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									From Brain Drain to National Hemorrhage



  The Global Migration of
 Philippine-Trained Nurses:
 Causes, Impacts and Future
          Prospects

      Erlinda Castro-Palaganas PhD, RN
      University of Ottawa, Nov. 3, 2008
           References

Several researches on the PHILIPPINE
 NURSING MIGRATION by Dr. Fely
 Marilyn Lorenzo, Dr. Jaime Galvez
 Tan, PNA, ADPCN, HEAD, PHM
     Outline of Presentation

   Philippine Health Care Context
   Philippine Basic Indicators
   The Government Responses:
     - Privatization as a Government Policy
     - Labor Export Policy
   Nurses and Migration
     - Migration Situation
     - Migration Issues and Concerns
     - Policy Implications
   Challenges
What could be the reason/s?
     Philippine Health Care System
                 Context
   Philippines composed of 7,150 islands organized into 3
    main island groups

   Population : 87million growing annually by 2.3%

   Productive age group estimated to be 42% of 34.2
    million

   Labor Force is 67% of all Filipinos in reproductive age

   Only 8.83% are estimated to comprise human health
    resources
    Philippine Health Care System
                Context

   Rapidly growing population , steady
    employment rates
   Unemployment rates around 12%
    1 out of 5 Filipinos underemployed
   Job opportunities have not increased
    correspondingly with population increase
   Labor productivity stagnant over last 12 years
   Every year about 800,000 young people begin
    looking for work in a contracting and job-
    scarce economy
    Philippine Health Care System
                Context
   Devolved health care system since 1995
   DOH lead agency that safeguards health and
    maintains specialty hospitals, regional hospitals,
    and medical centers
   All other hospitals and field health units
    maintained by local governments
   Private sector involvement in health care is
    enormous – 60% of 1,600 hospitals in country
    are private
   Problems of access and equity: hampered by
    high costs and physical and soci-cultural barriers
    Philippine Health Care System
                Context
   Health Sector Reform launched in 2000
    covering :
     Hospital
     Local Health Systems Development
     Public Health Programs
     Health Regulation
     Social Health Insurance

   No attention given to development of
    Health Human Resources
            Philippine Basic Indicators

   4 million unemployed and 7.3
    million underemployed in
    2006

   in the past six years, 11.3%
    unemployment rate and
    18.5% underemployment rate

   70% of Filipinos consider
    themselves poor (IBON
    survey)

    around 3,000 Filipinos daily
    forced overseas to work

                     source: IBON
Philippine Basic Indicators

               P100 billion estimated
                government deficit

               P278 billion target raised
                through higher taxes, fees,
                rates & public service
                charges

               P721.7 billion target to be
                repaid to creditors in ’06 or
                P6,391 per Filipino

               Real public spending per
                Filipino on education is
                P1,296; health P120
                  Source: “2006: The Economics of Hype”, IBON Foundation, published
                                                                   in bulatlat.com,
    Philippine Basic Indicators

The Philippines ranked
  83rd of 177 nations
  (down from 77th in 2002)
  in the quality-of-life
  survey (GDP, life
  expectancy, adult
  literacy, growth in
  school enrollment,
  environmental
  protection)
         - 2004 UN Human
        Development Index
  Privatization as a Government
           Health Policy




Health Sector Reform the
      Philippines
  Health Sector Privatization
“Health Sector Reform Agenda”
     “Fiscal autonomy” for govt hospitals
     Promote health insurance schemes with private
      sector
     Tokenism in “public health programs”, “community
      health” and “development of local health systems”

“FOURmula ONE for Health” (2005-2010)
     Integrated public health into hospital services
     Medical tourism
     “Innovative financing arrangements”
Health Services for Sale: Medical Tourism

                      Principally being
                       promoted by the
                       Philippine government
                       using the public health
                       care system
                      Linked to the issue of
                       organ trade (i.e. sale of
                       kidneys for US$3,000-
                       4,000)
                      Expected revenues:
                       US$ 10B in 5 years
“Medical Terrorism”: Growing military presence
         Labor Export Policy
This decline in the quality of life is due to the
worsening economic and political crisis in the
country.
Due to widening unemployment, the Philippine
  government has resorted to a Labor Export Policy
  (LEP) to:
(1) defuse social tension by exporting its vast
   numbers of unemployed and underemployed
   people abroad
(2) to rake in the much needed dollar remittances to
   prop up a falling peso, pay balance of trade
   deficits and onerous foreign loans.
“The fact that millions of Filipinos are forced
to work abroad is proof of government’s
economic failure.”

  - Manila Archbishop Gaudencio Rosales, July 2004
            Labor Export Policy
The Philippines’ Labor Export Policy is rooted in the
  failure of its government to chart its own economic
  and political development through genuine agrarian
  reform and the creation of a modern industrial base
  to make the local market vibrant, prosperous and
  stable.

This resulted into dependence on foreign technology
  and markets, political subservience to foreign policy
  dictates of the dominant economic powers.

Without a sustainable and self-reliant domestic
  economic base, the Philippine government will
  perpetually export its human resources to foreign
  masters in exchange for much-needed revenue at
  the expense of the rights and welfare of its workers.
           The development of
     the labor export program (LEP)
•   Since 1974, when the Labor Code was first revised,
    the “export” of Filipino workers overseas has
    intensified and become increasingly systematic

•   Creation of successive government agencies that
    institutionalized and intensified the export of Filipino
    workers overseas

•   Overseas Workers Welfare Administration,
    Philippine Overseas Employment Administration

•   Government target of 1 million workers overseas per
    year
     Organized Philippine Overseas
         Deployment System
   Goals:
       Maximize gains of overseas employment for migrants
        and sending countries
       Monitoring and Protection of OFW welfare
   Components:
       Managing overseas deployment: Finding , managing
        new markets, maintaining current partners;
       Welfare Protection: Ensuring rights are protected
        during recruitment, pre-departure and in overseas
        workplaces
       Migrant workers’ reintegration into society
  Organized Philippine Overseas
      Deployment System
Six major government agencies involved in migration
   process :
1.DOLE- Department of Labor and Employment
2. POEA- Phil. Overseas Employment Administration
3. OWWA- Overseas Workers Welfare Administration
4. BSP- Bangko Sentral ng Pilipinas (Central Bank)
5. DFA – Department of Foreign Affairs
6. CFO- Commission on Filipinos Overseas
    Key Migration Management Tools
   Migrant and Overseas Filipinos Act (RA 8042)
      Contains policies, rights , obligations, sanctions and
        regulations that govern overseas employment.
   POEA- handles documentation of land-based and sea-
    based contract workers recruited mostly by private
    recruiters, regulates recruiters; manages information on
    migrant and remittance flows to assist with policy
    formulation
   OWWA- responsible for promoting welfare of OFWs and
    dependents through implementation of welfare programs
    for migrants and dependents; includes health or
    repatriation assistance, livelihood loans, skills training,
    scholarships, and reintegration incentives
   POLOs – Philippine Overseas Labor Offices attached to
    Phil. embassies and consulates
                                   Labor Export
2006 Top 10 OFW destination countries:      •   36,000 Filipinos were
1.      Saudi Arabia 223,359                    “deployed” to other
2.      UAE            99,212                   countries in 1975.
3.      Hong Kong      96,929
                                            •   In 2006, the Arroyo
4.      Kuwait         47,917
                                                administration exported
5.      Qatar          45,795
                                                a record 1.08 million
6.      Taiwan         39,025
                                                Filipinos and received
7.      Singapore      28,369
                                                US$14 billion in
8.      Italy          25,413
                                                remittances of overseas
9.      UK             16,926
10.     Korea          13,984
                                                Filipinos.
Others                 151,041              •   Of the 308,142 deployed
Landbased              788,070                  OFWs as new hires,
Seabased               274,497                  184,454 or 60% were
Total                  1,062,657                females compared to
                       Source: POEA, 2006       123,688 males in 2006.
         Top Ten Occupational Group by Sex
                  For the Year 2006
                                           Male      Female    Total     % share
                                                                             to
                                                                            total
1. Household & related workers               1,590    89,861    91,451    29.7%
2. Factory & related workers                39,544    12,690    43,234    14.0%
3. Construction workers                     40,178     2,862    43,040    14.0%
4. Medical & related workers                 2,650    15,081    17,731    5.8%
5. Hotel & Restaurant related workers        6,210     9,483    15,693    5.1%
6. Caregivers & caretakers                    842     13,570    14,412    4.7%
7. Building caretakers & related workers     2,103    10,191    12,294    4.0%
8. Engineers & related workers              10,754      415     11,169    3.6%
9. Dressmakers, tailors & related             375      7,456     7.831    2.5%
   workers
10. Overseas Performing Artists               709      6,722     7,431     2.4
Total deployment – new hires               123,688   184,454   308,142   100.0%
  Intensified export of Filipino migrants




“Overseas Filipino Workers should stay where they are and not think of coming
home.” President Gloria, August 2002 during dinner with OFWs in Kuala Lumpur.
         Labor Export Policy
For the last 30 years, the Philippine economy,
  and all administrations have been propped
  up by the remittances of overseas Filipinos.
  The country’s economy is saved from
  eventual collapse by the remittances of
  Filipinos abroad.

Last year, close to 10 million Filipinos
  overseas remitted a total of US$12.8 billion to
  the Philippines, US$2.2 billion higher than
  the US$ 10.6 billion total of 2005. This is
  aided by the government’s pursuit of its
  labor export program that targets one (1)
  million Filipinos deployed annually.
             State exactions & dollar remittances
           Annual remittances:
           1984 US$659
                 million         State exactions:
           1989 US$973           76 Signatures           P 7,600
                 million         (P100/signature)
           1994 US$2.9           Passport                P   550
                 billion
                                 POEA fee                P 7,500
           1999 US$6.97          OWWA fee (US$25         P 1,375
                 billion
                                 per contract)
           2003 US$7.2           Medicare (annual)       P   900
                 billion
                                 Total                   P17,925
           2004 US$8.5
                 billion         P17,925 x 3,000         P19.6
                                 OFWs = P53.77           billion
           2005 US$10.7          million daily           per year
                 billion
           2006 US$12.8          Source: Central Bank;
                                 COURAGE
7/7/2011         billion   27
   Lucrative labor export program
           2005 Remittances of US$10.7
           billion (P545.7 billion) amounted to:

              •    More than the five top 2005
                   merchandise exports
              •   More than ½ of the 2005 national
                   budget (P907 B)
              •   100 times more than all Foreign
                   Direct Investments
              •   10% of the GDP
              •    9.5% of the GNP
              •   3 times more than 2001 US
                   military aid
7/7/2011                                             28
Overseas Filipinos
         •   More than 8.5 million or
             10% of Philippine
             population are in over
             196countries
         •   Mostly from peasant and
             worker families
         •   Overseas Filipinos
             include immigrants and
             naturalized citizens;
             undocumented workers;
             refugees; and contract
             workers (est. 3.5 million,
             DFA)
   Exporting Health Human Resource
 No. 1 Exporter of Nurses

 “An estimated 85% of employed Filipino nurses
 (more than 150,000) are working internationally.”
 (Aiken et al 2004)
 “70% of all Filipino nursing graduates are
 working overseas.” (Bach 2003)

 No. 2 Exporter of Doctors

 “68% of Filipino doctors work overseas, next to
 India.” (Mejia, WHO 1975)
                                          (NIH 2004)
      Hemorrhage of Human Resources:
                 Nurses
   13,536 nurses left the country in 2001.
   2000-2003: approx 50,000 nurses left.
     “Data casts doubt on the underreporting of the Philippine Overseas
    Employment Agency (POEA) that shows only 91 nurses left for the
    USA in 2000, 304 nurses in 2001, and 320 nurses in 2002.” (Tan et
    al 2004)
Source: Philippine Overseas Employment Administration (POEA)
Source: Philippine Overseas Employment Administration (POEA)
    Total Number of Nurses in the Country

   Total Registered Nurses (1960-2003) = 333, 581

   Estimated Deaths = 1, 375.20

   Estimated Current Stock of Nurses = 332, 205.80

SUPPLY AND DEMAND:

   Supply     = 332, 206

   Demand     = 193, 223

   Oversupply = 138, 983
Table 6. Estimated Number of Employed Filipino Nurses By
                    Work Setting, 2003

          Work Setting          Number      Percentage

I. Local/National               29, 467       15.25%
 A. Service

    1. Government Agencies      19, 052        9.86%
    2. Private Agencies          8, 173        4.23%
 B. Education                    2, 241        1.16%
II. International               163, 756      84.75%
Total                           193, 223     100.00%
    Estimated HRH Production Trends

   Nurses (10,000-15,000/year) from 475 nursing
    colleges
   Doctors (2,000/year) from 30 medical colleges
   Midwives (1,500/year) from 129 schools
   Dentists (2,000/year) from 31 dental schools
   Pharmacists (1,500/year from 35 pharmacy
    colleges
   Physical Therapists (1,000/year) from 95 PT/OT
    colleges
   Occupational Therapists (200/year) from 95
    PT/OT colleges
Top 5 Destinations of Filipino Nurses

    United States of America
    United Kingdom
    Saudi Arabia
    Ireland
    Singapore

                             (NIH 2004)
                Markets
Traditional Markets: Middle East, North
  America

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

Emerging Markets: Japan and Nurse
 Education abroad
     Profile of Nurse Migrants
   Mostly Women
   Age Range of 20-30 years old
   Middle-Income Group
   Basic Professional Educ/with Master’s
    Degree
   Specialized in areas ICU, ER, and OR
   Served 1-10 years before migration
      Profile of Nurse Medics
Increasing number – about 1000/year from 2000 to 2003-
   estimated to triple in 2005
From survey of 100 volunteer respondents (doctors
   currently taking nursing courses) in different regions of
   the Philippines:
 Gender Distribution – 45% female, 30% male, 25% no
   info
 Marital Status - 24% single, 76% married
 Age – 37 years old and above
 Annual Income Bracket – P 120, 000 to P 480, 000
 Specializations – Internal/General Medicine (30%),
   Pediatrics (14%), Family Medicine (13%), Surgery (8%),
   Pathology (6%), Others (29%)
 63% were practicing doctors for more than 10 years
     Hemorrhage of Human Resources:
                Doctors
   MD-NURSES: More than 9,000 MDs have already
    left as nurses in 2002-2005.
   Around 80% of public health physicians have
    taken up or are enrolled in nursing.
   Obstetricians and anaesthesiologists are fast
    depleting, followed by pediatricians and
    surgeons.

                                        (NIH 2004, PMA 2005)
    Hemorrhage of Human Resources: Doctors

   In some areas, the local PMA chapter facilitates
    the nursing education of its members
   Decrease in enrollment of first year medical
    students of 10% to 55% in the last 2 years.
   Decrease in applicants for residency positions

                                         (NIH 2004, PMA 2005)
      Hemorrhage of Human Resources:
            Other Professionals

   At least 37 Philippine nursing schools offer
    abbreviated 2-year courses for doctors to
    become nurses.
   More than 60% of nursing schools are geared
    mainly for “second coursers” (non-health
    professionals who want to take up nursing, e.g.
    engineers, accountants, teachers, soldiers).

                                       (HSA 2005, PNA 2005)
      Hemorrhage of Human Resources:
            Other Professionals

   HEAD estimates that there are between 30,000-
    40,000 “second-coursers” currently taking up
    nursing.
   TESDA has trained over 50,000 caregivers in the
    last 5 years and over 24,000 have been
    deployed abroad.
                                     (HSA 2005, PNA 2005)
Reasons Why Filipino Nurses Leave
          the Country
Push Factors

   Economic: low salary at home, no overtime and hazard
    pay, low coverage of health insurance

   Job-related: work overload or stressful working
    environment, slow promotion

   Socio-political and economic environment: limited
    opportunities for employment, decreased health budget,
    peace and order situation in the Philippines
Reasons Why Filipino Nurses Leave
          the Country
Pull Factors

   Economic: higher income, better benefits and
    compensation package

   Job-related: Lower nurse to patient ratio, more options in
    working hours

   Individual/Family-related: Chance to upgrade nursing
    skills, acquisition of immigrant visa and opportunity for
    family to migrate, opportunity to travel and learn other
    cultures, influence from peers and relatives

   Socio-political and Economic environment: Advanced
    technology, better peace and order situation
  Reasons Why Doctors Migrate as
          Nurse Medics
PUSH FACTORS
 very low compensation and salaries,
 feeling of hopelessness about the Philippine current
  situation,
 political instability and graft and corruption,
 poor working conditions and
 the threat of malpractice law


PULL FACTORS
 more socio-politico- economic security abroad,
 attractive salaries and compensation packages (High
  salaries, benefits, compensation)
 more job opportunities and career growth.
    Reasons Why Filipino Nurses Return:

   Personal Reasons
       To get married
       To raise children in homeland
       To take a vacation
       Homesickness and depression
       To retire
       To get family

   Professional Reasons
       To share expertise
       For professional stability
Reasons Why Filipino Nurses Return

   Financial Reasons
       Nurse has saved enough money
       To set up a business at home


   Job-related Reasons
       To buy a house or a car


   Social Reasons
       Contract has expired
       Plans to retire back home
    Perceived Impact of Migration
   Health Care System and Quality of
    Health Care
    o   Positive Effects
            Health care is enhanced.
            Availability of more aggressive staff replacements who are
             eager to learn.
    o   Negative Effects
            Continuity of programs/services is adversely affected.
            Quality of care is compromised.
            People in the community are deprived of health services.
            Improvement of the hospital is delayed when resources are
             used to train staff replacement.
    Perceived Impact of Migration
   Economy
    o   Positive Effects
            Economy improves with the remittances from workers
             abroad.
            Philippines posts 5th largest remittance earnings globally
             (WB) projected to be $30 B
            Unemployment is reduced.
    o   Negative Effects
            Loss of government resources used in education and
             training.
            Resources are spent on training of staff replacements.
            Reduced government income of the province and country
             from taxes of health professionals.
         Social Net Benefits
   Winners –
     Nurse migrants and their families- greater
      child schooling, reduced child labor ,
      increased educational expenditure,
     Economy – remittances, raise hours worked
      in self-employment and lead to relatively
      capital-intensive enterprises by migrants’
      hoouseholds
               Social Net Benefits
   Losers –
       Health Care System
          Loss of skilled trained health staff
          Rendered health system fragile

       Extended Families
            Social support
       Philippine Nursing
            Ability to renew and further nursing development is
             hampered
    Deteriorating Quality of Nursing Education

   The number of nursing schools
    have increased
                 1970s: only 40
                 1990s: 170
                 June 2003: 251
                 April 2004: 370
                 June 2005: 441
                 June 2006: 470

   In the last 3 years, there has
    been an 87% increase in
    nursing schools nationwide

                            (NIH 2004)
  Deteriorating Quality of Nursing Education

 Decreasing proportion of nursing graduates who pass
  the national nursing licensure examinations

      1970s and 80s: 80%-90%
      1991: below 61%
      2001-2003: 44%-48%
      2004: 55.9%
      2005: 49.7%
      2006: 41%
                                           (NIH 2004, PRC 2006)
  Deteriorating Quality of Nursing Education

 In 2001
  116 nursing schools: passing rate of <50%
  124 nursing schools: passing rate of >50%
 In 2002, 150 nursing schools had a passing
  rate <50%, which was already 63% of the
  237 nursing schools then.
 In the last 3 NLEs, at least 20 nursing schools
  consistently had a 0% passing rate.
                                   (NIH 2004, PRC 2006)
Source: PRC, 2005
        Nurses and Severe Exploitation and
                 Discrimination

   Canada: the Live-in Caregiver Program (LCP) for nurses
   United Kingdom: £ 2,000 payment to employer or
    recruiter, yet start at the lowest rung (~ healthcare
    assistant)
   Saudi Arabia: the visit of DOLE Sec. Patricia Sto. Tomas
    pushed for lower wages for Filipino nurses in order to
    maintain “competitiveness”.


                                   (AHW 2004, MIGRANTE INT’L 2005)
    Exploited Health Human Resources

   Health workers and professionals are
    overworked and underpaid.
    “Average monthly wages for nurses is between Php
    5,500 to 16,500 and for doctors is between Php 9,700
    to 23,500.” (Lorenzo et al, 2004)
    Exploited Health Human Resources
   Doctor to patient ratio (population)
      Cuba 1:225
      USA 1:450
      Philippines 1:10,000-26,000
      WHO (Ideal) 1:600

   Nurses to patient ratio
      PGH 1:15-26 per shift
      Davao del Sur 1:44-45 per shift
      Ideal 1:4 per shift
      Philippines 1:16,000 (population)
                     (AHW 2004, HealthWrights 2004)
Reasons for the Continuing Exodus

   Commercialized health education.
    “The average tuition fee for a 5-year medical
    course is Php 500,000 for school fees alone.”


   Labor export policy.
    “The national government earned USD 7.6B
    from OFW remittances in 2003 and USD 8.5B in
    2004. It expects to earn an estimated USD 10B
    in 2005.”
         Reasons for the Continuing Exodus

   Economic and political instability.
    “The fiscal crisis and the ballooning national debt; the
    unbridled corruption and lack of accountability; and the
    political crisis that worsen daily amid the incapacity of
    government to address these with long-term, definitive
    solutions.”


   Globalization policies.
    “The phenomenon of human trafficking across states,
    even under the guise of globalizing labor and human
    resource development, is still within the framework of
    privatization, deregulation, and liberalization.”
The Unhealthy Philippine Health Care System




     “A health care system that cannot maintain
          its own health human resource
                is not healthy at all.”
“Health is a basic human right. It is
  the responsibility of the state to
ensure that the people have access
       to quality health care.”
RIGHT TO HEALTH OF THE PEOPLE
Worsening State Neglect
                                    40%
                                    government

49% out
of                                        11% Shared-Risk
                                          Schemes
pocket                                    Including
                                          National Health
                                          Insurance
                                          (PhilHealth)


Total Health Expenditure P0.25 per Filipino per day
Increasing private burdens
           Decreasing Spending on Social Services




Debt payments: increased by 101%
Health: decreased by 19%

Military: increased by 11++%




   Nota: “%” ay inflation-adjusted per
          capita, tsart ay nominal
                                    Administrative Costs and
                 10%                 Regulatory Functions


   10%

                                                    80%


Public Health
Interventions                            Individual Healthcare
                (Romualdez, 2008)
  HEALTH has become a
commodity: subject to TRADE
      and PROFITS


National Governments have
     ABANDONED their
 responsibility to ensure the
  HEALTH of their PEOPLE.
    In these
 trying times,
WHAT ARE WE
    TO DO?
     Important Considerations
   Temporary migration most beneficial for sending
    country

   Permanent migration beneficial to individual
    migrants and families and receiving country

   Nursing most popular profession now due to job
    and career opportunities

   Nursing and HRH development are on national
    policy agenda -controversial
     Important Considerations
   Nursing development has not benefited from
    rollercoaster trends of migration

   Health Care system has not benefited from
    migration related transactions

   Nursing and health sectors need to manage
    relationships with trade and economic managers
    in private and government sectors

   Philippines has not utilized remittances to
    leverage job creation and domestic employment
    development
Health Worker Migration Policy Issues
   Areas that need attention: recruitment, retention, policy,
    education and strain on current nurses

   Funding of the education and training of health workers

   Employment situation within the source country and the
    degree to which health professionals would have been
    gainfully employed in their home country

   Consequences for the workers that remain in the country as
    their colleagues depart for employment abroad

   Whether movements reflect temporary or permanent shift in
    location
             Policy Analysis
   Local Policies – mainly regulate and
    manage domestic employment
     Many incompletely implemented or not
      implemented
     Does not manage outflow of workforce

     Does not adequately clarify standards of
      staffing and compensation
           Policy Provisions
   International Policies
     Provides models of regulating scope of
      practice and licensure, recruitment, entry
     Safeguards quality of health systems and
      health care in destination countries
     Few contain safeguards from source
      countries
Migration has to be managed
            by:
    Addressing protection of both health and
     human rights.
     - Dampening push forces by retaining
     talent in sending countries
    - Reducing pull forces by aiming for
     educational self sufficiency in destination
     countries

                            JLI Secretariat 2004
         Managed Migration
   Should facilitate both
    - development goals of source countries and
    - efficiency goals of destination countries
   Involves national
    - policy reforms
    - international agreements
   - cooperative education program by source
    and destination country institutions
   Health sector development projects
                (Commonwealth Secretaiat, 2005)
    Migration Related Policy
          Categories
 Recruitment, Entry, and Citizenship Policies
 Welfare and Human Resource Development and
  Retention
 Re-entry of Migrants (Brain Gain)

  - Permanent
  - Temporary (Brain Circulation)
 Licensure and Scope of Practice

 Skill Mix

 Poverty Alleviation and Social Development
Policy Development Criteria
   Mutually Beneficial
    - economic standpoint (social return)
    - development status (professional and social)
    - financial (private returns)
    - cultural
    - health systems
   Should achieve equity and efficiency
   Promote policy coherence
   Protection and safety human outcomes
              Policy Goals
   Equity – Nurse Distribution
   Effectiveness
   Efficiency
   Security/Safety – ensuring local/domestic
    health outcomes
     Policy Recommendations
   International Policies
     Bilateral Migration Management Policies
     Provision of Progressive Incentives
         HRH retention for destination countries
         Incentives for reintegration for Recruiting countries
     Policy Recommendations
   Domestic Policies
       Creation of incentives for return migration:
          Positions for return migrants
          Development of Framework for maximizing the
           utilization of those with skills, experience
          Incentives for investments/ temporaryreintegration
Policy Recommendations
   Within organizations
       Creation of Position that provide incentives for
       longevity
      Career Path Development

      Ensure continuing development

      Improve work conditions
               Policy Options
    Five Core Elements for National and Bilateral
         Policy on Labor Migration and Related
                   Support Measures:
     An informed and transparent labor migration
      admissions system designed to respond to
      measured, legitimate labor needs, taking into
      account domestic concerns as well.

     A standards-based approach to “migration
      management” protecting basic rights of all
      migrants and combating exploitation and
      trafficking.
   Enforcement of minimum national employment
    conditions standards in all sectors of activity.

   A plan of action against discrimination and
    xenophobia to sustain social cohesion.

   Institutional mechanisms for consultation and
    coordination with social partners in policy
    elaboration and practical implementation.
       Future Outlook

 Achieve mutually beneficial
 migration arrangements if
 reintegration programs are
 effective
But we should not loose sight
  of more empowering and
   actions towards social
      transformation….
    The State of the Nation’s Health: A Summary

   People’s health and welfare overall as the result
    of economic and political conditions
   Poor health outcomes, especially for the poorest
   Dysfunctional and fragmented health care
    delivery system
   Privatization as the state’s key health policy

   Systemic and worsening poverty and inequities
    urgently need to be address
                  Migration…
    Everyday, more than 3,000 Filipinos are forced to
    work overseas - P480,000 (approx. US$ 8,900.) in
    government revenue daily.
    Labor export program commodifies and exports
    Filipino workers abroad
    As the national economic and political crisis
    intensifies – so too will the export of workers
    because of the increased dependence on dollar
    remittances and inability to create jobs in the
    Philippines
    Abuses against migrants range from contract
    violations, physical and mental abuses and death
           Assert People's Control

Collective
action to
uphold and
defend people's
rights
   Health
   Land
   Living wages
   Social Equity
     Assert People's Control




Rescind detrimental government policies
         What Needs to Be Done?

Short Term/Immediate Intervention
  Increase wages
  Increase budget for health
  Hold national consultations with all stakeholders
  Improve regulation of medical and nursing schools
  Rescind commitments to General Agreement in Trade in
  Services (GATS)
         What Needs to Be Done?

Long Term/Strategic Intervention
  Review the overall health care system
  Formulate a pro-people health policy and program
  Discontinue labor export policy
  Review and rescind WTO commitments
  Discontinue globalization policies (deregulation,
  liberalization, and privatization)
  Draw up independent political and economic policies
             Challenges ahead
•   Alma Ata vs. “Alana Ata?”
•   Social determinants of health
•   “Ethical” recruitment of nurses vs. labor export
    policy
•   Universal health care? Socialized health care?
•   Medical tourism and sale of organs
•   WTO and health as a matter of trade and
    investment
•   Globalization and health privatization
                 Continuing advocacies

•   Health as a matter of right and state responsibility
•   Health in the framework of equity, not equality
•   Access to medicine as part of access to health
•   Health not just “the absence of disease” or
    adequate services but as a people’s overall well-
    being: economic, political, social, cultural
•   Health as a public service, not a business or trade
    investment
•   Health in the context of a truly independent and
    democratic society
       “Medicine has imperceptibly led us into the
social field and placed us in a position of confronting
directly the great problems of our time.”

       “For if medicine is really to accomplish its great
task, it must intervene in political and social life. It
must point out the hindrances that impede the normal
social functioning of vital processes, and effect their
removal.”



                     Dr. Rudolf Virchow (1821-1902)
  “I don’t deserve to be
  treated like this. I care
  about my job, SIR. I
  care about you!!!"




Sharon Cuneta
Artist, “Caregiver”
 WHAT WE WANT
Defend and Uphold People’s Right to
              Health

Resist the Commodification of Health

        WTO OUT of Health
WHAT WE WANT
          Health for ALL,
Health in the Hands of the People
Genuine Freedom and Democracy
        Migration…
Does it bridge the north and
      south problem?
        Is it ethical?
 Should it be supported?
 Constrained? Regulated?
              HEAL.
              STRUGGLE.
              LIBERATE.

               Health Alliance for
               Democracy (HEAD)


                Council for Health
                and Development

Maraming Salamat po….Thank you.

								
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