Medical tourism, BPOs won't stop brain drain of doctors, nurses
| 08/26/2008 2:43 AM
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The exodus of Filipino health professionals in search for better employment opportunities in other countries also leaves behind problems in helping the country meet its health care needs.
“As more Filipino health professionals migrate to developed countries, we lose the most educated, the most skilled, the ones with the highest potential to improve the health of the country,” said Dr. Mary Ann Evangelista, a public health expert of the GTZ, Germany's international cooperation agency.
Evangelista spoke on "Migration of Health Professionals as Opportunity for Improving the Philippine Health System," at the 8th International Conference on Philippine Studies held last month in Quezon City.
Based on Philippine Overseas and Employment Administration (POEA) data, she said that about 28,000 health professionals left the country to work abroad between 2004 and 2006.
She noted that doctors who have trained as nurses were among those who left the country for work abroad.
It would be good to see some of these medical professionals return to the country, but this has yet to happen.
“The volume of returnees is relatively small compared to the outflow of professionals,” she said.
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| Courtesy of Dr. Mary Anne Evangelista, German Technical Cooperation (GTZ) Health Program |
Pull, push factors
In her study, Evangelista named two factors that potentially drive professionals from leaving the country. She calls thse the “push” and “pull” factors.
Evangelista said there are two kinds of pull factors in this kind of migration—the actual money earned and the better lifestyle abroad.
She, meanwhile, cited lack of local opportunities and the frustration with the political situation in the country as the push factor in the migration of Filipino doctors and nurses.
There is also a huge discrepancy in the salaries of nurses in the Philippines and those who work abroad.
“In the Philippines, you will start from a very low minimum monthly salary unlike if you work in the US or in the UK,” she said, adding that even a doctor earns much less than what a nurse gets in the UK or US.
Migration, as a lifestyle upgrade
Most Filipino nurses and doctors opted to stay in their host countries because of the chance to improve their living conditions. These health professionals have better living and working environments abroad.
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| Courtesy of Dr. Mary Anne Evangelista, German Technical Cooperation (GTZ) Health Program |
“Some of them even gained the opportunity to bring their immediate families to the countries where they worked. Children get the opportunity to be educated in a developed country, and consequently, become a member of a society with better opportunities for growth than in the Philippines,” she said.
Poor people from rural and urban areas who need medical attention are the ones who suffer from the woes due to the hemorrhaging of health experts to other countries.
“It is what the common Juana would endure when she has to cue for hours at the nearest health center in order to have her youngest child vaccinated because not enough health staff is available,” she said.
The migration of health professionals “consequently drained medical and paramedical staff for municipal and barangay health centers.”
No change in policy
Since the seventies, exporting manpower to other countries has been the “main survival tactic” of the country to address the “suffering economy and from a large deficit plagued by massive foreign borrowing.”
“With the billions of dollars in remittances saving the economy from collapse, the government does not have the temerity to reverse the practice of manpower export,” said Evangelista.
Instead of reversing the policy, Evangelista noted that the government has further encouraged it to the point of even changing the label of migrating labor from OCW (overseas contract worker), to OFW (overseas Filipino worker), to Bagong Bayani, Global Pinoy, and then to overseas Filipino investors.
There is still no concrete policy response crafted to mitigate the exodus even when there is already a dramatic increase in labor migration of health professionals and the revelation that many doctors are going back to school for nurse training to gain employment abroad.
“So the brain drain dilemma has been taken in stride, seen only as a chronic problem to which there is no known solution,” she lamented.
The Philippine Nursing Association (PNA), in an earlier report, has been pushing for the implementation of the Nursing Law or the Republic Act 9173. PNA National President Dr. Leah Samaco-Paquiz said that since 2002, RA 9173 provides that salaries of nurses should have been not lower than salary grade 15.
A nurse in the government should be receiving a monthly salary of P16,093.00 but some are still being paid lower than P10,000 monthly income, the PNA said.
Unfortunately, Paquiz stated that six years after the enactment of the law, nurses remain underpaid in the country.
Paquiz asserted that many nurses are not intending to go abroad and would love to serve, but are discouraged by the very low salary they are getting from the workload given to them.
A husband of one of the nurses who passed the exams last year said that his wife is still jobless. The wife was offered a job in a hospital in Pasig City but turned it down after learning that she was going to be paid P150/day for 10 hours, six days a week.
“Lugi ka na patay ka pa sa pagod,” said the husband. The nursing licensure examinations produced 37,030 nurses in 2006 and 31,275 nurses in 2007.
Evangelista believes that this holds true for the hesitation of many health professionals to stay and work in the country, saying it “seemed to stem from the inability of the government to match the salaries offered by hospitals, clinics and centers abroad.
BPOs, medical tourism
One strategy being eyed by government to stem the outflow of medical professionals is by creating jobs in medical tourism and medical transcription. But it’s not likely to work.
“The strategy to mitigate brain drain then is to bring foreign money to the country,” said Evangelista.
The BPO, she said, is mainly for medical translation and transcription and has opened doors for many Filipinos to join the call center industry. However, its very nature limits the type of professionals who can and will choose to stay in the industry.
“Medical translation and medical transcription is not likely to be exciting enough for a person whose passion is actually heart surgery,” she said.
Medical tourism is another government strategy with the goal of catching up with Malaysia, Thailand and Singapore-led markets in specialized surgical and cosmetic surgery and rehabilitation care.
In fact, administration of President Arroyo wants to make the Philippines a hub for medical tourism in the region “to compete for the estimated US$188-B that will be spent on the industry worldwide by 2013. The government has reportedly had initial talks with countries like Russia, Romania, Poland, Italy and France on medical tourism services.
This early, some big private and public centers are said to be investing on infrastructures and securing the expenses for the technology.
As its success is anchored not only on infrastructures and technology, the need for people who are experts in such fields are already dwindling in number because of the migration phenomenon.
“The government’s response to the exodus is to mass produce doctors and nurses with the distorted hope that mere numbers will replace the quality lost,” explained Evangelista.
Recently, a scandal had placed the Philippine health sector in bad light after a surgery done in the province was uploaded in YouTube that showed medical staff making fun of the patient who had a canister removed from his rectum.
“This could spell doom to a country aiming to build confidence for medical tourism,” she said.
Quality vs quantity
She reiterated that mere numbers will not compensate for quality. The quality of nursing education is declining and has affected the chances of many Filipino nurses from being hired.
The issue of quality of education was also questioned in the wake of the cheating scandal during the nursing board exam.
Another incident that enraged the public was the remark in an episode of Desperate Housewives where one of its main characters Terry Thatcher demanded to see the credentials of a doctor to find out if he came from a diploma mill in a Philippine medical school.
“What has remained unresolved is the issue of medical quality and health service. What we failed to acknowledge in that Desperate Housewives episode was the hint of truth in that statement, and that a proportion of these so-called professionals educated and trained in the Philippines may not be as competent as we hope they would be,” Evangelista said.
She pointed out that as the episode criticized the Philippine health system, it also underscores the need to improve the quality of medical education and to offer better working conditions for skilled professionals.
“The government should be asking itself if remittances compensate enough for the loss of the best trained professionals in the health system, bearing in mind that these individuals often ends up settling abroad and consequently had no reason to send money back to the Philippines,” she said.
Brain gain
Evangelista said that the government must create concrete policies to draw experts back or even make local employment as attractive as those offered abroad.
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| Courtesy of Dr. Mary Anne Evangelista, German Technical Cooperation (GTZ) Health Program |
“An example of such programs includes the Balikbayan program of the Marcos regime. A new idea would be the returning experts program of the Center for International Migration and Development and programs like those in India that has resulted in what they call a brain gain,” she said.
She also cited the experiences of other countries in drawing back their experts. She said the German government’s returning experts program recognizes that returning experts can effectively contribute to economic, technological and social development with the use of professional skills acquired abroad.
Other good examples include lessons learned by India when they hurdle brain drain in the 60s and 70s and turned it into brain gain in the 90s, as well as the experience of Spain in the 60s in leading back its expatriate manpower.
“The Philippines needs to develop a national program that will not only invite Filipinos abroad to come home occasionally and render a few medical missions but to entice them to stay on and actually work in the country,” said Evangelista.
HB 4580
Recently, Negros Occidental Rep. Ignacio Arroyo filed a bill that would hopefully address the problem of brain drain in the country.
House Bill 4580 (Mandatory Two-Year Domestic Service For All Filipino Registered Professional Act) states that professionals must render two year’s of service in the country before they are allowed to leave.
Professions covered by the bill are doctors, nurses, pharmacists, midwives, medical technologists, physical therapists, engineers, teachers, sailors, accountants, interior designers, nutritionists, criminologists, librarians, guidance counselors, and master plumbers.
The filing of the bill earned the ire of the Trade Union Congress of the Philippines (TUCP), which claimed it as unconstitutional, as well as the UP College of Medicine.
For Evangelista, the issue of economics will always be present in any discussion about migration of Philippine health experts.
“If the country keeps on losing the best, the brightest, the most talented, the most skilled, it has to confront the prospect of a good predominantly mediocre manpower whether in the service or in the teaching sector of the profession,” she said adding that “the best would be largely limited to imperial Manila and the situation in the countryside, bad as it is already, would only become worse.”
