Against the odds

Experts have been sounding the alarm bells about the highly critical situation in both public and private hospitals these days with the unremitting brain drain of nurses and doctors leaving for greener pastures abroad.

The statistics are indisputable. An excellent study by the PCIJ released last month highlighted the fact that apart from still being the second top exporter of doctors, the Philippines provides a quarter of the world’s supply of nurses. This translates into a lot of good-paying jobs for Filipinos but the loss of competent nurses and a marked decline in the standards of nursing education as commercialism swamps instant nursing schools.

Moreover, the PCIJ study correctly points out that the shortage of health manpower in many parts of the country is further compounded by doctors taking up nursing to increase their chances of working abroad.

On top of a highly iniquitous health care system favoring the better off and urban-based sections of the population, there is now the added burden of competent nursing personnel and doctors in an exodus for better pay and working conditions outside the country. Hospitals and the rest of the health care system are left to unskilled or even incompetent hands. The inevitable result: further deterioration in health care services for most Filipinos, especially the desperately poor and even the so-called middle class.

One sad and ironic situation that unbridled globalization has yielded in a backward, underdeveloped country such as ours is the fact that whatever we produce, whether it be mangoes or nurses, the best ones we export to earn the needed dollars and we end up with the leftovers. The good quality ones that we manage to retain become available only at a steep price to the few locals who can still afford them.

Policy makers turn a bind eye to the dire implications of the impending breakdown of the country’s health care system in light of the more than $7B annual remittances of migrant Filipinos, the single biggest factor keeping the economy afloat. The outflow of skilled health human resources is but part of the policy of labor export that began during the Marcos dictatorship. Subsequent administrations tried to cover up the anti-Filipino, anti-people policy by sugarcoating this with the rationalization that it was a “temporary measure”.

The Arroyo administration has dispensed with this charade and institutionalized the policy as a “legitimate option” in its 2001-2004 Medium Term Development Program. This open policy means that it has abandoned any pretense at striving for industrialization and providing enough local jobs for our people including those for health professionals. The labor secretary, in the House budget committee hearings, admitted that 4 million of the 10 million jobs that government has promised are OFW or migrant jobs.

The reasons for the worsening of the health manpower crisis in this country run parallel to the steadily deteriorating macro economic situation. The younger generation faces a discouraging if not bleak prospect in terms of finding quality jobs that give decent pay, security of tenure and job satisfaction not to mention opportunities for career advancement. The health sector is not spared this reality.

On the other hand the lure of earning handsome dollar incomes abroad is just too irresistible and the neocolonial education and pro-Western cultural brainwashing young Filipinos receive make the prospect of relocating to a new but not alien culture mush less daunting. In recent years, increased demand for health manpower services abroad, especially in US, UK and the Middle East, have resulted in easier job hunting with more attractive terms and conditions.

So far the solutions offered are far short of being real solutions. At most there is talk about reforms that are not likely to make a dent on the problem. To cite a few: a proposal to add on the entire social expense for education and training in determining the price tag and marketing health manpower abroad; the creation of a national commission to oversee things; the appeal for “development aid” or “compensation” for countries exporting highly skilled personnel and health education reform to emphasize values formation that will hopefully stir patriotism among nursing and medical graduates.

Rather than wait for enlightenment on the part of the government whose anti-people policies should continue to be exposed and opposed, serious if limited reforms can be pursued at the level of health education and local initiatives through advocacy and activism.

Let us make it easier for the children of ordinary people, who have the talent, motivation and less potent urges to flee the country, to enter into nursing, medical and other health professions. There should be more such schools in secondary and even tertiary urban centers where students can be recruited locally and geared to practice locally.

Creative experimentations in health education, e.g. the ladder-type school for the health sciences in Tacloban, Leyte should be emulated and replicated. Public and private resources must be harnessed to create scholarships for poor and deserving students all the way up to residency training for tertiary level of care, coupled with iron-clad commitments that scholars will serve inside the country for a set number of years.

Decent salaries, housing and educational benefits for those professionals who opt to practice in more depressed areas and in difficult situations should be assured. The Armed Forces of the Philippines should be made to put a stop to the harassment of doctors who decide to work in non-traditional settings. Instead they should be extolled as role models. Practicing one’s profession inside the country is itself difficult enough as it is but there is still a whale of a difference between working in the urban centers and in the countryside.

Finally, we should encourage social and political activism among health students and professionals. In this way we nurture their humanitarian ideals and imbue them with social awareness and a progressive outlook that can sustain their determination to practice their chosen profession and serve their own people despite tremendous odds.

BusinessWorld
April 9-10, 2005