Are we fair to our health care workers?

One major issue that came out loud and clear with the coronavirus pandemic is how woefully we have underinvested in our health system capacity, both over time and compared with our Asean neighbors. This largely explains our country’s sorry state of having had the highest COVID-19 caseload to population ratio in this part of Asia despite the world’s longest lockdown, and the slowest economy to recover to boot. Such underinvestment concerns both human resources—medical doctors, nurses, medical technologists, etc. — and social infrastructure — hospitals, laboratories, quarantine facilities, etc.

While our country is prolific in educating and graduating health care workers, it seems remiss in sustaining them, primarily by seeing to it that they are suitably placed and gainfully employed — with or without a public health crisis. This is called for given the country’s large population, the largest in Asean, next only to Indonesia, relative to territorial size and resource base. At the minimum, public policy ought to ensure sufficient numbers of various health personnel accessible by the population in the regional centers at any one time, coupled with the needed social infrastructure.

The pandemic has underscored the folly of taking our health care workers for granted in terms of their remuneration and working conditions, let alone their occupational hazards, inducing them to leave for greener pastures abroad. Comparative data on annual average salaries of health care workers in six major Asean countries are very telling (iprice.ph, salaryexplorer, Ministry of Manpower, Singapore, 2020).

Doctors: Indonesia, $24,316; Malaysia, $46,040; Philippines, $26,222; Singapore, $205,428; Thailand, $56,036; Vietnam, $43,464. While Philippine doctors are paid annually slightly higher (8 percent) than their Indonesian counterparts, they get only 60 percent of Vietnamese doctors’ remuneration. Note that Vietnam was still behind the Philippines’ per capita income in 2020 and just overtook it by end-2020, with its economy growing by 2.9 percent versus the Philippines’ contracting by 9.5 percent. Compared with Malaysia, Thailand, and Singapore, Philippine doctors are paid even lower fractions of their counterparts in these three other countries.

Nurses: Indonesia, $19,729; Malaysia, $24,224; Philippines, $9,875; Singapore, $58,261; Thailand, $20,728; Vietnam, $15,783. Again, Philippine nurses are compensated under two-thirds of their Vietnamese peers, and only half of their Indonesian counterparts. The contrasts with the other countries are sharply more pronounced.

Medical technologists: Indonesia, $15,733; Malaysia, $20,478; Philippines, $7,353; Singapore, $52,443; Thailand, $16,232; Vietnam, $14,235. This group of health care personnel are the lowest paid among the three categories across all six Asean countries. Just comparing the Philippines and Vietnam, medical technologists in the former get only half of those in the latter, and the gaps vis-à-vis the more developed Asean neighbors are much wider.

All key health care workers in the Philippines—nurses and medical technologists, in particular—are starkly underpaid and disadvantaged vis-à-vis their Asean counterparts. Note that the other Asean members, except Singapore, are food- and agriculture-surplus countries that keep price inflation under control. Unfortunately, this is not the case in the Philippines where inflation tends to be unsteady.

The foregoing, among others, depresses morale and motivates workers to head overseas, which can only be attenuated by well-considered policy intervention. With the salaries of the military and the police, as well as public school teachers, having been upgraded, it is high time the government took care of our health care workers in the same manner. But the typical constraint is the budget due to heavy demands on the government’s fiscal position. So, what can be done?

Another notable thing that surfaced during the pandemic is the value of public-private partnerships (PPPs), given that the government cannot do it alone in coming to grips with a major crisis. The elements of solidarity á la bayanihan spirit came together with the private sector’s spontaneous magnanimity. This could also apply to PPP projects to increase the country’s social infrastructure that extends to the provinces. Likewise, raising the remuneration of health care workers could be facilitated through a PPP fund, with tax-deductible private contributions (or as part of corporate social responsibility), considering that better public health benefits the whole of society.

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Ernesto M. Pernia is professor emeritus of economics, University of the Philippines, and former secretary of socioeconomic planning, Neda. This commentary derives from his presentation at the UP System’s webinar, “Stop COVID Deaths,” March 5, 2021.

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