42〈教育報告〉
Human Resource Development in Rural Health Units and City
Health Offices in the Philippines<Team�No.2>
Team�members�:��Master�of�Public�Health�in�International�Health,
Ali�Omar�ALI,�Bouala�PHOMMACHACK,�Eri�OSAWA,�Hamida�ALAM,�
Liangyong�LU,�Nansalmaa�BAZARRAGCHAA,�Pheak�Dara�CHAU,�
Samuel�Agyemang�BOATENG,�Tarua�Dale�FRANK,�
Yuko�NAKAKUBO,�Yumiko�KASHIBA
Supervisors�:�Nobuyoshi�WATAHIKI,�Nobuyuki�HYOI,�Tomofumi�SONE

フィリピン国の第 1 次保健医療施設における人的資源に関する課題について
平成18年度合同臨地訓練第 2 チーム

Keywords： Human�resource�development,�training,�motivation,�information�sharing,�health�staff

Ⅰ.�INTRODUCTION
�1．Human�resource�development�
Human� resource� development� is� a� very� important�part� of� health� service� delivery� and� includes� a� broad�
range� of� activities� such� as� career� development,�
workforce� planning,� training,� motivation� and�
working� environment� to� develop� personnel� within�organizations.
In�the�Philippines,�available�domestic�health�human�resources� is� dependent� on� the� number� of� students�
admitted� to� health� schools� and� the� number� exiting�
into� the� health� profession.� The� domestic� supply� is�
affected� by� the� large� number� entering� the� foreign�labour� markets� either� temporarily� or� permanently.�
Most�of�the�health�human�resources�are�concentrated�in�the�urban�and�richer�regions�of�the�country�1）.
This� study� focuses� on� assessing� the� current�situation� on� training,� motivation� and� working�environment�aspects�of�human�resource�development�（HRD）.�
指導教官：綿引信義，兵井伸行（人材育成部）
曽根智史（公衆衛生政策部）

�2．Overview�of�the�health�services�offered�by�facilities�
As� part� of� the� health� services� devolution� in� 1990�
the� Rural� Health� Units�（ RHU）�and� the� Barangay�
Health� Stations�（BHS）�came� under� the� Municipal/
City� Mayors’�administration.� In� the� cities,� the� City�
Health� Offices�（ CHO）�became� responsible� for� the�administration� of� health� services� and� the� Barangays�
in�the�cities.
The�services�provided�by�the�CHO�include;�overall�in-charge� of� the� health� operation,� ensure�
implementation� of� Department� of� Health�（ DOH）�
programs,�receive�and�execute�communication�from�
local� Chief� executives,� DOH� and� other� agencies,�issuance� of� health� certificates� for� employment� and�
sanitary�permits�for�establishments�among�others.
The�RHUs�including�BHS�in�Municipality�and�BHC�in�
the� city� provide� the� following� services.� Medical� and�
dental� consultations� and� treatment,� first� aid�
management� of� emergency� cases,� pre� and� post�平成18年度合同臨地訓練第 2 チーム
consultation� and� health� education,� provision� of�
information,� education� and� communication�（ IEC）�
materials� to� patients,� recording� and� reporting� and�referral�of�patients�to�hospitals.
�3．ObjectivesThe�general�objective�of�this�study�is�to�assess�the�current� situation� of� human� resource� development�
focusing� on� training,� motivation� and� working�environment� in� the� Rural� Health� Units� and� City�
Health� Offices� in� the� Philippines.� The� specific�
objectives� are:� 1）�assess� topic� area,� frequency� and�
effectiveness� of� trainings� which� the� health� workers�
have� attended;� 2）�find� out� the� factors� motivating�h e a l t h � w o r k e r s ; � 3 ）� a s s e s s � c o m m u n i c a t i o n /information� sharing� among� health� workers;� 4）�
identify� problems� and� solutions� related� to� the�physical�working�environment.

Ⅱ.�METHODOLOGY
�1．Study�Sites�and�Subjects
Seventy-seven�（ 77）�health� workers�（ 33� in� two�
RHUs�and�44�in�two�CHOs）�were�interviewed.�Study�sites� were� selected� with� the� assistance� of� College� of�
Public� Health,� University� of� Philippines,� Manila.� All�
health� professionals� who� were� available� at� RHUs,�
CHOs�and�Centers�were�recruited�for�our�survey.
The� survey� was� conducted� at� Santa� Cruz� Health�
Centre�（ Laguna）,� at� Pila� Health� Centre�（ Laguna）,�
Muntinlupa� City� Health� Office� and� Paranaque� City�
Health�Office�in�November�2006.
�2．Study�designA� cross� sectional� descriptive� survey� was�
conducted.

43（ⅳ）Working�environment�which�included�information�
sharing� at� work,� decision� making� in� the� work�
place�and�problems�related�to�the�physical�working�environment�of�the�staff.
Field�interviews�were�conducted�in�English�and�
the� subjects� received� in-time� explanation� from�
group�members�using�a�questionnaire�guideline�
which� was� developed� for� standardization� of�
explanations.� Each� group� member� was�
responsible�to�guide�one�respondent�at�a�time.
�4．Data�analysis
Manual�coding�was�done�and�missing�values�were�assigned�codes.�Data�was�entered�into�Ms�Excel�and�
analyzed�using�Excel.

Ⅲ．RESULTS
�1．Socio-demographic�characteristics�of�subjects
The�socio-demographic�part�of�the�results�describes�
the� basic� characteristics� of� the� respondents� such� as�
age�and�gender�and�their�work�history.
A�total�of�77�respondents�were�recruited�of�which�
33�（43%）�were�from�RHUs�and�44�（57%）�from�CHOs�
with� 81.8%� being� females.� Health� workers� in� RHUs�
were� generally� older� than� those� in� the� city� health�
facilities.� Out� of� the� health� workers� in� RHUs,� 20�
respondents�（60.6%）�were� more� than� 50� years� old�
while� 11� respondents�（25%）�in� CHOs� were� over� 50�
years�old�（Mean�±�SD ＝46.6�±�6.8�years�old）.�More�than� 90%� of� the� respondents�（ n=71）� had� been�
working� for� more� than� 10� years� as� health� workers.�
Respondents’�professions�were:�13�Doctors�（16.9%）;�
14�Nurses�（18.2%）;�26�Midwives�（33.8%）;�10�Dentists�
（13%）;� 11� Sanitary� Inspectors�（14.3%）;� and� 3� Other�
professions�（3.9%）.

�3．MethodA� self-administered� questionnaire� survey� was�
completed� using� semi-structured� questionnaire� by�
the�subjects.�
The�main�contents�of�the�questionnaire�were:（ⅰ）Socio-demographic�Details�which�included�gender,�
age,�profession,�number�of�working�years�and�the�current�work�location;（ⅱ）Training� Details� which� included� the� latest� four�trainings�attended�in�the�last�five�years,�the�topic�area�and�effectiveness�of�the�trainings.�Training��2．TrainingIn� the� training� section,� the� questions� asked� were�targeted�towards�finding�out�whether�staff�had�been�
trained� recently,� what� types� of� training� were� being�
given�to�them,�the�frequency�and�effectiveness�of�the�
training� to� assess� human� resource� development� in�
their�work�performance.

was�also�included�the�perceived�needs�of�training�in�other�areas;（ⅲ）Motivating�factors�for�the�health�workers,�and�;（19.2%）�and�the�Sanitary�Inspectors�（18.2%）�had�not�
attended�any�training�within�the�last�five�years.

Figure� 1� shows� most� of� the� staff� had� attended�
some� training� within� the� last� five� years.� A�
comparatively� larger� percentage� of� the� midwives�

44

フィリピン国の第 1 次保健医療施設における人的資源に関する課題について

Figure�1.�Training�Attended�Within�the�Last�Five�Years�by�Profession

Information�sharing .�The�majority�of�the�respondents�
were� satisfied� with� the� materials� used� for� training�
them.� They� indicated� that� they� had� improved� their�
knowledge�and�skills�after�attending�the�training�and�
that� they� were� able� to� apply� the� newly� acquired�knowledge�and�skill�at�their�work�place.

Table� 1� describes� the� effectiveness� of� training� by�
scale� among� the� staff.� The� majority� of� the�respondents�rated�the�effectiveness�of�the�organized�
trainings� as�Good � and�Excellent � by�Appropriateness�of�training�materials ,�Improvement�of�their�Skills�and�
Knowledge ,� and�Application� at� their� workplace� and�
Table�1.�Effectiveness�of�training�by�scale�among�the�Staff��

Scale
Very�Poor

Poor

Fair

Good

Excellent

Total

n���%

n���%

n�������%n�����%n�����%nAppropriateness�of�training�materials

1���0.4

1���0.427���11.8

150���65.8

49���21.5

228

Improve�your�knowledge�&skill

1���0.4-12������5.3

157���68.9

58���25.4

228

Application�at�your�work

1���0.4

7���3.130����13.2

128���56.1

62���27.2

228

Information�sharing

2���0.8

3���1.327����11.8

139���61.053���23.2

224

As� shown� in� Table� 2,� many� staffs� were� able� to�
practice� what� they� learnt�（ 38.4%）�and� trainings�
improved�their�knowledge�for�their�work�（30.0%）�as�
well� as� for� advocacy�（12.1%）.� Some� staffs� could� not�
apply� their� new� knowledge� and� skills� because� there�
Table�2.�Reasons�for�Application�at�Work�after�Training

were�no�cases�of�the�specific�diseases�such�as�SARS,�
Avian� Influenza� and� HIV/AIDS�（1.2%）,� No� funding�（0.3%）,� Insufficient� material�（ 2.2%）,� Insufficient�
manpower�（1.5%）
�and�Not�applicable�for�work�（1.2%）.

(Multiple�answers)�

Reasonsn%

Practice�what�learned

124

38.4

Improve�knowledge

97

30.0

Advocacy�and�awareness

39

12.1

Improve�services

15

4.6

Client�demand

11

3.4

Political�reasons6

1.9

Improve�management

10

3.1

Insufficient�manpower5

1.5

Insufficient�materials

7

2.2

No�funding

1

0.3

No�case4

1.2

Not�applicable�for�work

4

1.2

323

100

Total

平成18年度合同臨地訓練第 2 チーム
Table� 3� presents� training� needs� of� topic� area� by�
profession.� A� high� percentage� of� the� doctors�
indicated� a� need� for� training� on� Health� Information�
System�（62.0%）,� STI/HIV/AIDS�（54.0%）�and� Health�Management�（ 46.0%）.� Most� public� health� nurses�

45

indicated� a� need� for� training� in� STI/HIV/AIDS�
（36.0%）,�Dengue�Fever�（35.7%）�and�Family�Planning�（29.0%）.�Most�midwives�indicated�a�need�for�training�on� Health� Management�（ 50.0%）,� STI/HIV/AIDS�
（42%）�and�Nutrition�（38%）.

Table�3.�Training�Needs�of�Topic�Area�by�Profession�（%）（Multiple�answers）
TB

Mal

STI

DF

MCH

IMCI

Nut

San

HIS

IEC

HM

FP

Other

Doctor

7.7�

7.7�

54.0�

7.7�

-

15.0�

-

7.7�

62.0�

31.0�

46.0�

23.0�

7.7�

Nurse
Midwife
DentistSanitary
Inspector

14.0�
19.0�
10.0�

7.1�
10.0�

36.0�
42.0�
30.0�

35.7�
26.9�
10.0�

28.6�
26.9�
-

7.1�
27.0�
-

7.1�
38.0�
40.0�

7.1�
12.0�
40.0�

15.0�
-

14.0�
19.0�
20.0�

21.0�
50.0�
40.0�

29.0�
7.7�
-

21.0�
40.0�

9.1�

27.0�

9.1�

54.5�

-

-

18.0�

73.0�

9.1�

9.1�

36.0�

-

9.1�

Others

-

-

-

33.3�

33.3�

33.0�

33.0�

-

33.0�

33.0�

67.0�

-

-

n=201�responses:�Number�of�selected�topics;�Doctors（n=35）,�Nurses（n=32）,�Midwives（n=74）,��Dentists（n=24）,�Sanitary�Inspectors（n=28）
�and�Other�professions（n=8）

As� can� be� seen� in� Table� 4,� the� major� skills� needed�
by� the� respondents� were� Planning（� 1 7 . 1 % ）,�
Monitoring�（ 17.1%）,� Management�（ 13.8%）� and�
Evaluation�（12.4%）.� Others� included� need� to� learn�Teaching� /� Training�（ 12.0%）�and� Communication�
（8.8%）.
Table�4.�Perceived�Skill�Needs�of�the�Respondents�(Multiple�answers)
Skill

n

%

Planning

37

17.1

Monitoring

37

17.1

Management

30

13.8

Evaluation

27

12.4

Teaching/Training

26

12.0

Budgeting

25

11.5

Communication

19

8.8

Reporting

13

6.0

Other

3

1.4

Total

217

100

�3．Motivation
Table�5�shows�there�were�slight�differences�among�motivating� factors� by� the� different� professional�
groups.� For� Doctors,� Nurses� and� Midwives� selfesteem�as�a�health�worker�was�identified�as�the�most�
i n f l u e n t i a l � f a c t o r �（ 3 8 . 5 % , � 6 4 . 3 % � a n d � 3 8 . 5 % �respectively）�while�Dentists�recognised�salary�as�the�most� influential� factor�（50.0%）.� � Sanitary� inspectors�
selected� recognition� by� community� as� the� strongest�
motivating�factor�（36.4%）.
As�shown�by�the�data�in�Table�6,�factors�that�would�
have� a� strong� impact� on� motivation� of� the� staff� are�
self-esteem� as� a� health� worker� and� recognition� by�the� community.� Factors� that� may� not� have� much�
impact�are�financial�incentives�and�available�vehicle/
fuel.

Table�5.�Percentage�of�Most�influential�motivating�factor�by�profession
Profession
Motivation�Factors

DoctorNurse

Midwife

n���%

n���%

n���%

Salary�Financial�incentives�
Promotion�or�Career�Development
Opportunity� to� participate�
training
Self-esteem�as�a�health�worker
Recognition�by�community
Working�environment
Others1���7.7
2���15.4

2���14.3-

6���23.1
5���19.2

1���7.7

3���21.4

2���7.7

5���38.5
1���7.7
3���23.1

9���64.3-

10���38.5
3���11.5-

Total

13���100

14���10026���100

Sanitary�
Inspector

Others

n���%

n���%

n���%

n���%

5���50.03���30.0

1���9.1
1���9.1
3���27.3-

15���19.5
1���1.3
13���16.9

1���10.0

1���9.1

1���33.3

9���11.7

1���10.0-4���36.4
1���9.1

1���33.3
1���33.3-

26���33.8
8���10.4
1���1.3
4���5.2

10���10011���1003���10077���100

DentistTotal

フィリピン国の第 1 次保健医療施設における人的資源に関する課題について

46

Table�6.�Frequency�of�scale�for�each�motivating�factor
Scale�of�Factors
Factors

Very�weak

Weak

Fair

StrongVery�Strong

Not�Applicable

Total

n���%

n���%

n���%

n���%

n���%

n���%

n���%

Salary-������-3�����3.9

40���52.6

19���25.0

14���18.4-�������-

76*��

��100

Financial�incentives

2���2.68����10.5

32���42.1

21���27.6

7������9.2

6���7.976*���

�100

Promotion/career�development1���1.3

5������6.5

27���35.1

26���33.8

16���20.8

2����2.677�����

�100

Opportunities� to� participate�
training

1���1.3

2������2.6

15���19.7

40���52.6

18���23.7-��������-76*����

100

Self-esteem�as�health�worker-������--���������-7������9.1

42���54.5

28���36.4-���������-77������

100

Recognition�by�community

1���1.3

1������1.3

14���18.2

35���45.5

26���33.8-���������-77������

100

Recognition�by�colleagues

1���1.3

1������1.3

24���31.2

31���40.3

20���26.0-���������-77������

100

Available�food�allowance-�����-7�������9.2

17���22.4

11���14.5

5������6.6

36���47.4

76*���

�100

Available�vehicle/fuel5���6.6

10���13.2

8�����10.5

15���19.7

8�����10.530���39.5

76*������100

Working�environment-

��5����6.2

22���29.3

26���34.7

22���29.3

�-����������-75**����100*One�missing�data�was�excluded�**Two�missing�data�were�excluded

�4．Working�environment
Table� 7� shows� information� sharing� among� health�
staff.�The�most�common�mode�of�information�sharing�
among� staff� within� the� health� facilities� was� through�staff� meetings�（ 87.8%）,� by� reports�（ 9.4%）�and�
through� trainings�（ 2.7%）.� There� were� no� major�
differences� among� the� different� professions� and�
modes�of�information�sharing.

Table�7.�Information�sharing�among�health�staff
Staff�Meeting

ReportTraining

Totaln������%n������%n�����%n�����%Doctor��12���92.3

1����7.6

���-���������-13���100Nurse��13���92.9

1����7.1

���-���������-14���100

Profession

Midwife��22���80.0-�������-���1�����4.3

23���100

Dentist����8���72.7

�1���10.0

����1���10.0

10���100

Sanitary�inspector

����8���72.7

�3���27.2

Others����2���66.7

�1���33.3

����-��������-��3���100

�Total��65���87.8

�7�����9.4

���2�����2.7

74���100As� shown� in� Table� 8,� the� suggested� ways� of�
improving�staff�meetings�within�health�facilities�differ�slightly� between� the� RHUs� and� the� CHOs.� � At� the�
RHU,� the� most� suggested� ways� of� improving� staff�
meeting� were� participation,� observation� of� meeting�norms� and� attendance.� At� the� CHO/BHC,� agenda�
preparation� in� advance� and� full� attendance� of� staff�
were� the� suggested� ways� of� improving� the� staff�
meetings.

11���100

Table� 9� presents� the� problems� related� to� working�environment.�The�most�frequent�problems�related�to�
working� environment� in� both� rural� and� city� health�
f a c i l i t i e s � w e r e � p o o r � f a c i l i t i e s �（ R H U = 3 2 . 1 % , �
CHO=22.1%）,� and� lack� of� medical� equipment�/materials�（RHU=17.9%,�CHO=32.4%）.�In�the�RHUs,�
insufficient� drugs/supplies�（19.6%）�and� insufficient�
working� place（16.1%）�were� also� major� problems�
faced� by� staff� whereas� in� the� city� facilities� poor�
amenities�were�a�major�problem�as�well.

平成18年度合同臨地訓練第 2 チーム

47

Table�8.�Ways�to�improve�staff�meeting�in�different�Health�Facilities
�(Multiple�answers)�
RHU

CHO

Suggested�ways�to�improvestaff��meeting

n

%

n

%

Room�and�equipment

9

15.8

4

6.3

Participation

10

17.5

8

12.7

Observe�of�meeting�norms

10

17.5

8

12.7

Agenda�preparation

3

5.3

12

19.0

In�time�feedback

1

1.8

3

4.8

Attendance

10

17.5

10

15.9

Hold�Regularly

2

3.5

3

4.8

Time�management

5

8.8

5

7.9

Food/Snack�and�Drinks

-

-�

4

6.3

No�problem

7

12.3

-

-

6

9.5

57

100

63

100

Others
Total

Table�9.�Problems�related�to�working�environment

Problems�of�working�environment���（Multiple�answers）

RHU

CHO

��n�������%���n���������%Poor�facility/building����18�����32.1

���15������22.1

Insufficient�drugs�and�supplies����11�����19.6

�����8������11.8

Lack� of� medical� equipment� and�
materials（vehicle/computer�）���10�����17.9

���22������32.4

Insufficient�working�place������9������16.1

�����6�������8.8

Amenities�（ poor� ventilation� and�
water�supply�etc.）�

�����4��������7.1

���12�����17.6

No� problem� related� to� working�environment������1�������1.8

�����1�������1.5

others������3�������5.4

�����4�������5.9

�Total������56�����100

����68�����100As� can� be� seen� in� Table� 10,� most� health� workers�
suggested� reconstruction� and� renovation� of� the�health�facility�（in�RHUs=28.6%,�in�CHOs=22.7%）�and�
local� government� coordination� and� support�（ in�
RHUs=17.9%,� in� CHOs=24.2%）�was� needed� to� solve�

problems� related� to� physical� working� environment.�
Increasing�donations�is�a�suggested�way�of�improving�the� staff� working� environment� for� the� staff� in� the�RHU�（7.1%）.

Table�10.�Solutions�to�the�problems�of�the�working�environment�by�facilities

Suggested�solutions�of�the�problems（Multiple�answers）

RHU

CHO

n������%n������%Reconstruction�and�renovation�

16�����28.6

�15�����22.7

Improve�availability�of�drugs�and�supplies�

��9�����16.1

���3��������4.5

Provision�and�maintenance�of�medical�equipment����2�������3.6

��11������16.7

Local�government�coordination�and�support�

10�����17.9

��16������24.2

Government�funding���9�����16.1

����8������21.1

Donation���4�������7.1

����1��������1.5

Provision�of�amenity���3�������5.4

����9������13.6

48

フィリピン国の第 1 次保健医療施設における人的資源に関する課題について

�2．TrainingIn� the� training� section,� the� questions� asked� were�targeted�towards�finding�out�whether�staff�had�been�
trained� recently,� what� types� of� training� were� being�
given�to�them,�the�frequency�and�effectiveness�of�the�
training� to� assess� human� resource� development� in�
their�work�performance.
Trainings� have� being� held� regularly� for� the� staff�
（Fig.�1）;�however,�midwives�and�sanitary�inspectors�
who�had�attended�trainings�within�the�last�five�years�
were�less�than�among�the�other�professions�（Fig.�1）.�
In� the� circumstances� of� limitation� on� medical� staff,�
doctors� and� nurses� shoulder� a� role� of� managers�
especially� in� decentralized� health� sectors � 4）.� It� is�
inferred�from�the�Philippines�circumstances�that�they�
were� given� the� opportunities� more� than� the� other�

performance� of� all� medical� staff � 5,6）.� Providing�
opportunities� to� participate� in� trainings� could� be� a�
motivating� factor� and� improves� the� quality� of� care.�
Thus,� there� is� a� need� to� equally� distribute� the�trainings� to� the� different� professions� as� much� as�
possible.�
When�asked�about�the�effectiveness�of�trainings�the�
respondents� had� attended,� most� of� the� respondents�
had� a� positive� opinion,� good� and� excellent,� about�
effectiveness�of�training�in�relation�to�Appropriateness�of�training�materials,�Improvement�of�their�Skills�and�
Knowledge,�and�Application�at�their�workplace�（Table�1）.� Furthermore,� the� effectiveness� of� trainings� was�
evaluated�by�asking�reasons�for�“Application�at�your�work”.� There� were� positive� reasons� that� evaluated�
their� trainings� as� effective.� It� is� likely� that� most�training�could�positively�influence�work�performance.�
No�funding,�insufficient�materials�and�manpower�and�
being� in� a� discordant� position� to� implement� new�knowledge� as� well� as� not� applicable� to� their� work�
were� other� reasons.� Providing� a� supportive� work�
place�to�apply�new�knowledge�is�important�to�develop�new� practices� and� capabilities� of� staff.� A� study�
showed�that�a�comprehensive�and�supportive�health�
system� is� important� to� strengthen� effective�
performances�7）.
The� perceived� training� needs� of� the� staff� for� the�future� were� then� assessed.� STI/HIV/AIDS� was�
ranked�high�among�the�different�professions�such�as�
doctors,� nurses� and� midwives�（ Table� 3）.� The�
Philippines,� unlike� its� Southeastern� neighbors� still�
does� not� have� a� large� problem� with� HIV� infection.�
However,� the� threat� of� HIV/AIDS� is� real� for� every�
country.� The� health� policies� of� the� Philippines� have�
been�prepared�in�case�of�an�emergency�of�infectious�
diseases � 8）,� thus,� the� trainings� of� SARS,� Avian�Influenza�and�HIV/AIDS�have�been�provided�for�part�of�health�workforces.�But�then,�the�health�workforce�
may� need� more� trainings� about� HIV/AIDS� in�
advance�9）.
The� next� highest� ranked� training� needs� among�
Doctors�were�Health�Information�System�and�Health�Management.�This�need�is�consistent�with�their�roles�
as�managers�of�the�health�services�in�their�respective�
municipalities,� health� centers� and� programs.� For�nurses,� Dengue� Fever� and� Family� Planning� were�indicated�as�higher�needs�for�training�next�STI/HIV/

medical�professions�because�of�the�managerial�roles.�
However,�for�the�workforce,�continuous�distribution�
of� the� opportunity� of� training� is� needed� to� enhance�

AIDS.� This� may� be� due� to� the� Nurse’s� role� as�
manager�in�the�Philippines�requiring�them�to�manage�
several� different� diseases� or� health� topics� at� work.�

Ⅳ．DISCUSSION.We�examined�current�situation�of�Human�Resource�
Development� focusing� on� training,� motivation� and�
working� environment� in� the� Rural� Health� Units�and�
the�City�Health�Offices�in�order�to�promote�their�skills�
and� provide� effective� health� services� to� people� in�
their�communities�in�the�Philippines.
� 1．Demographic� Details� of� Health� professionals� in� the�
RHUs�and�the�CHOs
Health�workers�in�RHUs�were�generally�older�than�
those� in� the� city� health� facilities（
� T a b l e � 1 ）.�
Interestingly,�the�average�of�age�of�all�health�workers�
was�very�high.�The�age�difference�may�be�attributed�
to� the� younger� health� professionals’�preference� to�
living�and�working�in�an�urban�area�as�compared�to�a�
rural� area� 2）.� Generally,� the� older� workforce� in� both�the�rural�and�urban�health�facilities�suggests�that�the�
younger� graduates� in� health� professions� may� be�
leaving� the� country� for� work� overseas.� This� is�
apparent� in� the� international� nurse� market� which�shows� the� Philippines� and� South� Africa� as� primary�donor� countries� from� the� developing� nations� from�
which� nurses� are� recruited� to� fill� manpower�
shortages� in� the� developed� nations� 3）.� However,� the�small� number� of� subjects� and� sites� may� have�
portrayed�a�biased�view�on�the�age�differences�and�a�
tendency� towards� older� health� workforce� in� the�Philippines.�

平成18年度合同臨地訓練第 2 チーム
For� Midwives,� Health� Management� and� Nutrition�
were�indicated�as�high�training�needs�after�STI/HIV/
AIDS.� Their� perceived� need� for� training� on�
management� may� be� attributed� to� the� managerial�
position� they� are� placed� in� while� working� in� the�Barangays.� They� may� need� new� knowledge� to�
manage� people� based� on� evidence.� Sanitary�Inspectors�indicated�“Sanitation”�as�the�first�training�need.� Giving� training� based� on� the� training� needs�
assessment�on�the�different�profession�is�important�to�enhance� work� performances12）.� Further� research� on�
this�type�of�training�needs�assessment,�would�clarify�
the�training�plan�for�the�future.
The�perceived�training�Needs�of�skills�for�the�future�was� assessed�（Table� 4）.� The� results� suggest� that� all�cadres� of� the� health� care� workers� feel� the� need� for�
some� form� of� knowledge� and� skills� training� on�
aspects�of�management�to�be�able�to�plan,�carry�out�
and�monitor�the�progress�of�their�tasks�or�projects�or�
their�activities.

49

strong/strong�motivating�factor�but�a�fair�motivating�factor�（ Table� 6）.� The� results� revealed� that� even�though� the� health� professionals� were� not� satisfied�with�their�current�salary,�it�can�greatly�influence�the�
motivation� of� health� professionals� in� the� RHUs� and�
CHOs.�According�to�the�supplemental�interview�with�
one� of� the� health� officers,� it� is� legal� for� government�
employed� health� professionals� in� the� Philippines� to�
operate� private� practice� outside� the� official� working�hours.� It� means� that� even� if� the� salary� form� local�
government� is� not� sufficient,� they� can� make� money�
by� other� business� besides� their� official� work.� This�
survey� did� not� ask� whether� they� have� other�businesses.� Consequently,� it� is� difficult� to� mention�how� much� this� influenced� their� responses� towards�salary� as� being� a� motivating� factor� in� their�
professions.

�3．Motivation
The� attributes� of� motivating� factors� among� health�
professionals� in� the� RHUs� and� CHOs� are� shown� in�
Tables� 5.� Generally,� self-esteem� as� a� health� worker�
was� recognized� as� the� most� influential� motivating�factor�followed�by�salary.�According�to�scoring�of�the�different� motivating� factors,� 90.9%� of� respondents�
considered� self-esteem� as� a� health� worker� as� very�strong� or� strong� motivating� factor�（ Table� 6）.�Following�that,�opportunities�to�participate�trainings,�
recognition� by� the� community� and� recognition� by�colleague� were� also� identified� as� very� strong� or�
strong�motivating�factors.�The�study�by�Inke�et�al�in�
Benin� and� Kenya� showed� that� professional� value� or�
professional�satisfaction�was�a�strong�aspect�of�work�that� encouraged� health� workers� to� do� their� tasks�
w e l l � 1 1 ）. � L M � F r a n c o � e t � a l � a l s o � s h o w e d � s o m e �commonalities�of�motivation�that�exist�in�developing�and� transition� country� health� sector� environments.�
Self-efficacy,� pride,� and� values� were� included� in�
important�aspects�of�motivation�12）.�These�professional�
values�found�among�the�Filipino�health�professionals�
in� the� RHUs� and� CHOs� will� lead� to� continued�
improvement� in� their� work� performance.� Nonfinancial� incentives,� such� as� those� that� improve�
motivation� need� to� be� addressed� and� built� upon��4．Working�EnvironmentThis� part� focused� on� information� sharing� among�the� staff� and� physical� working� environment� in� the�health� facilities.� The� most� common� mode� of�
information� sharing� among� staff� within� the� health�
facilities� was� through� staff� meetings�（ Table� 7）.�During� these� meetings,� the� most� common� topics� of�discussion� revolved� around� problems� encountered�
during� the� staff’s� routine� work� rather� than�management�aspects�of�the�health�services.�
Most� respondents� suggested� many� ways� to�
improve�staff�meetings�in�both�CHO/BHC�（Table�8）.��
These�suggestions�show�that�staff�meetings�would�be�
improved� for� more� effective� meetings.� Effective�
meeting� tips�（Susan� M� Heathfold）�are� divided� into�
three�parts.�Before�meeting�-�important�preparations�are� plan� meeting,� ensure� appropriate� participation,�
prepare� and� distribute� agenda.� During� meeting� -�they�are�effective�facilitation,�use�the�agenda,�involve�each� participant� in� actions,� and� create� an� effective�
meeting� follow-up� plan.� After� meeting� -� important�
tips�are�effective�follow-up,�accountability�for�followup�for�next�meeting�13）.�
Most� of� the� Health� workers� suggested� that�
reconstruction� and� renovation� of� the� health� facility�and� local� government� coordination� and� support� is�
needed�to�solve�problems�related�to�physical�working�environment�（ Tables� 9� and� 10）.� This� would� be�
because�the�local�government�is�now�responsible�for�

especially�in�developing�countries�like�the�Philippines.
Salary�was�the�second�most�influential�factor�
（Table�5）,� in� spite� of� it� not� being� considered� as� a� very�the�management�of�the�local�health�facilities�since�the�
devolution�of�health�services�in�the�Philippines�1）.��In�
the�RHUs,�improved�availability�of�drugs�and�supplies�

50

フィリピン国の第 1 次保健医療施設における人的資源に関する課題について

would� be� part� of� the� solution� to� improve� the� staff’s�
working� environment.� Increasing� donations� is� a�suggested� way� of� improving� the� staff� working�environment�for�the�staff�in�the�RHUs.��
The�working�environment,�especially�in�developing�
countries,� has� a� great� impact� on� the� quality� and�
quantity� of� health� services� provided� by� the� health�care� professionals � 14）.� With� its� shortage� in� human�resources,� aging� human� resources,� continuing�
existence� of� workplace� hazards� and� the� lack� of�equipment,� the� Philippines� will� also� be� affected.� As�
described� above,� the� strengths� of� the� working�network�of�the�Philippines�need�to�be�complemented�
with� a� continuing� push� to� improve� the� working�conditions� of� the� health� care� professionals� for� them�to� provide� the� best� services� they� possibly� can� with�the�resources�available�to�them.
�5．Limitations�of�the�study
There� was� limited� time� to� conduct� the� field�
questionnaires� and� so� a� more� in-depth� qualitative�
study� on� the� health� workers’�training,� motivational�
factors�and�working�environment�was�not�possible.�
The� study� sites� and� subjects� were� not� randomly�
selected� thus,� the� findings� of� this� study� cannot� be�
seen�as�representative�of�all�the�health�workers�in�the�Philippines.�
Prior� to� starting� the� field� study,� there� was� very�
limited�information�available�on�other�issues�affecting�the� RHUs� and� the� CHOs� and� the� organizational�
structure�of�these�offices.�
Despite�the�fact�that�there�were�several�limitations�in� the� study,� we� believe� that� our� findings� show� the�current� situation� on� HRD� in� the� four� selected� study�sites.

Ⅴ．CONCLUSIONSThe�majority�of�health�staff�had�the�opportunity�to�
participate� in� training� within� the� last� 5� years.� Most�
were� satisfied� with� the� training� materials� and�
improvement�in�their�knowledge�and�skills�from�the�
trainings� they� received.� A� high� number� of� staff�
indicated� a� need� for� further� training� in� Health�Management,� STI/HIV/AIDS� and� Dengue� control.�
The�major�skills�needed�by�the�respondents�were�the�skills�related�to�management.
Self-esteem� was� the� most� influential� motivating�factor� for� doctors,� nurses� and� midwives.� However,�
recognition� by� community� was� the� most� influential�
motivating� factor� for� sanitary� inspectors.� Self-

esteem,� recognition� by� community� and� opportunity�to�participate�in�training�were�recognized�as�strong�or�very� strong� motivating� factors� for� the� staff.� The�
health� professionals� were� not� satisfied� with� their�current�salary,�it�can�greatly�influence�the�motivation�
of�health�professionals�in�the�RHUs�and�CHOs.
The� most� common� mode� of� information� sharing�
among� staff� within� the� health� facilities� was� through�regular� staff� meetings.� The� suggested� ways� to�
improve�staff�meetings�were:�Active�participation�by�
all� staff;� Observation� of� meeting� norms;� Full�
attendance�of�all�staff�at�meetings�and�Agenda�to�be�
prepared� in� advance.� Most� of� the� Health� workers�
suggested�that�reconstruction�and�renovation�of�the�
health�facility�and�local�government�coordination�and�
support� is� needed� to� solve� problems� related� to�
physical�working�environment.�

Ⅵ．RECOMENDATIONSThe�current�level�of�training�provided�for�the�staff�
in�the�RHUs�and�CHOs�is�generally�good�and�should�
be� continued� but� with� more� focus� on� the� midwives�and�the�sanitary�inspectors.�Provision�of�the�training�
opportunity�on�regular�basis�could�enhance�the�work�
performance� at� the� primary� level� of� health� care�
facilities.
Self-esteem� is� the� most� motivating� factor� for� the�health� professionals.� Therefore,� there� is� need� an�
appropriate� mechanism� and� action� to� maintain� selfesteem� as� an� important� motivator� for� the� health�
professionals.
The�staff�meetings�being�held�in�the�CHOs�and�the�
RHUs� are� the� main� source� of� information� sharing�
among�staff�which�is�working�relatively�well�in�both�
facilities.� In� order� to� maintain� this� situation� and�
further� improve� information� sharing� among� staff,�
these� meetings� need� to� be� strengthened� some� areas�such� as� observation� of� meeting� norms� or� protocols,�
active� participation,� agenda� preparation� in� advance�and�by�full�attendance�of�all�the�health�staff.
The� local� government� units� and� municipal� offices�need� to� assist� the� health� professionals� by� way� of�
moral�and�financial�support�as�well�as�to�help�them�to�
coordinate� activities� to� utilize� the� limited� resources�available� to� provide� better� and� efficient� health�
services.

Ⅶ．REFERENCES
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