Cebu’s public healthcare ‘sick’ with referral delays, lack of resources

Upgrade to High-Speed Internet for only ₱1499/month!

Enjoy up to 100 Mbps fiber broadband, perfect for browsing, streaming, and gaming.

Visit Suniway.ph to learn

It was 10 pm on June 17 when Ma. Geneses Acibron brought her father to the Bantayan District Hospital (BDH) in Cebu, after he fell and began to slur.

There, she was told that the hospital did not have the equipment for a computerized tomography scan, a medical imaging service that health professionals would need to assess the trauma in her father’s brain. 

This was why they had to look for a hospital in Cebu City, almost 150 kilometers away, much farther than Bogo City, which was just around 50 kilometers away. Bogo City didn’t have enough tertiary hospitals and only tertiary hospitals had the equipment they needed.

The trip to Cebu City wasn’t easily made. Acibron had to pay over P8,000 and had to deal with Cebu’s electronic patient referral system. It required prior acceptance in a Cebu hospital before they could be released.

It took three referral attempts before a hospital finally accepted them. Acibron is not alone as many Cebuanos share her experience with the province’s public health care system that experts have long criticized.

Lacking facilities? 

According to the Department of Health’s (DOH) National Health Facility Registry (NHFR), as of July 24, Cebu province has 10 hospitals, 23 infirmaries, 62 rural health units, 968 barangay health stations, and 267 other health-related facilities.

The same NHFR data showed that Negros Occidental has 15 hospitals, 9 infirmaries, 30 rural health units, 673 barangay health stations, and 147 other health-related facilities. Despite having fewer health facilities than Cebu, Negros Occidental has more facilities recognized as hospitals. 

It’s worth noting that Cebu contributed P411.32 billion to the Visayas’ GDP in 2023, much bigger than Negros Occidental’s P263.52 billion, according to the Philippine Statistics Authority (PSA) data. 

At present, there are four Cebu provincial hospitals (CPH) and 12 district hospitals.

Rappler visited the Minglanilla District Hospital and Tuburan District Hospital. These hospitals are infirmaries — a category of healthcare facilities that provide the basic medical treatments for emergencies and care for laboring mothers. 

Other categories include Level 1 that typically have around 50 bed capacities. Level 2 hospitals have around 100 beds, and those in Level 3 have more than 200. Infirmaries have fewer staff, medical equipment, and bed capacities but are still considered hospitals under the Hospital Licensure Act.

RENOVATING. The Tuburan District Hospital has what it needs to deal with animal bites, minor injuries, and birthing. However, some room renovations, turned over to the provincial government in 2023 by the DOH Hospital Facilities Enhancement Program (HFEP), have yet to be finished. Photo by Jacqueline Hernandez/Rappler

INSPECTION. The Minglanilla District Hospital has essentials like an emergency room, wards, delivery rooms, animal bite treatment center, and a dietary area, but officials noted during an inspection on July 3 that it has significant damage and lacks equipment like dental chairs and nebulizers. Photo from Cebu Governor Pam Baricuatro’s Facebook

Patients with serious complications often have to be referred to the private and provincial hospitals like the CPH in Carcar City which caters to 24 towns/cities in the south — almost half of the province.

It has a 24/7 emergency room, and provides regular and ancillary services like pediatric consultations, major and minor surgeries, X-ray treatments, anesthesia and hemodialysis, to name a few. 

Prudencio Manubag, chief of hospital of CPH Carcar, told Rappler on July 7 that the hospital lacks supplies and has worn-out facilities. Yet it handles more than 100 patients per day.

According to Manubag, they have limited staff, which could account for delays in the e-referral system.

But will building more hospitals in the south help CPH Carcar manage its patient influx? Manubag said that upgrading hospitals would be better than building new ones. This way, existing hospitals in the south can handle more patients instead of referring them somewhere else.

Mary Ann Josephine Arsenal, officer-in-charge of the Provincial Health Office, told Rappler on July 23, that the DOH conducts yearly assessments of the hospitals’ manpower, infrastructure, and equipment to determine their capacity to be upgraded. 

“Depending on their [bed] capacity, number of admissions, the census of the hospital, overall, DOH will determine if they will be leveled up,” she said.

Arsenal explained that pushing for an upgrade would entail commitment from the government to acquire more equipment and staff, and improve infrastructure. This also means that the province has to allocate more money for its hospital fund.

WORN-OUT. A worn-out facade can be seen from the entrance gate of the Cebu Provincial Hospital in Carcar City. Photo taken on June 25, 2025, by John Sitchon

Need for more funds, staff

The province’s Programmed Appropriation and Obligation by Object of Expenditure showed that in 2024, the total fund for the operations of its hospitals was above P2.8 billion — a big jump from its 2023 fund of around P607.7 million.

Cebu Provincial Board Member Stanley Caminero explained that they are aiming to level up Cebu’s infirmaries and Level 1 hospitals, and have asked the DOH for a checklist of requirements for the upgrades.

“We need all the data, the inventory, and the census,” Caminero told Rappler on July 22.

While it’s unclear yet what the appropriations would look like, the board member said that they can still hire more staff regardless of a hospital’s category.

“It’s incumbent upon the province to hire more, not to comply with the minimum, but to address the needs of the census,” Caminero added.

On July 6, Cebu Governor Pamela Baricuatro ordered the hiring of more than 1,600 personnel for the province-run hospitals. This came days after she announced the release of P5 million to each of the hospitals for the purchase of essential medicines and medical supplies.

Still, there’s the problem of the high turnover of medical staff in provincial hospitals. 

Archie Kenneth Sabay, a Philippines and United States registered nurse at the Cebu South Medical Center (CSMC) in Talisay City told Rappler that low budgets and scarce resources affect staffing.

Many of his fellow nurses, he said, opted to leave the country because of the high workload and low pay here.

“Working abroad offers better pay, more advanced facilities which don’t restrict us,” the nurse added.

The salary grade for entry-level nurses working in the country’s government hospitals is 15, equivalent to pay of more than P38,000 per month. 

May 2024 data from the United States Bureau of Labor Statistics showed that the lowest 10% of the US nurse population earned around P313,200 ($5,500) monthly, exponentially higher than local rates.

For years, many nurses in the province-run hospitals have been job-order or contract of service workers. 

Under Civil Service Commission Resolution No 020709, job order/contract of service workers do not enjoy the benefits enjoyed by government employees like economic relief and representation, and transportation allowance.

Caminero explained that there’s a ceiling for salaries and wages that the provincial government is allowed to provide. They can use only 45% of the province’s total budget for permanent government worker slots.

To meet the demand for more medical staff, the province creates job orders. These job orders are not recognized as permanent government slots since no employer-employee relationship exists. It’s a temporary fix, according to the board member.

Long road for health

As of July 19, the Cebu governor ordered the hiring of an initial 78 doctors to be deployed in provincial and district hospitals. More than 1,800 individuals have sent their applications for different healthcare positions since the province began mass hiring efforts.

Manubag said that it will be a challenge to bring more doctors to remote and rural areas. He noted that many medical specialists work closer to the capital where it’s more convenient.

The Regional Development Council (RDC) of Central Visayas reported in its Regional Development Plan for 2023-2028 that a majority of hospitals are concentrated in the cities of Cebu, Mandaue, and Lapu-Lapu.

“It’s not very attractive for them to go to remote areas…It’s very far, the traveling expenses and the distance, the long hours of driving is not easy,” Manubag added.

But attempts to bring services closer to far-flung communities continue. According to Caminero, the province has partnered with several private health care facilities to provide immediate services when the provincial or district hospital does not have them.

Cebu Provincial Administrator Ace Durano was quoted as saying in a July 3 article in The Freeman that the provincial government is mapping out its roadmap for upgrading hospitals.

There’s still a long way to go before officials can accomplish the vision for province-wide hospital upgrades, especially since the DOH declared in May 2024 that there was a national shortage of 190,000 healthcare workers.

In the meantime, Acibron and her father can only pray that Cebu’s hospitals will one day become more accessible and affordable for islanders like them. – Rappler.com