Sapping Philippines' Health Care System

  1. Interesting Article and Perspective:

    http://news.ncmonline.com/news/view_...0b844e81e019d7


    Hiring of Nurses by U.S. and U.K. Saps Philippines' Health Care System
    Filipinas Magazine, Investigative Report,
    Booma Cruz, May 17, 2004

    The shortage of nurses in the U.S. and the U.K. has triggered an exodus, putting the Philippines' health care system on the verge of collapse.

    Dr. Jaime Galvez-Tan, vice chancellor for research at the University of the Philippines in Manila and executive director of the National Institutes of Health Philippines, is alarmed.

    Researching on the phenomenon of Filipino doctors taking up nursing courses to land jobs abroad, Tan discovered five hospitals in Mindanao that have no nurses and doctors.

    "Only midwives are running the operations. I saw that in Sulu, Lanao del Sur, Zamboanga del Sur and two other areas in Mindanao. They cannot close the hospitals because it will give the wrong signal," says Tan, a former health undersecretary during the Ramos administration.

    To Tan, what he saw in Mindanao was a clear indication that the health care system in the island, once referred to as the land of promise, is on the verge of collapse. "It's all a matter of time. Maybe in five years--first in Mindanao and then Manila," Tan predicts with much trepidation.

    Tan cites the case of a friend's relative who was brought to a private hospital in Metro Manila. "The patient was standing before he was confined in the hospital, had bedsores and then died. Any way you look at it, that's poor health care," he says.

    Tan attributes a big part of the problem to the exodus of experienced nurses to better-paying jobs abroad.

    "The ideal nurse to patient ratio is 1:20 for the ward. Now, it is 1:40 or 1:60. This is true even with big hospitals. At Philippine General Hospital, they used to get only those from the top 10. Now, their grades are 75 percent or 80 percent simply because of the shortage," he says.

    The problem is aggravated by the growing number of doctors who are turning to the nursing profession.

    Tan says the number of doctors switching to the nursing profession is increasing rapidly over time, from 2,000 three years ago to 3,000 last year and an estimated 4,000 new doctor-turned-nurses this year.

    "What we have is not just brain drain; it is brain hemorrhage of our nurses and doctors," he says.

    Fall-back Options

    Mia and Beng (not their real names) are among the batch of doctors who finished nursing this year. Both are looking at nursing as fall-back career options.

    Busy with their own professions, the two doctors attended nursing classes every Saturday and Sunday in a rented place in Metro Manila for one year. In their class of 200 students, at least 150 were doctors. They requested that the name of their nursing school be withheld.

    Mia earns an average of P70,000 to P100,000 ($1,250 to $1,785.71) a month as an anesthesiologist while her husband makes a little more as an obstetrician. She wants to leave the country because of a sense of despair.

    "My husband and I feel things will not change for the better here in the Philippines. The problem is not just with the government but with the people themselves. To each his own. Now there is FPJ; and the masa, I don't want to degrade them but, they are pulling all of us to the gutter. Even if FPJ doesn't win I don't think change is possible in our lifetime," says Mia, a forty-something mother of three kids.

    Beng belongs to the same nursing class as Mia. A nephrologist in a government hospital, Beng makes as much money as Mia, sometimes even more because she earns extra from clients in dialysis centers. Like her classmate, Beng plans to leave for the United States and work as a nurse because of a sense of helplessness.

    "I want to leave not only because of the government but because of the old doctors. Old doctors tend to exclude other doctors from the practice just because you don't come from a family of doctors. They do not welcome young blood. I don't see any future in this atmosphere," says the 43-year-old Beng, who is the only doctor in her family.

    Beng says the shift to nursing should not be a problem for her. "We do some of the things nurses do except perhaps the dirty job like scrubbing patients. We actually do more than just give medicines. When you are a government doctor even buying medicines for your patients becomes part of your job sometimes," she adds.

    Friends in the United States, who are doctor-turned-nurses like her, have already found a job for Beng. "It's really just a matter of time for me. I want to test the waters right away," she says, a few days before her graduation.

    Favored Destination

    Statistics from the Philippine Overseas Employment Administration (POEA) show that 9,086 nurses left the country last year. More than half of the hired nurses went to Saudi Arabia (5,996). The next most favored destination was the United Kingdom with 1,544 hires. The previous year, 12,335 nurses were deployed abroad with Saudi Arabia and the United Kingdom accounting for three-fourths of the manpower importation.

    The United States, which has been experiencing an acute shortage of nurses that is expected to last at least until 2010, has recruited only 197 nurses last year according to POEA figures. But this is grossly underreported.

    "One time, over 15,000 nurses left for the U.S. but the POEA reported only 304," recalls Tan.

    Based on the statements of their respective governments, the United States would need at least 10,000 nurses a year, while the United Kingdom, Ireland and other Europen countries would need the same number a year.

    POEA Administrator Rosalinda Baldoz says the POEA figures are not impressive because of the long wait nurses have to endure in fulfilling work requirements such as passing competitive examinations and applying for visas.

    She also acknowledges that many nurses working overseas do not pass through the POEA. Those already working abroad and hired directly by hospitals in other countries are not processed by the POEA. The same is true with Filipino nurses who go to the United States on an immigrant visa.

    No fewer than 700,000 Filipino workers leave the country to work abroad every year. They shell out more than P2,000 each for various processing fees charged by different government agencies.

    But more than individual minimal fees that collectively run up to millions, it is the yearly remittances of overseas Filipino workers (OFWs) that shore up the Philippine economy.

    For 2004 alone, the Bangko Sentral ng Pilipinas (BSP) expects OFW remittances to hit $8 billion--inflows that account for nearly 85 percent of the country's gross earnings. This excludes an estimated $5 billion OFW remittances that pass through informal channels like couriers and moneychangers not booked by the government. OFWs pay an average of $5 for every $100 they send home through banks and couriers.

    The BSP is counting on higher remittances this year with the deployment of more nurses and other workers to higher paying jobs to make up for the slowdown in foreign direct investments and sluggish exports.

    "The remittances that they send have a multiplier effect. There should also be technology transfer, but the problem here is that we don't have modern equipment. So even if our nurses are trained to use high tech equipment abroad, this acquired knowledge becomes useless when they come back because we don't have those push buttons," says Baldoz.

    Push Factors

    Instead of "push buttons," what nurses in the country see are push factors that encourage them to seek greener pastures.

    "When you look at reality here, the salary is low. Graduates can't find work so there are limited options like applying for jobs that do not match their skills or settling for low paychecks," admits Baldoz.

    Nurses in the country make P8,500 to P10,000 ($151 to $180) monthly.

    The rate goes down in rural areas where some nurses received only P3,500 ($63) a month.

    Republic Act 9173 pegs the minimum basic pay of nurses in public health and institution at P13,300 ($2,396). This is why nurses working in government hospitals earn more than those in private hospitals.

    When compared to the monthly package of their colleagues abroad, local nurses' take home pay is loose change.

    Romeo Poblete, a nurse at the St. Joseph Health System in California, wanted to break free from the oppressive work conditions in the government hospital he used to work for in the Philippines. Together with his wife, he left the country in June last year after passing the required examinations and securing an employment visa. Now a proud owner of a brand new car, Poblete can only say that he should have left the Philippines much earlier.

    With an hourly rate of $21 to $25 on a 12-hour shift three times a day and a second job, he was able to save and invest on so many things in less than a year.

    "A new car is downright impossible to own back home. I was also able to purchase a digital camera, my own PC and a TV. So far, we do not have plans to go back to the Philippines. We might visit but staying there for good is definitely out of the question," says Poblete.

    Beth Villaseor, manager of Saint Joseph's Hospital Perianesthesia and Radiology Nursing, went to the United States in 1978 to see how she would fare. She planned to stay for only a year but liked what she saw and decided to stay for good.

    "The patient load is lighter compared to home. There is advanced technology, good working conditions, constant training, permanent shift of your choice (unlike in the Philippines where there is rotation), recognition and a very decent pay," she says.

    According to Villaseor, nurses are paid from $20 to more than $50 per hour, depending on the state, the type of nursing and shift they work. Hospitals are even competing in giving the highest bonus to recruit nurses, she adds.

    The amounts range from $2,000 to $10,000, depending on the area. Some hospitals are reportedly willing to petition for permanent status for their valued recruits.

    U.K. and Ireland Magnets

    Equally attractive is the package offered to nurses working in the United Kingdom and Ireland.

    Bond Worldwide Inc., a representative of O'Grady Peyton International, the number one international nurse placement agency, guarantees registered nurses a two-year contract with a 1,200 to 1,400 pounds monthly salary, excluding overtime and holiday pay which can jack up take home pay to 1,600 to 1,800 pounds.

    All nurses bound for the United Kingdom and Ireland are required to first undergo a three to six-month adaptation period during which they are paid 1,000 pounds.

    "The adaptation period is supposed to be an adjustment period to the British system. In the last five years that we have been sending nurses to the United Kingdom only one failed the adaptation period. She was absorbed by a caregiver center," says Carmela Azurin, president and CEO of Bond Worldwide Inc.

    A retired nurse, Azurin says Filipina nurses in the United Kingdom are treated very well and are able to save a lot of money despite the high standard of living in Europe.

    "Their only problem there is housing but most of them share an apartment. One of our recruits now drives a Mercedes Benz; another owns a Rolls Royce.

    Another one is able to send her mother as much as 1,000 pounds a month. Compare that to what they used to earn as nurses in the province--P3,500," she says.

    As an added come-on, nurses working in the United Kingdom can bring their spouses who are allowed to work on the strength of their wife or husband's work permit. A five-year continuous service record in the United Kingdom is enough for a nurse to secure a resident visa. But unlike in the United States, foreign nurses cannot apply for citizenship or immigrant status.

    Bond Worldwide does not charge any fees from applicants because the United Kingdom and Ireland have banned the collection of placement fees. Bond even pays for the expensive NCLEX examination that nurses applying for jobs in the United States take in Saipan, Guam.

    In the absence of recruitment fees, hospitals pay recruiters for every nurse that they hire. At the height of the demand for nurses in Europe, Oxford Radcliffe University Hospital and University of Birmingham Hospital paid as much as 2,000 pounds per recruited nurse.

    "From 1999 to 2002, sometimes I had three U.K. hospitals requesting at the same time for 40 to 70 nurses with two to three years experience. And they wanted it in two months. We were able to send 3,000 nurses during that time.

    But by the last quarter of 2002, they were no longer desperate. Either they have solved the crisis or stabilized," says Azurin.

    With the supposed tapering of the demand, the price per recruited nurse has also taken a nosedive. Bond Worldwide is currently paid 1,000 pounds for every nurse it deploys to the United Kingdom and Ireland.

    On the lookout for recruits, Azurin says there is also a shortage of experienced nurses in the Philippines. She now goes to Singapore and as far as Dubai to scout for Filipina nurses interested in job placements in the United Kingdom.

    "Hospitals now want nurses with overseas experience so I go to Singapore, sometimes to Dubai, to look for Filipina nurses there. It's easier to recruit from Singapore," says Azurin.

    Deteriorating Quality

    Azurin says the quality of nurses has deteriorated over the years not only due to the exodus of experienced hands but more because of the low quality of nursing schools in the country.

    "There is a deluge of nursing schools here. I'm just waiting for McDonald's to open one," she says.

    The high demand for nurses in the late 1990's resulted in the mushrooming of nursing schools from 40 in the middle 1990s to 233 last year. Tan says his latest count is 257.

    "Yes, enrollment has grown by leaps and bounds. Schools are bursting at the seams but what is the quality of our nursing schools? How many students to a class? Do these schools have qualified teachers? How about laboratories?" asks Tan.

    The results of the licensure examinations support Tan's concern. The percentage of those who pass the examinations have dipped over the years.

    Statistics from the Philippine Regulatory Commission (PRC) show that 57 percent of those who took the licensure tests in 1994 to 1998 made the grade. In 2001, only 52.58 percent passed; the following year, 2002, only 43.6 percent of the examinees made it.

    Of the 223 nursing schools in 2002, 136 schools posted a passing rate of below 50 percent. Graduates from 39 schools failed the licensure exams.

    Not one nursing school has been closed by the Commission on Higher Education (CHED). The CHED could only order the closure of a school if it posted a low 3 percent to 5 percent passing rate in five consecutive examinations.

    Nursing schools make a killing out of the high demand for nurses abroad. Tan estimates the cost of nursing education is $4,000 to $7,000. The amount does not include the review classes which nursing schools give before the licensure exams.

    "When you look at PRC, there are enough nurses. What we don't have are specialized nurses. Our schools are just trying to respond to the demand abroad so they just produce nurses without specialization. What we must do is replenish the supply of nurses who leave the country," says Baldoz.

    But Baldoz stresses that the government cannot address the problem alone.

    "All stakeholders should work out a mechanism so we can upgrade the quality of our nurses. The private sector should upgrade salaries. We are thinking of a development fund where host countries invest and share in the production and training of nurses," she says.

    But even a development fund is no guarantee that the Philippines will cease to be a poaching ground.

    "When countries open its borders because of shortage of skills, you cannot stop people from leaving," Baldoz admits.

    Like so many complex and interrelated concerns, stopping the exodus of nurses is almost wishful thinking. Hospitals cannot afford to compete with the salary package their foreign counterparts offer. The government cannot open job opportunities for fresh nursing graduates because of its limited budget.

    The high demand for nurses abroad will always lure Filipinos out of the country.

    In the end, only an improved economy can manage the outflow of medical professionals and stop the collapse of the country's health care system.

    Booma Cruz is a supervising producer/editorial consultant of the magazine's "Probe Team." She is also a regular contributor of Newsbreak magazine. Prior to this, she was associate editor of Manila Times and managing editor of Pinoy Times.
    •  
  2. 38 Comments

  3. by   MellowOne
    Actually, we're hardly sapping their health care system, unless you consider bringing the nurses who are forced to work as unpaid volunteers while waiting for a paid position to open to a paid position in the US to be sapping their system.

    Quality may be a concern, but my own hospital has recruited from the Phillapines, and every nurse that I've worked with has been clinically curious as well as sound, and very interested in improving their skills and knowledge base.

    This article does raise many issues, but I'm more than happy to have my Phillipino colleagues working beside me.

    Be well...

    The Mellow One
  4. by   deathnurse
    Always a pleasure to work with.
    Last edit by Nurse Ratched on Jun 22, '04 : Reason: tasteless title
  5. by   Farkinott
    This is a very interesting article. Thanks for posting it. It seems somewhat ironic that nurses from the Phillipines come to western countries like Oz to make a better living and choose to reside their permanently, and nurses from Oz go to places like Saudi and the arab Emirates for the money! The main difference being of course that Oz nurses use the money to travel or to come home and whack off a big slice of the mortgage!
  6. by   Rep
    Quote from Farkinott
    This is a very interesting article. Thanks for posting it. It seems somewhat ironic that nurses from the Phillipines come to western countries like Oz to make a better living and choose to reside their permanently, and nurses from Oz go to places like Saudi and the arab Emirates for the money! The main difference being of course that Oz nurses use the money to travel or to come home and whack off a big slice of the mortgage!

    The truth is that nurses from western countries are paid higher in Saudi Arabia than their counterparts from the Philippines. There is a discrimination on this aspect. Also, everything is free which includes food allowances, lodging, etc. And no taxes.

    My friends said that if one has to make money, it is better to work in the middle east because of the benefits unlike in western countries where one has to pay her/his bills which include food, apartment rental and also taxes.
  7. by   nightingale
    Last I heard, in Saudi, there is a stipend for food and allowance but not all expenses are covered (just like a Travel Nursing Contract). I have also been told, if you are overseas for a year (without a break... ugh) you will get a break on taxes.

    I value my head, and my quality of life too much to consider leaving my homeland for such a dangerous and stressfull environment.

    Back to the subject matter of Philippine Nurses Leaving Their Homeland for a Different Life: their choices are made for many reasons. I wonder what enspires them to make these choices and how happy are they truly once they have left all that is familiar to them?
  8. by   Rep
    Quote from nightngale1998
    Last I heard, in Saudi, there is a stipend for food and allowance but not all expenses are covered (just like a Travel Nursing Contract). I have also been told, if you are overseas for a year (without a break... ugh) you will get a break on taxes.

    I value my head, and my quality of life too much to consider leaving my homeland for such a dangerous and stressfull environment.

    Back to the subject matter of Philippine Nurses Leaving Their Homeland for a Different Life: their choices are made for many reasons. I wonder what enspires them to make these choices and how happy are they truly once they have left all that is familiar to them?
    This is from my cousin who is working as a nurse in Saudi Arabia. She has a two year contract. A stipend for food and lodging. Fix workling hours and no overtime. Plus round trip ticket between Philippines and Saudi. Also, the Saudi government do not tax its foreign workers. Neither do our government.

    As for the subject why Filipino overseas workers which includes the nurses leave the country to work abroad is because of financial reason. As a nurse here, you will earn only $100 a month considering that one has to spent $6000 to $7000 in a 4 years nursing education. By working on other countries, one can earn much and help his/her families back home.

    You are right that you value your life and not working in an unfamiliar stressful environment. But to most us, what choice do we have. How I wish most filipinos nurses will stay at home but that is the reality we are facing here now. And I know I will surely be one of them in the near future.

    Hope this info will help. Have a great day! :
  9. by   elnski
    If the nursing profession is respected and recognized fairly in the Philippines that the government will look after givng us a decent salary, enough for me to live a decent life, with what i can call proper living, a reasonable nurse-patient ratio, up to date nursing/medical facilities in each hospital and a chance for continuous professional updates and training, i'd definitely stay and ask no more.. Genuine happiness is a state of the mind's content. When you have become conscious and aware of the needs - for you and your loved ones - that is the familiar lyf for me. Our orientation of happiness will always be different from the non-third world countries... our situation and choice are unique.. if we happen to affect you countries w/ our presence, pardones, but we have to thrive.. SOmehow, I may be out of my country, but i will stay brown and down..
  10. by   lee1
    If their is such a "brain drain" then the numbers of medical prepared people leaving should be limited. If the USA need to send money to this country to help defray it's medical problems then the numbers of immigrants should be limited. If you have NO national pride to do something for your own country isn't that a problem??? IS it ALL about the money??? Working conditions for nurses around the globe are impaired because it has been tooooooo easy for certain countries to get immigrant nurses IMO.
  11. by   afhroends
    Quote from lee1
    If their is such a "brain drain" then the numbers of medical prepared people leaving should be limited. If the USA need to send money to this country to help defray it's medical problems then the numbers of immigrants should be limited. If you have NO national pride to do something for your own country isn't that a problem??? IS it ALL about the money??? Working conditions for nurses around the globe are impaired because it has been tooooooo easy for certain countries to get immigrant nurses IMO.
    You have absolutely no right to talk to us Filipinos about national pride. If your concern is to limit the number of immigrants in this country, talk or stalk your president, your legislators for all I care. Until then, we will be legally doing what is best for ourselves and our families.
  12. by   Rep
    Quote from afhroends
    You have absolutely no right to talk to us Filipinos about national pride. If your concern is to limit the number of immigrants in this country, talk or stalk your president, your legislators for all I care. Until then, we will be legally doing what is best for ourselves and our families.
    You are right. USA is a nation of immigrants. Surely nobody saying then to the ancestor of the Americans about national pride when they left their countries and immigrate to the USA.

    Nobody can stop people from achieving their dreams through the American way.
  13. by   jonRNMD
    Quote from lee1
    If you have NO national pride to do something for your own country isn't that a problem??? IS it ALL about the money??? Working conditions for nurses around the globe are impaired because it has been tooooooo easy for certain countries to get immigrant nurses IMO.
    Lee1, if not because of the thousands of my fellow Filipinos working in the US, the US healthcare system would have collapsed a couple of years ago.

    both the US and the philippines have benefitted from migration. Migration is what made the US a great nation as it is. the best minds/brains from rich and poor nations contributed to the greatnesss of America. dont you forget that
  14. by   lindarn
    Quote from jonRNMD
    Lee1, if not because of the thousands of my fellow Filipinos working in the US, the US healthcare system would have collapsed a couple of years ago.

    both the US and the philippines have benefitted from migration. Migration is what made the US a great nation as it is. the best minds/brains from rich and poor nations contributed to the greatnesss of America. dont you forget that
    How would the US Healthcare system have collapsed? There are 500, 000 American nurses who are not working in nursing because of poor workng conditions, and sub standard wages.

    What really should/would have happened, is that American hospitals would have been forced to work on retention, instead of recruitment, increase the wages, working conditions, and benefits to American nurses, who would have not left bedside nursing en masse, as conditions/pay have deteriorated. Unfortunately, by having the option to bring in foreign nurses to fill in the staffing gaps, there has been no incentive for hospitals to correct these conditions. An overabundance of foreign nurses willing to come to the US and work for the lowest possible legal wage that can be offered, has also lowered the pay, benefits, and working conditions here.

    I have nothing agaist foreign nurses, but until pay, benefits, and working conditions are brought up to where they shoud be, there should not be the option to being in foreign nurses to give the hospitals the out, and foreign nurses should stay home and work on improving conditions in their own country. JMHO and $0.02.

    Lindarn, RN, BSN, CCRN
    Spokane, Washington

close