Transcript Brain Drain in the Philippines

Brain Drain in the Philippines
Connie Gundayao
Health Students’ Action - Philippines
At A Glance: Philippine Health
Situation
50% of the population
has no health care
access.
5 out of 10 Filipinos
die without getting
any medical attention.
Only 60% of the
population has full
access to essential
drugs.
(AHW 2004, CHD 2004, NIH 2005)
At A Glance: Philippine Health
Situation
10 mothers die daily
due to pregnancyand childbirthrelated causes.
The average
hospital bill is three
times the average
monthly income.

23.4 M Filipinos still
do not have access
to toilets. CBHP
experience would
double this figure.
(AHW 2004, CHD 2004, NIH 2005)
Hemorrhage of Health Human
Resources
Philippines is the no. 1 exporter of
nurses worldwide
85% of Filipino nurses work abroad in
some 50 countries (approx. 163,756
nurses in 2003)
From 1999-2003: Licensed 27,342
nurses yet over 56,000 went abroad.
Increasing number of nursing schools:
170 (1990s)  251 (2003)  470 (2006)
HEAD, 2007
Hemorrhage of Health Human
Resources
Phenomenon of doctors becoming nurses to
go abroad
More than 9,000 doctors have already left as
nurses from 2002 to 2005.
80% of public health physicians have taken up
or are enrolled in nursing.
90% of Municipal Health Officers (MHOs) are
taking up nursing and expected to leave the
country.
HEAD, 2007
Obstetricians and anesthesiologists are
rapidly depleting, followed by pediatricians
and surgeons.
At least 37 Philippine nursing schools offer
abbreviated 2-year courses for doctors to
become nurses.
More than 60% of nursing schools are geared
mainly for “second coursers”
Pharmacists are the next target for
employment abroad
HEAD, 2007
TESDA has trained over 50,000 caregivers in
the last 5 years and over 24,000 have been
deployed abroad.
An estimated 15,000 health professionals leave
the country annually for employment abroad.
Decreased enrollment in medical schools of
10%-55% in the last 2 years.
Hospitals closing down for lack of
doctors/nurses: 200 completely closed, 800
partially closed (2003-2005)
HEAD, 2007
Figure 2. Trend of Deployment of Health Workers Abroad, 1992-2003
20000
DENTISTS
18000
DIETITIANS AND PUBLIC
HEALTH NUTRITIONISTS
16000
DOCTORS MEDICAL
14000
12000
NURSES PROFESSIONAL
10000
8000
OPTOMETRISTS AND
OPTICIANS
6000
PHARMACISTS
4000
PHYSIOTHERAPISTS AND
OCCUPATIONAL THERAPISTS
2000
TECHNICIANS MEDICAL XRAY
Lorenzo, NIH, 2003
03
20
02
20
01
20
00
20
99
19
98
19
97
19
96
19
95
19
94
19
93
19
92
0
19
Population
MIDWIVES PROFESSIONAL
CAREGIVERS AND
CARETAKERS
Estimated Number of Employed Filipino Nurses By Work Setting,
2003
Number
Percentage
29, 467
15.25%
1. Government Agencies
19, 052
9.86%
2. Private Agencies
8, 173
4.23%
B. Education
2, 241
1.16%
II. International
163, 756
84.75%
Total
193, 223
100.00%
Work Setting
I. Local/National
A. Service
Lorenzo, NIH, 2003
Markets
Traditional Markets: Middle East, North
America
New Markets: Europe especially UK,
Netherlands, High Income Asia
Emerging Markets: Japan and Nurse
Education abroad
Lorenzo, NIH, 2003
Overseas Filipino Workers (OFWs) Remittances
OFW Remittance in Billion US Dollars, 1999-2005
YEAR
US$
1999
US$ 6.79
2000
US$ 6.05
10
2001
US$ 6.03
8
2002
US$ 7.19
12
6
4
2003
US$ 7.64
2004
US$ 8.50
2
0
1999
2005
2000
2001
2002
2003
US$ 10.8
In Billion US$
Source: Central Bank of the Philippines, 2005-06
2004
2005
Other consequences
Decline in the interest of young Filipinos to
study medicine – evidenced by a drop of
53% in NMAT examinees with Yr. 2000 as
baseline
Decline in the applicants for medical
residency positions to become specialists
with an average of 50%
Nurse to patient ratios in provincial and
district hospitals now 1:40-1:60
Loss of highly skilled nurses in all hospitals
across the country
Galvez-Tan, 2003
Reasons Why Health Professionals
Leave the Country
Push Factors
Economic: low salary at home, no overtime and hazard
pay, low coverage of health insurance
Job-related: work overload or stressful working
environment, slow promotion
Socio-political and economic environment: limited
opportunities for employment, decreased health budget,
peace and order situation in the Philippines, “Labor
Export Policy” of the government, western orientation
and high cost of health science education
Reasons why Health Professionals
Leave the Country
Pull Factors (Receiving Countries)
Economic: higher income, better benefits and compensation
package
Job-related: Lower nurse to patient ratio, more options in working
hours
Individual/Family-related: Chance to upgrade nursing skills,
acquisition of immigrant visa and opportunity for family to migrate,
opportunity to travel and learn other cultures, influence from peers
and relatives
Socio-political and Economic environment: Advanced technology,
better peace and order situation
Lorenzo, NIH, 2003
Reasons Why Doctors Migrate as
Nurse Medics
PUSH FACTORS
very low compensation and salaries,
feeling of hopelessness about the Philippine current
situation,
political instability and graft and corruption,
poor working conditions and
the threat of malpractice law
PULL FACTORS (Receiving countries)
more socio-politico- economic security abroad,
attractive salaries and compensation packages (High
salaries, benefits, compensation)
more job opportunities and career growth.
Lorenzo, NIH, 2003
The Unhealthy Philippine Health Care System
“A health care system that cannot maintain
its own health human resource
is not healthy at all.”
HEAD, 2007
Proposed Courses of Action
Policy Level
Review/scrap “labor export policy”
Regulate the outflow of health professionals
Increase health budget, improve the salaries &
working conditions of health
workers/professionals
Reorientation of health science education
Advocacy & Mobilization
Awareness-raising among health science
students/ Exposure to social realities
“WTO out of health” campaign
Other Proposed Reforms
National Health Service Act (2-year
service in the Philippines)
Compensation from receiving
countries
Bilateral agreements with Receiving
Countries
Challenges
Sustained and concerted efforts at the
country and global level
Involvement of the health
professionals into the campaign