Advancing Nursing Practice to Forward Universal Health Care in the Philippines

     The constantly changing healthcare landscape requires the health workforce to enhance their competencies and respond to the complex needs of the population they serve. In the Philippines, Universal Health Care (UHC) is a national priority, which aims to ensure equitable access to affordable and quality health services for all Filipinos. The UHC Act (Republic Act No. 11223)1 stresses that the health system provides comprehensive services across the spectrum of health promotion, illness prevention, health restoration, rehabilitation, and palliation. Moreover, the UHC primarily requires health service delivery to be people-centered, cognizant of their necessities, culture, and values. Primary Health Care, which involves accessible, continuous, and comprehensive care from initial patient contact, together with coordinated care among healthcare workers, is the most inclusive and effective means to achieve UHC.2 Therefore, an adequately supplied and well-equipped human health resources are crucial to guarantee that population’s healthcare needs are appropriately recognized, prioritized, and addressed.    The Philippines continues to face health problems as it aims to achieve UHC, considering the underserved populations suffering from high prevalence of communicable and non-communicable diseases, adolescents and young adults confronting the epidemic of sexually transmitted infections, mothers and newborns dying from preventable causes, and older adults requiring increased healthcare demands. While policymakers continue to explore reasonable means to address these problems, what is clear is that the status quo in the current health system cannot be allowed to persist. Rather, health agencies should be reoriented, and the healthcare workforce supported to respond to the growing, yet preventable healthcare problems.    Nurses are critically positioned to advance the universal health care of Filipinos. With almost half of the health workforce both locally and globally,3 nurses can significantly contribute to the country’s objective of achieving better health outcomes – by promoting health and preventing illnesses among the well and at-risk groups, supporting the treatment of the sick and disabled, and empowering families and communities to attain health and well-being. As nurses provide quality care in various settings, particularly in primary health care, enabling nurses to practice their profession fully can contribute to the goal of “Health for All”. Hence, we enjoin the call for the development and implementation of advanced practice nursing in the Philippines, aiming to provide safe, quality, accessible, and affordable healthcare.    An advanced practice nurse (APN), as defined by the International Council of Nurses, is one who has an “expert knowledge base, complex decision-making skills, and clinical competencies for expanded nursing practice,” wherein such qualities are influenced by the country or context where the person is certified to practice.3 The last phrase emphasizes that the APN scope of practice is heterogeneous across nations and is shaped by the local healthcare situation. Nonetheless, it should be stressed that the APN is essentially a nursing role and is rooted in principles inherent in the profession. Therefore, APNs should not be perceived as substituting for another practice role, competing with other professionals, or obtaining domain expertise from other healthcare disciplines. Instead of utilizing the traditional biomedical model, APNs are guided by interdisciplinary knowledge and nursing, which places the patient at the center of healthcare. This is because the APN role is grounded on the core of nursing – caring. 4 Notably, facilitating a holistic approach, fostering effective communication, and building therapeutic relationships are crucial to human caring practice, which can be articulated well through advanced practice.4 APNs aim to manage not only the physical domains of persons nursed, but also their psychosocial or spiritual needs across the health continuum. Such aspects of care are consistent in achieving UHC through primary health care, that is, meeting the health needs of persons across the lifespan with accessible and comprehensive healthcare services delivery.    A recent global survey of low- and middle-income countries incorporating advanced practice nursing in their health systems revealed that the primary reason for developing APN roles was the need to care for underserved populations.5 This is particularly relevant to the Philippines, where healthcare access remains a significant challenge for those in geographically isolated and economically disadvantaged communities. Meanwhile, a country-wide study by the Department of Health and the United States Agency for International Development (USAID) in 2019 revealed that primary care workers, including nurses and midwives, performed their duties beyond their professional training due to significant taskshifting and sharing, thereby recommending the need to revise their scopes of practice.6 In particular, a study in this Nursing Issue reported that nurses working in some underserved areas prescribed and administered medications for common illnesses, ordered laboratory examinations, sutured skin lacerations, and facilitated labor and deliveries, upon collaborative agreements with the physicians.7 With the literature reporting positive results in client satisfaction, cost-effectiveness, consultation waiting times, and chronic disease management from APN-facilitated care,8 the development and integration of APNs in the local health system could be a promising means to promote better healthcare access for all Filipinos.    The country’s progression toward the integration of APNs in the health system requires support from various stakeholders, including professionals, healthcare and educational institutions, and government agencies. This is because additional education, training, certification, and regulation are needed for APNs to provide health services effectively and legally. Moreover, the perennial shortage of health workers is another potential barrier toward this endeavor. Nevertheless, advanced practice nursing might promote better career advancement and salary opportunities for our Filipino nurses, which could aid in improving their recruitment and retention. This is consistent with the recommendations of a national policy dialog to support the resilience and retention of healthcare workers beyond the COVID-19 pandemic, which is reported in this Nursing Issue.9 The Philippines can learn from more than 70 countries on how to facilitate the development and integration of APNs in our health systems.3 It should be noted that such numbers include developing countries in Asia and Africa, as they realized the importance of APNs in delivering quality and accessible health services to their constituents.    Today more than ever, nurses provide safe and quality care to patients beyond the hospital walls – building relationships and fostering partnerships with communities to empower them towards better health. Thus, we reiterate the call among various local and national agencies to support the advancement of nursing practice to provide primary care across communities, which will contribute to forwarding UHC in the country. As underscored by the WHO Declaration of Astana in 2018,10 Health for All could be realized by investing in the education, development, recruitment, and retention of health human resources prepared to deliver primary health care to the population.