Republic of the Philippines
HOUSE OF REPRESENTATIVES.
EIGHTEENTH CONGRESS
First Regular Session

HOUSE BILL NO. 2881

INTRODUCED BY REPRESENTATIVE ANN K. HOFER

EXPLANATORY NOTE

The 1987 Constitution mandates the State “to protect and promote the right of all
citizens to quality education at all levels and to take appropriate steps to make education
accessible to all” (Art XIV Sec). It is also the policy of the State to protect and promote the
right to health of the people and instill health consciousness among them.

The Philippines is in dire need of additional doctors. The country’s current ratio of
one doctor for every 33,000 persons is a far cry from the World Health Organization’s
(WHO) ideal ratio of one doctor for every 10,000 persons. Thus, at least 15,000 more doctors
need to be produced and maintained to address the inadequacy. At present, the Philippine
medical schools produce around 2,600 doctors annually.

The WHO likewise noted in its Philippines Health System Review that attracting and
retaining staff in underserved areas of the country is a key challenge. Although the
Philippines is a major exporter of health workers, some areas still face critical shortages.
Inefficiency in service delivery persists as patient referral system and gatekeeping do not
work well. While there are many vacant government health sector positions in rural and low-
income areas, some doctors find these areas unattractive due to long and irregular working
hours, isolation from medical colleagues, and the absence of incentives to stay in these areas.
Hence, it is not uncommon for residents in far-flung villages to never have seen a doctor from
birth to death.

Meanwhile, the Philippine Medical Association reported that there are 130,000
licensed physicians in the country, but only 70,000 are active in the profession. A good
number have actually turned to nursing and work as nurses overseas. Likewise, the Philippine
College of Physicians estimated that there were only 2.3 healthcare workers per 10,000
population. Majority of Filipino patients also rely on services of public health facilities served
by only 4.5 percent of doctors out of the total number of almost 70,000. Former Health
Secretary Dr. Enrique Ona referred to this situation as a maldistribution, and not necessarily a
shortage, of physicians since most doctors are concentrated in the National Capital Region
and work in private hospitals instead of serving in rural communities in the provinces.

Experts attributed this shortage to migration of healthcare workers, as well as to fewer
students going into medical schools. The Philippine Hospital Association (PHA) noted that a
lower medical school enrolment turnout may also be witnessed in the near future because of
the currently dwindling number of medical school graduates and passers, thus translating to
fewer physicians in practice. Of the 30 medical schools in the country, less than ten are public
higher education institutions. Moreover, the cost of education in private medical schools is


three times as much as government-funded institutions. Medical school tuition fees, which
can range from roughly P20,000.00 to P2S0,000.00 per semester, not to mention other extra
costs like books, kits, etc., are quite steep for a good number of Filipino students. Thus, many
students would rather take the practical road with degrees that require less fees, fewer number
of years of study, and with quicker and more achievable return of investment.

The PHA also stated that graduates from medical schools located outside of Metro
Manila would stay behind to work locally while the ones coming from Metro Manila schools
would eventually work overseas. This reality is bolstered by data from the University of the
Philippines College of Medicine, which showed that eighty percent (80%) of medical
graduates leave the country to practice medicine abroad.

Since the cost of medical education is high, a lot of medical school graduates and new
doctors shy away from public hospitals and opt instead to join private hospitals, which offer
higher pay, to recoup their investment. This bill seeks to address the shortage of doctors
especially in rural and low-income areas by providing for free medical education to qualified
students. To prevent more brain drain and shortage of physicians, the bill also requires a
mandatory integration of the scholars into the public health and medical service system in his
or her hometown or any municipality or rural community in the province, once he becomes a
medical doctor, for a period of eight years or two years for every scholarship year availed of.

This bill will also enable applicants from different sectors such as indigenous peoples,
poor residents from the provinces, and aspiring doctors from far-flung communities to avail
themselves of a medical scholarship and other financial assistance to be able to pursue a
degree in Medicine and serve in their communities and other underserved areas in the
provinces. This will ultimately help address the shortage of physicians and assure the country
of a steady supply of human resources even after some of the doctors have finished their
integration.

In view of the foregoing reasons, immediate approval of this measure is earnestly

sought.

‘epresentative
2™ District, Zamboanga Sibugay


Republic of the Philippines
HOUSE OF REPRESENTATIVES
EIGHTEENTH CONGRESS

First Regular Sessj
2881

HOUSE BILL NO.

Introduced by: REP. ANN K. HOFER

AN ACT
ESTABLISHING A MEDICAL SCHOLARSHIP AND RETURN
SERVICE PROGRAM FOR DESERVING STUDENTS AND
APPROPRIATING FUNDS THEREFOR

Be it enacted by the Senate and House of Representatives of the Philippines in Congress
assembled:

SECTION 1. Short Title. - This Act shall be known as the “Medical Scholarship and
Return Service Program Act.”

SEC. 2. Declaration of Policy. It is the policy of the State to protect and promote the
right to health of the people, and to to develop its health human resources to meet the medical
needs of its citizens and to ensure that the shortage of medical practitioners in the country is
addressed.

‘Towards this end, the State shall establish a Medical Scholarship and Return Service
Program that will help deserving medical students pursue medical education and training in
the field of medicine and who shall render their services in government hospitals or health
offices in their hometown or any municipality in their home province or in any underserved
municipality in any province, as part of their integration into the public health and medical
service system. This shall ensure the availability of doctors who will provide quality basic,
promotive, preventive and curative health care services in every municipality in the country,
especially the underserved, remote, economically underdeveloped, distressed, conflict-
afflicted, and geographically disadvantaged areas.

SEC. 3. Establishment of the Medical Scholarship and Return Service Program. -
There shall be established a Medical Scholarship and Return Service Program for deserving
students in State Universities and Colleges (SUCs) or in private higher education institutions
(PHEls) in regions where there are no SUCs offering medicine: Provided, That the
scholarship program shall accept at least one scholar from each municipality of the country:
Provided, further, That only upon determination that there is no qualified applicant from a
certain municipality shall another qualified applicant be considered, irrespective of domicile:
Provided, furthermore, That the applicant has passed the admission and other qualifying
requirements of the SUCs and PHEls: Provided, finally, That the total number of scholars per
province or municipality shall depend on the number of government physicians needed for
each province or municipality, as determined by the Department of Health (DOH).


SEC. 4. Coverage of the Medical Scholarship and Return Service Program. ~ The
Medical Scholarship and Return Service Program established under this Act shall be made
available to deserving Filipino students who want to pursue a degree in Doctor of Medicine
in SUCs or PHEIs in regions where there are no SUCs.

The financial assistance for the Medical Scholarship and Return Service Program
shall include the following:

a) Free tuition and other school fees;

b) Allowance for prescribed books, supplies and equipment;

¢) Clothing or uniform allowance;

4) Allowance for dormitory or boarding house accommodation;

e) Transportation allowance;

f) Internship fees, including financial assistance during post-graduate internshi
2) Medical board review fees;

h) Annual medical insurance; and

i) Other education-related miscellaneous subsistence or living allowances.

SEC. 5. Qualification Requirements. — An applicant for the Medical Scholarship and
Return Service Program shall possess the following qualifications:

a) Must be a natural-born or naturalized Filipino citizen residing in the Philippines;

b) Must be a graduating student or a graduate of an appropriate undergraduate
program identified as a prerequisite for a Doctor of Medicine degree from any
higher education institution (HEI) recognized by the Commission on Higher
Education (CHED) including the Direct Entrant to the seven-year Integrated
Liberal Arts Medicine Program (or INTARMED Program) of the University of
the Philippines who satisfactorily completes the first two years of the program:
Provided, That deserving incoming second year medical students and those in the
higher year levels of the Doctor of Medicine program shall also be covered under
this Act;

c) Must have passed the entrance examinations and other related requirements for
admission for a Doctor of Medicine course in the SUC or PHEIwhere the scholar
intends to enroll, as well as the other requirements of the CHED and the DOH;
and

d) Must have obtained a National Medical Admission Test (NMAT) score mandated
by the CHED and the cut-off score required by the SUC or PHEI where the
student intends to enroll in.

SEC. 6. Conditions for the Grant of Scholarship. — Deserving students accepted to
the Medical Scholarship and Return Service Program shall be subject to the following
conditionalities:

a) Must sign an agreement stating the terms and conditions of the scholarship on a
form prescribed by the CHED and the DOH;

b) Must carry the full load of subjects prescribed per semester by the SUC or PHEI,
and shall, under no circumstance, drop a course which will result in underloading;


©) Must finish the entire Doctor of Medicine program in the prescribed time frame in
the SUC or PHEI where the scholar is enrolled in, subject to the retention policies
of the SUC or PHEI;

d) Must undertake postgraduate internship in a DOH-accredited public health facility
or hospital upon graduation from a four (4)-year Doctor of Medicine program,
subject to the Association of Philippine Medical Colleges (APMC) Internship
Matrching Program: Provided, That, the graduate of the four (4)-year Doctor of
Medicine program must satisfy all the requirements of the APMC Internship
Matching Program: Provided, further, That, for a five (5)-year Doctor of Medicine
program, the scholar enrolled in the SUC or PHEI must undertake the
postgraduate internship in the SUC’s or PHEI’s base hospital;

©)

Must take the board examination within a maximum period of one (1) year after
completion of an internship program which may be a postgraduate internship
program for scholars under a four (4)-year Doctor of Medicine program or after
completion of internship as a fifth-year medical student for scholars under a five
(5)-year Doctor of Medicine program; and

f) Must serve in a government public health office or government hospital in the
scholar’s hometown or, in the absence of a need thereat, in any municipality
within the scholar’s home province, or in any underserved municipality closest to
the scholar’s hometown in any province determined by the DOH as a priority area,
for at least eight (8) years or two (2) years for every scholarship year availed of,
which shall be completed within ten (10) years upon completion of internship for
those who have availed of a four (4)-year program, and twelve (12) years for those
who have availed of a five (5)-year program, upon passing the licensure
examination for physicians, which shall be part of the mandatory return service
and integration into the public health and medical service system: Provided, That
this mandatory return service shall be in addition to the required postgraduate
internship after graduating from a four (4)-year Doctor of Medicine program and
shall also be in addition to the return service requirement of the USC or PHEI:
Provided, further, That residency training shall not be considered as a return
service under this provision: Provided, finally, That the physician shall receive
appropriate salaries and other benefits for services rendered under the mandatory
integration into the public health and medical service system.

The scholar may be allowed, for valid reasons preventing the enrollment, to defer
availing of the scholarship and file a leave of absence for a period not exceeding
one (1) school year, subject to the guidelines and policies of the concerned SUC
and PHEI.

The scholar who fails to pass the licensure examination within one (1) year after
graduation and completion of postgraduate internship and other academic
requirements shall shoulder all the necessary expenses for the succeeding
professional licensure examinations.

SEC. 7. Disqualifications. — The scholar shall repay the full cost of scholarship and
related benefits received, including all the expenses incurred during the participation in the


scholarship program, and the scholarship shall be terminated in case of the following
circumstances:

a) If the scholar accepts another scholarship from other government or private
agencies or entities while enjoying the benefits of this Act; and,

b) If the scholar fails in forty percent (40%) of the subjects or fails to meet the
academic requirements of the SUCs or PHEIs or to complete the course within the
prescribed period without valid cause as may be determined by the SUC or PHEI,
the CHED or the DOH such as due to absence without notice, reasons of willful
neglect or other causes within the control of the scholar: Provided, That, if the
terminated scholar chooses, instead of repayment of scholarship costs, to work
within the government’s public health and medical service system, such as
engaging in health-related research work for the government or by teaching
health-related subjects in a public educational institution or be integrated into the
public health and medical service system for a period equivalent to eight (8) years
or the mandatory length of service that should have been rendered as stipulated in
this Act: Provided, further, That the alternative return service shall exclude
residence training;

°)

If the scholar fails to pass the licensure examination for physicians for the second
time; and

d)

If the scholar commits behavioral misconduct in a manner that would bring
significant damage to the HEI, government institution concerned, persons, and the
community.

SEC. 8. Mandatory Return Service and Integration of the Scholar into the Public
Health and Medical Service System. — Upon passing the Physician Licensure Examination
(PLE) administered by the Professional Regulation Commission (PRC), the scholar shall be
integrated into the public health and medical service system, through the DOH, with the
appropriate rank and salary and related benefits. The mandatory return service upon
integration into the public health and medical service system under this Act shall be for a
period equivalent to at least eight (8) years within ten (10) years for those who availed of a
four (4)-year program, and twelve (12) years for those who availed of a five (5)-year
program, upon passing the PLE.

‘The mandatory integration to the public health and medical service system under this
Act shall be separate and distinct from the return service requirement of the SUCs or PHEIs
and the mandatory post-graduate internship in a DOH-accredited public health facility or
hospital required by the PRC as a prerequisite for taking the PLE.

SEC. 9. Sanctions. In the event that a physician who has availed of the Medical
Scholarship and Return Service Program fails or refuses to serve in a government hospital or
any local health office in the scholars’s hometown or in any municipality in any province, as
provided under Section 6(f) hereof, or fails or refuses to comply with the mandatory
integration, as provided in Section 8 hereof, the physician shall be required to pay twice the
full cost of scholarship including other benefits and expenses incurred by reason of
participation in the scholarship program.


In case of nonpayment, as provided in the preceding paragraph, the PRC shall deny
the renewal of the physicians license: Provided, That the abovementioned penalties shall not
apply to physicians who fail to comply with the required return service on account of, or by
reason of, severe or serious illness.

SEC. 10. Roles of the CHED. - The CHED shall perform the following functions:

a) Conduct regular information dissemination of and recruitment to the Medical

Scholarship and Return Service Program in SUCs and PHEIs to ensure that there

will be an adequate number of medical doctors in all the municipalities and

provinces;

Review, modify and enhance the medical education curriculum to prepare

graduates to work in community-based health programs, and to function

competently when working with experienced physicians;

Coordinate, together with the SUCs and PHEls, with the DOH for the integration

of the medical scholar who has passed the PLE into the public health and medical

service system;

Formulate, promulgate, disseminate and implement the necessary policies,

standards, guidelines, and rules and regulations for the effective impiementation

of the Medical Scholarship and Return Service Program under this Act;

Develop strategies to improve the quality of the Doctor of Medicine program and

implement a system of quality control for the offering of Doctor of Medicine

program in SUCs and PHEIs;

£) Monitor and evaluate existing Doctor of Medicine programs of SUCs and effect
the continuation or closure of programs in accordance with the provisions of
Republic Act No. 7722 or the "Higher Education Act of 1994" and other CHED
issuances, as applicable;

2) Review and approve or disapprove proposals from SUCs and PHEIs for the

offering of new Doctor of Medicine programs;

Disseminate information on the required percentile cut-off score of SUCs and

PHEls to guide the student applicants on which school to apply to;

Require SUCs and PHEIs to submit a tracking, monitoring and assistance

proposal; and to implement and evaluate the tracking, monitoring and assistance

program in order to determine the whereabouts of the medical scholars after

graduation from SUCs or PHEIs;

j) Ensure that the SUCs and PHEIs provide the timely release and accurate
distribution of allowances and other fees to the scholars; and

k) Recommend to the Department of Budget and Management (DBM) the budget for
the implementation of the Medical Scholarship and Return Service Program in
SUCs and PHEIs based on its monitoring and evaluation results.

b)

¢

d

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h

SEC. 11. Roles of the SUCs and PHEIs. ~ The SUCs and PHEls shall perform the

following functions:

a) Monitor the progress of all scholars in their respective educational institutions,
identify students who have low or failing grades, and counsel them to improve
their academic performance;

b) Ensure the timely release and accurate distribution of allowances and other fees to
the scholars;

©) Make an annual report to the CHED on the performance of medical scholars and
other necessary or vital information regarding the Medical Scholarship and Return
Service Program;


d

Assist the CHED in the conduct of regular information dissemination on, and

recruitment to, the Medical Scholarship and Return Service Program;

Review, modify and enhance the medical education curriculum to prepare the

scholars to work in community-based health programs;

f) Coordinate with the DOH in the conduct of an inventory of its trainable personnel
who can be potential beneficiaries of the program;

2) Coordinate with the CHED, DOH, PRC, other concerned agencies, and local

government units (LGUs) in the integration of the scholar into the public health

and medical service system;

Develop strategies to improve the quality of the Doctor of Medicine program and

implement a system of review and evaluation for quality control for the offering

of Doctor of Medicine program in their respective educational institutions;

i) Conduct a tracer study on the whereabouts of their respective medical scholars
after graduation form their respective educational institutions and submit the
results of the tracer study to the CHED;

j) Recommend to the CHED and the DBM the budget necessary to implement the
Medical Scholarship and Return Service Program in their respective institutions,
based on their own monitoring and evaluation of results; and

k) Perform such other functions as the Presidents of the SUC or PHEI may deem

necessary for the success of the Medical Scholarship and Return Service Program

in their respective educational institutions.

©)

h)

Sec. 12. Roles of the DOH. - The DOH shall perform the following functions:

a) Determine the number of physicians needed for every municipality or province, as
well as the number of physicians needed in the town or province where the SUC is
situated;

b) Determine the distribution of scholars per municipality or province;

c) Coordinate with the CHED, SUCs, PHEIs and PRC to determine the number of
graduates of the Doctor of Medicine course and passers of the medical board
examination;

d) Provide for the integration of the scholar into the public health and medical
service system, including the necessary number of plantilla positions to
accommodate the new doctors in the provincial hospitals;
Assist the CHED in the conduct of the regular information dissemination on the
Medical Scholarship and Return Service Program, the recruitment of scholar
applicants, and the integration of successful scholars into the public health and
medical service system to ensure the continuous deployment of medical doctors to
all provinces, especially in the underserved, remote, economically
underdeveloped, distressed, conflict-afflicted, and geographically disadvantaged
municipalities;

f) Craft a career pathway for public health practitioners in the DOH and at the local
level as an incentive to the graduates of medicine to enhance their competencies
and skills for career progression;

g) Coordinate with the LGUs for the mandatory integration of doctors/scholars into
the public health and medical service system;

h) Monitor, supervise and evaluate the performance and length of service of the
scholars integrated into the public health and medical service system;

i) Provide funds for the implementation of the integration program under this Act;
and

¢)


j) Recommend to the DBM the budget for the plantilla positions for the doctors to
be integrated into the public health and medical service system, including the
determination of salaries and salary increases.

SEC. 13. Roles of LGUs. — LGUs are mandated to support the integration of the
scholar into the public health and medical service system by performing the following
functions:

a) Ensure that there is a mechanism to provide the necessary support to the

integration program of physicians who will be assigned to the LGU;

b) Coordinate with the DOH and the physicians to determine the specific health
needs or requirements of the community and provide the necessary assistance,
including the improvement of the health facilities in the municipality and
involvement in the research component of the public health and medical service
system;

©) May maintain a regular counterpart fund to be used for providing the balance of
the scholarship budget for scholars enrolled in PHEIs, subject to availability of

funds;
d) Provide for the board and lodging, travel expenses and other forms of financial
assistance enumerated under Section 4 of this Act, subject to availability of funds,
for the scholar enrolled in the PHEIs located in the municipality under the
concerned LGU: Provided, That the scholar shall serve in the same LGU upon
passing the licensure examination. If the municipal government cannot afford said
expenses, the provincial government shall shoulder the same: Provided, further,
‘That said provincial government shall decide in what municipality the schola shall
eventually serve;
Provide other forms of financial assistance, subject to availability of funds, to
support the integration program of doctors in the LGUs;
f) Ensure the safety and security of the physicians integrated into the public health
and medical service program;
g) Recommend to the concerned SUC or PHEI any improvement in the
implementation of the Medical Scholarship and Return Service Program;
Conduct an information dissemination campaign on the Medical Scholarship and
Return Service Program within the municipality or province, with the objective of
attracting bright applicants to said program;
i) Coordinate with the CHED and other government agencies and nongovernmental
organizations involved in the Medical Scholarship and Return Service Program;
j) Coordinate with and encourage the active participation of the parents and other
family members of the scholars in the Medical Scholarship and Return Service
Program;
Exercise such other powers and perform all other acts and duties which shall assist
the scholar and ascertain the success of the Medical Scholarship and Return
Service Program; and
1) Execute and enforce laws, ordinances and regulations which may, directly or
indirectly, have a positive impact on the Medical Scholarship and Return Service

Program.

©

h)

k

SEC. 14. Appropriations. — The amount necessary to carry out the initial
implementation of this Act shall be charged against the current year’s appropriations of the
SUCs and the DOH.


Thereafter, the amount necessary for the continued implementation of the Medical
Scholarship and Return Service Program for deserving students shall be included and
subsumed into the scholarship program of SUCs and CHED in the annual General
Appropriations Act.

SEC. 15. Joint Congressional Oversight Committee on Medical Scholarship and
Return Service System. — There is hereby created a Joint Congressional Oversight
Committee to oversee, monitor and evaluate the implementation of this Act.

‘The Oversight Committee shall be composed of five (5) members each from the Senate
and from the House of Representatives, and shall include the following: Chairperson of the
Senate Committee on Education, Arts and Culture; Chairperson of the House Committee on
Higher and Technical Education; Chairperson of the Senate Committee on Health;
Chairperson of the House Committee on Health; and three (3) members each to be chosen
from the membership of the Senate Committee on Education, Arts and Culture and the House
Committee on Higher and Technical Education by the Senate President and the House
Speaker, respectively: Provided, That at least one (1) member from the respective nominees
of the House of Representatives and the Senate shall be chosen from the Minority party/bloc.

SEC. 16. Five-Year Review of the Number of Scholars to be Admitted. - Every five
(5) years from the effectivity of this Act, the CHED, DOH, SUCs and PHEIs shall determine
the number of scholars to be admitted every school year. The number of physicians needed
by the municipality or province where the SUC or PHEI is situated shall be taken into
consideration in determining the number of scholars.

SEC. 17. Implementing Rules and Regulations. - Within sixty (60) days from the
effectivity of this Act, the CHED and the DOH, in coordination with the Philippine
Association of State Universities and Colleges, Coordinating Council of Private Educational
Associations, League of Municipalities, Association of Municipal Health Officers of the
Philippines, Nongovernment Community-Based Health Programs, PRC, DBM, SUCs, PHEls,
APMC, APMC-Student Network and other relevant stakeholders, shall formulate and issue
the rules and regulations to fully implement the provisions of this Act.

SEC. 18. Separability Clause. - If any part or provision of this Act shall be held
unconstitutional or invalid, the other parts or provisions not affected thereby shall remain in
full force and effect.

SEC 16. Repealing Clause. — All laws, decrees, executive orders, rules and
regulations and other issuances or parts thereof, inconsistent with the provisions of this Act,
are hereby repealed or modified accordingly.

SEC. 17. Effectivity. - This Act shall take effect fifteen (15) days after its publication
in the Official Gazette or in a newspaper of general circulation.

Approved,