The Philippines Must Confront Its Healthcare Brain Drain Problem

The migration of Philippine workers is far from new; indeed, it is one of the most familiar stories in Southeast Asian labor trends. The Philippines boasts one of the world’s largest diaspora populations, with estimates that more than one in 10 Filipinos live abroad. Overseas Filipino workers (OFWs) contribute the third-highest amount in remittances in the world, according to recent statistics from the World Bank.

In the last two decades, however, there has been a sharp increase in the number of doctors and nurses migrating to other countries, shedding light in particular on the consequences of the migration of Philippine health workers. As a fundamental brain drain, this has seriously undermined the nation’s capability to provide health services to its people.

The matter of health worker migration has become a national concern over the past few years as top doctors and nurses have begun to leave and hospitals have been forced to stop operations due to a lack of qualified health workers. At the same time, the trends driving this phenomenon, including migration patterns and the high worldwide demand for health workers, are expected to continue. This makes it imperative for “donor” countries like the Philippines to implement policies, procedures, and programs to protect domestic human health resources.

The Philippines remains among the top exporters of nurses and doctors to the world, with around 70 percent of all Filipino nursing graduates working overseas. Philippine Medical Association records show that 2,000 doctors leave the country each year.

The trends are clear. Developments such as the rise of the population in need of long-term healthcare, and the dwindling number of young people entering the nursing profession in some developed countries, have fueled the demand for English-speaking Filipino nurses.

Apart from these “pull factors,” unemployment also “pushes” licensed nurses to leave the country. Poor working conditions in local hospitals, the decreased stature of doctors, high taxes, and the threat of malpractice lawsuits have also prompted health workers to leave the country. Developed countries, meanwhile, offer better compensation and benefit packages.

Ideally, migration brings beneficial results both for the migrating individual and national economies. However, the Philippine case attests that unrestrained migration can seriously weaken the national resources of the country. While overseas workers gain from higher incomes, the social impact of migration on families and communities must be probed further. The loss of health workers is already a distressing trend, and, if it continues unabated, it could put the Philippine health system in a state of prolonged crisis.

The consequences are already apparent. Hospitals are lowering their standards in hiring nurses and doctors, since the top graduates are already leaving the country. Some hospitals in more rural areas are hiring unlicensed nurses and midwives. Even large hospitals in Manila have reported delays in specialized medical procedures, as there is a lack of qualified nurses who will assist in surgical operations.

In the long term, from the perspective of the Philippine government, the opportunity costs accompanying labor migration may outweigh the short-term benefits generated by dollar remittances. The loss of educated and skilled manpower may prove to be so disastrous to the economy that it cannot be compensated by foreign exchange remittances.

To be sure, there is a viewpoint that downplays the “brain drain” analysis in favor of “brain exchange” and “brain circulation.” According to this perspective, the migration of skilled workers in a global economy generates foreign direct investment, stimulates entrepreneurship, and encourages returning migrants to make dynamic investments in home countries.

While these arguments reflect the positive lessons of migration in the IT industry in particular, it is doubtful whether these are wholly applicable to the health sector, where skills may be less transferrable, and labor may be less mobile due to the nature of the work.

What, then, needs to be done to reverse the migration of health workers from the Philippines?

Doctors and nurses will not be prevented from leaving the country. Their right to travel and the chance to pursue a career in other countries needs to be respected, especially in a democracy such as the Philippines. The government can only stop the departure of health workers by providing incentives for them to remain.

There is agreement on some initial steps that could be taken. Most agree, for instance, that financial incentives must be given to encourage health workers to remain in the country. It has been suggested that there could be more efforts to make the salaries of public health workers competitive or comparable at least to the earnings of healthcare personnel from other countries.

There has also been discussion of a proposal for medical and nursing graduates of public universities to be required to render service equivalent to the duration of their studies. If this is to be extended to all institutions for a bigger impact, the private sector will have to be consulted first before enacting this policy since there are more privately owned nursing and medical schools in the country.

Another variant of this proposal is to require all registered nurses to work for two to three years within the country before being allowed to work abroad, as a compromise position of sorts. If this proposal is approved, participation of private hospitals is necessary, especially since poorly financed public hospitals cannot absorb all health workers.

A compulsory service, even if for an initial period, arguably benefits even the “destination” countries, since they will be assured that migrating health workers fulfilled their obligations in “source” countries. More importantly, the nurses and doctors they recruited would be more skilled and experienced.

One other proposal has been for the government to initiate bilateral negotiations with importing countries to provide financial grants to hospitals in the Philippines in exchange for Filipino doctors and/or nurses that leave the country. This would also include securing an agreement that guarantees the protection of health workers’ rights in “destination” countries, which is another aspect of this challenge that ought not to be neglected.

Irrespective of what options are actually pursued, it is clear that managing migration today is crucial to avert a possible collapse of the healthcare system in the Philippines. Failure to stem the alarming number of migrating doctors and nurses will further cripple the deteriorating health services in the country. Beyond the implications for that sector alone, this will jeopardize the attainment of development goals, which seek to empower people by eradicating poverty. The Philippine government needs to make this a priority amid the sea of challenges it faces.