by Victor Gregor Limon
At the end of every academic year in UP, students stage a lightning rally during the commencement exercises. It has become an annual tradition, largely tolerated by administration officials and government guests even as they sit uncomfortably in their seats, watching a group of students appeal earnestly for UP graduates to rise to the challenge of selfless service to the nation and the people.
Such an urgent appeal is not lost on Adam (not his real name), who plans to study medicine at UP Manila (UPM) after he finishes his undergraduate degree this year. To be admitted to the program, one of the requirements is to sign the Return Service Agreement (RSA), a contract that will require him to complete three years of return service in the Philippines within five years of his graduation.
Adam said he is aware that many opportunities await him abroad when he graduates from the UP College of Medicine (CM), the oldest college in the university and the premier medical school in the country. “But three years seem like a reasonable way to give back to those who paid for my education,” he said in an interview with the Collegian.
Recently, however, the RSA has come under closer scrutiny, after the Board of Regents approved an amendment to the contract that seeks to impose a blanket penalty fee on students who will fail to comply with the RSA. Is the RSA still the best policy to encourage UP health sciences graduates to serve the nation? Or has it in fact become merely a token policy that will further diminish the national university’s service-oriented identity?
Symptoms
Originally formalized in the UPCM in 2009, the RSA has now been implemented in six other health colleges of UPM: Nursing, Dentistry, Pharmacy, Public Health, Allied Medical Profession, and the School of Health Sciences in Palo, Koronadal, and Baler.
The wisdom of the RSA operates under the recognition that UPM is the country’s Health Sciences Center, mandated to lead as a public service university by providing various forms of community, public, and volunteer service, explained UPM Chancellor Carmencita Padilla in an email to the Collegian.
As early as 1975, the World Health Organization has tagged the Philippines as one of the major exporters of health workers in the world. Among Asian countries, the Philippines holds the record for the greatest increase in migration of health professionals, according to a 2011 report by the Asia Pacific Observatory on Health Systems and Policies.
From 1997 to 2008 alone, a total of 3,678 doctors, 128,100 nurses, 2,120 dentists, 1,655 pharmacists, and 2,737 midwives sought employment abroad, mostly to industrialized nations like the United States and Canada, the report revealed.
As a result, there is an average of only one doctor for every 1429 Filipinos as of 2014, according to official figures from the Department of Health (DOH). In rural areas, the ratio is much more dismal, at one doctor for every 33,000 patients, despite the fact that local government units are mandated to spend around 30 percent of their internal revenue allotment for public health care.
Such a bleak situation is aggravated by the K-12 education system and the ASEAN integration, which will further facilitate outward labor migration. As nations in Southeast Asia work towards the so-called internationalization and the liberalization of labor markets, Filipino health professionals will find it increasingly difficult to forego opportunities abroad, while the Philippine healthcare system becomes even more privatized in a bid to be more “competitive” in answering global market demand.
The RSA aims to respond to this situation by requiring UP’s health professionals to render at least two years of required service to the people who are after all direct primary stakeholders in their education and training, said Dr. Gene Nisperos, CM professor and vice chair of the advocacy group Health Alliance for Democracy.
Diagnosis
With the latest changes in the RSA, sections of the UP community are questioning if the policy has remained faithful to its original idea of “service to the people.” For some student leaders, the RSA is becoming a form of commercialization, where return service can be easily foregone by paying a penalty fee, which is equal to double the cost of medical education up to the year level completed.
As of academic year 2014-2015, the total amount of annual tuition and other fees for a CM student ranges from around P20,000 to P50,000, depending on the student’s family income bracket.
Under the amendments approved by the BOR in January, there are no longer any acceptable reasons for pre-terminating the RSA, which means that the penalty is imposed by default on all cases of non-compliance—pending any appeal which will be reviewed on a case-to-case basis.
In January, the UPM University Student Council slammed the amendments to the RSA, saying there was “absolutely no student consultation.” In an email to the Collegian, however, RSA Committee Chair Dr. Melfred Hernandez maintained that all colleges implementing the RSA have consulted all stakeholders through meetings, surveys, and presentations.
For Adam, however, such a policy is suspect in the first place, because it institutionalizes a backdoor, no-questions-asked option for those who would rather pay a penalty fee rather than rendering return service. “Even if I want to practice here in the Philippines where I am needed most, the penalty won’t really reinforce my decision, because my parents could just ‘bail’ me out of the RSA,” he confided.
Militant student groups are quick to warn that the new blanket penalty fee will become an income-generating mechanism that merely attempts to recoup “investments,” rather than addressing the urgent need for UP’s health professionals to serve the nation.
“In a way, UP is trying to maximize the return of its [capital and] somehow [this reduces] students [to] mere investments,” said Mark Girasol, a first year MD-PhD student.
For Dr. Nisperos, the RSA has become a “watered-down” version that has strayed from its priorities. For instance, while graduates covered by the RSA were originally limited to practice in the public sector or in underserved areas, UPM’s health professionals have since been allowed to render service in private hospitals and clinics.
This sentiment is echoed by the UPM CM Student council. “We recognize the fact that medical practice is very metropolis-centric. We have to redistribute doctors to give equal attention and service to all the regions in the Philippines,” said UPM CM SC Chair Mark Jason Milan.
The RSA is, thus, only a stopgap measure to, at least, mitigate the effects of the deeply rooted problems of our healthcare system, said Adrian Sampang, an intern at the Philippine General Hospital and former UPM USC vice chair.
“We need to have improved health care services, create decent local job opportunities, build more hospitals. But how do we actually do these if the budget for health remains low, hospitals are closing down, and the government has resorted to public-private partnership to escape its mandate of providing basic social services?”
Gene Nisperos, vice chair of the Health Alliance for Democracy, argues that the Return Service Agreement was originally meant to address the issue of graduates from UP opting to work abroad instead of serving the country. Under the RSA, incoming freshmen starting in 2011 in health-related colleges in UPM are required to sign the agreement, forcing them to work in the county for a minimum of two years. Kenneth Gutlay
Prescription
The success of a truly nationalist and mass-oriented RSA therefore goes beyond a legally binding contract and deterrent penalties. For the RSA to truly carry out its potential, other interventions have to be made, such as a more perceptive admissions process, a nationalist curriculum, and a needs-based deployment program, said Dr. Nisperos.
When the RSA was formalized in 2009 in the UPCM and implemented in the other white colleges beginning 2011, there was no simultaneous effort to review and revise the admissions policy. “Dapat mas mahusay na piliin ng UP ang mga estudyanteng tatanggapin nito, upang iyong mga tunay na may kagustuhang maglingkod sa bayan ang mabibigyan ng pagkakataon na makapag-aral,” explained Dr. Nisperos.
Given the finite resources of the university and the number of students dropping out of the medicine program, reforming the admissions policy seems to make sense. Based on figures from the RSA committee, the quit rate is an average of around one to three students per learning unit.
Fighting for a nationalist and service-oriented university’s curriculum is also of the utmost importance, to shape students into future health professionals that will heed the call to serve the nation. Threatening the achievement of such an objective is the proposed reform to the General Education Program (GEP), which has been approved in all UP units except Diliman, where fierce opposition from faculty and students prevent its implementation.
The proposed reform to the GEP seeks to reduce the number of GE units from the current to 45 units to as low as 21 units, a clear bias for specialization over a liberal, more holistic education. In a statement by the Congress of Teachers/Educators for Nationalism and Democracy, UP professors slammed the proposed reform, saying UP’s GEP must be nationalist and firmly grounded in the interests of the Filipino people.
Finally, the RSA can only be strengthened if the government will also ensure that employment here at home meets both the personal and professional needs of our health professionals. “Sa madaling salita, para asahan ng gobyerno na manatili at magsilbi rito ang mga graduate ng UP, dapat ay may disenteng trabaho na may disenteng sahod na naghihintay sa kanila,” said Dr. Nisperos.
For students like Adrian and professors like Dr. Nisperos, the aspiration is for the day to come when the RSA becomes an obsolete piece of paper and UP’s Iskolar ng Bayan would willingly and selflessly choose to serve the nation and the Filipino people.
When Adrian graduates, he plans to serve his return service as a doctor in an underserved community or perhaps work at a public hospital. “I’d love to see the day when we no longer need a piece of paper to ensure we give back because every graduate is instinctively, unequivocally, and voluntarily geared towards the betterment of this nation’s health and society in general.”
Adrian Sampang, a student at the University of the Philippines Manila, says he’s going to enter the Doctors to the Barrios program after graduating. Under the Return Service Agreement, students from health-related colleges in UPM are required to work with the country for at least two years, depending on the program entered, or pay double the amount of the tuition fee. Kenneth Gutlay