Policy critique: Republic Act No. 7305 (The Magna Carta of Public Health Workers) and Its Revised Implementing Rules and Regulations
ABSTRACT Objective: 1) To identify policy gaps with respect to the Magna Carta of Public Health Workers. 2) To develop recommendations for action to address identified gaps.
Methods: Searches of electronic databases (PubMed and Google), Key informant interviews.
Results: Republic Act No. 7305 mandates the payment of additional cash incentives and allowances to health workers. However, implementation of this provision has been uneven in the two decades since it was passed into law. Not all government agencies are implementing the law nor is it being fully implemented among agencies that have adopted the legislation due to insufficiency of funds. Further compounding the issue is the confusion as to who constitutes public health workers and, therefore, who are entitled to its benefits, resulting to a perception that it has become a milking cow of some public health workers. Finally, monitoring of policy implementation has been generally weak.
Conclusion: Policy gaps have rendered the law ineffective. Contrary to its intent, health workers remain undervalued, underdeveloped but over-utilized two decades since Republic Act No. 7305 was passed into law. Policy recommendations are offered to address these concerns.
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ABSTRACT: Policy analysis is an established discipline in the industrialized world, yet its application to developing countries has been limited. The health sector in particular appears to have been neglected. This is surprising because there is a well recognized crisis in health systems, and prescriptions abound of what health policy reforms countries should introduce. However, little attention has been paid to how countries should carry out reforms, much less who is likely to favour or resist such policies. This paper argues that much health policy wrongly focuses attention on the content of reform, and neglects the actors involved in policy reform (at the international, national sub-national levels), the processes contingent on developing and implementing change and the context within which policy is developed. Focus on policy content diverts attention from understanding the processes which explain why desired policy outcomes fail to emerge. The paper is organized in 4 sections. The first sets the scene, demonstrating how the shift from consensus to conflict in health policy established the need for a greater emphasis on policy analysis. The second section explores what is meant by policy analysis. The third investigates what other disciplines have written that help to develop a framework of analysis. And the final section suggests how policy analysis can be used not only to analyze the policy process, but also to plan.Health Policy and Planning 01/1995; 9(4):353-70. · 3.06 Impact Factor
- 2009-34 Improving local service delivery for the MDGs in Asia: the case of the Philippines. Philippine Institute for Development Studies Web site://dirp4.pids.gov.ph/ris/dps/pidsdps0934..
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REPUBLIC ACT NO. 7305 (THE MAGNA CARTA OF PUBLIC HEALTH WORKERS)
AND ITS REVISED IMPLEMENTING RULES AND REGULATIONS
by Carl Abelardo T. Antonio, MD
HPS 201 (Fundamentals of Policy Studies)
Francis S. Cruz, MD, MPH
College of Public Health
University of the Philippines Manila
12 October 2012
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Objective: 1) To identify policy gaps with respect to the Magna Carta of Public
Health Workers. 2) To develop recommendations for action to address identified gaps.
Methods: Searches of electronic databases (PubMed and Google), Key
Results: Republic Act No. 7305 mandates the payment of additional cash
incentives and allowances to health workers. However, implementation of this provision
has been uneven in the two decades since it was passed into law. Not all government
agencies are implementing the law nor is it being fully implemented among agencies
that have adopted the legislation due to insufficiency of funds. Further compounding the
issue is the confusion as to who constitutes public health workers and, therefore, who
are entitled to its benefits, resulting to a perception that it has become a milking cow of
some public health workers. Finally, monitoring of policy implementation has been
Conclusion: Policy gaps have rendered the law ineffective. Contrary to its intent,
health workers remain undervalued, underdeveloped but over-utilized two decades
since Republic Act No. 7305 was passed into law. Policy recommendations are offered
to address these concerns.
Keywords: health policy, human resources for health, Magna Carta, Philippines
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Human resources for health are vital to a functional health system (1). In most
instances, however, especially in developing economies, health workers – government
health workers more so – face the challenge of being overworked (from the myriad of
vertical programs handled by ministries of health, as well as projects implemented by
aid agencies) yet being underpaid, oftentimes subsisting on meager salaries that are
insufficient to support a family (2). In the end, health workers are forced to migrate and
leave behind fractured health systems (2).
In response to this challenge, the Philippines has legislated a Magna Carta of
Public Health Workers (Republic Act 7603) in 1992, promising a host of incentives,
primarily financial, to health workers to attract them to government service (3). The law
was especially crafted with those assigned to hardship posts in mind (3) (4). However,
there are concerns that the law has failed to live up to its promise: a significant number
of public health workers have not received the incentives and benefits due them (5).
In this paper, the content and context (both past and present) of the law were
examined to identify policy gaps and develop recommendations for action. This paper is
not a systematic review of the issue, but is best viewed as being primarily a focused
critique of particular human resources for health legislation in the country.
Materials and Methods. Searches of electronic databases (PubMed and Google)
for keywords relating to the Magna Carta of Public Health Workers were complemented
with interviews of key informants (6) (7). Collected data were analyzed using Walt and
Gilson’s policy triangle framework (8).
Positionality. Policy analysis was carried out from two perspectives – the author
is himself a public health worker employed by a local government health office, who
also considers himself a student of health policy.
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Results and Discussion
Table 1. Policy Triangle Framework: Key points
Low salaries of government health workers
Unfilled positions, especially in rural posts
Post-1986 democratic space
Broad civil service reforms implemented by the post-
Three-fold policy goal: (i) socioeconomic and (ii)
professional development of public health workers,
and (iii) recruitment and retention in government
service of competent health workers
Provision of additional financial incentives as well as
examination) for health workers
Establishment of health human resource development
and management system
Recognition of the right to self-organization
Periodic review of legislation implementation
Formation of the National Management Health Workers
Confluence of three events: (i) legislation of Magna
Carta for Public School Teachers, (ii) success by
health workers in public policy (i.e., Generics Act, Milk
Code), and (iii) devolution of health services
1989-1991: Lobbying by health workers’ groups for
the enactment of a magna carta
1992: Magna Carta of Public Health Workers
passed into law and Implementing Rules and
1999: Implementing Rules and Regulations revised
DBM appears opposed to full payment of benefits given
scarce government resources
Health workers’ groups and the DOH lobbying for full
implementation of benefits
Agencies employing health workers budget for magna
carta benefits, but these are regulated by DBM
CSC, COA and Courts implement the letter of the law
(i.e. housing, medical
Public health workers in the Philippines, especially those in hardship posts, were
faced with the burden of subsisting on meager salaries. In 1989, for instance, the latest
modification in salary grades for government employees was implemented (9). Rural
health midwives, the main health fieldworker in remote areas, had a gross basic salary
of Php2,473.00 (Table 2) at a time when the minimum wage (for both Metro Manila and
non-Metro Manila areas) was Php89.00 per day (9) (10) (11). Thus, it was not
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uncommon for this cadre of health professionals, or for government employees in
general, to be described as being overworked yet underpaid, and for them to seek
better opportunities in the private sector or overseas. This scenario provided the
impetus for the creation of a Magna Carta of Public Health Workers.
Table 2. Salaries of selected public health workers (Philippines, 1989).
Position Salary Grade
Rural Health Physician
Sanitation Inspector I
More importantly, however, a confluence of three events influenced and fuelled
the passage of the proposed legislation: (i) the 1986 post-democratic space, in which
health workers were able to influence public policy (i.e., enactment of the Generics Act
and the Milk Code); (ii) passage of Republic Act No. 4670, or the Magna Carta for
Public School Teachers, in 1966; and (iii) the devolution of health services in 1991 by
virtue of Republic Act No. 7160 or the Local Government Code of 1991a (4).
Following the adoption of the legislation in 1992, its implementing rules and
regulations was formulated in the same year and revised in 1999.
Republic Act 7305 or the Magna Carta of Public Health Workers was passed into
law with the end in view of fulfilling three goals: the promotion of (i) socioeconomic and
(ii) professional development of public health workers, and (iii) the recruitment and
retention in government service of competent health workers (3). To this end, the law
and its implementing rules and regulations mandated the payment of additional cash
incentives and allowances to health workers (Table 3) (3) (12). In effect, this made
public health workers the highest paid employees in the whole civil service (4).
In addition to the provision of incentives, the law also mandates for non-monetary
incentives for health workers (i.e. housing, medical examination); placed emphasis on
human resource management and development across the workforce lifespan; and
recognized the rights of health workers to self-organization (3) (12). Furthermore,
a Perez notes that the enactment of Republic Act 7305 can be seen as a move meant to appease displeased health
workers, following the devolution of health services to local governments (4).
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consultative bodies (Management Health Workers' Consultative Council) at the different
geopolitical subdivisions were also formed to serve as a forum for dialogue in so far as
the formulation of policies relating to public health workers are concerned (3) (12).
Finally, a review of the human resource development and management system in place
was to be conducted periodically (3) (12).
Table 3. Compensation of health workers under Republic Act No. 7305.
Remote assignment allowance
Additional compensation for additional work
On call service
Work during rest day
Night shift service
Highest basic salary upon retirement
After post-graduate studies
How are health workers faring two decades after the law was enacted? The
short answer is that nothing much has changed over the intervening years. The initial
problems of implementation are still present today: not all government agencies are
implementing the law nor is it being fully implemented among agencies that have
adopted the legislation (5) (13) (14) (15) (16). Government agencies claim that they
have insufficient funds to pay for full magna carta benefits, and are constrained by the
available resources granted them by the Department of Budget and Management
Just how much exactly the full implementation of the law would cost remains
uncertain, but estimates put it at around Php 7-8 billion annually, roughly equally divided
between employees under the national and local governments (7). At present, however,
only 12% has been provided for public health workers of the national government under
the General Appropriations Act of 2012, with the remaining balance chargeable against
agency savings at the end of the year (7). In the Department of Health (DOH), for
instance, allocation for magna carta benefits amount to Php348 million (or 1% of the
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total health budget) for the payment of subsistence and laundry allowances alone.
Allocation of benefits payment for local government agency employees are much more
difficult to ascertain, but cannot be far from (if not less than) national figures.
The call for payment of benefits has been sounded by health workers’ unions and
has been echoed by legislators (who have called for investigations in aid of legislation),
DOH, and the Department of Interior and Local Government (DILG) (17) (18) (19) (20).
The courts have also been asked by health workers’ groups to intervene, but these
cases have been dismissed on the grounds that respondent government officials did not
wilfully withhold the payment of benefits, but have been constrained by available
resources, hence the non-payment of magna carta incentives (21) (22) (23).
Further compounding the issue is the confusion as to who constitutes public
health workers and, therefore, who are entitled to its benefits. This has been the subject
of cases brought before the courts as well as before the Commission on Audit, which
has disallowed the payment of benefits (24) (25) (26) (27) (28). In most of these cases,
office-based health workers received hazard pay despite the non-hazardous nature of
their functions. Thus, other government employees refer to the benefit as “Magna
Cuarta” (7). More recently, DBM withheld the payment of hazard pay for DOH
employees pending review of the mechanism for its disbursement, as the agency is
concerned with possible abuse of its distribution (29) (30) (31) (32) (33) (34).
At the forefront of the fight for full implementation of magna carta benefits are the
DOH and various health workers’ groups (Table 4), as well as some legislators
sympathetic to health workers’ rights (17) (18). Government agencies employing health
workers appear to include in their annual budget payment of magna carta benefits, but
this line item is reduced, if not outright curtailed, by the DBM presumably in the exercise
of fiscal discipline (with the suggestion that full payment of benefits be charged against
agency savings). Third-party players include the courts, COA, and Civil Service
Commission (CSC), all which merely implement the provisions of the law as it applies to
Governments always face the dilemma of providing for the needs of its citizens given
limited resources at its disposal. While prioritization of needs might appear forthright,
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choosing which items in the budget to fund may mean the difference between a disease
outbreak occurring in the community, or an economic downturn that would prove
catastrophic to large segments of the population. This argument is what has been
advanced by the DBM, as well as other local government units, when confronted with
the non-payment of magna carta benefits to public health workers (hence, they say, the
provision in the law that the payment of benefits is subject to availability of funds). And
indeed, the cost for providing full magna carta benefits for all public health workers is
Table 4. Position map of stakeholders: Republic Act No. 7305.
Opposed Neutral Supportive
Level of influence
Department of Budget
Commission on Audit
Department of Health
At first blush, then, non-payment of magna carta benefits simply redounds to an
issue of funding, and the solution, therefore, is to search for sources of additional funds
outside the regular budget (should its inclusion really be beyond the capacity of regular
appropriations to pay), and these appear to abound within government: Priority
Development Assistance Funds of lawmakers, PAGCOR funds of local officials, excise
tax from tobacco. How to channel these funds for the payment of health workers may
mean an altogether different matter, but suffice it to say that there are fund sources
A more pressing issue, however, is the perception that the Republic Act 7305
has become a milking cow of public health workers (“Magna Cuarta”), aided no doubt by
the seemingly exorbitant sums (seen from the vantage point of a typical office worker)
received by health workers on top of their regular salary (the hazard pay alone is
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computed at 25% of base pay). The amount seems more scandalous when it is
received by a medical officer whose primary function is administrative in nature and,
therefore, is not exposed to a risk greater than another government employee similarly
situated. The situation, of course, is different for a rural health midwife who has to
literally cross rivers and mountains to deliver healthcare services.
Finally, monitoring of policy implementation has been generally weak. Since its
inception, there has only been one DOH initiative to identify the level of implementation
of Republic Act No. 7305.
The Revised Implementing Rules and Regulations of Republic Act No. 7305 states
“Every Public Health Worker is an asset or resource to be valued, developed and
utilized in the delivery of basic services to the public. Hence, the development and
retention of a highly competent and professional workforce in the public service shall be
the main concern of every department or agency” (12). Policy gaps have rendered the
law ineffective. Contrary to its intent, health workers remain undervalued,
underdeveloped but over-utilized two decades since Republic Act No. 7305 was passed
In light of the foregoing discussion, the following recommendations are offered:
Utilization of extra-budgetary sources (i.e., Priority Development
Assistance Funds of lawmakers, PAGCOR funds of local officials, excise
tax from tobacco) for payment of magna carta benefits;
Review of the definition of public health workers. The Revised
Implementing Rules and Regulations proffers a very broad definition of
public health workers, encompassing nearly all health professionals
employed in government, as well as employees working in agencies which
deliver health services;
Streamlining of procedures for benefits availment, especially for hazard
pay, which should reflect the true level of risk (and the relative period of
time) to which a health worker is exposed; and
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Periodic review of policy implementation, which can be a joint effort
between the government, academe, and the greater research community
to document level of policy implementation.
Acknowledgements: Dr. Christine Joan R. Co (Health Human Resources
Development Bureau, Department of Health) and Mr. Jossel I. Ebesate (Alliance of
Health Workers Philippines) were primary sources for this paper. Dr. Maria Susan
Yanga Mabunga (University of the Philippines Manila, College of Public Health,
Department of Health Policy and Promotion) provided critique on the initial content of
the manuscript. Dr. Edelina P. dela Paz (University of the Philippines Manila, College of
Medicine, Department of Family and Community Medicine) was liaison between the
author and the Alliance of Health Workers.
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12. Revised Implementing Rules and Regulations of Republic Act 7305 (Magna Carta of
Public Health Workers,. November 1999.
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issuances and related laws on the matter. June 6, 2006.
21. People vs. Wilson R. Florendo et. al. Crim. Case No. 25028, s.l. : Supreme Court,
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22. People vs. Cesar B. Sulong et. al. Crim. Case No. 25021, s.l. : Sandiganbayan,
August 8, 2005.
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vs. Commission on Audit (COA). GR No. 150769, s.l. : Supreme Court, August 31,
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implementation of the magna carta benefits of public health workers. [Online] August
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32. DOH Department Memorandum 2012-0002, Payment of magna carta benefits to
officials and employees of the Department of Health. January 11, 2012.
33. DOH Department Memorandum 2012-0002-A, Amendment to DOH Department
Memorandum 2012-0002 dated January 11, 2012 regarding payment of magna carta
benefits to officials and employees of the Department of Health. March 5, 2012.
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34. DOH Department Memorandum 2012-0181, Payment of hazard pay and
augmentation for laundry and subsistence allowance for public health workers of the
Department of Health. June 25, 2012.