1,292,912.00
3,962,470.50
3 Expand scholarships with enforceable RSA that also offers incentives
Use WISN results as basis for providing scholarships in rural areas 5,104,462.50
1,118,668.00
6,223,130.50
Harmonize public and private scholarships to boost health sciences program enrolment in rural and GIDA areas 2,450,371.50
1,114,461,391.40
1,116,911,762.90
Strengthen RSA (implementation, monitoring, non-compliance, identify incentives) 4,900,743.00
912,824.00
5,813,567.00
4Re-orient curriculum to PHC and integrate public health, rural health courses/ topics, rural exposure/immersion, and use of technology to deliver health services Intensify pre-service education and training on PHC, public health, rural exposure/immersion, and use of technology to deliver health services 3,267,162.00
542,216.00
3,809,378.00
Advocate for the inclusion of PHC, public health, and rural health topics/ immersion in public and private HEIs 3,667,512.00
1,181,432.00
4,848,944.00
Utilize flexible learning options (FLOs) in pre- service training of health professionals
1,633,581.00
24,273,608.00
25,907,189.00

Activity Description Cost considerations Subtotal Strategic Objective Strategy Activity Remuneration Operational cost

Form a functioning interagency working group to introduce changes to curricula 200,175.00
273,608.00
473,783.00
TOTAL 51,826,708.00
1,158,002,755.40
1,209,829,463.40
Percent 4% 96% 100%

WORKFORCE STRATEGIES

Activity Description Cost considerations

Subtotal Strategic Objective Strategy Activity Remuneration Operational cost

Strategic Objective 2 Create and sustain systems for developing HRH competencies and the careers of health workers to improve productivity and responsiveness, and to promote greater HRH retention. Support career development of volunteer health workers (e.g, BHW, BNS, etc.) [Medium-term: Professionalizing volunteer health workers] Review existing capacity building programs for volunteer health workers 200,175.00
50,536.00
250,711.00
Craft career development paths for volunteer health workers 1,258,083.00
4,131,608.00
5,389,691.00
Explore new initiatives such as micro credentialing to be able to provide home- /community-based services 600,525.00
4,815,824.00
5,416,349.00
Strengthen implementation of national certification program for volunteer health workers 600,525.00
815,824.00
1,416,349.00
Enable health workers to obtain appropriate skills, knowledge and attitudes through learning and in-service staff development methods Develop more alternative modes of learning (e.g., e-learning, webinars) on Primary Care in DOH e-Learning platform with CPD units 17,874,162.00
96,866,824.00
114,740,986.00
Provide access to available face-to-face learning and development programs and providers while earning CPD units 600,525.00
6,608,405,645.50
6,609,006,170.50
Enforce/strengthen the provision of coaching, mentoring, and supportive supervision to health workers Determine competencies of coaches and mentors and capacitate them as necessary 4,536,093.00
764,388.00
5,300,481.00
Include coaching and mentoring in the learning and development programs 10,208,925.00
1,528,776.00
11,737,701.00
Design mentoring and coaching programs aligned with area or program needs as needed 929,304.00
7,128,776.00
8,058,080.00

Activity Description Cost considerations

Subtotal Strategic Objective Strategy Activity Remuneration Operational cost

Develop and implement career paths of health workers across the public and private sector from national to local levels Design harmonized career progression paths of HRH in government and private sector 4,545,873.00
24,131,608.00
28,677,481.00
Provide information on careers in the health sector for potential health workers 266,829.00
30,268.00
297,097.00
Strategic Objective 3 Raise HRH productivity and responsiveness by promoting job satisfaction and motivation at all levels and improve greater HRH retention. Create adequate permanent positions for HRH (including Barangay Health Workers [BHWs] & Barangay Nutrition Scholar [BNS]) in response to health sector needs
Broadcast widely unfilled government and private HRH positions 3,399,354.00
764,388.00
4,163,742.00
Collaborate between the national and local governments to source funds and recruit local HRH to fill necessary vacant positions 2,416,938.00
70,804.00
2,487,742.00
Advocate to LGUs to create positions for HRH 4,536,093.00
764,388.00
5,300,481.00
Review existing policies 266,829.00
70,804.00
337,633.00
Standardize health workers’ positions and competitive compensation, benefits and incentives such as supporting career progression, standardized, decent compenstion and benefits, recognition and rewards system to improve job satisfaction and motivation (public and private sectors; national and local) Advocate and capacitate LGUs to allocate sufficient budgets for HRH in accordance with staffing standards 4,536,093.00
764,388.00
5,300,481.00
Request exemption from PS cap and LGU income class-dependent rates for health workers 2,416,938.00
70,804.00
2,487,742.00
Explore expansion of Magna Carta to cover private sector HRH 266,829.00
70,804.00
337,633.00
Enforce implementation of Magna Carta for Public Health Workers across national and LGU health facilities 10,208,925.00
1,528,776.00
11,737,701.00
Review/amend provisions under existing laws on compensation and benefits of health workers (e.g., PS limit and Magna Carta to cover private sector HRH) 266,829.00
70,804.00
337,633.00
Identify compensation packages, benefits and incentives for professional and non- professional health workers that are motivating
266,829.00
70,804.00
337,633.00
Review of existing benefits and incentives for the public and private sector 1,033,005.00
50,536.00
1,083,541.00
Review of positions classification and job descriptions 1,433,355.00
131,608.00
1,564,963.00
Ensure well-being of health workers including protection from emerging and re-emerging diseases (e.g. wellness Develop health, wellness, and infection prevention and control programs (e.g., mental health, physical health, etc.) for health workers 266,829.00
70,804.00
337,633.00

Activity Description Cost considerations

Subtotal Strategic Objective Strategy Activity Remuneration Operational cost

programs, mental health, etc.) - (from long term) Craft policy on health care worker protection (e.g., stigma, bullying), and infection prevention and control measures for emerging and re- emerging decisions 2,765,319.00
415,912.00
3,181,231.00
Ensure compliance with minimum work environment standards by implementing Occupational safety and health (OSH) standards and infection and prevention control initiatives - (from long term) Review existing OHS Standards and its implementation 266,829.00
70,804.00
337,633.00
Explore use of available technology to deliver health care services 2,765,319.00
739,660.00
3,504,979.00
Identify alternative work arrangements in cases of public health emergencies 2,765,319.00
739,660.00
3,504,979.00
Review and implement minimum work environment standards (e.g., hazard pay, PPEs, short-term accommodations) to prevent and control emerging and re-emerging diseases to protect health workers 2,765,319.00
739,660.00
3,504,979.00
Ensure appropriate skills mix and roles/functions present in health facilities (from medium-term) Review current minimum staffing (composition and number) for health service delivery, including needs for workload and public health emergencies, outbreaks, etc. 10,208,925.00
1,528,776.00
11,737,701.00
Craft policy on minimum staffing (composition and number) for health facilities for public health emergencies, outbreaks, etc. 2,765,319.00
739,660.00
3,504,979.00
Develop guidelines on HRH standards to ensure optimal response to public health emergencies, outbreaks, etc. 2,765,319.00
739,660.00
3,504,979.00
TOTAL 100,003,533.00
6,758,883,581.50
6,858,887,114.50
Percent 1% 99% 100% CROSS-CUTTING STRATEGIES

Activity Description Cost considerations Subtotal Strategic Objective Strategy Activity Remuneration Operational cost

Strategic Objective 5 Strengthen information systems/data on HRH for 14 Strengthen and integrate information systems to ensure up-to-date HRH data and data sharing across the HRH sector Conduct data mapping to identify data gaps and sources, frequency of data collection, and overlaps, if any 4,900,743.00
815,824.00
5,716,567.00

Activity Description Cost considerations Subtotal Strategic Objective Strategy Activity Remuneration Operational cost

monitoring, informing decision making, and ensuring accountability e.g. National Health Workforce Registry (NHWR), National Health Workforce Account (NHWA) Utilize the NHWA system as the national repository of HRH data and information 3,267,162.00
16,630,216.00
19,897,378.00
Identify specific NHWA data modules to be contributed consistent with their mandates
943,267.50
73,988.00
1,017,255.50
Provide updated health worker information aligned with agency process (e.g. PRC licensing, POEA exit information, etc.) 3,709,992.00
298,944.00
4,008,936.00
Include a NHWA system of data collection in the processes of agencies collecting HRH data 943,267.50
96,448.00
1,039,715.50
15 Conduct HRH research (including operations and evaluation research and analysis of health labor markets) Identify specific HRH research agenda and lead groups 2,244,420.00
80,126,608.00
82,371,028.00
Align HRH development and management research agenda of national agencies 885,339.00
80,083,768.00
80,969,107.00
Strategic Objective 7 Increase investments in HRH and align investments with current and future population health needs and of health systems. 16 Generate resources for HRH from various sources (domestic, international, and other sources) Explore co-financing mechanisms between national and local governments 400,350.00
122,232.00
522,582.00
Funding for local HRH needs (development and management) provided by LGUs and supported, if necessary, by National government 2,450,371.50
412,912.00
2,863,283.50
Explore government subsidies (conditional transfer) for private sector health worker development and management to expand access to health care
200,175.00
25,268.00
225,443.00
17 Invest in HR systems (education and training, recruitment, deployment and retention, etc.) to meet national and subnational needs Allocate resources to support HRH in the LIPH 4,532,472.00
1,036,184.00
5,568,656.00
Organize advocacy activities and campaigns to engage key stakeholders in investing and supporting HRH development and management initiatives 3,267,162.00
572,048.00
3,839,210.00
Identify sources for funds in areas that are under invested at appropriate levels to support primary health care 1,633,581.00
278,608.00
1,912,189.00
Identify areas in training and education, recruitment, deployment and retention at national and local levels requiring (additional) investments 400,350.00
34,086,072.00
34,486,422.00

Activity Description Cost considerations Subtotal Strategic Objective Strategy Activity Remuneration Operational cost

18 Develop fiscal capacity to absorb and utilize effectively and transparently both domestic and international resources for HRH systems in the public and private sector Build capacity for planning, resource management (Fiscal Management) and analysis 5,777,487.00
3,837,336.00
9,614,823.00
Develop a system for co-managing resources, such that management directions will be provided by national agencies, and implementation of specific plan of actions will be handled by local government units 3,267,162.00
547,216.00
3,814,378.00
TOTAL 38,823,301.50
219,043,672.00
257,866,973.50
Percent 15% 85% 100%

Appendix E. About the HRH Network
The HRH Network Philippines integrates agency efforts to harmonize HRH policy directions and coordinate the action of its members in the development of an adequate, globally competent and sustainable health workforce that can contribute significantly to the attainment of universal quality health care for Filipinos. It has been recognized as the first inter-agency collaborative network for HRH in Asia.

In 2006, the Department of Health (DOH) spearheaded the creation of the HRH Network Philippines which is composed of 18 multi-sectoral government agencies and non-government organizations bound by a signed Memorandum of Understanding. These agencies and organizations are as follows:

▪ Association of Deans of Philippine Colleges of Nursing ▪ Department of Interior and Local Government ▪ Association of Philippine Medical Colleges ▪ National Economic and Development Authority ▪ Bureau of Immigration ▪ Overseas Workers Welfare Administration ▪ Civil Service Commission ▪ Philippine Nurses Association ▪ Commission on Filipinos Overseas ▪ Philippine Overseas Employment Administration ▪ Commission on Higher Education ▪ Professional Regulation Commission ▪ Department of Budget and Management ▪ Public Services Labor Independent Confederation ▪ Department of Health ▪ Technical Education and Skills Development Authority ▪ Department of Labor and Employment ▪ University of the Philippines Manila

The HRH Network Philippines is further organized into three Technical Working Committees namely: Entry (education, training, pre- deployment), Workforce (working conditions and productivity), and Exit and Re-entry (migration and re-integration). The Network regularly meets (once every quarter) to conduct various discussions on collaboration, issues, and updates on the HRH situation in the country.

Throughout the years, the HRH Network Philippines has helped shape national policies, programs, systems, and initiatives towards realizing the Philippine’s HRH Master Plan and the adjacent international and national plans and commitments, which combined, provide the anchoring schema to respond to workforce needs such as production, training, recruitment, distribution, compensation, and standardization.

The HRH Network Philippines has several initiatives and accomplishments, including the development of various researches and policies on HRH. Some of the initiatives and accomplishments are as follows:

● Organized eight fora since its establishment. The last forum was held in 2017 with the theme: “Keeping Momentum: Accelerating Progress towards Sustainable Human Resources for Health for National Development and Universal Health Care”.
● Developed multi-stakeholder country reports on the monitoring of the World Health Organization (WHO) Global Code of Practice every three years since 2012.
● Engaged in the development of bilateral and multilateral labor agreements and has an active participation in the ASEAN meetings of Committee on Services for discussion on Mutual Recognition Arrangements and other economic cooperation agreements with HRH implications. ● Developed two HRH information systems: 1. National Database for HRH Information System (NDHRHIS) which provides statistical information on HRH distribution by geographical location, sex, gender, age, type of facility ownership (private/government) and 2.
Integrated Database System for HRH Information System (IDSHRHIS) which captures processes, stores and reports information on HRH from production to deployment to migration, re-entry, and retirement. ● Guided the development of seven researches on HRH and multisectoral HRH policies. Amongst the latest policies developed by the Network are DOH-CHED Joint Administrative Order (JAO) No. 2013-0034 “Affiliation of Higher Education Institutions with Hospitals and Other Health Facilities for Training of Students in Health Professional Education” and DOH-PRC JAO No. 2015-01 “Policies and Guidelines on the Conduct of Medical Residency and Fellowship Training Program for Foreign Medical Professionals in the Philippines”

Furthermore, the HRH Network Philippines had collaborative work and projects with the USAID’s HRH2030 Philippines, and WHO for the development and implementation of National Health Workforce Accounts, Workload Indicators of Staffing Needs, Health Labor Market Analysis, and National HRH Master Plan 2020-2040.

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Accompanying Documents Document Title Description HLMA Report A printed report containing the result of the health labor market study conducted by USAID’s HRH2030/Philippines Situation Analysis A printed report describing the current situation of, and issues faced by HRH in the Philippines Strategy paper A printed report containing the result of the strategy development process completed by USAID’s HRH2030/Philippines for the Masterplan 2020-2040 HRH Blueprint A printed report presenting the overview of the situation analysis and the strategies identified for the HRH Masterplan 2020-2040 Omnibus Policy Review Report A printed report containing the result of the HRH omnibus policy review conducted by USAID’s HRH2030/Philippines Policy briefs A compilation of policy briefs on: • Investing and financing human resources for health as a strategy to attain health outcomes • Enhancing Health Workforce Distribution and Retention to Improve Access to Health Care Services • Migration of human resources for health

National Human Resources for Health Master Plan 2020-2040

Document Info

National Human Resources for Health Master Plan 2020-2040

Table 1. Timeline of preparatory activities of the HRH Masterplan Year Preparatory activities Purpose 2020  Review existing Memorandum of Understanding among members of the HRH Network and establish a formal agreement among the HRH Network members including

The Network is the implementing unit of the HRH Masterplan

Reconfiguring structures such as TWCs and their functions

Establishment of a full-time secretariat that will be in charge of the Masterplan’s daily implementation and monitoring

Agreement on an accountability framework  Establish governance and management structures  Facilitate the accomplishment of strategies and monitoring of multi- sectoral indicators  Create mechanisms and implementing arrangements including identification of

Point/focal persons for each agency per strategy

Decision making, communication and other processes

setting up and operating the governance and management structures of the Masterplan

The passage of time is necessary for innovations to be adopted; they are rarely adopted instantaneously.

The message must be widely adopted in order to self-sustain.

Adoption of messages and assist in its dissemination

Deep involvement (buy-in) in the process by a variety of stakeholders tend to generate better outcomes and a greater sense of ownership.

Actively involve partners and stakeholders in the process.

Stakeholders involved in strategic planning will have more interest and investment in the plan’s
success.

Include representatives of stakeholder groups in discussions for strategic planning to the greatest extent possible

of interns/trainees by cadre

List of volunteer health workers 2024 - onwards

and types of advocacy

and types of advocacy

Health worker capacity building per health program: 4 e-learning modules7 will be developed for each health program8

Related Documents

National Human Resources for Health Master Plan 2020-2040

Document Info

National Human Resources for Health Master Plan 2020-2040

Table 1. Timeline of preparatory activities of the HRH Masterplan Year Preparatory activities Purpose 2020  Review existing Memorandum of Understanding among members of the HRH Network and establish a formal agreement among the HRH Network members including

The Network is the implementing unit of the HRH Masterplan

Reconfiguring structures such as TWCs and their functions

Establishment of a full-time secretariat that will be in charge of the Masterplan’s daily implementation and monitoring

Agreement on an accountability framework  Establish governance and management structures  Facilitate the accomplishment of strategies and monitoring of multi- sectoral indicators  Create mechanisms and implementing arrangements including identification of

Point/focal persons for each agency per strategy

Decision making, communication and other processes

setting up and operating the governance and management structures of the Masterplan

The passage of time is necessary for innovations to be adopted; they are rarely adopted instantaneously.

The message must be widely adopted in order to self-sustain.

Adoption of messages and assist in its dissemination

Deep involvement (buy-in) in the process by a variety of stakeholders tend to generate better outcomes and a greater sense of ownership.

Actively involve partners and stakeholders in the process.

Stakeholders involved in strategic planning will have more interest and investment in the plan’s success.

Include representatives of stakeholder groups in discussions for strategic planning to the greatest extent possible

of interns/trainees by cadre

List of volunteer health workers 2024 - onwards

and types of advocacy

and types of advocacy

Health worker capacity building per health program: 4 e-learning modules7 will be developed for each health program8

Related Documents

Stakeholders involved in strategic planning will have more interest and investment in the plan’s
success.