Coming 'full circle' - Annabelle Borromeo, Philippines
The WHO CC UTS acknowledges use of key language from The WHO Global Strategic Directions for Nursing and Midwifery (2021–2025).
Dr Annabelle Borromeo has spent the last two decades actively raising the status of nurses in the Philippines.
Borromeo left the Philippines in 1979 and spent the next 23 years working in the United States. Starting off as a staff nurse, she then worked her way up to management. Along the way she became a neuro and cardiovascular critical nurse, and later a widely-published academic and researcher.
In 2001, Borromeo moved back home to Manila and worked in high level positions in hospitals and at a university. Before retiring in 2017, she was Senior Vice President for Operations at St Luke’s Medical Centre, a very large tertiary care hospital.
I was able to actually look at the entire ecosystem of the hospital system that I was then employed with. We had two large hospitals and I was in charge of the nursing systems in both,
she says.
In this job, she introduced an American concept called the Magnet journey, a program which recognises nursing service or nursing departments that have excelled in keeping their nurses and guiding them on pathways towards leadership roles.
She ran another program which strengthened the retention policies of hospitals, which included giving nurses large pay rises. From earning around AUD $515 per month, they are soon expected to be on up to $850. While Borromeo says it’s a “far cry” from what a Filipino nurse could earn overseas, “that’s a big jump”.
She has also been involved in changing the perception of nurses as gophers — people who pick up medication and accompany patients. She has wanted to see nurses working at their level of education and at their full scope of practice and not exploited for functions and roles they aren’t suited to.
I envisioned the role of the nurse as someone who stays at the bedside, collaborates with physicians, plans the care, coordinates the care in a very high level kind of way so that the care that is delivered is seamless,
she says.
Although retired, Borromeo is still part of The Philippines Nurses Association, where is she Vice President for Finance. The large national organisation pushes for greater visibility for nurses.
If I had all the power in the world like a Bill Gates or someone like that, I would put a lot of resources on a new nursing education system,
she says.
Borromeo has a number of ideas about how the Filipino system should change. She’d like to see a greater appreciation for local healers and herbs. “We should get back to our roots.”
She also would like to see more qualitative research done in the nursing world. “The majority of the research that has been coming out is medical model, qualitative, measuring things, et cetera. I think nursing lends itself to a qualitative kind of an approach, but not many of us have those skills,” she says. “I myself, I'm a quantitative researcher and I'm now getting into the qualitative and I find that the knowledge that we still need to build as a profession will be probably best be elucidated and understood through qualitative methods. That's my bias now even if I was a quantitative researcher for the longest time.
Aside from plans to have a national chief nursing officer position created, Borromeo says a new nursing law is also being pushed to raise the legitimacy of an advanced nursing practice nurse.
We are positioning nursing now to be the dominant profession in universal healthcare because there's just so many of us. If the government … organizes us properly, then we might be able to really make a big difference,
she says.
Borromeo can also see changes in the current model where the doctor is seen as king, particularly amongst the younger generation of nursing professionals.
“The kids now can chime in at any time to the point that we think it's disrespectful. I guess there's some inter-generational stuff going on there,” she says.
“Whereas when I was a nurse, I was reluctant to approach the physician just in a straightforward way, I had to mitigate my language just so he didn't get offended. Now, our kids, they come to the hospital, talk to the doctors, and say, ‘Yes, so what are you going to order?,’ in that straightforward way. So I think there's hope there. It's just that we need to harness their efforts because now it's about them.”
Borromeo is optimistic about the future of healthcare in the Phillippines because she has witnessed the rise of a new generation of leaders who view the world differently and are bringing in fresh ideas for governance.
Borromeo has also been heartened by the recent reforms to UHC in the Philippines. In February 2019, President Rodrigo Duterte signed a Universal Healthcare Law, which aims to give basic healthcare coverage, including screening and intervention, which will be free for all. The challenge for the Department of Health will be in the implementation - putting in place the infrastructure for primary care and changes to rules and regulations across a country which is highly de-centralised and has 6 levels of government.
“What's important for us who work here in the trenches is that our partners in government also really understand the importance of health as a way of leading to a productive citizenry”.
The mayor for the city of Manila was the son of a garbage man and grew up on the streets of Manila. Since he was elected, he has built the largest dialysis ecosystem in the country.
One day he saw people lining up at 3am in order to be hooked up to a machine at 8am. So he purchased dozens of dialysis machines, and hired extra nurses and technicians and upgraded all the hospitals in his district and also donated part of salary to the Phillippine General Hospital. NCDs are the biggest cause of mortality in the Phillippines.
While retired, she is still very busy and says she feels like she has come “full circle”. Having spent most of her career in the private sector, she is now also in the process of setting up her own NGO to improve the healthcare for Filipinos living in remote areas.
"I want to end my career with trying to do demonstration projects of best practices that have worked," she says.
