Cocreation in Health Workforce Planning to Shape the Future of the Health Care System in the Philippines

Abstract

Background: The Philippines passed landmark legislation in 2019 on universal health coverage, including reforms in the development of its health workforce, an essential building block of responsive health care systems.

Health workforce planning cocreation process: We based our planning process on a model of cocreation defined as sharing power and decision making to solve problems collaboratively and build consensus around action. Through cocreation with policy makers, researchers, and other stakeholders, we performed projection studies on 10 selected health professions and estimated the need for primary care at national and subnational levels, which was the most extensive health workforce projection carried out by the Philippine Department of Health to date. We determined health workforce requirements based on target densities recommended by the World Health Organization and a health needs approach that considered epidemiological and sociodemographic factors. In consultation with stakeholders, we interpreted our analysis to guide recommendations to address issues related to health workforce quantity, skill mix, and distribution. These included a broad range of proposals, including task shifting, expanding scholarships and deployment, reforming health professionals' education, and pursuing a whole-of-society approach, which together informed the National Human Resources for Health Master Plan.

Conclusions: Our cocreation model offers lessons for policy makers, program managers, and researchers in low- and middle-income countries who deal with health workforce challenges. Cocreation led to relationship building between policy makers and researchers who jointly performed the research and identified solutions through open communication and agile coordination. To shape future health care systems that are responsive both during normal times and during crises, cocreation would be essential for evidence-informed policy development and policy-relevant research.

FIGURE 1

The Linear Model of Research Translation Versus the Cocreation Model Used by the Philippine Department of Health in the Health Workforce Planning Process

FIGURE 2

Total Number of Licensed Health Professionals in the Philippines per Cadre, April 2020 (A); Density of Skilled Health Workers to Achieve UHC, by Cadre, 2010–2019 (B); Health Professions With the Highest Densities per 10,000 Population, 2010–2019 (C); Health Professions With the Lowest Densities per 10,000 Population,^a 2010–2019 (D) Abbreviations: NDs, nutritionist-dieticians; OTs, occupational therapists; PTs, physical therapists; RMTs, registered medical technologists; RTs, radiologic technologists; UHC, universal health coverage. ^a Per 50,000 for OTs from 2010 to 2019.

FIGURE 3

Number of Licensed Physicians (A), Nurses (B), and Midwives (C) in the Philippines per Year, 2017–2020, and the Projected Numbers and Densities Every 5 Years, 2025–2050, Against the Benchmark Thresholds for Universal Health Coverage^{a a} Numbers for 2020 were underestimated because of the licensure examinations delay caused by the coronavirus disease (COVID-19) pandemic.

FIGURE 4

Number and Density of Licensed Physicians, Nurses, and Midwives in the Philippines, 2010–April 2020, Between the National Capital Region and Region IV-B in MIMAROPA Abbreviations: MIMAROPA, Mindoro, Marinduque, Romblon, and Palawan; NCR, National Capital Region.

FIGURE 5

Estimated Number of Skilled Health Workers Required in 2025 and 2030 in the Philippines to Meet the Recommended Density for Universal Health Coverage (A) or the Projected Need for Primary Care Services Based on Epidemiological and Sociodemographic Factors, Service Utilization, and Activity Standards (B)