Last of two parts
THIS column gives way to the abridged version of a featured article in the Philippine Journal of Nursing in 2025, written by a public health luminary, educator from the University of the Philippines and former member of the Board of Nursing: Dr. Cora de los Angeles-Añonuevo. This feature is published with her permission.
The intention of this sharing is the greater and deeper appreciation of the role of nurses, one of the unsung heroes of public health, upon which programs and policies may emanate toward the envisioned universal health care (UHC).
Simply put, without the nurses fully engaged, along with other health professionals, the Universal Health Care Act is nothing but a good law and a dream.
Synopsis of the first part
Public health nurses (PHNs) in the Philippines play a vital role in advancing UHC and primary health care by serving as frontline leaders in community engagement, health promotion and policy implementation.
Despite their contributions, they face persistent challenges, including workforce shortages, wage disparities, hospital-centric education and fragmented governance.
Recent data reveal a significant disparity between the nursing supply and community health needs. The Department of Health estimates a deficit of over 127,000 nurses, with a maldistribution of them, as only 13 percent serve in primary care facilities such as rural health units and barangay health centers that have resulted in critical service gaps in underserved communities. As of 2021, approximately 51 percent of licensed Filipino nurses (316,000) had left the country due to low pay, job insecurity and limited career growth opportunities. In 2024, over 8,000 newly hired nurses were deployed for overseas employment.
The gaps in education and training are characterized by hospital-centric nursing programs that focus on hospital and clinical care, thereby leaving graduates ill-prepared for community-based public health work. Hence, opportunities for specialization and leadership in public health nursing, representing advanced practice pathways, remain limited.
As of 2025, the monthly salary for nurses in public service, as per the Salary Standardization Law, ranges from P36,619 (salary grade 15) to P51,357 (salary grade 19). Although this is something to be thankful for, salaries are still not competitive compared to those in neighboring countries since nurses in the country earn less than half of what their counterparts receive. For instance, public health nurses in Vietnam receive nearly 57 percent more than their Philippine counterparts, while Thailand gives over 100 percent more (Hospital Management Asia, 2024).
This wage disparity fuels migration and undermines morale and retention within the local health care system.
In addition, some public health nurses experience job insecurity due to their contractual arrangements under the Nurse Deployment Program. The limited career advancement also discourages long-term commitment to public health roles. Practice-level challenges include functioning in under-resourced settings, where limited supplies and personnel intensify the pressure of patient care. High population-to-nurse ratios overburden nurses in their efforts to provide quality care. Based on DOH data, there was one public health nurse for approximately 5,900 people and this data showed how such a ratio is one of the lowest in Southeast Asia. By comparison, Thailand’s public-sector nurse ratio (1:343) reflects much stronger frontline coverage in subdistrict health centers and health promotion hospitals (Hospital Management Asia, 2024).
Birth and growth of a unified voice
The establishment of the National Association of Public Health Nurses Inc. (Naphni) on Dec. 1, 2021, was a strategic and deeply motivated response to the evolving demands of public health and the nursing profession. At its core, Naphni emerged from a collective vision among nurse leaders to strengthen public health nursing, while directly supporting and advancing our country’s development goals, particularly in universal health.
Before Naphni’s formation, public health nurses operated within disparate systems that lacked a unified platform to advocate for their unique contributions to health care delivery services and professional development.
Members were united in the vision of having a healthy and empowered community and population through excellence in public health nursing practice and transformative leadership and governance. To achieve this said vision, members were called to advocate for and to work toward policies and systems that advanced public health nursing practice, thereby improving the health and social well-being of the Filipino people.
The light at the end of the tunnel
In having recognized the full potential of public health nursing in helping shape a more equitable and more responsive health care system, the need for a robust policy framework emerged.
Firstly, there is a need for legislation of a National Nursing Workforce Plan that addresses production, deployment, retention and specialty mix of public health nurses. Such a plan should use real-time data to forecast needs and enforce equitable nurse-to-population ratios across all regions.
Secondly, there is also a need to push for the passage of the Comprehensive Nursing bill, which formally recognizes public health nurse practitioners and specialists. A career-track framework for advanced practice nursing in public health is nearly complete, which, in turn, will drive health system innovation in order to ensure that communities have expert and culturally responsive leadership at the forefront of prevention, health promotion and policy advocacy.
In terms of compensation and incentives, there must be a guarantee of hazard pay, rural allowances and performance bonuses for nurses deployed in primary care settings. Contractual arrangements and short-term fixes for the nursing shortage should be stopped. Address inequitable nurse distribution to meet the World Health Organization’s (WHO) threshold of 27.4 per 10,000 population (WHO, 2016).
On the other hand, education and continuing development should also emphasize a holistic UHC approach that tackles social determinants of health, promotes health literacy and fosters community participation. Primary health care competencies must be embedded into nursing education to ensure that graduates are practice-ready and equipped to lead at the grassroots level.
Regarding governance and local health system integration, local government units must allocate a budget for nurse-led barangay health centers/stations with clear governance structures and PHN-specific line items in municipal health appropriations. For digital health infrastructure, interoperable electronic medical record systems must be mandated, while rural internet connectivity is subsidized, and mobile health toolkits for PHNs are provided.
Reflections and key learnings
The health situation in the Philippines continues to be marked by inequities, between urban and rural areas, between those who can afford care and those who cannot, and between the aspirations of health reforms and the realities of implementation. Yet, amid these persistent struggles, the role of nurses has never diminished; in fact, it has grown more vital.
Public health nurses in the Philippines play a pivotal role in bridging the gap between communities and the health care system. By addressing challenges such as workforce constraints, resource limitations, wage disparities and professional development, they can continue to strengthen health systems and improve health outcomes.
Then, the UHC will not remain a legal and academic framework for discussion. It has a chance to bring its value to the Filipino. And the Filipinos will live happily, healthily, ever after.
Looking back, the nurses bridged us out of the pandemic. In UHC, the International Council of Nurses’ slogan, “We can lead the way,” resonates deeply.
