Brain Drain in the Philippines

Lilet Basilio

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 18000 16000 14000
MIDWIVES PROFESSIONAL DENTISTS

DIETITIANS AND PUBLIC HEALTH NUTRITIONISTS DOCTORS MEDICAL

Population

12000
NURSES PROFESSIONAL

10000 8000 6000 4000 2000 0

OPTOMETRISTS AND OPTICIANS PHARMACISTS

PHYSIOTHERAPISTS AND OCCUPATIONAL THERAPISTS TECHNICIANS MEDICAL XRAY CAREGIVERS AND CARETAKERS

92

93

94

95

96

97

98

99

00

01

02 20

19

19

19

19

19

19

19

19

20

20

Lorenzo, NIH, 2003

20

03

Estimated Number of Employed Filipino Nurses By Work Setting, 2003 Work Setting I. Local/National A. Service 1. Government Agencies 2. Private Agencies B. Education 19, 052 8, 173 2, 241 163, 756 193, 223
Lorenzo, NIH, 2003

Number 29, 467

Percentage 15.25%

9.86% 4.23% 1.16% 84.75% 100.00%

II. International
Total

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$

OFW Remittance in Billion US Dollars, 1999-2005

1999 2000
2001 2002 2003 2004 2005

US$ 6.79 US$ 6.05

US$ 6.03 US$ 7.19 US$ 7.64 US$ 8.50 US$ 10.8

12 10 8 6 4 2 0 1999 2000 2001 2002 2003 2004 2005

In Billion US$
Source: Central Bank of the Philippines, 2005-06

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

Economic: low salary at home, no overtime and hazard pay, low coverage of health insurance

Push Factors

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