Export of Filipino Nurses:

From Brain Drain to National Hemorrhage

to NLE Leakage

Health Alliance for Democracy (HEAD)

13 September 2006
 Exporting Health Human Resource

 No. 1 Exporter of Nurses

“An estimated 85% of employed Filipino nurses (more than
150,000) are working internationally.” (Aiken et al 2004)
“70% of all Filipino nursing graduates are working overseas.”
(Bach 2003)

 No. 2 Exporter of Doctors

“68% of Filipino doctors work overseas, next to India.” (Mejia,
WHO 1975)
(NIH 2004)
 Hemorrhage of Human Resources: Nurses

 13,536 nurses left in 2001.

 2000-2003: approx 50,000 nurses left.
“Data casts doubt on the underreporting of the Philippine Overseas
Employment Agency (POEA) that shows only 91 nurses left for the
USA in 2000, 304 nurses in 2001, and 320 nurses in 2002.” (Tan et
al 2004)
 Top 5 Destinations of Filipino Nurses

 United States of America

 United Kingdom
 Saudi Arabia
 Ireland
 Singapore

“The number of nurses that left in the last 4 years

(50,000) far exceeds the production of nurses of
only 20,000 in the same period.”
(NIH 2004)
 Deteriorating Quality of Nursing Education
 The number of nursing
schools have increased
1970s: only 40
1990s: 170
June 2003: 251
April 2004: 370
June 2005: 441
June 2006: 470

 By June 2006, almost

200% increase in nursing
schools nationwide since
2003
(NIH 2004)
 Deteriorating Quality of Nursing Education

 Decreasing proportion of nursing graduates who pass

the national nursing licensure examinations

1970s and 80s: 80%-90%

1991: below 61%
2001-2003: 44%-48%
2004: 55.9%
2005: 49.7%
2006: 42.42%
(NIH 2004, PRC 2005)
 Deteriorating Quality of Nursing Education

 In 2001
116 nursing schools: passing rate of <50%
124 nursing schools: passing rate of >50%
 In 2002, 150 nursing schools had a passing
rate <50%, which was already 63% of the 237
nursing schools then.
 In the last 3 NLE 2005, at least 20 schools
consistently a <30% passing rate.
(NIH 2004)
 Hemorrhage of Human Resources: Other Professionals

 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” (non-health professionals who want to
take up nursing, e.g. engineers, accountants, teachers,
soldiers).

(HSA 2005, PNA 2005)

 Hemorrhage of Human Resources: Other Professionals

 Initial HEAD estimates:

around 30% of nursing students are “second-coursers”
at least 80% of those taking up nursing are planning to
work abroad
between 75%-90% of faculty members are planning to
work abroad

(HSA 2005, PNA 2005)

 Hemorrhage of Human Resources: Other Professionals

 Biggest review centers:

INRESS – P10,000 for 6 weeks
Gapuz – P13,400 for 3 weeks
Pentagon – P14,500 from Sept to Dec
 Most nursing colleges also have compulsory “in-house”
reviews that are paid for by the students (separate from
tuition and other expenses)
 Students/graduates spend around P40,000+ just for
review
 Exploited Health Human Resources

► Health workers and professionals are

overworked and underpaid.
Exploited Health Human Resources

► Doctor to patient ratio (population)

Cuba 1:225
USA 1:450
Philippines 1:10,000-26,000
WHO (Ideal) 1:600

► Nurses to patient ratio

PGH 1:15-26 per shift
Davao del Sur 1:44-45 per shift
Ideal 1:4 per shift
Philippines 1:16,000 (population)

(AHW 2004, HealthWrights 2004)

The Unhealthy Philippine Health Care System

“A health care system that cannot maintain

its own health human resource
is not healthy at all.”
 The Nursing Exam Leakage

 The Nursing Licensure Examination (NLE)

Given by the PRC twice a year

Exam questions are prepared by members of the

Board of Nursing

Has 5 parts: Test I (Community Nursing), Test II

(Maternal and Child), Test III (Medical-Surgical
Nursing), Test IV (Fundamentals), Test V
(Psychiatric Nursing)
 The Nursing Exam Leakage

 Basic chronology of the NLE leak

A few days before the June 2006 NLE,

INRESS held an “final coaching” at one of
the cinemas in SM North EDSA

Shortly after the NLE, the leakage was

exposed in Baguio City. PRC-CAR
immediately informed PRC national office.
 The Nursing Exam Leakage
 Basic chronology of the NLE leak
PRC initially said it would investigate before
releasing the list of those who passed.
Mass resignation of the Technical Committee on
Nursing Education (TCNE) on July 7, citing “that
CHED has instead (of implementing past memos)
buckled down to pressure from poor performing
schools, politicians and Malacañang, sacrificing
quality for mediocrity and business
interest.”
 The Nursing Exam Leakage

 Basic chronology of the NLE leak

But even without an investigation, the PRC
released the list of those who passed and
stated there was no leak involved.
PNA President George Cordero also
lobbied the PNA chapter in Baguio to keep
the matter under wraps as it might
jeopardize the country’s request to be
made an NCLEX center.
 The Nursing Exam Leakage

 Basic chronology of the NLE leak

Nursing groups were formed to pressure the

PRC. The UST-led group called for a nullification
of the entire NLE and a re-take.

The nursing community became embroiled and

divided on the re-take debate.

The PRC allowed the oath-taking of those who

passed even after promising the ADPCN that it
will defer such action.
 The Nursing Exam Leakage

 Basic chronology of the NLE leak

The UST-led group filed a TRO against the PRC
for the oath-taking. The processing of papers also
stopped.
The Senate and the HOR Committees on Health
began conducting their respective investigations,
but the gov’t agencies involved did not attend the
hearings.
Witness testimonies already point to the
involvement of key leaders/members of the PNA
and BON.
 The Nursing Exam Leakage

 Major groups implicated

Dr. George Cordero: owner of INRESS and
Philippine Colleges of Health Sciences (PCHS);
President of the Philippine Nurses Association
(PNA)
BON members Anesia B. Dionisio and Virginia D.
Madeja
Gapuz and Pentagon Review centers
PRC Chair Leonor Tripon-Rosero
 The Nursing Exam Leakage

 Major government agencies involved

Professional Regulation Commission (PRC)
Board of Nursing (BON)
Commission on Higher Education (CHED)
Dante Ang (Commission on Overseas Filipino and
Presidential Task Force on the National Licensure
Exam/EO 550)
National Bureau of Investigation
 The Nursing Exam Leakage

 Major groups of stakeholders

Association of Deans of Philippine Colleges of
Nursing (President Carmelita Divinagracia, Dean
UERM CN)
PNA and PNA-CAR
Concerned Nurses… (UST, FEU)
ANSWER (broad inter-school alliance)
BSN (Bukluran ng mga Samahang Nurses)
Health Alliance for Democracy (HEAD)
 The Nursing Exam Leakage

 Positions regarding the issue

PRC: “No Leakage”  No Re-take  Voluntary

re-take for free  Bonus 2%

Dante Ang/Arroyo admin: Compulsory Re-take 

Compulsory re-take of Tests III and V

PNA: Re-take all  No re-take

UST, UE, UP: Compulsory re-take of Tests III, V

CHED: “Wala kaming kinalaman dyan!”

 The Nursing Exam Leakage

HEAD analysis
• Leakage is only a symptom of a long-
standing deterioration of the nursing
education
• Like other exams given by the PRC, the
NLE has been fraught with leakages that
have exemplified the collusion between
gov’t officials and big business
 The Nursing Exam Leakage

HEAD analysis
• Gov’t agencies (PRC, CHED, BON) have
eroded the quality of nursing education
and the integrity of the nursing
profession
• The actions of gov’t agencies are divisive
and meant to distract stakeholders from
the main issue
 The Nursing Exam Leakage

HEAD analysis
•
The commercialization of nursing
education has worsened the quality of
nursing education
•
This commercialization is rooted in the
Labor Export Policy of the Arroyo regime
•
Rather than seek solutions, the Arroyo
gov’t seeks to centralize everything (e.g.
regulate review centers under gov’t
control) to increase its revenues
 Health Under the Arroyo Regime

Filipino nurses have become a

commodity: subject to TRADE and
PROFITS

The national government has

ABANDONED its responsibility to
ensure the HEALTH of their PEOPLE
 WHAT WE WANT
HEAD proposals: IMMEDIATE
• Conduct a speedy, thorough, impartial, and
independent investigation of the leakage
• Identify and prosecute the guilty
• Completely revamp the PRC, BON, and CHED
• Allow those who have passed to seek jobs
without discrimination
 WHAT WE WANT
HEAD proposals: LONG-TERM
•
Review and uphold the recommendations set by
the TCNE. Set the standards for nursing schools
to operate and ensure compliance
•
Ensure the quality of education through a
thorough review of the curricula and quality of
nursing faculty
•
Ensure the integrity of the conduct of
examinations and other tests pertinent to the
competence of Filipino nurses
 WHAT WE WANT
HEAD calls:
• Unite and Uphold the Integrity of the Nursing
Profession!
• Conduct a Speedy, Thorough, and Independent
Investigation! Identify and Prosecute the Guilty!
• Stop the Commercialization of Nursing
Education!
• Stop the Arroyo Administration’s Labor Export
Policy!
HEAL.
STRUGGLE.
LIBERATE.

Health Alliance for

Democracy (HEAD)