While the problem of migrating health professionals is escalating, the distribution of health professionals in the country is yet to be resolved. Data presented by Dr. Marilyn Lorenzo of the UP-NIH's Institute of Health Policy and Development Studies showed that in 1997, the bulk of government-employed Filipino doctors and nurses practice in urban areas, particularly the National Capital Region. Of 7,671 government doctors, 36 percent work in the NCR, while each of the other regions has roughly 300 doctors among them. Or even fewer--the Autonomous Region of Muslim Mindanao and Caraga, for instance, have to make do with 89 and 76 doctors each. The divide between Metro Manila and the regions would probably widen if data on the 60,000 other doctors practicing in the country were available.

    The condition among nurses is hardly different. Of the 9,778 nurses employed by the government, about a third are in Metro Manila. Contrast this to the 149 nurses in ARMM, and 147 in Caraga. The only regions that have a relatively higher number of nurses are Regions IV (973) and VII (807).

    Although there are more schools offering nursing courses--many too are those seeking accreditation--most of these are there exactly to cater to students attracted to the prospect of working abroad.

Plugging the drain

    Hyped by President Gloria Macapagal-Arroyo as a "landmark law" when it was passed in October 2002, the Nursing Act of 2002 was an early attempt to plug the nursing drain. The law offers two things--a wage increase to both government and private nurses (for government nurses, a monthly pay of PhP15,810 from PhP8,000-PhP 9,000), and mandatory regular retraining under the Comprehensive Nursing Specialty Program.

    Still, the promised pay is much lower, even with the differences in standards of living considered, than the amount nurses are likely to receive if they worked in the US, UK, Australia, or Canada instead. For instance, a nurse working in a US nursing home is paid at least US$12 an hour, while an entry-level nurse in a hospital is paid about US$16--these are already more than double the US minimum wage.

    This didn't turn out to be entirely attractive to many Filipino nurses--aside from the fact that there had been considerable debate on where to extract the money for the hike.

    And so if relatively better pay couldn't keep in, perhaps stricter measures must be taken. Late last year Representative Tranquilino Carmona of Negros Occidental filed House Bill 2700, which requires all new nurses to work in the country for at least two years before being allowed to seek employment abroad.

    This proposal, of course, was met with conflicting opinions. Nursing students, many of whom admit outright that they enter the field precisely to seek employment abroad, find the proposal a bit too harsh. Many of them feel it infringes their right to choose where to practice their nursing degree, little of which is subsidized by the government anyway.

    Meanwhile, there are those nurses who find the proposal agreeable, since this would give them the opportunity to build on "experience" and become more "globally competitive." Since a nursing degree does not exactly guarantee foreign employment, this requirement actually allows them the chance to buff their résumés.

"A solution to health-worker migration!"

    With these legislative solutions still leaving a number of key issues hanging, nurses' organizations, institutions, and schools are trying to come up with ways to handle the problem. One of these is the University of the Philippines Manila, which launched the Manila Placement Program for its health-sciences graduates in December.

    The "voluntary program," which sees itself as "a solution to health-worker migration," aims to provide employment opportunities for health-sciences graduates from UP Manila in the Philippine health-care system. This will be achieved by creating a link between the graduates and possible employers from the government and private sectors. This seeks to address two key issues--the loss of health-care professionals to foreign employment and the lack of health workers in "underserved regions and communities."

    With the help of the UP Manila Alumni Office, the program will identify "needs that can be filled by UP Manila graduates." These "needs" can be anywhere from community health work, health advocacy, hospital duty, or even a nine-to-five desk job.

    Dr. Marita Reyes, UP Manila chancellor, said that the project aims to "convince [UP Manila graduates] to commit to one year--two to three years, at most." She said that in the past similar projects by the national government failed for a couple of reasons--the projects, being mandatory, were met with hostility by the affected parties; the government was unable to provide the necessary logistical support to sustain them.

    Since the program is completely voluntary, there is the danger of no one availing himself or herself of it, but Reyes and the rest of the UP Manila administration have high hopes. She cited some statistics: nurses trained at the Philippine General Hospital stay in the country roughly three to four years; 95 to 98 percent of graduates from the UP Health Sciences Campus in Leyte choose to work in rural areas. The National Institute of Health Policy and Development Studies also showed that of the 146 members of the UP College of Medicine 2002, 81 percent stayed in the country, either to pursue further training or to return to and practice in their home provinces. And so perhaps, they said, the response to the program would not be so bad.

    At present the UP Manila administration is conducting a series of discussions with different stakeholders such as local government units and government agencies, hospital administrators, and private corporations. Once memorandums of agreement are signed with the stakeholders, the Alumni Office will coordinate prospects for the possible employment of UP Manila graduates.

    nothing new. However, this "phenomenon" has intensified in the last decade, and is showing no signs of letting up.