Jamaine Punzalan

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<div><img src="https://od2-image-api.abs-cbn.com/prod/editorImage/17696532512621.webp" style="width:960px;display:block;height:auto" class="fr-fic fr-dib" width="960"/>A rabies information seminar at Mararison Elementary School on Mararison Island in Culasi, Antique. Karl Ubial, DW</div>When Dr. Katrina Magbojos joined the Philippines&#x27; Doctors to the Barrios (DTTB) program, she was assigned not to a distant island or a conflict zone, as the term &quot;barrios&quot; might suggest, but to Jalajala, Rizal, about two hours southwest of the capital, Manila.Jalajala is considered remote due to limited transportation options, scarce resources and challenges in accessing early medical care.Magbojos served as a rural health physician in Jalajala under the Department of Health&#x27;s DTTB between 2022 and 2025.Morning clinics often ran through noon, followed by afternoon consultations and administrative work.Patients at the clinic needed treatment for issues including upper respiratory tract infections, tuberculosis, diabetes, and hypertension.While electricity and the internet were generally stable, public transportation dictated daily limits.&quot;Water was the main problem in my last year of deployment,&quot; Magbojos told DW, explaining how her supply was often cut off to save costs.<div><img src="https://od2-image-api.abs-cbn.com/prod/editorImage/17696533116812.jpg" style="width:960px" class="fr-fic fr-dib" width="960"/>Dr. Katrina Magbojos spent three years consulting patients in Jalajala. Katarina Magbojos/DW</div>For her, social problems in developing countries like the Philippines remain a challenge. People with lower incomes have poor health-seeking behavior, she said, because &quot;whenever they seek consultation, they always think it is just an expense, so sometimes they seek it too late.&quot;Magbojos said that many patients could not complete their treatment because medicines were limited. She recalled two cases of human rabies that affected her deeply.  &quot;Preventable vaccines are subsidized by the government, but the two cases did not access preventive vaccines,&quot; she said.<div>Why DTTB still exists</div>The Doctors to the Barrios program began in 1993 after a health department survey found that 271 municipalities were without a resident doctor. Yet, after three decades, many health officials claim the underlying issue persists. The Philippines has 7.92 doctors per 10,000 population as of 2022, according to figures from the Philippine Senate — lower than the benchmark of 10 doctors per 10,000. <div><img src="https://od2-image-api.abs-cbn.com/prod/editorImage/176965337052075694553_906.jpg" style="width:960px;display:block;height:auto" class="fr-fic fr-dib" width="960"/>Stakeholder consultations for rabies-free certification in the upland village of San Vicente in Culasi, Antique, Philippines. Karl Ubial/DW</div><div> </div>As of December 2025, the Department of Health had 739 Doctors to the Barrios deployed across the country, according to Dr. Karl Ubial, who serves as the team lead for Primary Care Provider Network support under the DTTB program. &quot;The DTTB is a program that ensures that universal health care is achieved through equitable access and distribution of doctors,&quot; Ubial said.He added that the mandate goes beyond filling vacancies to strengthening local health systems.<div>Numbers and systems both matter</div>At the heart of the DTTB discussion is a persistent question: is the problem simply a lack of doctors? Ubial said the answer is more complex.&quot;The binding constraint in many areas is maldistribution and local system capacity [financing, HRH absorption, referral networks, medicines, diagnostics, governance],&quot; he told DW. Even when doctors are available, system limitations often make retention difficult. DTTB functions as a bridge while broader reforms under the Universal Health Care (UHC) law take shape.&quot;DTTB is designed to close an access gap until such time that LGUs [local government units] are capacitated to supply themselves with the proper amount and quality of Human Resources for Health,&quot; Ubial said. <div>Why towns still rely on DTTBs</div>Many municipalities remain dependent on the DTTB because they cannot sustain a physician&#x27;s presence, often due to limited budgets or difficulty recruiting doctors to more remote areas.Ubial also pointed to constrained access to medical education, now being addressed through the Doktor Para sa Bayan Act, which aims to address the shortage of physicians by providing free education.Meanwhile, Magbojos said he saw these limits play out in referrals.Jalajala has a provincial infirmary, but &quot;they lack manpower, tools and equipment,&quot; she said.Serious cases were referred to hospitals several municipalities away. Transport often became a bottleneck.&quot;If they&#x27;re unlucky enough that all the ambulances are unavailable, they will have to transfer by their own means,&quot; she said. Referral coordination, she added, was uneven.<div>DTTB as a transitional measure</div>Some observers describe DTTB as a temporary solution. Ubial, however, described it as a transitional program.&quot;For me, it is more like a bridge — a transition while long‑term human resource and capacity delivery solutions are being built,&quot; he said.Ubial acknowledged that the DTTB program has areas for improvement.&quot;Real and lasting change requires shared responsibility,&quot; Ubial said, pointing to governance, financing and local leadership as decisive factors.Success, he stressed, is not measured by how long a community keeps a DTTB physician, but by whether it eventually no longer needs one.Some municipalities have managed to permanently retain doctors, strengthen their primary care systems and build functional referral networks.<div>When health becomes political</div>Magbojos said local politics often shaped health outcomes.&quot;Not all necessary members attended the local health board meeting due to political differences,&quot; she said, noting that budget constraints were constant.&quot;Throughout my three years of public service, I was used to hearing &#x27;there are no budgets for that.&#x27;&quot;The lack of medicines, equipment and staff defined many of her hard days. She said the local government could not provide a minor surgical kit, so she bought her own.She also said that understaffing was persistent, claiming that &quot;underqualified&quot; health workers were hired despite the need to hire &quot;licensed professionals.&quot;When asked whether the country lacked doctors, she said the issue was due to &quot;distribution&quot; issues and &quot;system design.&quot;<div><img src="https://od2-image-api.abs-cbn.com/prod/editorImage/17696534666204.jpg" style="width:960px" class="fr-fic fr-dib" width="960"/>Health workers in Jalajala educate locals on the prevention and management of water-borne diseases. Katarina Magbojos/DW</div>Some doctors, including Magbojos, question whether practicing medicine in the Philippines remains worthwhile.As the Philippines continues to pursue Universal Health Coverage, the challenge is not whether programs like DTTB matter, but how to build a system in which no community must rely on stopgap solutions just to see a doctor.With this, Ubial stressed shared responsibility.&quot;The DOH can deploy and support, yet it is our local governments and communities that must create the conditions that allow doctors to serve safely, effectively, and with dignity,&quot; he said.<div>Building trust in patient care</div>Magbojos believes the Philippines still needs the DTTB program because many municipalities do not prioritize health, affecting staffing, equipment and training.As an archipelago, she added, it remains difficult to attract health workers to remote communities without strong local support.Fulfillment, for Magbojos, came through trust.She recalled how one tuberculosis patient initially resisted treatment. After home visits and a family meeting, he became compliant and was cured.<div><img src="https://od2-image-api.abs-cbn.com/prod/editorImage/17696535321005.jpg" style="width:960px;display:block;height:auto" class="fr-fic fr-dib" width="960"/>Magbojos described her rural experience as both challenging and personally formative. Katarina Magbojos/DW</div>The Philippines&#x27; 2019 Universal Health Care Act placed all national health‑worker deployment programs under the National Health Workforce Support System.Ubial described DTTB as one of its frontline expressions, with doctors serving as first contact and gatekeepers of care.&quot;The DTTB program has been a grassroots advocate for the Universal Health Care Law,&quot; he said.One of the less visible impacts of the DTTB program is what happens to doctors after they leave it.&quot;Once a DTTB, always a DTTB,&quot; Ubial said. &quot;As these physicians leave the program, the program does not leave them.&quot;He described DTTB doctors as developing a systems-thinking mindset shaped by years of working within constrained environments where medicine, governance and community dynamics intersect.&quot;The main perk of the DTTB program is the mindset of being a doctor for all,&quot; he said, emphasizing that many alumni carry this perspective into hospitals, academia, public health and policy roles.<div>The role of presence in rural medical work</div>Magbojos described the experience as both challenging and personally formative.&quot;Being alone, young and new to an unfamiliar and far‑flung community stretched my character,&quot; she said. &quot;DTTB also taught me to do more with what I can.&quot;For her, rural medicine reshaped both her practice and perspective.&quot;Our treatment should always be patient-centered,&quot; she said. &quot;You can&#x27;t always prescribe the best medicines because sometimes they can&#x27;t afford them.&quot;<div>Edited by: Keith Walker</div><div> </div><div> </div><div> </div>

The Philippines' "doctors to the barrios" model shows how workforce shortages, intersected with governance, financing and system design, reveal why rural care remains fragile despite years of reforms.

The Philippines' "doctors to the barrios" model shows how workforce shortages, intersected with governance, financing and system design, reveal why rural care remains fragile despite years of reforms.

Inside the Philippines' struggle for rural health care

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Inside the Philippines' struggle for rural health care

Stanley Gajete,

Deutsche Welle

Published Jan 29, 2026 10:32 AM PHT

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