A mixed-methods study on the Espesyalista Para sa Bayan (Specialists for the Country) Program: Factors affecting retention, unintended consequences, and recommendations for improvement

Abstract Background The Espesyalista Para sa Bayan (EPSB, literally Specialists for the Country) Program, has been implemented to address the inequitable distribution of specialist physicians in the Philippines. However, this program is only newly implemented and there is limited evidence on specialist physician deployment programs in low- and middle-income countries. This study aimed to identify determinants of retention in the program, its unintended consequences, and recommendations for improvement. Methods We administered an online survey to currently deployed EPSBs. We interviewed a subset of our survey respondents. We then supplemented it with interviews and focus group discussions with program implementers from the Department of Health at the local, regional, and national level. We analyzed the survey data descriptively. Meanwhile, we transcribed and analyzed the responses in the interviews and focus group discussions thematically. Results Our survey had 17 respondents, while we conducted a total of 17 interviews and focus group discussions with EPSBs and program implementers. We identified a total of four individual environment factors, five local environment factors, six work environment factors, and five national environment factors that influence retention. Some EPSBs consider relocating abroad temporarily for further training or studies, or permanently for better career opportunities. We also identified three unintended consequences of the EPSB Program, as well as five recommendations to improve the program. Conclusion The initial years of the EPSB program have not been without problems but is generally well regarded by its implementers and its deployed physicians. However, further improvements are needed to optimize it and to make sure it meets its goal of making specialist care accessible to all Filipinos.