ahwmigration of nurses

8/3/2019 AHWMigration of Nurses

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Migration of Filipino Nurses &Migration of Filipino Nurses &

Other Health ProfessionalsOther Health Professionals

Alliance of Health WorkersAlliance of Health Workers


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Migration of Filipino Nurses &Migration of Filipino Nurses &Other Health ProfessionalsOther Health Professionals

IntroductionIntroduction

Brief History of Filipino MigrationBrief History of Filipino Migration Philippine Health Situation At a GlancePhilippine Health Situation At a Glance

Migration of Filipino Nurses and OtherMigration of Filipino Nurses and OtherHealth ProfessionalsHealth Professionals

Proposed Action & ChallengesProposed Action & Challenges


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Brief HistoryBrief History

of Filipino Migrationof Filipino Migration


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Philippine Migration HistoryPhilippine Migration History

1565-1815 Galleon Trade

Post WW II

1906-1934 US Colony

1974 - LEP

Shipbuildersand seafarers

Pearl Divers

PropagandistaPlantationWorkers

Pensionados

Sacadas 46

Professionals

Mil. BasePersonnel

Wives andchildren

Contracted Labor


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Migration Before the LEPMigration Before the LEP

1417 - China

1565-1815Galleon Trade

1900

AmericanOccupation

(1903) Pencionados

at (1906) HSPA

(1930) Great Depression

(1935) US Repatriation Act

(1935) Tydings-McDuffie Law

(1946) Post WWII

(1965) Immigration andNationality Act


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Labor Export ProgramLabor Export Program

0

200000

400000

600000

800000

1000000

1200000

1 2 3 4 5 6 7 8 9 10 11 12

Series1

Series2

Deployment 1995-2006


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PrePre--LEP MigrationLEP MigrationFilipino Immigrants Admitted to the U.S. (1965Filipino Immigrants Admitted to the U.S. (1965--1973)1973)

19651965 19661966 19671967 19691969 19711971 19731973

3,1303,130 6,0936,093 10,86510,865 20,75520,755 28,47128,471 30,79930,799

NOTE: Majority are wives and children followed by professionals.NOTE: Majority are wives and children followed by professionals.

OFWs = 16,290 (Jan-June1975

6.72 2.57

5.24

2.27

21.32

61.88

services

construction

production

managerial

professional

aircraft, transport,comm

OCWs = 5,964 (Jan-June1975)

18.04

6.15

14.32

1.93

54.83

2.2

2.53

services

construction

production

managerial

professional

aircraft,

transpo, comm

clerical


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1974 Labor Code of the Philippines1974 Labor Code of the Philippines

Ministry of Labor

OEDBOverseas Employment

Development Board

BESBureau of Employment

Services

NSBNational Seamans

Board

OEAOffice of Emigrant

Affairs


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Historical Significance of LEPHistorical Significance of LEP

PrePre--LEPLEP Bugso ang mga period ngBugso ang mga period ng

migrasyon na maymigrasyon na maypaghupa sa mga pagitanpaghupa sa mga pagitannito.nito.

Direktang nakabatay saDirektang nakabatay sadikta at pangangailangandikta at pangangailanganng nangongolonyangng nangongolonyangpamahalaan.pamahalaan.

Hindi laganap atHindi laganap atsistematiko angsistematiko ang

recruitment.recruitment. Mga immigrant workersMga immigrant workers Pangunguna ng privatePangunguna ng private

recruitment agencies sarecruitment agencies saoverseas employmentoverseas employmentbefore 1974.before 1974.

LEPLEP 19741974 TuloyTuloy--tuloy na paglaki attuloy na paglaki at

walang patid nawalang patid nadeployment.deployment.

Pagmonopolisa ng govt saPagmonopolisa ng govt sa

recruitment at deployment.recruitment at deployment. Strategic labor marketingStrategic labor marketing

abroad at nationwide laborabroad at nationwide laborregistry.registry.

Pledge/mandatoryPledge/mandatoryremittances.remittances.

State exactions.State exactions. Contracted workersContracted workers refugees and politicalrefugees and political

asylum seekers.asylum seekers.


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Labor Export ProgramLabor Export Program

Aggressive Labor MarketingAggressive Labor Marketing

Manpower PoolingManpower PoolingPricing (recruitment expenses &Pricing (recruitment expenses &

salary range)salary range)

State ExactionsState ExactionsRemittance SchemeRemittance Scheme


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Difference of Normal Migration FlowDifference of Normal Migration Flow

and the LEP Nowand the LEP Now

Galleon TradeSacadas&pensionados

Post-WW II

1974-5,964

ocws

2007-

8-10.MOFWs


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Philippine Health SituationPhilippine Health SituationAt A GlanceAt A Glance


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At A Glance: Philippine HealthAt A Glance: Philippine Health

SituationSituation50% of the population50% of the population

has no health carehas no health careaccess.access.

7 out of 10 Filipinos7 out of 10 Filipinosdie without gettingdie without gettingany medical attention.any medical attention.

Only 60% of theOnly 60% of thepopulation has fullpopulation has fullaccess to essentialaccess to essentialdrugs.drugs.

(AHW 2004, CHD 2004, NIH 2005)(AHW 2004, CHD 2004, NIH 2005)


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10 mothers die daily due10 mothers die daily dueto pregnancyto pregnancy-- andandchildbirthchildbirth--related causes.related causes.

The average hospital billThe average hospital billis three times theis three times theaverage monthly income.average monthly income.

23.4 M Filipinos still do23.4 M Filipinos still do

not have access tonot have access totoilets. CBHP experiencetoilets. CBHP experiencewould double this figure.would double this figure.

(AHW 2004, CHD 2004, NIH 2005)(AHW 2004, CHD 2004, NIH 2005)

At A Glance:At A Glance:

Philippine Health SituationPhilippine Health Situation


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1965 1970 1975 1980 1985 1990 1995 2000 2002

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Percen

t

Year

Death by Attendance in 5-year Intervals, Philippines 1965-2002

Unattended

Attended

Source: National Statistics Office, 2006

70%medicallyunattendeddeaths in2002 and

1975.


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Proportion of Fully Immunized Children

69.4

58.265.3 64.5 65.2 61.3 62.9 59.9

0

20

40

60

80

100

1993 1997 1998 1999 2000 2001 2002 2003

Year

Proport

ion

Source: National Statistics Office 2006, NDHS, MCH Surveys 1993-2003


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Migration of Filipino Nurses &Migration of Filipino Nurses &Other Health ProfessionalsOther Health Professionals


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Hemorrhage of Health Human ResourcesHemorrhage of Health Human Resources

Philippines is thePhilippines is the no. 1 exporter of nursesno. 1 exporter of nursesworldwide andworldwide and no. 2 for doctorsno. 2 for doctors

85% of Filipino nurses work abroad in some 5085% of Filipino nurses work abroad in some 50countries (approx. 163,756 nurses in 2003)countries (approx. 163,756 nurses in 2003)

From 1999From 1999--2003: Licensed 27,342 nurses yet2003: Licensed 27,342 nurses yetover 56,000 went abroad.over 56,000 went abroad.

Increasing number of nursing schools: 170Increasing number of nursing schools: 170(1990s)(1990s) 251 (2003)251 (2003) 470 (2006)470 (2006)

HEAD, 2007


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Hemorrhage of Health Human ResourcesHemorrhage of Health Human Resources

Phenomenon ofPhenomenon ofdoctors becoming nursesdoctors becoming nurses to goto goabroadabroad

More than 9,000 doctors have already left as nursesMore than 9,000 doctors have already left as nursesfrom 2002 to 2005.from 2002 to 2005.

80% of public health physicians have taken up or are80% of public health physicians have taken up or areenrolled in nursing.enrolled in nursing.

90% of Municipal Health Officers (MHOs) are taking up90% of Municipal Health Officers (MHOs) are taking upnursing and expected to leave the country.nursing and expected to leave the country.

HEAD, 2007


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Obstetricians and anesthesiologists are rapidlyObstetricians and anesthesiologists are rapidlydepleted, followed by pediatricians and surgeons.depleted, followed by pediatricians and surgeons.

At least 37 Philippine nursing schools offerAt least 37 Philippine nursing schools offerabbreviated 2abbreviated 2--year courses for doctors to becomeyear courses for doctors to become

nurses.nurses.

More than 60% of nursing schools are gearedMore than 60% of nursing schools are gearedmainly for second coursersmainly for second coursers

Pharmacists are the next target for employmentPharmacists are the next target for employmentabroadabroad

HEAD, 2007


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TESDA has trained over 50,000 caregivers in the lastTESDA has trained over 50,000 caregivers in the last5 years and over 24,000 have been deployed abroad.5 years and over 24,000 have been deployed abroad.

An estimated 15,000 health professionals leave theAn estimated 15,000 health professionals leave thecountry annually for employment abroad.country annually for employment abroad.

Decreased enrollment in medical schools of 10%Decreased enrollment in medical schools of 10%--55% in the last 2 years.55% in the last 2 years.

Hospitals closing down for lack of doctors/nurses: 200Hospitals closing down for lack of doctors/nurses: 200

completely closed, 800 partially closed (2003completely closed, 800 partially closed (2003--2005)2005)

HEAD, 2007


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Other consequencesOther consequencesDecline in the interest of young Filipinos toDecline in the interest of young Filipinos to

study medicinestudy medicine evidenced by a drop ofevidenced by a drop of53% in NMAT examinees with Yr. 2000 as53% in NMAT examinees with Yr. 2000 asbaselinebaseline

Decline in the applicants for medicalDecline in the applicants for medicalresidency positions to become specialistsresidency positions to become specialistswith an average of 50%with an average of 50%

Nurse to patient ratios in provincial andNurse to patient ratios in provincial anddistrict hospitals now 1:40district hospitals now 1:40--1:601:60

Loss of highly skilled nurses in all hospitalsLoss of highly skilled nurses in all hospitalsacross the countryacross the country

Galvez-Tan, 2003


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Lorenzo, et. Al.

InternationalInternationalDemand andDemand and

NurseNurseMigrationMigration

PatternsPatterns


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Due to increasing and aging population, there is a significant increasein the demand for skilled nurses. In USA alone, roughly half to onemillion nurses are needed between the years 2010-2020. Supply ofnurses is failing to keep pace with increasing demand.

Data Source: USA Bureau of Health Professions

US Projections of Nursing Supply Versus Demand

0

500,000

1,000,000

1,500,000

2,000,000

2,500,000

3,000,000

2000 2005 2010 2015 2020

Supply Demand

US Projected Nursing Shortage, 2000 - 2020

0

200,000

400,000

600,000

800,000

1,000,000

1,200,000

2000 2005 2010 2015 2020

Y e a r S upply D e m a nd S ho rt a ge P er c e nt

2000 1,890,700 2,001,500 -110,800 -6%

2005 1,942,500 2,161,300 -218,800 -10%

2010 1,941,200 2,347,000 -405,800 -17%

2015 1,886,100 2,569,800 -683,700 -27%

2020 1,808,000 2,824,900 -1,016,900 -36%


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More so, other countries have similardemand for skilled nurses. Respective

projected shortfall in workforce supply arein thousands by 2010.

Country Number ofRNs Predicted shortfall (shortfall year)

UK 500,000 53,000 2010

Ireland 49,400 10,000 2008Canada 230,300 78,000 2011

Australia 179,200 40,000 2010

Sub-Saharan African Countries have a short fall of morethan 600,000 nurses

Singapore, Middle East, Ireland, Finland, Japan, Australia,

New Zealand are also markets requiring skilled nurses

Source: Trends in International Nurse Migration, 2004


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This global nursing demand has attracted Filipinos to pursue nursingprofession as migration for nurses have become prominent. Philippinesthen becomes one of the largest sources of nurses around the world.

Philippines main advantage: Common educational curriculum, English as asecond native language, positive feedback on Filipino nurses work ethics abroad

Common Destination Common Source ofNursesAustralia United Kingdom, New Zealand, Philippines

Ireland United Kingdom, Philippines, South Africa

Norway Other Scandinavian Countries, Germany, Philippines

United Kingdom Philippines, South Africa, Australia

United States Philippines, Canada, South Africa, Nigeria

Middle East Philippines

Number of Nurse Migrant in the United States ofAmerica

-

1,000

2,000

3,000

4,000

5,000

6,000

7,000

1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006

Number of Nurse Migrants to Other Country of Destinations,

1996-2006

-102030405060708090

100110120130140150

1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006

Canada Australia New Zealand

Germany Japan United Kingdom

Norway

Data Source: Migrant Data, Commission on Filipinos Overseas, 2007


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Total Number of Filipino Nurse Migrants, 1996-2006

366

1569

2235

3824

5994

3983

2238

1220

314431495

0

1000

2000

3000

4000

5000

6000

7000

1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006

Year

N

o.

ofN

urseM

igrants

Indeed, there is an overall upward trend in the number of Filipinonurse migrants. On the other hand, number of deployed OFW*nurses appear to be declining. This may be attributed to Nursespreference on migration package against contractual status.

Total Nurse Overseas Contract Workers, 1999-2006

5413

7683

13536

11867

10718

80768556

8968

02000

4000

6000

8000

10000

12000

14000

16000

1999 2000 2001 2002 2003 2004 2005 2006

Year

No.

ofNurseO

FWs

*OFW means Overseas Contract Workers. Under this category, nurses cannot bring their family in the country of destination.Migration package however allows nurses to bring theirimmediate family with them in the country of destination.Data Sources: Migrant Data, Commission on Filipinos Overseas, 2007; OFW Data, Philippine Overseas Employment Agency, 2007


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Magnitude of Permanent NurseMagnitude of Permanent NurseMigration,1996Migration,1996--20062006

-

1,000

2,000

3,000

4,000

5,000

6,000

7,000

1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006

Total Number of Nurses who migrated, CFO


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-

1,000

2,000

3,000

4,000

5,000

6,000

7,000

1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006

Australia

Canada

Germany

Japan

New Zealand

Norway

United Kingdom

United States of America

Total Number of Emigrants who were nurses beforeTotal Number of Emigrants who were nurses before

migration, by Destination Country, 1996migration, by Destination Country, 1996--20062006

Source: CFO


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Magnitude of TemporaryMagnitude of TemporaryNurse Migration, 2001Nurse Migration, 2001--11stst Sem. 2006Sem. 2006

0

2,000

4,000

6,000

8,000

10,000

12,000

14,000

16,000

2001 2002 2003 2004 2005 1st sem, 2006

Total OFW Deployment, Nursing Professionals, POEA


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Year of DeploymentYear of DeploymentCOUNTRYCOUNTRY 20032003 20042004 20052005 20062006

SAUDI ARABIASAUDI ARABIA5,7405,740 5,6405,640 4,6274,627 5,6405,640

UNITED ARAB EMIRATESUNITED ARAB EMIRATES452452 218218 670670 768768

KUWAITKUWAIT102102 408408 191191 340340

IRELANDIRELAND 414414 190190 297297 248248

UNITED STATESUNITED STATES392392 373373 3,8533,853 202202

LIBYALIBYA104104 1010 2323 158158

UNITED KINGDOMUNITED KINGDOM3,0883,088 800800 546546 145145

QATARQATAR484484 318318 133133 140140

SINGAPORESINGAPORE652652 166166 129129 7373

TRINIDAD AND TOBAGOTRINIDAD AND TOBAGO-- -- 113113 6868

ALL COUNTRIESALL COUNTRIES 8,9688,968 8,5568,556 10,71810,718 8,0768,076

Distribution of Nurses by Destination Country, 2003-2006

Source: POEA


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Table 1. Number of Filipino Nurses Deployed Abroad Per Year, 1992Table 1. Number of Filipino Nurses Deployed Abroad Per Year, 1992--20032003

19921992 57475747

1993199367446744

19941994 66996699

19951995 75847584

19961996 47344734

19971997 4242424219981998 45914591

19991999 54135413

20002000 76837683

20012001 135361353620022002 1191111911

20032003 89688968

TotalTotal 8785287852

Source: Philippine Overseas Employment Administration (POEA)


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Table 2. Number Of Selected Health WorkersTable 2. Number Of Selected Health WorkersWho Left The Country And Worked Abroad 1998Who Left The Country And Worked Abroad 1998--20032003

19921992 19931993 19941994 19951995 19961996 19971997 19981998 19991999 20002000 20012001 20022002 20032003

DentistsDentists 2727 2222 3838 4848 3636 5252 3232 5656 3333 5757 6262 4040

Dietitians AndDietitians AndPublic HealthPublic HealthNutritionistsNutritionists

ndnd ndnd ndnd ndnd ndnd ndnd 9898 6666 4545 6464 9898 134134

Doctors MedicalDoctors Medical 8686 9191 5757 6969 4747 8282 5555 5959 2727 6161 129129 112112

MidwivesMidwivesProfessionalProfessional

246246 295295 126126 161161 142142 113113 149149 6666 5555 190190 312312 276276

NursesNursesProfessionalProfessional

57475747 67446744 66996699 75847584 47344734 42424242 45914591 54135413 76837683 1353613536 1186711867 89688968

Optometrists AndOptometrists AndOpticiansOpticians


PharmacistsPharmacists 5252 3232 3232 5454 5757 4242 4747 5555 3030 6464 5757 7474

PhysiotherapistsPhysiotherapists

AndAndOccupationalOccupationalTherapistsTherapists

542542 608608 645645 581581 426426 289289 317317 147147 235235 330330 517517 371371

TechniciansTechniciansMedical XMedical X--RayRay


Caregivers AndCaregivers AndCaretakersCaretakers

ndnd ndnd ndnd ndnd ndnd ndnd ndnd ndnd ndnd 465465 53835383 1887818878

Source: Philippine Overseas Employment Administration (POEA)


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Figure 2. Trend of Deployment of Health Workers Abroad, 1992-2003

0

2000

4000

6000

8000

10000

12000

14000

16000

18000

20000

1992

1993

1994

1995

1996

1997

1998

1999

2000

2001

2002

2003

Populatio

n

DENTISTS

DIETITIANS AND PUBLIC

HEALTH NUTRITIONISTS

DOCTORS MEDICAL

MIDWIVES PROFESSIONAL

NURSES PROFESSIONAL

OPTOMETRISTS AND

OPTICIANS

PHARMACISTS

PHYSIOTHERAPISTS ANDOCCUPATIONAL THERAPISTS

TECHNICIANS MEDICAL X-

RAY

CAREGIVERS ANDCARETAKERS

Lorenzo, NIH, 2003


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Estimated Number of Employed Filipino Nurses By Work Setting,Estimated Number of Employed Filipino Nurses By Work Setting,20032003

Work SettingWork Setting NumberNumber PercentagePercentage

II.. Local/NationalLocal/National 29, 46729, 467 15.25%15.25%

AA.. ServiceService

11.. GovernmentGovernment AgenciesAgencies 19, 05219, 052 9.86%9.86%

22.. PrivatePrivate AgenciesAgencies 8, 1738, 173 4.23%4.23%

BB.. EducationEducation 2, 2412, 241 1.16%1.16%

IIII.. InternationalInternational 163, 756163, 756 84.75%84.75%

TotalTotal 193, 223193, 223 100.00%100.00%

Lorenzo, NIH, 2003


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MarketsMarkets

Traditional Markets: Middle East, NorthTraditional Markets: Middle East, NorthAmericaAmerica

New Markets: Europe especially UK,New Markets: Europe especially UK,Netherlands, High Income AsiaNetherlands, High Income Asia

Emerging Markets: Japan and NurseEmerging Markets: Japan and NurseEducation abroadEducation abroad

Lorenzo, NIH, 2003


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Overseas Filipino Workers (OFWs)Overseas Filipino Workers (OFWs)RemittancesRemittances

YEARYEAR US$US$

19991999 USUS$$ 66..7979

20002000 USUS$$ 66..0505

20012001 USUS$$ 66..0303

20022002 USUS$$ 77..1919

20032003 USUS$$ 77..6464

20042004

20052005

USUS$$ 88..5050

USUS$$ 1100..88

Source: Central Bank of the Philippines, 2005Source: Central Bank of the Philippines, 2005--0606

0

2

4

6

8

10

12

1999 2000 2001 2002 2003 2004 2005

OFW Rem ittance in Billion US Dollars , 1999-2005

In Billion US$


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Reasons Why Health ProfessionalsReasons Why Health ProfessionalsLeave the CountryLeave the Country

Push FactorsPush Factors

EconomicEconomic: low salary at home, no overtime and hazard: low salary at home, no overtime and hazardpay, low coverage of health insurancepay, low coverage of health insurance

JobJob--relatedrelated: work overload or stressful working: work overload or stressful workingenvironment, slow promotionenvironment, slow promotion

SocioSocio--political and economic environmentpolitical and economic environment: limited: limitedopportunities for employment, decreased health budget,opportunities for employment, decreased health budget,peace and order situation in the Philippines, Laborpeace and order situation in the Philippines, LaborExport Policy of the government, western orientationExport Policy of the government, western orientationand high cost of health science educationand high cost of health science education


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Reasons why HealthReasons why HealthProfessionals Leave the CountryProfessionals Leave the Country

Pull Factors (Receiving Countries)Pull Factors (Receiving Countries)

EconomicEconomic: higher income, better benefits and compensation: higher income, better benefits and compensationpackagepackage

JobJob--relatedrelated: Lower nurse to patient ratio, more options in working: Lower nurse to patient ratio, more options in workinghourshours

Individual/FamilyIndividual/Family--relatedrelated: Chance to upgrade nursing skills,: Chance to upgrade nursing skills,acquisition of immigrant visa and opportunity for family to migrate,acquisition of immigrant visa and opportunity for family to migrate,

opportunity to travel and learn other cultures, influence from peersopportunity to travel and learn other cultures, influence from peersand relativesand relatives

SocioSocio--political and Economic environmentpolitical and Economic environment: Advanced technology,: Advanced technology,better peace and order situationbetter peace and order situation

Lorenzo, NIH, 2003


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Reasons Why Doctors Migrate asReasons Why Doctors Migrate asNurse MedicsNurse Medics

PUSH FACTORSPUSH FACTORSvery low compensation and salaries,very low compensation and salaries,feeling of hopelessness about the Philippine currentfeeling of hopelessness about the Philippine current

situation,situation,political instability and graft and corruption,political instability and graft and corruption,poor working conditions andpoor working conditions andthe threat of malpractice lawthe threat of malpractice law

PULL FACTORS (Receiving countries)PULL FACTORS (Receiving countries)

more sociomore socio--politicopolitico-- economic security abroad,economic security abroad,attractive salaries and compensation packages (Highattractive salaries and compensation packages (High

salaries, benefits, compensation)salaries, benefits, compensation)more job opportunities and career growth.more job opportunities and career growth.

Lorenzo, NIH, 2003


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Proposed ActionProposed Action& Challenges& Challenges


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Proposed ActionProposed Action Policy LevelPolicy Level

Scrap labor export policy (LEP)Scrap labor export policy (LEP)

Regulate the outflow of health professionalsRegulate the outflow of health professionals

Increase health budget, improve the salaries &Increase health budget, improve the salaries &

working conditions of health workers/professionalsworking conditions of health workers/professionals Reorientation of health science educationReorientation of health science education

Advocacy & MobilizationAdvocacy & Mobilization AwarenessAwareness--raising among health science studentsraising among health science students

and professionals/Exposure to social realitiesand professionals/Exposure to social realities WTO Out of Health campaignWTO Out of Health campaign

Organize Health Migrants at the National andOrganize Health Migrants at the National andInternational LevelsInternational Levels an org. for health migrantsan org. for health migrants


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ChallengesChallenges Sustained and concerted effortsSustained and concerted efforts

at the country and global levelat the country and global level

Involvement of the healthInvolvement of the health

professionals into the campaignprofessionals into the campaign

ahwmigration of nurses

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