The Institute of Health Sciences (IHS) was established by the University of the Philippines in Tacloban, Leyte Province, in 1976 as an experiment in medical education. It aimed at developing a broad range of community-oriented health workers such as barangay health workers, midwives, nurses, nurse practitioners, and physicians. On May 3, 1989, the IHS formally ceased as an experiment when it was renamed as the School of Health Sciences (SHS) and became a separate, regular unit of the University of the Philippines Manila.

The SHS represents a bold strategy to counteract the twin problems of the "brain drain," which refers to the alarming exodus of more than 50 percent of Filipino physicians to more affluent countries like the United States, and of the maldistribution of the available health manpower in the country, whose concentration in urban areas left some 70 percent of the Filipinos in the rural areas without adequate health and medical services (Lepreau, Koh and Olds, 1990).

The objectives of the SHS are:

1. To produce a broad range of health manpower that will serve the depressed and other underserved communities; and

2. To design and test program models for health manpower development that would be replicable in various parts of the country and, hopefully, in other countries similarly situated as the Philippines (WMA, 1978).

To accomplish its objectives, the SHS operationalizes "counter-culture" ideas for health manpower development that radically depart from traditional training programs (Borrinaga and Koh, 1993). These include highly democratized admissions procedures that delegate most responsibilities for student recruitment to the community level, a step-ladder curriculum (see Figure 1) that offers a sequential yet integrated approach to health manpower education, and an educational principle that emphasizes community relevance rather than academic excellence.

These principles are reinforced with a concept of "service leave" between each stage of professional training, which serves to continually link the students with their home communities. This process, in turn, generates an active partnership with communities in training and shaping the outlook of SHS students, a responsive entry-exit mechanism to and from the formal curriculum, and linkages with other agencies for their cooperation and support to SHS operations. Research and development (R&D) as a component seeks to contextualize the SHS academic pursuits with community realities.

The SHS, aside from training health workers to become relevant and effective in rural Philippine contexts, also played key roles in health sector reform in the Philippines. These were particularly on the aspects of policy-making to improve access to health care, conceptualizing new health-related academic and research disciplines, and serving as experiential model for alternative health sciences education now being replicated in other parts of the country.

Through a joint Research and Development (R&D) Project with the Department of Health (DOH) in the Leyte-Samar region (Region VIII) from 1977 to 1982, the SHS contributed to the formulation of the Philippine and global policies on "Primary Health Care (PHC)" and "Health for All by the Year 2000". That R&D Project was technically supported by the World Health Organization (WHO) Regional Office for the Western Pacific with funding from the Danish and Swedish international development agencies (Borrinaga and Koh, 1990; WHO, 1983).

Implemented in the Carigara Catchment Area (CCA) in Leyte Province, the R&D Project aimed to develop a monitoring system that would enable: (1) the SHS to plan curricula and develop training/teaching methods relevant to the needs of the rural population; and, (2) the DOH in the Leyte-Samar region to design and implement rural health programs relevant to the changing needs of the population.

The monitoring system was implemented in five phases:

Phase I (1977-1980): Reorientation of health workers from providing basic health services to the development of community health programs in rural areas.

Phase II (1978-1981): Development of methods for health workers to organize communities to participate in health development work.

Phase III (1979-1981): Development of methods for lay reporting of family health.

Phase IV (1981-1982): Development of methods for planning and evaluating health development programs with the community, using lay reports and official reports.

Phase V (1981-1982): Development of methods for integrating hospital and public health services at the district level.

When "Health for All by the Year 2000" and "Primary Health Care" became international health policies in 1977 and 1978, respectively, the DOH proposed to adopt a partnership approach to achieve the goal of "Health for All Filipinos by the Year 2000". The Carigara project immediately provided the DOH with a practical example of such an approach to health development. The initial experiences of this project were used as basis for the intersectoral group convened by the DOH to formulate a national strategy for expanding and further developing the experiences that had been started in Carigara. The concept of partnership and its strategy of implementation became part of national policy in October 1979.

In May 1980, the national strategy document was presented to the World Health Assembly as the Philippine Government’s contribution to approaches for achieving Health for All by the Year 2000 (Acosta, 1980). The strategy supported a decentralized and "bottom-to-top" approach to the development and improvement of the health system.

The Carigara project also provided the basis for formulating the national guidelines for developing community health activities and the Region VIII (Leyte-Samar) organizational strategy and plan of action for achieving Health for All Filipinos by the Year 2000 (MOH, 1980).

During its last year of operation, the Carigara project developed methods for integrating hospital and public health services at the district level. This formed the basis for the country’s "district health system" concept, which became part of national health policy in February 1982. Unfortunately, the district health system structure, which had been replicated in other parts of the world, was dissolved with the devolution of health services to local government units starting in 1993.

The Carigara project was itself an experiment for the evolution of a research method appropriate for primary health care (PHC). The result was a method called "research and development (R&D)", which was officially adopted and endorsed by the WHO as its principal strategy and approach to develop PHC in the Western Pacific region (WHO, 1980).

The SHS also contributed in the evolution of "community-based education" as an educational approach for the training of health personnel. A faculty member of SHS sat in the WHO study group which formulated this methodology (WHO, 1987).

Recently, the SHS contributed a solicited case study which would hopefully build up "health social science" as a new academic and research discipline (Borrinaga, et.al., 1995).

One of the "23 in ’93" thrusts of the Department of Health was "step-ladder education for health workers." This sought to replicate an innovation of the SHS to meet the need for health workers in depressed and marginalized communities of the country.

Towards this end, the DOH constituted a multi-sectoral Council for Alternative Health Sciences Education (CAHSE). The CAHSE has conducted a series of workshops starting in November 1993 to facilitate the establishment and development of alternative health sciences education with DOH funding and support in selected institutions all over the country (DOH, 1994).

The CAHSE was later guided in its work by two DOH documents issued in early 1994: "Policies on Health Human Resource Development" and "Health Human Resource Development (HHRD) Master Plan."

By September 1994, the DOH had drafted an administrative order "The Department of Health’s ‘Partnership for AHSE’ (PAHSE) Program to Facilitate and Encourage Alternative Health Sciences Education Programs in the Country." The program strategies for step-ladder education were virtual adaptations from the SHS model.

Four new schools, two in Luzon and two in Mindanao, have started their step-ladder health sciences education: the University of Northern Philippines in Vigan, Ilocos Sur, the Bicol Christian College of Medicine in Legazpi City, the Davao Medical Foundation in Davao City, and the Western Mindanao State University in Zamboanga City.

In his speech during the 15th Recognition Rites of the SHS last May 3, 1995, Acting Health Secretary Jaime Z. Galvez Tan hoped that what is presently considered "alternative" in health sciences education would become the "mainstream" in the near future.

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