(Part 2 of 2)
LAST week, I shared the first part of the speech by Atty. Arnedo Valera, Legal Counsel of the Philippine Nurses Association in America (PNAA) and Executive Director of the Migrant Heritage Commission (MHC), delivered at the FIRST GLOBAL SUMMIT OF FILIPINO NURSES 2014 in Manila on January 16.
Part 1 discussed the big picture, which illustrates the significant role Filipino nurses play in Philippine society and anywhere around the world, and why there is an exodus for these hardworking kababayans to work abroad.
Here is Part 2 of Nurses Without Borders: What can be done to help our modern day heroes and address the problem of brain drain in the Philippines?
Revisiting the Labor Export Policy
In recent years, however, the policy of commoditization and deployment of nurses for overseas jobs has been revisited because of its social costs. Analysts found that this policy actually aggravates instead of addresses unemployment in the nursing profession. The massive brain drain it creates also contributes to the deterioration of the public health care system in the Philippines.
The Philippine government’s labor export policy faces the constant risk of uncertainty. It is vulnerable to the imbalances or instabilities of the world’s labor market demand and supply. The nursing sector, for instance, has been vulnerable to fluctuations in the US market and other foreign destinations, owing to economic recessions and domestic pressures against the importation of foreign nurses. Some host countries have been besieged by armed conflicts, particularly those in the Middle East and North Africa (MENA).
Economic recessions in the US in the early 1990s and the latest episode that began in 2008 have led to a decline in demand for Filipino nurses. Jobs were being filled by locally educated nurses. From 15,382 in 2009, the number of Filipino nurses who took the US NCLEX examination for RNs or licensed practical/vocational nurses nose-dived by 37 percent to just 9,789 in 2010. In the first quarter of 2011, the figure plunged by 52 percent to just 1,454 as against 3,024 in the same quarter in 2010.
As a result, the decline in the entry of Filipino nurses in the U.S., among other reasons, has spawned huge unemployment in the nursing profession in the Philippines.
According to the Commission on Higher Education (CHED), some 400,000 Filipino nurses were unemployed in 2012. Unemployment has driven some nursing graduates to seek other jobs such as those in call centers. Others go back to school to pursue higher degrees or work as caregivers abroad.
At the same time, the number of nursing schools jumped from 200 in 2006 to 491 in 2012, with 2 million enrollees. So intense has been the competition for the few available job slots – whether foreign or at home – that board examination standards have also been raised to quality competency that has taken a toll on aspiring RNs.
The number Nursing Licensure Examination (NLE) passers was a low 35.35 percent in December 2012 (16,908 out of 49,066 examinees) – albeit slightly higher than December 2011 (33.92 percent) and December 2010 (35.35 percent). In July 2013, 16,219 qualified out of 37,887 examinees – or a slight improvement of 43 percent.
Amid the oversupply of RNs who remain in the Philippines, only 15 percent can be absorbed in the health industry, mostly in government hospitals and other institutions as well as private hospitals. Out of 1,600 national-based hospitals, only 90 are government-run.
The rest are private hospitals. Many of these hospitals face the constant threat of closures, mainly due to the out-migration of experienced nurses and doctors. The push factors are low pay amid inflation, lack of benefits, poor working conditions, government corruption, and uncertainty in career development. In fact, more and more physicians train as nurses for better opportunities in overseas jobs.
Brain drain
Medical researchers and social scientists agree that the “brain drain” out-migration and the transnational marketing of Filipino nurses and other professionals are hurting the public health care system. While the Philippines exports tens of thousands of its health professionals, 7 out of 10 Filipinos die without being attended by health personnel. At least 50 percent of the population have no access to health care; only 30 percent of the country’s 42,000 barangays have health stations.
Most alarming of all is the declining access to health services, indicated by the drop in immunization among children – from 69 percent in 1993 to 60 percent in 2003. Corruption, in the form of kickbacks and absence of biddings, further restricts the availability of essential drugs and facilities for the poor.
The Philippines already has one of the poorest public health care systems in Southeast Asia. The government’s total health expenditures in proportion to GDP is only 3.3 percent, based on reports by the National Economic Development Authority (NEDA) – or way below the WHO-recommended minimum 5 percent of GDP. The 2013 figure fell from 2009’s 3.8 percent. The Philippines’ public health expenditure is lower than Thailand’s 4.1 percent, Vietnam’s 6.8 percent, China’s 5.2 percent and especially Cuba’s 10 percent, and the United States’ 17.9 percent. In short, the claimed GDP growth in the Philippines (7 percent) does not translate to a proportional increase in public health expenditures.
Some public health advocates, like registered nurse and UP Staff Regent Jossel Ebesate, have attributed the deterioration of the country’s public health service to the government’s neo-liberal and labor-export policies. These policies are blamed for the reduction of budgets for social services, freezing of wages, unjust labor conditions, and failure to address the exodus of professionals and skilled workers to foreign countries.
While it is true that remittances prop up the economy and allow some families to have more spending power, the money is not transformed into national investments that can boost long-term development.
Additionally, analysts have concluded that being a perpetual supplier of human capital hurts the country’s national development. It doesn’t allow for a public health system where Filipino nurses and doctors can serve with adequate compensation and benefits they deserve.
These are compelling reasons to support proposed policies and legislation boosting domestic employment of nurses. The government should seriously also consider the proposal to hire unemployed nurses and deploy them to provide urgent health care services in the country’s poorest municipalities.
There should also be a strong resolve to protect the employment rights and benefits of Filipino nurses abroad, amid reports of workplace abuses and discriminatory practices in many countries. Proposed solutions include bilateral labor agreements to protect the Filipino nurses’ labor rights.
Urgent appeal
As we reflect on these solutions, I would also like to make an urgent appeal that resonates with the conference theme.
The devastation wrought by super typhoon Yolanda should serve as a wake-up call for the national government. Eastern Visayas is the country’s third poorest region where the social divide is also the widest, with the upper 30 percent earning eight times more than the bottom 30 percent.
The majority of its 4 million residents – mostly of farmers and fisher folk – has long suffered from an extractive economy that depleted the region’s logging and mining resources, with no meaningful economic productivity for the people. Poverty has made them more vulnerable to both natural and man-made disasters. It has left them without the capability to recover their losses.
By the way, Eastern Visayas has seen many of its nurses going abroad. It ranks fifth in the country for having the most number of nursing schools and fourth in term of enrollees.
The millions of displaced families urgently need medical assistance and infrastructures as they start rebuilding their lives. They cannot rebuild their lives without their medical needs being addressed first.
So I would like to appeal to all of you here today to use this occasion to join hands and come up with short- and long-term plans to support the rebuilding of Eastern Visayas. This is a great way of giving back to our country of birth.
After this conference, I am flying to Tacloban and Carigara, Leyte to discuss Migrant Heritage Commission’s project REVIVE (REBUILDING VISAYAS WITH VIBRANT ECOLOGY). We are here for a long pull. We need to rebuild lives and rebuild the future of communities impacted by Yolanda/Haiyan. Project REVIVE calls for addressing as its first task medical needs of communities, livelihood projects and building of storm shelters which can also function as health care centers.
As the saying goes, “Charity Begins at Home.” I would revise this slightly and say: “Charity, Compassion and Care Begin at Home.”
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Gel Santos Relos is the anchor of TFC’s “Balitang America.” Views and opinions expressed by the author in this column are are solely those of the author and not of Asian Journal and ABS-CBN-TFC. For comments, go to www.TheFil-AmPerspective.com, https://www.facebook.com/Gel.Santos.Relos
