Health Workforce Planning: A Comparison of Australia and Philippines

This report compares and contrasts the health workforce plans of Australia and Philippines, analyzing the strategies adopted by both countries in formation of their health workforces. It evaluates the environmental scan of the health workforce of both countries, analyzes the data profile of each country, identifies the critical issues to be addressed in each country, and applies the WHO priorities in the national workforce planning of both countries using the recommendations developed by WHO.

Running head: Health workforce planning
Health workforce planning

Health workforce planning 1
Executive Summary
The National Health Workforce Planning in Australia has been a mixed system comprising of
universal health care by the public sector and the private providers of insurance services. Most of
the health care in Australia is provided by the hospitals and primary health care while the
residual services are provided by the private sector i.e. private hospitals, allied health care
facilities such as physiotherapy and dental.
Medicare is the universal health care system of Australia which is the main scheme which
provide subsidizes regarding the medical costs to the citizens of Australia. The various
organizations carry out the planning of the national health workforce and the challenges
confronted by them are well documented. It comprises of ageing population and increased
expectations of the service delivery and demand for health services. The national health agenda
of Australia also comprises of the reinforcement of national workforce planning. So, in this
report, the national health workforce plans of Australia and Philippines shall be compared and
contrasted to address the critical issues faced by both the countries. Furthermore, as per the
framework provided by WHO, it shall be determined whether each of the countries are
addressing the WHO preferences in their workforce plans.

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Contents
Introduction.................................................................................................................................................3
Environmental Scan of the health workforce of the two countries.............................................................3
Analysis of the data profile of the health workforce for each country........................................................5
Identification of the critical issues to be addressed in each country...........................................................6
Application of the WHO priorities in the national workforce planning of both the countries using the
recommendations developed by WHO.......................................................................................................7
References.................................................................................................................................................10

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Introduction
In order to develop a health workforce which can offer primary to tertiary sector services needs a
well-established infrastructure for governance. In this regard proper assessment of the health
workforce, development of the policy, regulating and supervising requires dialogue amongst the
stakeholders ranging from government to non-government partners who are dedicated to create a
responsive and sustainable workforce.
In this regard, WHO responses to the challenges by providing a range of policies and strategies
to its member states in the West Pacific Region for developing a workforce which is competent,
responsive, sufficiently supported and to meet the health needs of the population. The strategy
comprises of five objectives which focus around three areas viz. development, positioning ,
supply and retaining of an effective and efficient workforce .Governance and management of the
workforce and thirdly , developing a workforce which is responsive to the health needs and
demands of the population residing in those countries (World Health Organization ,2013).
So, in this report, the health workforce plans of Australia and Philippines would be compared
and contrasted to analyze the strategies adopted by both the countries in formation of their health
workforces. For this purpose, the environmental scan of the health workforce of both the
countries would be evaluated through assessing the policy and planning documents of both the
countries. The data profile of each country would be evaluated using the data provided by WHO
in this context. On the basis of the evaluation, the issues to be addressed in each country would
be identified and using the framework of recommendations, it would be determined if each of
them is addressing and adopting the priorities developed by WHO in their health workforce
plans.
The purpose of comparing the health workforce planning of Australia and Philippines is that the
former belongs to the high income group whereas the latter belongs to the lower middle income
group. It will assist in comparing the health workforce strategies adopted by both the countries
and the disparities of distribution of the health workforce facilities especially in the lower middle
income group countries in particular. It will also assist in finding solutions to fill the gaps in the
supply and demand of the health workforce in both the countries.

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Environmental Scan of the health workforce of the two countries
Over 60% of the nurses in Australia are employed by facilities which are financed, administered
and managed by the governments of state and territories. However, many of them have been
placed under severe restrictions regarding the increase in their wage structures through imposing
stricter legislations on them or by negotiating for their salaries. The employers in the private
medical care sector continue to follow the wage structure and conditions for nurses as per the
public sector and the nurses employed in the aged care amenities in the residential areas receive
wages and are employed at standards which are comparatively below in the hospital sector
(Finnish Nurses Association, 2015).
Apart from this, the new federal government has formulated a policy targeted to cut the budget
of the health facilities which will severely impact the universal health system of Australia and
shall reduce the accessibility of the primary health care services to the low middle income groups
and the sick in Australia. It will also result in reduction of funding to be provided to the states
and territories which were previously committed to meet the growing demands of health care
services and workforce.
However, the federal governments still continues to instill major reforms for delivering major
reforms for consumer centered and market driven aged care system of Australia. A code of
conduct was developed for the health care workers so that occupational standards can be
followed to inculcate safe and ethical practices by the health workforce. In this context another
reform which is introduced in the health care sector is transforming the enrolment model and
installing the personally controlled electronic health record in the health care system. A set of
consistent and authoritative health workforce framework has been evaluated for the planning of
health workforce planning. It provides a means for planners to supervise the impact of the
significant changes on the health systems and the supporting social and economic environment
(Commission on Filipinos Overseas, 2012).
The health workforce of Philippines is influenced by the international migration of nurses.
Between 1992 and 2004, about 100000 nurses left the country to work because they were getting
better employment opportunities abroad as a result there was a great rise in the annual departure
of nurses from the country. The emigration of nurses has depleted the workforce dramatically

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with its severe impact on the rural areas of the country. It has also resulted in the loss of medical
practitioners who have been retrained as nurses so that they can secure their jobs in other
countries.
According to a research by Health Alliance for Democracy (HEAD), it was found that 80% of
the medical practitioners have applied for working in other countries while 90% of the municipal
health officials were planning to settle abroad due to better working opportunities.
The increase in private sector health workforce education has increased the number of
institutions to provide medical training to the students but they are often confronted by quality
issues. Most of them lack in efficient regulatory mechanisms. The graduates applying for the
Nursing Board examination has tripled almost every year between the years 2000 and 2005. But
the according to a study , 60% of the nursing schools saw a deterioration in their quality since
only 50% of the graduates passed the Nursing examinations .Amongst 20 of the schools were not
produce even a single graduate who had passed in the examinations( HRH Global Resource
Center ,n.d.).
However, the Philippines Commission on Higher Education in nursing has applied certain
measures to discontinue the nursing programs and institutions which are showing no
improvement in their performance or do not abide by the standards issued in this regard.
A Human Resource for Health Master Plan 2005-2030 in Philippines has been developed and 17
governments and agencies have been listed in this regard who are accountable for influencing the
health workforce. The Ministry of Health and the nursing leaders in Philippines have begun to
increase the accessibility to health services in the rural areas through employing and training the
nurses (McCarty & Fenech, 2013).
Analysis of the data profile of the health workforce for each country
According to Laurence & KarnonI (2016) the objective of health workforce planning in
Australia is enable to have the right skills at the right time at the right place and to
provide right services to the right patients. It comprises of predictions for the necessities of
health care services and the supply of resources for providing the services. It also aims at testing

Health workforce planning 6
the policy framework and addressing the disparities between the demand and supply of the
health care services.
(Source: Health Workforce Australia, 2014)
The reports on Australia’s Future Health Workforce provides the national workforce planning
estimations regarding the identification of the gaps between the supply and demand of the
workforce in future which would be impacted by a range of scenarios. These scenarios depict a
vision of future health care delivery and reflect the probable government policy decisions, the
employer practices, activities related to higher education, training of the workforce and trends of
the services and the current health workforce.
As shown in the graph, in the year 2012, there were about 331,804 registered and enrolled nurses
in Australia which shows a significant investment in the Australian economy. This comparison
scenario shows an oversupply in the nursing sector till 2015 but afterwards the supply is less than
the demand having the undersupply of 41,000 nurses in the year 2030.

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As per Liu et al., (2016) in the low and middle income group countries like Philippines , the
health development targets are restricted by lack of skilled health professionals for delivering
health services.
(Source: Liu et al., 2013)
As seen in the figure, the low middle income group countries such as Philippines is experiencing
the greatest and most rapid increase in demand and shortages over a period of time. The
average annual growth of supply of health work force is less as compared to its demand . The
supply of the health workers shall be slowest in the low middle income group countries .There is
a shortage of 7 million workers in 2013 which has increased to 8.3 million by 2030.
The growth of demand and supply is predicted to be slowest in the low middle income countries
like Philippines and these are estimated to be below the WHO threshold of 4.45 workers amongst
the population of 1000 persons. As a result, Philippines might face a contradictory situation in
which it faces the shortage of health workers required for providing the health services , though
there will be unemployed health workers because of the restricted capacity of the government to
employ them (WHO,2018).

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Identification of the critical issues to be addressed in each country
One of the major issues in terms of health workforce planning in Australia is that there are less
number of health workers particularly, the medical specialists, general practitioners and some
associated professions. The nurses and the medical practitioners are not available for the
communities which are located in the remote areas of the country.
In the remote areas, the ratio of the general practitioners to the population is half as compared to
cities and for physiotherapist, it is even less than half and for specialists the ratio is less than one
fifth. To add on to the misery, the accessibility to the primary health care services might be hours
away. The more specialized services are available only at large population centers involving
larger travelling times. In addition to this, the accessibility to the health services can result in
huge financial costs which can impact the income and result in disruptions in careers and
education of the population (World Health Organization ,2015) .
The limited access to the specialized health services depicts the disincentive of the workforce
operating in those areas. It also projects that the medical practitioners does not have the mass
which is necessary to assist the residential specialists in terms of required infrastructure and
population.
According to Asia Pacific Observatory on Health Systems and Policies (2011) the major issues
confronted by Philippian’s Department of Health is that some of the categories of health
workers do not correspond to the international classifications as they arose as a result of the
demands of the health care system of the country. Moreover, there is no proper statistical record
available of the active health workers in this context.
The largest category of the health care workers comprises of nurses and midwives due to their
increasing demands in other countries. Contradictory to this, most of them are unable to find
employment in their own country. So, the insufficient number of government jobs is due to the
incapability of the government to create the job positions in the bigger health care centers.
Also , there are so many vacant positions in the rural and low income group areas but the
doctors find these unappealing due to inflexible and long working areas, lack of incentives to
stay in there and seclusions from their counterparts while the newly trained doctors are

Health workforce planning 9
confronted with the issues of where and how to practice . They are not inclined towards solo
practice and more interested to take the salaried jobs.
Application of the WHO priorities in the national workforce planning of both the countries
using the recommendations developed by WHO
According to World Health Organization (2016) there are certain recommendations given by
High-Level Commission on Health Employment and Economic Growth which was established
by UN Secretary-General Ban Ki-moon in the month of March 2016. These pertain to creation
and investments in the health care sector jobs specifically for youth and female section of the
society.
In the Australian context, there are around 1 million health care workers who are employed for
the delivery of health and welfare services across the country. In the Philippian context, there are
more migrations of the nurses to the other countries, so it should develop appropriate job
opportunities for the workforce in the domestic country to avoid their migration (Cometto et al.,
2013).
Secondly, the commission has recommended that women should be allowed to participate and
avail the employment opportunities in the health care sector. In the Australian context, the
number of females working in the health care sector has decreased from 79 % in 2011 to 78.5%
in 2016(Australian Bureau of Statistics, 2017).
Whereas in Philippines, the number of women employed in the health care sector is increasing as
compared to men.
The third recommendation is development of the education and training skills of the health care
workers to match the necessities of the population. In the Australian context, the health care
providers have received the education and training to work as primary health care providers in
the rural and remote areas. In Philippines, the quality of training provided by the institutions is of
low standard so policies for strengthening of the training framework should be adopted.
The fourth recommendation is to introduce reforms by transforming the service models and
focusing on providing high quality and affordable health care services. In Australia , the reforms

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10
pertaining to the health insurance facilities to the public are introduced(Dixit &
Sambasivan,2018).
While Philippines is confronted with the difficulties in introducing the various health care
reforms in the public sector.
The fifth recommendation is adopting cost effective technologies to develop people centric
health care services and information systems. Australia has adopted cost effective technologies
to facilitate capability building, strengthening the education infrastructure improvements and
resource sharing. Philippines have also begun to increase the health care services through
adopting the modern technologies but it is on the initial stage and requires further research.
The sixth recommendation is investing in the development of the skills of the health workers in
relation to cope up with the health emergencies of the public. Australia is working towards the
evolution of the health care policies which will help to cope up with the health emergencies. In
this context, Philippines been greatly working in this area (WHO, 2018).
The seventh recommendation is raising appropriate funding from the domestic and international
resources to consider wider health financing reforms. Australia has been collaborating with the
national and international agencies to support certain health programs. Philippines have initiated
to focus on UN Sustainable Goals of health and wellbeing for its citizens.
The eighth recommendation is promoting cooperation amongst the various stakeholders for
supporting investments in the health work force. Australia has been coordinating with its
international counterparts to make contributions to facilitate improvements in the health care
sector. Philippines is much behind than Australia in this context (World Health Organization,
2014).
The ninth recommendation is to mitigate the adverse effects of migration in the low middle
income countries .In this regard, the international agreement on the workforce health migration
should comprise of provisions to enhance the benefits. The health care workers migrate to
Australia and it has signed bilateral agreements with the regional countries for resettlement of
the immigrants (Larking, 2017).

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Philippines is much behind than Australia in this regard. It has to implement certain reforms to
mitigate the negative impacts of migration (Marcus, Quimson & Short, 2014).
The tenth recommendation being undertaking research and analysis by using harmonized metrics
and methods to empower evidence, responsibility and action. Australia has been implementing
certain research programs for empowering accountability in the various stakeholders. Philippines
have made investments for the growth and development of the health care sector in the recent
scenario (World Health Organization, 2017).
Conclusion
Hence, to conclude, it can be said that Philippines being a low income group country needs to
introduce many reforms for the development and growth of the health acre sector and health
workforce planning. It needs to introduce certain policies and reforms to lessen migration of the
health care workforce so that the domestic population can be benefited by the s services provided
by medical personnel. Furthermore, accessibility to the health care services should be enhanced
through providing the availability of the necessary resources to all the stakeholders.

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