Doctors to The Barrios, Masters of Public Health
November 03, 2021
By: Harold Joshua De Guzman, UPCM 2023
This year, the Doctors to the Barrios-Masters in Public Health (DTTB-MPH) program will be sending forth their first graduates. Since its beginnings, the DTTB program has not only augmented communities’ health workforce, but it has also trained and equipped participating doctors with relevant knowledge and skills in public health through continuing medical education (CME). The DTTB-MPH is the latest iteration of the DTTB program, and it is designed to prepare doctors for the unique challenges they will face as clinicians and health administrators in their assigned municipalities. This is overseen by the UP College of Public Health, with some courses handled by the College of Medicine and the College of Arts and Sciences. Upon completion of this program, participants will earn a master’s degree in public health in addition to being a DTTB graduate.
The original DTTB program established in 1993 was intended to supply doctors to the estimated 200 doctorless municipalities at the time; however, only 50 applicants per year could be accepted. Around 2009, the program had evolved with the needs and policies of the times, requiring a minimum of two years of service to assigned municipalities. Moreover, the government had expanded the program coverage to include more than just doctorless municipalities. Following an increased demand, the number of people taking the program likewise increased with the introduction of two government scholarships: one offered by the DOH and the other being the Bagong Doktor Para sa Bayan offered by the First Gentleman Foundation. By then, around 100 DTTBs were being accepted per batch.
Dr. Jasmine Arcilla (leftmost), together with municipal officials, conduct a 4-day capacity development training for Barangay Health Workers on basic first aid and initial medical assessment and referrals. With initiatives like this, DTTB-MPH program aims to empower communities to cultivate their own local health systems. Photo from Dr. Jasmine Arcilla.
To equip doctors with the proper skills and knowledge required of a DTTB, they are to undergo a CME course. This consists of a two-week-long saga of seminars, with one week dedicated to clinical topics and another covering public health topics. At first, this was conducted by the DOH Health Human Resource Development Bureau. By around 2009, the CME course was upgraded to a proper academic track by a dedicated academic institution, the Development Academy of the Philippines, to handle new logistical challenges. With this arrangement, the DTTBs could earn a master’s degree in public management, major in health systems and development upon completion of their contract.
In 2017, however, the DOH opted to transfer the responsibility of delivering the CME to UP Manila. With the combined efforts of university executives and staff, the institution was able to quickly set up the MPH program. The course consists of nine core subjects which cover topics such as biostatistics, epidemiology, and principles of effective health system administration.[1] Through this program, UP was further capacitated to help doctors become invaluable assets to improving Philippine healthcare.
Dr. Jasmine Arcilla (front row; center) caps off the Annual Individual Performance Assessment with her DOH-deployed Human Resources for Health staff. DTTBs are meant to reinforce, not replace, the municipal healthcare workforce such that DTTBs would no longer be needed. Photo from Dr. Jasmine Arcilla.
The program, however, calls for a certain drive in those filling in the shoes of a DTTB. Doctors are to juggle their responsibilities in the municipalities while fulfilling the MPH track requirements. Dr. Jasmine Arcilla, a graduate of UP College of Medicine (UPCM) Class of 2018 and the DTTB-MPH program who was assigned to Dumaran, Palawan, says, “When I got into UPCM and noong nag-clerkship and internship, namulat ang aking mga mata sa actual situation ng patients.” To be a DTTB, “you really have to understand the needs of the community, and you have to be ready to go all in. You have to be willing to serve in a community despite knowing it will be very frustrating.”
Currently, Philippine healthcare functions as a two-tiered parallel system of public and private healthcare. On one hand, the government-run public system aims to provide free or discounted health care for all citizens. On the other hand, the private system mostly caters to those who are able to pay; thus, they are able to access any level of care if they so desire, and they can even choose to forgo seeing a general practitioner and instead visit a specialist right away. It is no secret that many, if not most, of our countrymen only have access to the public healthcare system. Unfortunately, the public healthcare system is neither funded nor developed enough to meet the needs of those who require it.
To help this ailing system, DTTB was specifically implemented to work as an augmentation program meant to temporarily increase the healthcare human resources in areas where primary healthcare is lacking. The program is to run indefinitely—as long as is necessary to reach as many municipalities as possible. As the program is primarily intended to reinforce rather than replace the municipality’s healthcare force, the ultimate goal is to help the area develop enough such that DTTBs will no longer be needed.
The success of DTTB is measured in different ways. From the perspective of the national government, the first measure of success is achieved when the DOH is able to assign a doctor to a municipality in need of one. However, a more meaningful success is achieved when the doctor assigned to that municipality is able to improve the healthcare system of that area. While this is difficult to quantify, the DOH does employ the Local Government Unit scorecard system which classifies LGU performance into Red, Yellow, and Green. This measurement system helps assess whether LGUs have achieved set target health indices such as those for health sector spending, health facilities enhancements, and health governance. It is the goal of the assigned DTTB to assist the community in achieving these targets through community empowerment.
Achieving the latter measure of success is where the additional training from the CPH comes to use. By training in public health administration, doctors would be more able to design better health programs that are much needed by their communities. “The six building blocks of health systems can be seen in action in the community,“ says Dr. Jasmine. Discussing the most impactful subjects for her service, she says epidemiology and the principles of data-driven decision-making were very helpful in determining the best types of programs to design for the community. The applied field practice[1] in public health was also very helpful in planning and coming up with a program relevant to the community.
Municipal Health staff and administrators, Red Cross Palawan Chapter, together with Dr. Jasmine Arcilla (first row; 3rd from the left) conclude a Blood Drive for community members. Photo from Dr. Jasmine Arcilla.
While the doctors are known and expected to provide both clinical and community services, it is less known that they must also provide administrative services. Apart from diagnosing and treating diseases and organizing health-promoting events at the community level, the assigned doctors are also the respective administrators of their local offices. Through this, it becomes necessary that they be socially adept. DTTBs have to contend with the personal beliefs and affairs of both the citizens and local officials just as much as, if not more than, the diseases and health problems of the area. “When the pandemic hit, it was difficult to get people to follow the health protocols [such as] washing hands frequently, wearing masks in public, etc. kasi hindi naman nila nakasanayan yoon. We had to contend with many kinds of misconceptions; some didn’t even believe in the pandemic. It is also very difficult to balance their different needs, [and] to convince someone to isolate when ‘yung kabuhayan nila on a day-to-day basis depends on them going out.” Dr. Jasmine relays that they had to go barangay-to-barangay to teach the different officials the importance of health protocols. The municipality even decided to set up policies and fines for violations.
Dr. Jasmine Arcilla (2nd from the right) and her entire DTTB Batch 36 assigned to the MIMAROPA region finalize their preparations before they are sent off to their own areas to where healthcare is needed most. Photo from Dr. Jasmine Arcilla.
One natural critique of the DTTB program is that municipalities might take advantage of it by relying on the consistent supply of doctors. Why would they need to invest in local healthcare systems if the DOH is going to assign doctors to them anyway? However, it may also be the case that municipalities may simply be struggling to set up their own local systems. Whatever the reason may be for each municipality, the reality is that some areas remain doctorless despite having received a succession of DTTBs throughout the years. Such is the case of Dumaran which, during Dr. Jasmine’s time there, was yet to have its first permanent municipal health officer. “Willing naman magsupport ang LGU ng whatever hilingin ng DTTB,” says Dr. Jasmine, but she also acknowledges that “depende rin sa LGU kung paano sila mag-alaga ng doktor. Kung alam nila na hindi ok, e di, walang mags-stay. LGUs need to have a better understanding of what health is and how it is multifactorial and multisectoral. Kapag iniisip nila na pagdating sa health, health ‘lang yung gumagalaw, nakakapagod ‘pag ganoon, and it’s not really going to work. Kung itatambak lang nila lahat ng responsibility onto the rural health unit, superficial lang ‘yung support nila.”
Health systems are inextricably tied to the governments that run them, and no matter how many DTTBs are sent to a municipality, it is up to the local government and the community to decide what their course will be. The ultimate goal of a well-functioning and sufficient healthcare system can therefore only be achieved if local leaders and communities work toward such a goal on their own accord. That being said, with the approaching elections, we must remember that it is our duty to elect just and competent leaders who will help us reach this goal. Hopefully, in the future, instead of doctors to the barrios, we may have doctors from and for the barrios.
Reference:
College of Public Health. Master of Public Health [Curriculum]. University of the Philippines Manila; 2019 [cited 2021]. Available from https://cph.upm.edu.ph/sites/default/files/MPH_2019.pdf