The Philippine school that produces health workers who stay
PALO, Leyte — A first-year college student tracks down a municipal mayor at his farm. On this sweltering day in rural Leyte, the health sciences major only has one agenda: to ask for enough funds to complete their village health program.
His pitch is confident, detailed, practiced. The mayor listens.
Days later, funds cobbled together by the freshman students of the University of the Philippines School of Health Sciences are used to rent a sound system. Curious residents of the sleepy town of Tolosa, Leyte listen to the students describe how far their barangay has come in health and sanitation after a month. For the first time, through borrowed speakers, many hear of real change.
For many, it's an unlikely sight: a freshman student trudging through a farm, lobbying for support for a health program of a barangay that's not even his.
But this is no ordinary medical school. At the UP Manila School of Health Sciences (SHS), health workers in training are taught to serve where others won't go.
For nearly five decades, UP's small campus in Palo, Leyte has been running a successful experiment in medical education. They accept scholars from disadvantaged barangays, train them through a curriculum without numerical grades, and send them back as doctors, nurses or midwives where they're needed most.
The results are striking. While the country's healthcare workers flee to cities or overseas jobs, leaving several rural areas without a single doctor, at least nine out of 10 graduates in the UPM SHS since its establishment in 1976 have stayed in the country.
"The healthcare profession typically produces graduates that go abroad. But in our school, 95% of our graduates are in the country and returned to their endorsing communities," said Filedito Tandinco, former dean of the original UPM SHS campus in Palo, Leyte (whose term ended in July, after this interview was conducted). Other campuses are in Baler and Koronodal.
For the school's dean, UP has quietly cracked a problem that has long stumped the Philippines: how to get health workers to serve — and stay — in the country's poorest villages.
"We are moving away from calling it a return service obligation," Tandinco told Philstar.com. "It's more of an expression of the commitment of the student to do return service in appreciation of the fact that they were sent to SHS in the first place."
School of the people
The unique approach starts even before classes begin. Each student is nominated by their local government unit, often from underserved barangays. A committee, formed by the barangay chair and representatives from the Department of Education, selects scholars they believe will return to serve.
To qualify for admission, students must be permanent residents of a depressed community with limited access to health services, where they must have resided for at least a year prior to nomination.
They must be nominated by the community via a Barangay Resolution signed by 75% of household heads and have a family income not exceeding P100,000 per year.
Additionally, scholars must commit to a Return Service Agreement, where they will serve underserved areas for two years for every year of training.
The university's curriculum itself is tailored to helping students go back. Under the "stepladder curriculum" — the first of its kind in Asia — students begin with a two-and-a-half year midwifery program. They can then decide to return to serve their communities or continue to nursing, then medicine. The choice usually depends on what their endorsing communities need. Most exit early by design.
"We're not just a medical school," Tandinco explains. "We're a midwifery school, nursing school, and medical school rolled into one. Our primary strategy is to serve underserved communities, like rural and geographically isolated areas."
For every 10 students that complete midwifery training, only three will go to nursing. Out of those, only one will become a doctor, according to Tandinco's estimated. At least 97 to 100% of its midwifery graduates pass the licensure exam, with consistent topnotchers.
"We customize our graduates to what communities need," he said.
For every level completed, students take a "service leave," returning to their communities to implement what they've learned. Graduates are also expected to fulfill their contract by staying in the country to work: one year of training equals to two years of service.
"In fact, we say that our clients are not the students themselves. Our clients are the LGUs and communities, and the students are here to represent the interest them," Tandinco said.
No numerical grades
Unlike other UP units, there are no numerical grades at the UPM SHS. There's only "Pass" or "Needs Tutorial."
This system, Tandinco said, shifts students' focus from competition to competency. They're less grade-conscious and focus more on delivering results, he added.
"The benefit here is that students are looking forward to accomplishing what they're expected to do, rather than focusing on grades. This is a stronger motivation than simply trying to compete with each other," he added.
Students are also thrust into community work from day one. Janus Navier Gatela, now in the BS Nursing program after getting his certification in midwifery, recalled having a community integration program during the first quarter of his first year at the UPM SHS. He was among those assigned to Barangay Kapangihan in Tolosa — a fifth class municipality.
"You're still adapting to the institution, and then you're suddenly immersed. It's no-holds-barred education," he told Philstar.com.
Gatela recalled having to sleep in barangay halls, conduct house-to-house health surveys and improvise with limited resources. Some of his classmates also had to learn the local language to communicate with residents, who they see as their partners in implementing programs.
When his assigned community in Tolosa needed a drainage system but couldn't afford PVC pipes, his team fashioned one from locally available bamboo. When they noticed garbage bins were scarce, they built makeshift bins from old rice sacks.
"We had to be creative. We also developed the attitude of being determined to pull through despite limited resources. Whatever's available, we had to make do," said Gatela, who also ranked first in the November 2022 midwifery licensure exam.
Even midwifery students learn skills like circumcision, which is not required in traditional medical curricula but vital in communities where access to doctors is limited. They're also taught community planning and project management from the start.
"Midwives have to know how to manage the health system of a barangay because they will be calling the shots in that jurisdiction," Tandinco explained. "It serves them well, because in the Philippine health system, there are really portions without a doctor or nurse."
From the poor, to the poor
While other UP campuses are increasingly filled with students from top private high schools, the students who enter the UPM SHS do not always come from well-funded and well-established schools.
Some students arrive reading at a fourth-grade level based on the university's assessment, recalled Rolando Borrinaga, a retired professor who taught communication courses at the UPM SHS.
While most could still cope with college work, the few who tested lower faced extreme difficulties.
Borrinaga's solution was unique for a UP unit. He decided to teach Remedial English, a course not offered in other UP campuses but needed by the UPM SHS's scholars.
He watched them transform from shy fresh high school graduates to intense community advocates. "I know some students who started out as scared communicators at SHS who had even become group leaders and talkers in their community assignments," he said.
The university's emphasis on teaching students to communicate extends beyond language. Students learn to navigate local politics, organize community meetings, and advocate for health programs to people who have the funds to help them.
"One thing the community preceptors made us realize is that community members won’t participate in projects and programs if they don’t feel that these are necessary," he said.
"From the planning stage, we had to already make them realize this is something that they need for their barangay," he added.
Since joining the UPM SHS in 2009, Tandinco said he has watched his students face several high-ranking local officials on behalf of their assigned barangays.
One student who is a surgeon now impressed Tandinco by introducing a municipal mayor to his constituents. "The way they conducted themselves was different, like they were already acting as the real municipal health officer," he said.
Over the years, the school's reach has expanded, with graduates serving across the country. The distribution of graduates is also strategic. Palo takes care of the Visayas, Bicol, and Caraga region. Baler handles northern and eastern Luzon. Tarlac covers Region 4A and western Region 3. Koronadal serves the entire Mindanao.
"Based on tracking, the majority of them have gone back to their sending LGUs," Tandinco says proudly. "We did a study 10 years ago, they were still there in the rural health unit. We know where they are."
Despite its successes, the school faces steep challenges ahead with its location. The contract for their Palo campus expires in 2032. While there's alternative land in Tacloban City (the school's original home), it remains undeveloped and unfunded.
"Whatever happens, we have to think of expanding our learning spaces now," Tandinco said, noting that the school is awaiting P50 million to build additional floors for their academic building.
It's a far cry from 1976, when this approach was considered so experimental it was dubbed the "Tacloban Experiment." The school's first home was a modest two-classroom building behind what is now the Eastern Visayas Medical Center.
Even Typhoon Yolanda's devastation of Leyte in 2013 couldn't stop the university from delivering its mandate. The school rebuilt, expanded and continued its mission.
"Our graduates were able to contribute to social transformation in rural areas," Tandinco said. "When they become municipal health officers, they transform communities with high mortality indices to communities with low or zero indices."
Gatela believes the SHS model should be replicated across the UP system. Here, he said, students learn quickly: sometimes, the most important medical equipment isn't a stethoscope or scalpel, but a length of bamboo and the will to make it work.
"We are really bound to go back to the grassroots, to the communities kung saan tayo nanggaling (where we came from), because we are Filipinos," he said.
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