After 20 years of existence, the School of Health Sciences (SHS), the distant unit of the University of the Philippines Manila (UPM) in Palo, Leyte, can look back with pride and satisfaction at its outcome and accomplishments.

As of April 15, 1997, a total of 1,327 students from 20 annual batches, or some 66 students per year, have been enrolled at SHS. Five out of eight (63 percent) of the SHS students/ graduates come from the Leyte-Samar region which has a population of 3.2 million. One-fifth (20 percent) come from Mindanao, with a large portion from the Autonomous Region for Muslim Mindanao (ARMM). The others come from other parts of the country, including the Cordillera region and the lahar-stricken areas of Central Luzon. Nearly 80 percent are females.

The students/graduates of SHS represent 65 out of 77 provinces of the country.

One thousand one hundred sixty-five (1,165) had finished the Barangay Health Worker (BHW) program, 899 had finished the Community Health Worker (CHW) or Midwifery program, 426 had finished the Community Health Nursing (CHN) program, 281 had finished the Bachelor of Science in Community Health (BSCH) program, and 45 had finished the Doctor of Medicine (MD) program, including a lone foreigner from Bangladesh (see Table 1).

Of the 899 CHW graduates, 816 or 91 percent had passed the Midwife Licensure Examination. And of 335 CHN graduates who had taken the Nurse Licensure Examination, 300 or about 90 percent had become licensed nurses.

Ninety-one (91) CHN graduates since 1992 have not taken the Nurse Licensure Examination, because of a discriminatory provision in the Nursing Law of 1991 that only Bachelor of Science in Nursing or BSN graduates shall be allowed to take this professional examination. The SHS sought to redress this situation through legislative action (the appropriate bill to amend some provisions of the law was filed in the Senate late last year by Senator Juan M. Flavier). The SHS also just completed a curriculum review process that merges the CHN and BSCH programs into a BSN curriculum.

Of the 44 Filipino MD graduates of SHS, 37 or 84 percent have passed the Physician Licensure Examination. Almost all of them work in their region, province, or town of origin.

Thus, the SHS graduates have not only overcome the basically inferior quality of their high school education in the rural communities. They have also out-performed their peers from traditional health sciences schools in the nationally-administered academic tests.

However, the statistics we mentioned merely reflect the academic capabilities of SHS graduates from the viewpoint of the traditional professional regulatory boards in the Philippines. There is as yet no standard test that determines the community-related capabilities of SHS graduates, which comprise a significant part of their training, and in which they are unique in the country!

There are about 600 Barangay Health Stations in the Leyte-Samar region. We estimate that 20 percent of the Rural Health Midwives managing these village health centers are graduates of SHS. They personalize the low-key, but effective approach to rural health delivery that the SHS sought to achieve.

The midwives are the most versatile graduates of SHS. However, they belong to the least recognized and appreciated profession in the Philippine health care delivery system, which remains physician-oriented.

SHS researches have shown that the midwives have the most comprehensive coverage among all categories of health workers in the rural areas (i.e., at least 60 percent of the village mothers according to a 1994 survey).

There are about 164 Rural Health Units or RHUs in the Leyte-Samar region. We estimate that about 40 percent of the government public health nurses assigned to these RHUs are CHN or BSCH graduates of SHS. A number of CHN or BSCH graduates were also employed by the DOH as staff nurses of district hospitals or as nurse supervisors responsible for overseeing public health programs in the field. Since 1994, most of the government-employed graduates of SHS have been devolved to the local government units (LGUs).

At present, however, the chances of rank promotion as nurses for our employed CHN and BSCH graduates have been hampered by discriminatory regulations of the new nursing law, which provide that only a Bachelor of Science in Nursing or BSN degree is considered the basic educational qualification for the nursing profession. The SHS proposes to redress this situation through a supplemental program for its employed graduates once the status of the SHS nursing curriculum has been clarified and settled.

Among the 45 MD graduates of SHS, 34 or three-fourths are natives of the Leyte-Samar region, where the SHS was established (see Table 2). Of the 34, 28 or 82 percent are already licensed physicians. Of these 28 licensed physicians, 22 or nearly 80 percent are employed in Leyte and Samar as physicians of different district hospitals, or with provincial and rural health units. Four are municipal health officers of their remote hometowns.

We estimate that 75 percent of our graduates from all levels are based in rural and underserved communities, and that 95 percent of them are still in the country. The few graduates who now work mainly as nurses in several Arab countries (about 25 of them) or in the United States (about 12 of them), serve to underscore the fact that economic plight is at the root of our country’s rural health problems. Indeed, addressing the country’s "western-oriented" medical and health sciences curricula is just one, although crucial, part of the solution.

The SHS also engages in Research and Development or R&D activities to contextualize the school’s academic pursuits with field realities.

Through a joint Research and Development Project with the Department of Health Regional Office for Leyte and Samar, the SHS contributed to the formulation of the policies on Primary Health Care and Health for All, not only for the Philippines but also for the Western Pacific Regional Office of the World Health Organization.

The collaborative R&D Project was implemented in the Carigara Catchment Area in nothern Leyte from 1977 to 1982. It received technical assistance from WHO and funding from the Danish and Swedish governments.

Utilizing an "action research" approach, the Carigara project developed and tested various methodologies by which the communities, the health services and other sectors could jointly design, implement and evaluate health development programs. The thrust towards "district health systems" in the Western Pacific region derived much insights from the Carigara project.

From the SHS perspective, the Carigara project provided the faculty and students with a critical look at the needs and potential of our rural communities, at the shortcomings of the existing health services, and opportunities to modify the work patterns of health workers and their interface with the communities, and to measure the impact of these changes. The SHS curriculum grew out of this formative experience.

One SHS research showed that our medical graduates possess high "rural bias" or preference for rural work. Several other researches provide socio-economic profiles of diverse communities in the Leyte-Samar region.

In 1993 and 1994, a UNICEF-funded Maternal and Child Health Survey was spearheaded by a faculty of SHS in Eastern Samar Province. The results of this research were used in the Municipal Health Planning for Maternal and Child Health in four (4) towns of that province. From the research, the SHS was also able to look into the performance of three SHS midwifery graduates working in remote rural areas, and of an MD graduate who works as the Municipal Health Officer of her hometown.

Some concepts introduced and experimented by the SHS are gaining wider acceptance and recognition. For instance, the step-ladder system has been adapted for the fields of computer education and secretarial training.

In 1993, the Department of Health included "step-ladder education" as the third among its 23 main thrusts for that year. The purpose was to replicate the SHS innovations to meet the need for health workers in depressed and marginalized communities of the country.

Since then, four other schools, two in Luzon and two in Mindanao, have started their step-ladder health sciences education with DOH funding and support.

The greatest impact of SHS has been in the fields of health systems development and health sciences education. As alluded earlier, a joint DOH-SHS Research and Development (R&D) Project gave the Philippines its national policy on Primary Health Care (PHC) and the original plan of action for achieving "Health for All Filipinos by the Year 2000." The Philippine policy document was used by the World Health Organization (WHO) as a model for formulating its own PHC policy for the Western Pacific Region.

The SHS has been featured in many monographs, journal and magazine articles, and official reports of the WHO since the founding of the school in 1976. It continues to serve as a model for shifting health sciences education towards community orientation and community-based training.

Innovative Tracks at Established Institutions for the Education of Health Personnel, a 1987 WHO monograph with seven case studies including SHS, cited U.P. for establishing an "innovative track" (the SHS) parallel to its traditional curricula for producing health professionals. This approach to achieving community orientation in training health professionals is being adapted by many health sciences schools around the world.

Another 1987 WHO monograph, Innovative Schools for Health Personnel, included SHS among 10 schools selected for study. It noted: "Two very important achievements in the training of health personnel reported by a few schools were (the) adoption of the ladder curriculum concept and the integration of medical education with health services delivery. A ladder curriculum allows those being trained to progress to a level commensurate with their ability and motivation and with a region’s need for particular category of health worker concerned, thus making highly efficient use of training resources."

Only the SHS offered the ladder curriculum among the schools included in the study.

According the Prof. Charles E. Engel, the editor of Education for Health, an international journal that advocates change in training and practice in the health professions in the 1990s, the SHS step-ladder system of "producing different levels of health professionals (is the) School’s special claim to fame."

In its conclusion, the 1993 Oxford book Reaching Health for All noted "the critical importance of properly trained and motivated health ‘person-power’, responsive to the people’s felt needs and able to work simultaneously with poor individuals, families and communities and ‘bureaucratic’ support systems. The major experiment carried out by the (School) of Health Sciences in the Philippines to systematically develop such workers has put actions to rhetoric voiced in many parts of the world and provided important lessons."

All these international recognition and acclaim for the SHS helped place the University of the Philippines Manila right in the forefront of health development. And all these for a relatively low annual budget that never went beyond four percent (4%) of the total U.P. Manila budget. The annual SHS budget is roughly three-fourths (less than 75 percent) of the $350,000 daily interest that the government pays for the mothballed Bataan Nuclear Power Plant.

A journal article published in the 1993 Annals of Community-Oriented Education showed that the SHS produces a community-oriented physician at only 40 percent of the equivalent cost in "traditional" medical schools in the country.

After 20 years, the SHS has certainly gone a long way.

Home