BBC News

A rural health solution to Philippine brain drain

By Kate McGeown
BBC News, Philippines


The little health clinic in the town of Tanauan, on the rural island of Leyte, is often so full of patients that some have to wait outside.

Ryan Almirez is one of only two doctors steadily working his way through the crowds.

Technically, he is still a trainee and due to qualify next year. But he's already seen as an essential member of the team.

The people of Tanauan are lucky to have Ryan.

Most Philippine doctors prefer to work in the cities, where they can supplement their government incomes by taking on private patients.

Still others - at least 11,000 since 2000 - have retrained as nurses and gone abroad, earning four or five times as much as they would as a doctor back at home.

But Ryan is not a typical medical student, and neither will he become a typical doctor.

Community spirit

He is enrolled in the University of the Philippines' School of Health Sciences, which is based down the road from Tanauan.

image captionRyan's clinic is popular

The school has a very different approach from a traditional medical course. Students come from rural areas, train in rural areas and the vast majority, an estimated 98%, work in rural areas after they have qualified.

"Students are sent, or nominated, by their communities," explained Dr Meredith del Pilar, who teaches at the school.

"There's an agreement between the school, the student and the community that after the programme the student will go back to serve in their community."

There's another major difference too - the school has what it calls a stepladder curriculum.


Students entering the school first do a midwifery course. When they've passed that, they can carry on to a nursing programme if both they and their community agrees. In the same way, after qualifying as nurses, they can move up to the medical programme.

"We have some students who go straight up to medicine. But most of the time the students are called back to the community to serve as midwives or nurses first, before they go into the medical programme," said Dr Del Pilar.

Everything is based on what each community needs, and according to one of the best-known alumni of the school, its new dean Salvador Destura, this affects the whole ethos of the programme.

"As soon as we arrived it was made clear to us that we were entering the school not because of us, but we carry our communities with us," he said.

image captionNew dean Salvador Destura has high hopes

"Most of us come from poor families. We wouldn't have become health professionals if it were not for the school."

When a community nominates a student, it pays for at least part of their tuition.

For students like Jec Pane, from a small remote island in the impoverished south, this was a major financial undertaking for everyone in his village.

"We talked in our community… about their obligations. You need to have at least 75% of the households, you need to gain their signature. I was able to do that," he said proudly.

Jec, like Ryan, will finally become a doctor later this year, but it has taken him more than 10 years to get this far. He's already worked as a nurse in his community, and also taken time out to help in his father's farm.

Other countries

It might be an unconventional education, but Dean Destura believes that other countries might also benefit from the scheme.

"It needs to be adjusted to the culture of each country, but the basic concept of the government recruiting students to become health professionals so they will go back and help their communities - I think that concept is very applicable in many places," he said.

Groups in Guam, East Timor and Australia's Aboriginal community have already contacted, expressing interest.

The ultimate test of the school's success, though, is what the patients think.

image captionMother Lorna is grateful to have somebody in the community who is medically trained

While visiting Ryan Almirez in Tanauan, I saw him treat five-year-old Lyka-Mae Redonia, who was suffering from a fever and a bad cough.

Later in the day we went to visit Lyka-Mae and her mother Lorna, in their simple wooden and corrugated iron house.

Lyka-Mae was already looking better, and Lorna was grateful for Ryan's medical skills.

"It's good to have these doctors," she said. "They're good at helping us identify our health problems. And they live near us - they see us around - they know us."