The Exodus of Filipino Health Care Professionals

The Philippines is known as one of the world's biggest suppliers of healthcare professionals, so much so that its own health system is driven to a state of near collapse. In a Nov. 23, 2005 statement, no less than Malacañang said that the exodus of Filipino doctors and other medical practitioners to look for high-paying jobs abroad poses a serious problem to the country's health services, noting that "the decision of our best and well-trained medical practitioners to leave the country to look for greener pastures abroad is somewhat out of our hands."1

Early last year, the Private Hospitals Association of the Philippines (PHAP) expressed concern over the unrestrained departure of Filipino medical professionals looking for higher paying jobs in foreign countries. Lack of medical personnel has reportedly already forced the closure of 1,000 private hospitals since 2000, particularly in the rural areas.

There is certainly a dearth in skilled medical and healthcare professionals in the country at present, says UP College of Public Health professor Dr. Marilyn Lorenzo. It is too simplistic, however, to put the blame on the exodus of competent workers in the health sector. "I think what we are suffering is the age-old case of misdistribution of human resources," Lorenzo, a specialist in health policy and administration, says. "It has been happening since I was a nursing student in the 70s." She identifies the following causes: the lack of a functioning system rationalizing recruitment, retention, training and development, and placement of health professionals.

Effect on public health

According to Lorenzo, the Philippine healthcare system has not been very flexible. As it is, the health industry can only absorb so many doctors and nurses who join the labor force every year. "If positions in hospitals and health centers become available, they would just be enough to cover the next set of people that the school system trains," she explains.

In fact, there is even an oversupply in some fields, like nursing. In April 2008, UP College of Nursing Dean Dr. Josefina Tuazon and Philippine Nurses Association national president Leah Paquiz raised the alarm that the oversupply of nurses was fast becoming the country's problem because the promise of overseas employment was luring many to take up nursing.2

Where doctors are concerned, the Philippines may still be producing just the right number. Unfortunately, they are not where they are most needed. Medical services are still concentrated in the metropolitan areas.

Lorenzo does not believe, however, that doctors should be faulted for not going where their services matter most. "To begin with, there are no positions available," she says. "Even if they want to go, they simply cannot because there would be nothing waiting for them."

We also need to consider the working conditions a typical health professional has to endure. According to the 2008 Occupational Wages Survey by the Bureau of Labor and Employment Statistics (DOLE-BLES), a medical doctor receives on average just P20,135 as month. Teachers actually fare better, receiving on average P12,221 to P35,728, depending on the industry. Nurses, on the other hand, are among the lowest paid professionals in the Philippines, earning an average of P9,867 per month-just slightly higher than a cook's average monthly pay of P9,646.

Compensation, Lorenzo says, does not even have to be financial. A young, dedicated, unattached doctor who has no kids or family to support may welcome the challenge of working in far-flung or isolated communities. As he or she grows older, however, concerns shift to building a home, sending kids to a good school, earning an ample income, and getting modest pensions upon retirement. Lorenzo believes it is possible for professionals to be interested in working in the provinces even without monetary rewards if better social amenities were made available to them-living quarters, schools for their kids, and a reliable career development program. Those who opt to go to the province usually face the bleak scenario of a snail-paced promotion scheme; or worse, being stuck in their low-tiered positions for the rest of their lives.

Recent migration studies also confirm that income is only one variable affecting the job-related decisions of health professionals. Nurses, for instance, are often seen as exclusively economic migrants. However, a 2009 study by Alvaro Alonso Garbayo and Jill Maben which appeared in Human Resources for Health found that professional motives can be a very strong incentive for migration among nurses that it sometimes outweighs economic factors. Less-experienced nurses, according to the article, tend to leave their countries in search of opportunities to apply their recently acquired skills while senior nurses leave in the hope of landing better professional careers.

Need for better health human resources policies

"That is why we insist that it is not enough to keep on training healthcare professionals," says Lorenzo. It is equally important to prepare the environment where these professionals would find themselves eventually after they graduate. "I believe we should not train beyond the country's absorptive capacity in terms of labor because when we do we also diminish the value of the people we train."

Government alone should not be solely faulted either. "If we look at the state of healthcare in the Philippines a great part of it is private-led," says Lorenzo. The inadequacy of the government in the past may have largely been the cause of the country's healthcare woes but the lack of coordination between private and public efforts in recent years has also contributed to these problems.

"Consider health education, for example. Why do we have so many nurses and such a severe shortage in dentists? It is because the private sector has virtually taken over education in the health sciences." Things are very different in, say, Malaysia, notes Lorenzo, where higher education decisions are made in close coordination with state policies. This way, they can be sure that the universities train only as much as the market demands.

To be fair, the government, through the Department of Health (DOH), did come up with a 30-year human resource master plan which maps out the migration, retention, and the career patterns of professionals in the healthcare sector. The plan was conceived during former DOH Secretary Manuel Dayrit's term and had the Institute of Health Policy and Development Studies-National Institutes of Health (IHPDS-NIH of UP Manila) among the committees tasked to prepare the draft. Earlier, when Senator Juan Flavier was still secretary of health, he institutionalized the Doctors to the Barrio program which became the model for subsequent rural integration and placement programs for medical doctors.

But while there are programs, delivery and implementation are an altogether different story. This is largely due to the fact that agencies are not working in coordination with one another. According to Lorenzo, "Even if the DOH says we need this many doctors as long as the DBM [Department of Budget] does not release the budget, what can we do? Clearly, there is need for the various agencies to get their acts together."

What UP can do

Ultimately, the inequitable distribution of health professionals is just part of larger socio-political deficiencies that manifest themselves in the culture of clientilism, red tape, and poor institutional capacity. To say that improved salaries and working conditions are the strategies to attract personnel to remote areas and get them to stay is valid. However, it may be too simplistic because the problems of low salaries and bad working conditions have their roots in complex organizational and social problems that must be tackled simultaneously. The focus is currently on the healthcare issue, according to Lorenzo, only because at present there is a huge demand for cheaper human resources in health, especially in the developed countries. However, the human resources issues confronting the health sector equally apply to other industries.

Needless to say, there is a need for the University to be more proactive not just in influencing society but in influencing the crafting of policies. "I think the University should go beyond job fairs and get itself involved in coming up with placement programs, networking, and forging partnerships with the public and private sector to leverage jobs," Lorenzo says. She likens the role of the University to a farmer who must first prepare the soil before casting the seeds to ensure they will sprout.

Lorenzo cites the example of Singapore and Malaysia where universities not only serve as potent change agents but literally assume a more active role in the introduction and distribution of various commercial products developed in their research laboratories. The portable diagnostic tool kits for dengue, avian influenza, and malaria produced by Veredus Laboratories in Singapore are notable examples. The kits are based on patented breakthrough technologies developed by researchers from the National University of Singapore and the Institute of Molecular and Cell Biology.

Currently, Singapore is fast emerging as a global powerhouse in the biomedical sciences industry, attracting the investments of the top pharmaceutical and biotechnology companies and creating stable employment opportunities for new graduates.

"If they were able to do it, I do not see any reason why we cannot," Lorenzo says.

Notes

1 http://www.ops.gov.ph/news/archives2005/nov23.htm#Medical

2Gloria Esguerra Melencio. (2008, April 3). Oversupply of nurses plagues RP. Inquirer Global Nation. http://globalnation.inquirer.net/news/breakingnews/view/20080403-128210/Oversupply-of-nurses-plagues-RP (accessed Nov. 13, 2009).