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 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)
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

DENTISTS
20000

18000 DIETITIANS AND PUBLIC

HEALTH NUTRITIONISTS

16000
DOCTORS MEDICAL

14000
MIDWIVES PROFESSIONAL

12000
Population

NURSES PROFESSIONAL
10000
OPTOMETRISTS AND
8000 OPTICIANS

6000 PHARMACISTS

4000 PHYSIOTHERAPISTS AND

OCCUPATIONAL THERAPISTS
2000
TECHNICIANS MEDICAL X-
RAY
0
CAREGIVERS AND
2 93 994 995 996 997 998 999 000 001 002 003
1 99 19 1 1 1 1 1 1 2 2 2 2
CARETAKERS

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

OFW Remittance in Billion US Dollars, 1999-2005

YEAR US$

1999 US$ 6.79

12
2000 US$ 6.05 10

2001 US$ 6.03 8

6
2002 US$ 7.19
4
2003 US$ 7.64 2
2004 US$ 8.50 0
1999 2000 2001 2002 2003 2004 2005
2005 US$ 10.8
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
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