by Imelda V. Abaño
– The Philippines –
For decades, the Philippines, one of the poorest countries in Asia, has provided skilled medical professionals primarily to wealthy places such as the United States, Europe and the Middle East. But as more and more health workers leave the country for greener pastures abroad, public health experts say the country’s health care system is on the brink of collapse.
Long hours, backbreaking schedules, poor conditions and little pay pushed 37-year-old Mary Ann Visaya to leave her job at a public hospital in an impoverished town in Cagayan Valley for higher salary abroad. For the past four years, Visaya has been working as a staff nurse, administering to roughly 30 or 40 patients a day. She has seen poor people lined up at the hospital and heard patients complain of the long wait to get treatment. But like many of her colleagues, she jumps at the opportunity to leave the country and work abroad.
“Most of the time your heart breaks seeing poor people lined up to seek treatment. But I have learned to persevere [through] more hours of work especially during critical staff shortage,” Visaya explains. “But I also have to think of the welfare of my parents because with my present salary of $170, it is not enough to sustain our expenses.”
The average salary of a nurse in the provinces is about US$150 a month, sometimes lower. In contrast, a Filipino nurse in the U.S. could earn between $3,500 and $5,000 a month.
In a number of middle-income countries and those with good medical education systems, such as Fiji, Jamaica, Mauritius and the Philippines, a significant proportion of students, especially in nursing school, start their education with the intention of migrating, usually in search of a good income.
Making matters worse, some countries—notably the Philippines—are seeking to capitalize on the demand for imported health workers by deliberately producing graduates for international export.
Just how many Filipino or Asian health care workers are working abroad is unclear, though Philippine government statistics estimate that 15,000 Filipino health care workers like Visaya leave each year. Health experts even say that this exodus is taking a heavy toll on the country’s already inadequate health system.
“The exodus of health care workers are more [about] socio-political and economic security abroad,” says former Health Secretary Jaime Galvez Tan. “This exodus has not only sparked brain drain but also the worsening of the health system.”
Tan points out in his research paper The Brain Drain Phenomenon and Its Implications to Health that since 1994, more than 100,000 nurses alone have left the country to work abroad.
Health care workers in the Philippines and most parts of Asia—doctors, nurses and caregivers—who are seeking better-paying jobs and career advancement, continue to migrate as the region’s population ages, and as the burden of chronic diseases rise and new health threats emerge, says to Mubashar Sheikh, director of the Global Alliance on Health Workforce.
Sheikh points to the World Health Organization’s 2006 World Health report which estimates the current global health workforce to be around 59 million people. Though there are 39.5 million health service providers and 19.5 million management and support workers, WHO estimates a global health worker shortage of more than 4 million doctors, midwives, nurses, pharmacists, dentists and support workers.
“This is a global problem. The demand for health workers has increased in the developed countries because these rich countries are not producing enough work force locally,” Mubashar says. “Urgent measures are needed to scale up education and training in poor countries like Asia and even Africa.”
If the present trends continue, this worsening shortage will push already taxed health systems ever closer to disaster. According to the National Populations Fund (UNFPA), the Philippine population has now ballooned to nearly 90 million and is set to hit 150 million by 2050. The health of millions of people in the Philippines alone is at risk from health care worker shortage.
Virtually, every poor person in the Philippines’ far-flung villages can recount a story about a relative dying in childbirth, often from minor complications that could be easily remedied with proper treatment.
Vegetable farmer Orlando Kindawan, 39, from Cordillera recalls how his wife Edna bled to death last year after giving birth to their fifth child. He blames her death on the clinic and its lack of health care workers, as well as the lack of transportation and road access in their remote village.
“My wife could have survived. Now I am afraid that my children will get sick and there is no clinic nearby to treat them,” worries Kindawan.
“The health care system in the country has gone critical. Nurses and doctors are leaving for a variety of reasons like political instability, low pay, corruption and poor working conditions. But we cannot stop them from leaving because it’s their right [to leave],” says Filipino health researcher Don Eliseo Prisno.
Prisno says that besides overall health worker shortages, the work force problem is compounded by minimal expertise in epidemiology and laboratory analysis, which is necessary to meet emerging infectious disease threats.
Still, he concedes, “The movement of health workers abroad also has positive features. Each year, migration generates millions of dollars in remittances and has, therefore, been associated somehow with a decline in poverty.”
The health-related Millennium Development Goals aim to reduce child mortality, improve maternal health, combat HIV/AIDS and other diseases, such as tuberculosis and malaria, and ensure access to essential medicines. Many health experts say that the health worker shortage has been a major impediment to making progress on these goals.
Ndioro Ndiaye, Deputy Director General of the International Organization for Migration, says it is high time programs and policies are put in place to reverse the devastating effects of the “brain drain” in developing countries.
Ndiaye says experts, for example, in the African continent, are increasingly engaged in strategies and programs to retain skilled professionals at home. They include restrictive policies aimed at delaying emigration, such as adding extra years to medical students’ training. Various tax proposals have also been put forward as governments realize that the large number of citizens living outside their borders is a potential economic resource.
She says another strategy is the adoption of international agreements by industrial and developing nations under which wealthy countries pledge not to recruit skilled people from developing states.
WHO points out that training, sustaining and retaining a motivated and supported workforce will require long-term commitment, structural and fiscal changes, and partnership at all levels.
As a means of curbing brain drain, health experts like Mubashar say governments need to scale up education and training of health workers, pay reasonable salaries, enforce better policies and foster healthy work environments. They must also provide better financial and non-financial incentives and seek creative solutions that address worker retention.
Maybe time is running short. Truly, health care workers are the cornerstone and driver of health systems. The loss of this work force can and will bring the whole health system to its knees without prompt action. Though the problem of migration and health care worker shortage is becoming bigger and more alarming, we can overcome this crisis if we get our acts together and address the issue globally.
About the Author
Imelda Visaya-Abaño, began her journalism career in 1998 as a reporter at the Philippine Daily Inquirer, the leading daily newspaper in the Philippines. Her areas of interest are women and children’s issues, science, environment, health, agriculture and education.
In 2002, Ms. Abaño was honored as the Asian Winner of the Global REUTERS-IUCN Media Awards on Environmental Reporting.
Ms. Abaño vows to continue serving her community through balanced news and fearless views. She believes in better journalism for better communities.
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