The Health Human Resources Development in the Philippines: 2009 Situationer

Jaime Z. Galvez Tan MD, MPH

President, Health Futures Foundation Inc.

Professor, University of the Philippines College of Medicine

The Philippines at a Glance Total Population: 90 million

(NSO est. 2009) Population growth rate: 2.02%

(NSO 2007) 1.5 million added annually;

4,110 babies a day Average family size: 5 Proportion of population

below 15 years of age: 37% Proportion above 65 years old:

3.8%

Total labor force: 35 Million Total Unemployment Rate:

10.1% (LFS Oct. ’03) Total Underemployment Rate:

15.7% ( LFS Oct. ’03) Annual average family

income: US$2,619 (FIES 2000)

Poverty incidence: 34% or 25.8 million people (NEDA 2001)

Budget deficit 2009: US$5B or 35% of the national budget

% of National Budget for debt servicing: 30%-35%

Philippine Health at a GlanceAccess to Health Care:

% of death medically attended: 40% (NSO 2005)

% of children born at home: 56% (NDHS 2008)

% of births attended by health professionals: 62% (NDHS 08)

% of population with full access to essential drugs: 60%

% of children 12-23 mos. Fully immunized: 80% (NDHS 2008)

Contraceptive prevalence rate: 51%

Vital Health Statistics:

Under-five mortality rate: 34 (NDHS 2008)

Infant mortality rate: 25 (NDHS 2008)

Maternal mortality ratio: 172 per 100,000 births (1998) i.e. 10 mothers dying everyday due to pregnancy and childbirth related causes

% of national budget for health: 2% (2009)

% of health expenditures to GDP: 3.1% (2002)

Health Human Resources: The No. 1 Philippine Health Export

No. 1 exporter of NURSES “An estimated 85 percent of employed Filipino nurses

(more than 150,000) are working internationally.” (Aiken et al. 2004)

“70 per cent of all Filipino nursing graduates are working overseas” (Bach, 2003)

“The Philippines is the top exporter of nurses to the world with 85% of all Filipino nurses working in 46 countries.” (Corcega et. al, 2003)

No. 2 exporter of DOCTORS“68 per cent of Filipino doctors work overseas, next to India.”

(Mejia, WHO, 1979)

Newsweek, Oct. 4, 2004, “Philippines: Workers for the World”, pp. 31-33

Why Such Human Resources Policy?

2003 - Overseas Filipino Workers (OFWs) brought in a total of US$ 7.6 billion remittances.

2008 – Remittances from OFWs totaled US$14.3 billion

((Source:Source: Central Bank of the Philippines, 2008) Central Bank of the Philippines, 2008)

If all data accounted for, at least 100,000 Nurses left in the last 10 ten years – the highest volume in

Philippine history

Note: full USA data not Note: full USA data not accounted for accounted for

Source: Source: Philippine Overseas Employment Agency, 2004

Deployment of Filipino Nurses, 1994-2003

02,0004,0006,0008,000

10,00012,00014,00016,00018,00020,000

1994 1995 1996 1997 1998 1999 2000 2001 2002 2003

VOLUME

YEAR VOLUME1994 6,6991995 7,5841996 4,7341997 4,2421998 4,5911999 5,4132000 7,6832001 13,5362002 11,9112003 18,450

TOTAL 84,843Average (10-year period)

8,931 nurses/year

While the market for nurses in the USA was closed due to the recent economic crisis, Canada, Finland, Japan, Australia and Bahrain are emerging to become the top destination countries for our nurses.

Due to the global demand, the number of nursing schools have risen from 175 in 2000 to 479 today (Philippine Inquirer, 2008).

The quality of nursing education has been adversely affected with a less than 50% passing rate in the Nursing Licensure Examination since 1999.

41,45938,689

25,16319,54617,101

13,1529,351 8,281 9,453

15,624

25,32525,951

40147

64909 64459

77901

010,00020,00030,00040,00050,00060,00070,00080,00090,000

Number of examinees

Number of Philippine Nurse Examinees 1994-2009

61.4558.24

54.2250.02

55.79

49.86 49.253.5

44.7548.18 49.68 51.6

49 48.1843.07 41.9

0

10

20

30

40

50

60

70

Passing Rates

Passing Rate in the Philippine Nursing Licensure Examinations 1994-2009

In a compilation of statistics on the performance of schools in the NLE from 2000-2005 made by CHEd and the Professional Regulatory Commission, only 12 out of the 479 nursing schools had passing rates of 90% and higher.

Only 25 of the of the 479 schools have passing rates of 85% and higher

Performance of Philippine Nursing Schools 2000-2005

Name of School

Passing Rate

University of the Philippines-Manila

100%

St. Paul College - Iloilo

99.57%

Siliman University - Dumaguete

98.39%

West Visayas State University

97.06%

University of Santo Tomas

96.67%

St. Louis University - Baguio

95.05%

Name of School

Passing Rate

Mindanao State University Marawi

95%

St. Paul College - Dumaguete

93.38%

Pamantasan ng Lungsod ng Maynila

92.53%

St. Mary’s University-Nueva Vizcaya

91.02%

St. Paul College - Manila

90.81%

University of the East Ramon Magsaysay Memorial Medical Center

90.57%

The Commission on Higher Education has been urged to close down 177 nursing programs who have 0% passing rate for the past 5 years.

• In a meeting hosted by Philippine Senator Pia Cayetano last October 2008 attended by the top 25 nursing schools, the Global Circle of Nursing Competence and Compassion was formed with a commitment to maintaining quality education

• It was also created to provide equitable overseas job opportunities for graduates of these 25 Philippine nursing schools through managed migration and ethical recruitment.

A total estimate of 9,000 Filipino doctors have become nurses from 1999-2008.

In 2003-2005, more than 4,000 physicians took the Philippine Board of Nursing Licensure Examinations.

Around 6,000 doctors have left as nurses since 2000

Consequences of the Increasing Global Demand for Nurses

50495360

5814 5730 5948 6121 6245 61925853

44754070

2912

42504886

6043

8268

0100020003000400050006000700080009000

1994

1995

1996

1997

1998

1999

2000

2001

2002

2003

2004

2005

2006

2007

2008

2009

VOLUME

VOLUME

Consequences of the Increasing Global Demand for Nurses

200 hospitals have closed down within the past two years – no more doctors and nurses (PHA, November 2005)

800 hospitals have partially closed (with one to two wards closed) – lack of doctors and nurses (PHA, November 2005)

Nurse to patient ratios in provincial and district hospitals now 1:40-1:60

Loss of highly skilled nurses in all hospitals across the country

Proportion of Filipinos dying without medical attention has reverted to its 1975 levels of 60% of deaths unattended during the height of nurse & nursing medics migration 2002-2005. (NSO 2005)

Contraceptive Prevalence Rates have remained stagnant from 1998-2009 (NSO-NDHS 2008)

Health services coverage declining e.g. immunization coverage down (NDHS, MCH Survey, NSO 1993-2003)

Source: Philippine Progress Report on the Millennium Development Goals 2003, 2006 Family Planning Survey

Consequences of the Brain Drain: MDG Goal #5 Imperiled - Progress in reducing MMR has been slow

209

172 162

52.5

180186191197203

0

50

100

150

200

250

1990 1991 1992 1993 1994 1995 1998 2006 2015

P r ogr ess Made P r ogr ess Needed

MMR has been reduced by just 22%. Target 2015 is 75%

The Queensland-Philippines Partnership in Global Health Care

So What Can Be Done?Can the Global Health Community develop

strategic solutions to the mass migration of Filipino nurses?

What can a country like the Philippines do? What actions should countries like Australia

in need of international nurses take?

Goals of Global Migration Strategies

Tame the mass exodus to North countries Achieve a rational programmed departure or

our health professionals Secure a win-win situation for the Philippines

and the receiving countries

Note: These do not aim to prevent health professionals from leaving the country

A Win-Win Bilateral AgreementAn Ethical Framework for

RecruitmentA Transparent and Accountable

PartnershipAn Equitable, Just and Fair

Arrangement

Queensland and the Philippines

Both Queensland and the Philippines would receive mutual benefits from each other

Both Australia and the Philippines respect each other’s rights as nation states

Both recognize the legitimate interests held by all Queensland and Filipino stakeholders to provide care for their patients and communities

Queensland needs international nurses now and in the future to provide adequate health care for its population

The Philippines guarantees international nurses for Queensland.But without compromising the need to further

improve its health care system for greater equity.

Queensland and the Philippines

Autonomy: freedom of individual and freedom of movement; freedom to determine one’s own destiny

Cooperation: protection of inputs from multiple interested parties Favors dispute resolution through

bilateral and multilateral organizations

Based on International Ethical Principles Currently in Practice

Social Justice: fair labor practicesequitable workplace non-discriminationprotection of public health maintenance of an equitable allocation of

nursing resourcesminimization of existing inequities in

health care resourcesprovision of language skills

Based on International Ethical Principles Currently in Practice

Responsible Recruitment: fair and transparent, with accountability

Respect for the rights of nation states: recognition of the legitimate interests held by

all stakeholders to provide care to their patients and communities

Compensation to source countries: Facilitating economic and educational benefits

that result from emigration and return

Queensland and the Philippines

Just and fair benefits to the Philippines from Queensland:

Facilitating health sciences educational benefits and health care management services that result from emigration

Ensuring direct positive consequences to the health care delivery system of the Philippines

Benefits from Queensland facilitated through a Queensland – Mindanao Philippines Foundation

Benefits focused in a defined geographical set of provinces with equivalent population for greater effects and impact on health care ex. Queensland (population 4.25M) -Northern

Mindanao (population 3.95M)

As The Philippines and Queensland Learn From Each Other As New Partners in International Health Care

#1 An ethical recruitment approach to “migration management” protecting basic rights of migrants, combating exploitation and trafficking, enforcement of minimum national employment conditions standards in all sectors of activity

Based on I.L.O.’s Promotion of Decent & Productive Work

# 2 An informed and transparent labor migration admissions system designed to respond to measured, legitimate labor needs, taking into account domestic concerns as well

Based on I.L.O.’s Promotion of Decent & Productive Work

#3 A Plan of Action against discrimination and xenophobia to sustain social cohesion

#4 Institutional mechanisms for consultation and coordination with social partners in policy elaboration and practical implementation

Based on I.L.O.’s Promotion of Decent & Productive Work

In the Field of Nursing Education and Nursing Education Policies

#1 Development of reciprocities in policies and equivalence standards of nursing education and training between Queensland and the Philippines

#1 Migration Watch: Partnerships between Philippine and Australian universities and non-government organizations monitoring for ethical framework from recruitment to employment.

#2 Health Development Watch: Partnerships also monitor health systems and facility improvement in Mindanao partner region

Headed to the Future Together

The Queensland-Philippines Partnership in Health Human Resources Management will be a FIRST in the world to ensure a fair, just, ethical framework in the recruitment of international nurses

Beyond the boundaries of Australia and the Philippines, the Queensland-Philippine Partnership will be the Global Trailblazer and International Model for all countries of the world to emulate

Thank you very much! Salamat Po! Mabuhay!