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)

10 mothers die daily due to pregnancy- and childbirth-related 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)

At A Glance: Philippine Health Situation

Hemorrhage of Health Human ResourcesPhilippines 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

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2000

4000

6000

8000

10000

12000

14000

16000

18000

20000

1992

1993

1994

1995

1996

1997

1998

1999

2000

2001

2002

2003

Po

pu

lati

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DENTISTS

DIETITIANS AND PUBLICHEALTH NUTRITIONISTS

DOCTORS MEDICAL

MIDWIVES PROFESSIONAL

NURSES PROFESSIONAL

OPTOMETRISTS ANDOPTICIANS

PHARMACISTS

PHYSIOTHERAPISTS ANDOCCUPATIONAL THERAPISTS

TECHNICIANS MEDICAL X-RAY

CAREGIVERS ANDCARETAKERS

Lorenzo, NIH, 2003

Estimated Number of Employed Filipino Nurses By Work Setting, 2003

Work Setting Number Percentage

I. Local/National 29, 467 15.25%

A. Service

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%

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

YEAR US$

1999 US$ 6.79

2000 US$ 6.05

2001 US$ 6.03

2002 US$ 7.19

2003 US$ 7.64

2004

2005

US$ 8.50

US$ 10.8

Source: Central Bank of the Philippines, 2005-06Source: Central Bank of the Philippines, 2005-06

0

2

4

6

8

10

12

1999 2000 2001 2002 2003 2004 2005

OFW Remittance in Billion US Dollars, 1999-2005

In Billion US$

Other consequencesDecline in the interest of young Filipinos to study medicine – evidenced by a drop of 53% in NMAT examinees with Yr. 2000 as baselineDecline 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 1:40-1:60Loss 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 FACTORSvery 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 LevelReview/scrap “labor export policy”Regulate the outflow of health professionalsIncrease health budget, improve the salaries & working conditions of health workers/professionalsReorientation of health science education

Advocacy & MobilizationAwareness-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