Justice for People Who Serve: The Plight of Contractual Personnel in the DOH

References: NARS ng Bayan/Alliance of Health Workers, Philippines

The Context of Hiring Contractual Personnel at the Department of Health

The Philippine government’s moral responsibility to save the lives of thousands of Filipino people from dying due to poor maternal and child health situation pushed the Department of Health to adopt the Maternal, Newborn and Child Health Nutrition Strategy last 2008 as a significant element of its overall framework of Universal Health Care.

Four years later, the grim picture of maternal deaths, neonatal and infant deaths, and the poor access of thousands of mothers and children to essential health care remains to be seen. To fast track the MNCHN implementation nationwide at the local levels, the National Center for Disease Prevention and Control (NCDPC) under the leadership of its former Director, Dr. Eduardo C. Janairo, hired more than a hundred job order/contractual personnel to augment the health manpower who are supposed to catalyze the implementation of DOH health programs. Other than those contractual personnel last 2009, the following were hired between 2010 and 2011:

•27 hired 2010
•100 hired between February and March 2011
•13 hired June 2011

The said job order/contractual personnel were hired as program-based personnel and not just project-based. This simply means that the contribution of these personnel must not be measured at a project level but rather in their significant inputs to the overall health programs of DOH. In effect, they will be the critical mass to the Philippine’s “scores” in achieving Millennium Development Goals # 1, 4, 5 and 6 by the year 2015.

In the DOH organizational structure, NCDPC is under the Policy and Standards Development for Service Delivery Cluster. Policy and standards development in its real sense is not simply paper work. This requires validation of data, documentation of evidences and actual field experiences of health policy implementers, testing of strategies, validating correct target/s of health programs, motivating LGUs for its implementation, monitoring and evaluating results/impacts of DOH policies and standards, and documenting the findings to be used again as inputs for re-assessment of programs and reviewing/crafting policies. Below are the items of the job order/contractual personnel hired in NCDPC:

JOB POSITIONS                          Number of Personnel  Percentage
Nurses                                                        75                       46
Administrative Positions                               50                       30
Computer Programmers/Data Encoders       28                       17
Statisticians                                                   3                         2
Supervising Health Program Officers              2                         1
Data Controllers                                            2                         1
Transplant Coordinators                                2                         1
Dentist                                                          1                         0.5
Engineer                                                        1                        0.5
Lawyer                                                          1                        0.5
Cooperative Development Specialist I            1                        0.5
TOTAL                                                     166                    100

A group of contractual personnel was specially hire for the Autonomous Region of Muslim Mindanao (ARMM) due to the peculiarity and uniqueness of this region such as the people’s culture and beliefs, geographical description, peace and order situation and its unique political set up.

The Cry for Justice

When the new Director, Dr. Lilibeth David assumed office in NCDPC last June 16, 2011, abrupt termination of service of all contractual personnel began. Last June 27, 2011, OIC-Undersecretary Assec. Gerardo Bayugo instructed the DOH Personnel Division to hold the processing of July-December 2011 contracts of job order/contractual personnel which was submitted to Personnel Division on June 8, 2011.

This was followed last June 30, 2011, at around 1:00 PM, by an instruction from Director Lilibeth David thru Ms. Vivencia Martinez and Ms. Luz See not to report the following day (July 1) on the premise that their contracts already ended. Everybody were shocked with this devastating advise.

At 5:00PM of the same day (June 30), it was followed by an issuance of a memorandum signed by Dr. Kenneth Ronquillo of HHRDB-DOH that all contractual personnel are “temporarily terminated” effective July 1, 2011 pending submission of full assessment of their job performance and review by the DOH Executive Committee. All these events occurred few hours before July 1, 2011.

What happened to the contracts they have signed with Dr. Eduardo C. Janairo (former Director IV of NCDPC) for the period July-December 2011? Where is the due process? Why is there not enough time to notify all contractual personnel?

At around 3:00 PM of July 4, 2011, Ms. Vivencia and Ms. See distributed Assessment Forms to some contractual personnel to be accomplished and submitted on or before 5:00PM of July 5, 2011. Apparently, the said assessments will justify the need to rehire contractual personnel.

However on July 6, 2011, the contractual personnel discovered other violations of their rights: (1) Dr. Kenneth Ronquillo of HHRDB-DOH allegedly issued the memorandum dated June 30, 2011 to end contracts of contractual personnel hired in 2010 and 2011 because of absence of performance evaluation. Dr. Ronquillo apparently is not aware that the contractual personnel have undergone performance evaluation from May 16 – 20, 2011. He also claimed that he did not receive the recommendations of Dr. Janairo to rehire all the contractual personnel for July-December 2011. (2) Dr. Ronquillo also claimed that he and OIC-Usec Gerardo Bayugo are not aware of the contracts signed between the contractual personnel (First Party) and Dr. Eduardo Janairo (Second Party) for the period July-December 2011.

These apathetic actions of the DOH Management is a clear manifestation of unfair labor practice and inhumane treatment of its own health personnel. It is not consistent with what DOH have been pronouncing in public that they are committed to save the lives of dying and sick Filipino people. In contrast, they have not been responsive to the plight of their own health employees.

NCDPC contractual personnel demand justice from DOH! Legal labor practices and human dignity must be recognized and respected!

To date, all job order/contractual personnel have not received any update on the result of the Performance Assessment which further aggravated and prolonged their agony while their families are continuously deprived of their basic survival needs. Is this the price the job order/contractual personnel have to pay after rendering services to the DOH?

Thus, the NCDPC contractual personnel call on DOH Secretary Enrique Ona for the following:

1. Immediate rehiring of all NCDPC contractual personnel in respect to the July-December 2011 which they have already signed;
2. Fast track all reimbursements of contractual personnel which they have incurred in the performance of their service in the field such as transportation expenses during the External Rapid Coverage Assessment (RCA) in relation to Measles-Rubella Campaign last June 13 – 30, 2011.
3. Timely release of salaries of contractual personnel; and
4. Provide compensation for the moral-emotional damages brought to contractual personnel and their families.

P-Noy urged to allot P90B for health care services » Nation » News | Philippine News | philstar.com

The Philippine Star

By Dennis Carcamo Home Updated July 21, 2011 09:08 AM

MANILA, Philippines - Various health groups today called on President Benigno Aquino III to make good on his promise to prioritize the health care service for the people.

Jossel Ebesate, national president of the Alliance of Health Workers, said health groups also demanded that the government allocate P90 billion for health care.

"As President Simeon Aquino prepares for his State of the Nation Address, he should remember and fulfill the promises he made as he assumed office a year ago. Foremost amongst these is to give utmost priority to the health of the people," Ebesate said.

He cited that health care service in the country has become worse with several state-run hospitals burdening their patients with various additional fees.

At the Philippine General Hospital, even Class D patients who used to receive full support are now being charged various rates ranging from P20 to P340 for diagnostic and laboratory examinations, all of which were previously free.

Similarly, at the Philippine Orthopedic Center, the new rates are more than double the previous rates, Ebesate added.

"The promise of universal health care has been reduced to expanded coverage of the Philippine Health Insurance Corporation (PhilHealth), which remains a stop-gap measure. Doctors and nurses, still badly needed in the country, are not being employed properly with adequate remuneration. The RN HEALS program for nurses does not even provide nurses with the salary mandated by law and offers no real job security," he said.

For her part, Dr. Geneve Rivera, Health Alliance for Democracy secretary general, said the promotion of public-private partnerships by the Aquino administration has left public hospitals in a state of disrepair and neglect to justify the entry of private investments.

"Rather than promote the commercialization and sale of public hospitals, Aquino should stop the privatization of healthcare and provide a meaningful budget that allows public hospitals to fulfill their mandate of serving the underserved," Rivera said.

P-Noy urged to allot P90B for health care services » Nation » News | Philippine News | philstar.com

PPPs in health threaten to make health care costlier – health workers - Bulatlat

Published on July 22, 2011
Bulatlat.com

“You go to a public hospital emergency room to have your wound cleaned, you have to first buy some cotton, wound antiseptic, and dressings, before you can be treated,” said Joel Bitanga, 40, an X-ray technician in San Lazaro Hospital.

By MARYA SALAMAT

Sidebar: Health workers blame Aquino’s PPPs for further crippling the Philippine Orthopedic Center

MANILA – After one year, healthcare in the country has gone from bad to worse — this is the assessment of the Alliance of Health Workers (AHW) on the Aquino government’s impact on health. In a series of protests held by its member unions in different public hospitals in Metro Manila, the group aired the various shocks of Aquino’s touted PPPs (public-private partnerships) on the services of public hospitals and the working condition of health workers and professionals in the country. The group challenged Aquino to stop the privatization “in any form” of public hospitals and to bail out public health by infusing it with a P90-billion ($2.09 billion) budget at least.

UP-PGH health workers urge their hospital management to revert to giving poorest charity patients free treatment. A mother brought out a child patient. (Photos by Marya Salamat / bulatlat.com)

During Aquino’s first year, the country’s main public hospital, the Philippine General Hospital (PGH), for example, has, for the first time in its history, resorted to charging fees even from its lowest ranked charity or indigent patients. In a memo issued last month, the PGH administration reportedly directed its hospital staff to charge the previously free diagnostic and laboratory examinations of “class D” patients. These are the patients who, according to the hospital social workers, belong to the lowest earners or the poorest of the poor among the four groups who qualify for “social service.” Class D used to receive full support (or full charity), while the other classes under social service get discounts, much like the socialized tuition fees being implemented in the University of the Philippines, explained Jossel Ebesate, AHW national president.

In the Philippine Orthopedic Center, fees have been drastically increased early this year, with some increasing more than twice its old amount.

Because of the budget cutbacks implemented by the Aquino administration in the budget for maintenance and other operating expenses of public hospitals, the previous shortages in medicines, supplies and other equipment have become worse, reported the AHW. The exacerbated shortage in turn prompted the administrations of public hospitals to increase fees and to charge fees on previously free items in the hospital menu of services.

“You go to a public hospital emergency room to have your wound cleaned, you have to first buy some cotton, wound antiseptic, and dressings, before you can be treated,” said Joel Bitanga, 40, an X-ray technician in San Lazaro Hospital. He added that if you were brought to their hospital and you can’t breathe, you have to buy the hose and other paraphernalia for your oxygen.

Health workers and a child urge the Aquino government to treat healthcare not as source of profit but as public service.(Photos by Marya Salamat / bulatlat.com)

Picketing in front of San Lazaro Hospital, then at Jose Reyes Memorial Medical Center and in front of the Department of Health, the health workers decried last Monday the increased fees also prevalent in the Philippine Heart Center, the Lung Center of the Philippines, the National Kidney and Transplant Institute (NKTI), the Philippine Children’s Medical Center (PCMC) and the East Avenue Center (EAMC). These are some of the hospitals retained by the national government after it implemented a devolution of health services in 1992.

The practice of charging and increasing fees which the majority of low-income Filipinos are already finding as tough, would likely worsen if the Aquino government pushes through with its planned PPPs targeting even government hospitals, the AHW warned.

Already, the health group noted that some private companies that were able to get concessions in public hospitals have been profiting from this public-private partnership. They cited as example Himex, which provides the radiology “services” of Jose Reyes Memorial Medical Center; the Carte-blance in Lung Center which profits from its dietary services; and Fabricare for Lung Center’s laundry. In PGH, the privately-operated Faculty Medical Arts Building has begun operations this year.

In public hospitals being operated by local government units, a measure of success is the increase in hospital income, which could be
had by adding “private” or “pay wards” and other services that charge fees. The biggest example, for having been the first to be declared as a corporatized hospital is the La Union Medical Center. Provincial hospitals are now trying to follow its example, after its local governments have sent their public hospitals’ directors and staff to “Lakbay Aral” (Study Travel) to learn from “successful” provincial public hospitals.

Up for starting new PPPs soon are the Philippine Orthopedic Center (POC), the San Lazaro Hospital and the Research Institute for Tropical Medicine (RITM). While the moves are seeking to improve and upgrade the said hospitals – something which the health workers’ union said they also wish to happen – they are decrying the fact that these have to be planned under a PPP setup. They urged the government instead to fund the needed development, rather than enter into partnerships with the private sector whose motives for entering health services are mainly for profit.

Health groups blame US imperialist dictates for Aquino’s drive to privatize and commercialize healthcare.(Photo by Marya Salamat / bulatlat.com)

“What will happen to our mentally ill patients? Will they be abandoned on the streets?” asked Arman Palaganas, vice-president of the health workers’ union in National Center for Mental Health. This mental hospital and the Philippine Heart Center are up for bidding in a public auction set to be held under the Aquino administration, the AHW reported.

When all these upcoming PPPs happen, the AHW warned, health care will become even less accessible to ordinary Filipinos.

Killing you softly

Given the frequently slashed budgets, health workers’ wages and benefits have also taken a beating. In fact, the Department of Budget and Management itself has told public hospital administrators and even local government units that benefits being given to health workers are contingent on the hospital’s savings or on the availability of funds. The result, according to AHW, is either lacking or almost nil benefits especially for health workers under the local government units.

A PGH patient’s charity cards and papers attesting to her indigency could mean little now in terms of free or affordable treatment. (Photo by Marya Salamat / bulatlat.com)

For twenty years now, the country’s plantilla position for health workers and professionals have barely increased, despite the continued pressure of population increases. Worse, while the plantilla positions are being controlled, the AHW noted that the ranks of the country’s health workers are under attack and being reduced by bouts of retrenchment or streamlining through transfer, attrition and early retirement.

Instead of replacing the lost regular health workers, AHW noted that the government itself has been increasingly implementing “flexible labor arrangements,” a favorite under profit-oriented corporations. In the health sector, these arrangements range from contractualization, job-order employment (similar to project-based hiring), and the notorious “volunteerism” where the hospitals not only do not pay the health professionals who serve them but even make them pay for the “training” and “experience.”

As if to gag the health workers’ groups who have been criticizing and providing proofs of the government’s abandonment of its responsibility top ensure the people’s health, there are alleged moves from public hospital managements to bust the health workers’ unions, or else “deceive, divide and crush” the progressive unions under the Alliance of Health Workers. The AHW complained that the management of some public hospitals, such as the National Center for Mental Health, Jose Reyes Memorial Medical Center, Philippine Orthopedic Center and Philippine Children’s Medical Center, “do not recognize and even try to coerce the accredited sole bargaining unit.”

As such, judging from the way the government has been treating Filipinos as patients and as health workers, the health group charged that “the people has never been Aquino’s real ‘boss,’ as he had boasted, but the politicians, the local big landlords and the big local and foreign investors.”

The poor cannot survive under the Aquino government’s health agenda of privatization, the Health Alliance for Democracy said in a statement. The poor will get sicker and die sooner if the rate increases continued, said PGH nursing attendant Ellen Jamison in a picket protest in front of the PGH this week.

The health groups encourage health workers and the families of patients in public hospitals to join in protesting privatization and pushing for health as a human right.

PPPs in health threaten to make health care costlier – health workers - Bulatlat

Nursing Must Return To The Bedside

July 9, 2007 Courant.com/news/local

Last week, The Courant stated that by the year 2010, Connecticut will have 11,000 too few nurses. I assume that means 11,000 too few nurses who would be giving direct patient care.

UConn's board of trustees approved a proposal to help alleviate this nursing shortage ("hemorrhage" is more like it) by adding a master's entry-level program for nursing at two of its branches, graduating 64 new master's prepared nurses each year. Candidates need only a bachelor's degree in any major to be considered. There are two major flaws to this proposal. First, the obvious: 64 vs. 11,000 ... still hemorrhaging! Second, master's prepared nurses typically do not provide direct patient care.

During the last couple of decades, nursing became more focused on credentials and less focused on the patient. Nursing education itself became more academic oriented and less clinical or patient oriented.

All hospital-based schools of nursing closed; LPN's and nurse's aides lost their hospital jobs. We threw away our caps and white uniforms (except on TV), leaving a guessing game of who's who in the scrubs.

Hospitals initiated programs called "nursing ladders" where nurses could distinguish themselves. Individual portfolios were created to document meetings attended, committees joined and classes taken. The more non-nursing tasks documented, the further up the ladder you "climbed." Accordingly, your wages increased. Ironically, the further up the ladder you went, the further from direct patient care you were. There is no denying the benefits of continuing education. However, in our quest to be treated as professionals, we created an environment where a new generation of nurses run as fast as they can from direct patient care.

Now, they say the bigger problem is not enough teachers to teach nursing. My guess is the 64 who received their master's in nursing will teach. They have the right credentials. My question is, how will they teach without any experience? Here is my solution. Let nurses teach based on their years of experience, not just credentials. The nurses with 15- to 20-plus years of bedside experience, whose backs are killing them, may not want to write for nursing journals, but they do know how to take care of patients. So, who better to teach? Second, increase compensation to nurses who give direct patient care, twofold. Make good old-fashioned bedside nursing desirable to the next generation of nurses. Perhaps then, even more men will join us. Last, for the nurses calling the shots, but not giving the shots, build in a few clinical hours into their schedules. (Doctors do!) We must remove the focus of this hemorrhaging profession away from the credentialing scorecard that it's become, and return it back to the patient, where it belongs.

Kate Dunn Scott, RN, Portland

Copyright © 2007, The Hartford Courant

Mga Sirang Batayang Kagamitan: Prayoridad ba ng Administrasyon?

Sa paghahanda kaugnay sa Sentenaryo ng PGH, maraming mga kagamitang medikal ang nasa prayoridad sa pagpapatupad ng “modernization” subalit hindi maitatanggi na ang mga ilang batayang gamit ng ospital ay luma na at dapat mas nasa proyoridad ng pagkumpuni o pagbili ng bago tulad ng generator, elevator, chiller, autoclave, PABX at CBC machine

Ito ay ilan lamang sa nagiging paksa sa diyalogo noong ika-2 ng Hulyo 2007 sa pagitan ng Unyon at PGH Administration.

Dinala ng Unyon ang isyu kaugnay sa mga sirang batayang gamit dahil sa malaking implikasyon nito sa ating serbisyo sa mamamayan at sa ating kalagayan sa paggawa.

Ang ating dalawang pangunahing generator ay puro sira na at may pondo na para sa pagbili ng mga piyesa (ang iba ay bibilhin pa sa Singapore).

Ang mga sirang elevator naman sa Central Block Building ay may inilaan nang pondo para sa pagbili ng bago.

Ang mga chiller plant (3) naman sa DEMS ay puro sira kaya parang pugon sa init ang ER. Kagyat na pinapahanapan ng pondo sa Budget para sa pagkumpuni.

Ang autoclave sa CSR na puro sira din ay kinukumpuni na at may plano ang Administrasyon na ikabit sa CSR ang isang nakatiwangwang na Autoclave Machine na kasama pa sa DEMS Modernization Project, at bibili pa ng karagdagang unit, para pamalit sa madalas masirang unit.

Samantalang ang local telephone exchange system (PABX) natin ay sinabing may nakikita ng pagkukunan ng pondo para sa pagbili ng bago.

Inaasahan natin na ang diyalogong ito ay magpapabilis na maibalik sa normal na operasyon ang mga batayang gamit - para sa maayos na serbisyo sa mamamayan at upang magaan na magampanan ng ating mga kapwa kawani ang kani-kanilang mga tungkulin.

Sabi nga ng marami sa atin: “Anong silbi ng modern medical equipment tulad ng MRI kung ang mga batayang gamit sa ospital tulad ng standby generator, telepono, elevator, aircon at autoclave, kung hindi madalas masira ay di na talaga magamit?

Masusi nating susundan ang mga ipinangakong ito.