ahwmigration of nurses
TRANSCRIPT
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Migration of Filipino Nurses &Migration of Filipino Nurses &
Other Health ProfessionalsOther Health Professionals
Alliance of Health WorkersAlliance of Health Workers
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Migration of Filipino Nurses &Migration of Filipino Nurses &Other Health ProfessionalsOther Health Professionals
IntroductionIntroduction
Brief History of Filipino MigrationBrief History of Filipino Migration Philippine Health Situation At a GlancePhilippine Health Situation At a Glance
Migration of Filipino Nurses and OtherMigration of Filipino Nurses and OtherHealth ProfessionalsHealth Professionals
Proposed Action & ChallengesProposed Action & Challenges
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Brief HistoryBrief History
of Filipino Migrationof Filipino Migration
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Philippine Migration HistoryPhilippine Migration History
1565-1815 Galleon Trade
Post WW II
1906-1934 US Colony
1974 - LEP
Shipbuildersand seafarers
Pearl Divers
PropagandistaPlantationWorkers
Pensionados
Sacadas 46
Professionals
Mil. BasePersonnel
Wives andchildren
Contracted Labor
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Migration Before the LEPMigration Before the LEP
1417 - China
1565-1815Galleon Trade
1900
AmericanOccupation
(1903) Pencionados
at (1906) HSPA
(1930) Great Depression
(1935) US Repatriation Act
(1935) Tydings-McDuffie Law
(1946) Post WWII
(1965) Immigration andNationality Act
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Labor Export ProgramLabor Export Program
0
200000
400000
600000
800000
1000000
1200000
1 2 3 4 5 6 7 8 9 10 11 12
Series1
Series2
Deployment 1995-2006
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PrePre--LEP MigrationLEP MigrationFilipino Immigrants Admitted to the U.S. (1965Filipino Immigrants Admitted to the U.S. (1965--1973)1973)
19651965 19661966 19671967 19691969 19711971 19731973
3,1303,130 6,0936,093 10,86510,865 20,75520,755 28,47128,471 30,79930,799
NOTE: Majority are wives and children followed by professionals.NOTE: Majority are wives and children followed by professionals.
OFWs = 16,290 (Jan-June1975
6.72 2.57
5.24
2.27
21.32
61.88
services
construction
production
managerial
professional
aircraft, transport,comm
OCWs = 5,964 (Jan-June1975)
18.04
6.15
14.32
1.93
54.83
2.2
2.53
services
construction
production
managerial
professional
aircraft,
transpo, comm
clerical
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1974 Labor Code of the Philippines1974 Labor Code of the Philippines
Ministry of Labor
OEDBOverseas Employment
Development Board
BESBureau of Employment
Services
NSBNational Seamans
Board
OEAOffice of Emigrant
Affairs
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Historical Significance of LEPHistorical Significance of LEP
PrePre--LEPLEP Bugso ang mga period ngBugso ang mga period ng
migrasyon na maymigrasyon na maypaghupa sa mga pagitanpaghupa sa mga pagitannito.nito.
Direktang nakabatay saDirektang nakabatay sadikta at pangangailangandikta at pangangailanganng nangongolonyangng nangongolonyangpamahalaan.pamahalaan.
Hindi laganap atHindi laganap atsistematiko angsistematiko ang
recruitment.recruitment. Mga immigrant workersMga immigrant workers Pangunguna ng privatePangunguna ng private
recruitment agencies sarecruitment agencies saoverseas employmentoverseas employmentbefore 1974.before 1974.
LEPLEP 19741974 TuloyTuloy--tuloy na paglaki attuloy na paglaki at
walang patid nawalang patid nadeployment.deployment.
Pagmonopolisa ng govt saPagmonopolisa ng govt sa
recruitment at deployment.recruitment at deployment. Strategic labor marketingStrategic labor marketing
abroad at nationwide laborabroad at nationwide laborregistry.registry.
Pledge/mandatoryPledge/mandatoryremittances.remittances.
State exactions.State exactions. Contracted workersContracted workers refugees and politicalrefugees and political
asylum seekers.asylum seekers.
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Labor Export ProgramLabor Export Program
Aggressive Labor MarketingAggressive Labor Marketing
Manpower PoolingManpower PoolingPricing (recruitment expenses &Pricing (recruitment expenses &
salary range)salary range)
State ExactionsState ExactionsRemittance SchemeRemittance Scheme
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Difference of Normal Migration FlowDifference of Normal Migration Flow
and the LEP Nowand the LEP Now
Galleon TradeSacadas&pensionados
Post-WW II
1974-5,964
ocws
2007-
8-10.MOFWs
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Philippine Health SituationPhilippine Health SituationAt A GlanceAt A Glance
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At A Glance: Philippine HealthAt A Glance: Philippine Health
SituationSituation50% of the population50% of the population
has no health carehas no health careaccess.access.
7 out of 10 Filipinos7 out of 10 Filipinosdie without gettingdie without gettingany medical attention.any medical attention.
Only 60% of theOnly 60% of thepopulation has fullpopulation has fullaccess to essentialaccess to essentialdrugs.drugs.
(AHW 2004, CHD 2004, NIH 2005)(AHW 2004, CHD 2004, NIH 2005)
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10 mothers die daily due10 mothers die daily dueto pregnancyto pregnancy-- andandchildbirthchildbirth--related causes.related causes.
The average hospital billThe average hospital billis three times theis three times theaverage monthly income.average monthly income.
23.4 M Filipinos still do23.4 M Filipinos still do
not have access tonot have access totoilets. CBHP experiencetoilets. CBHP experiencewould double this figure.would double this figure.
(AHW 2004, CHD 2004, NIH 2005)(AHW 2004, CHD 2004, NIH 2005)
At A Glance:At A Glance:
Philippine Health SituationPhilippine Health Situation
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1965 1970 1975 1980 1985 1990 1995 2000 2002
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Percen
t
Year
Death by Attendance in 5-year Intervals, Philippines 1965-2002
Unattended
Attended
Source: National Statistics Office, 2006
70%medicallyunattendeddeaths in2002 and
1975.
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Proportion of Fully Immunized Children
69.4
58.265.3 64.5 65.2 61.3 62.9 59.9
0
20
40
60
80
100
1993 1997 1998 1999 2000 2001 2002 2003
Year
Proport
ion
Source: National Statistics Office 2006, NDHS, MCH Surveys 1993-2003
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Migration of Filipino Nurses &Migration of Filipino Nurses &Other Health ProfessionalsOther Health Professionals
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Hemorrhage of Health Human ResourcesHemorrhage of Health Human Resources
Philippines is thePhilippines is the no. 1 exporter of nursesno. 1 exporter of nursesworldwide andworldwide and no. 2 for doctorsno. 2 for doctors
85% of Filipino nurses work abroad in some 5085% of Filipino nurses work abroad in some 50countries (approx. 163,756 nurses in 2003)countries (approx. 163,756 nurses in 2003)
From 1999From 1999--2003: Licensed 27,342 nurses yet2003: Licensed 27,342 nurses yetover 56,000 went abroad.over 56,000 went abroad.
Increasing number of nursing schools: 170Increasing number of nursing schools: 170(1990s)(1990s) 251 (2003)251 (2003) 470 (2006)470 (2006)
HEAD, 2007
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Hemorrhage of Health Human ResourcesHemorrhage of Health Human Resources
Phenomenon ofPhenomenon ofdoctors becoming nursesdoctors becoming nurses to goto goabroadabroad
More than 9,000 doctors have already left as nursesMore than 9,000 doctors have already left as nursesfrom 2002 to 2005.from 2002 to 2005.
80% of public health physicians have taken up or are80% of public health physicians have taken up or areenrolled in nursing.enrolled in nursing.
90% of Municipal Health Officers (MHOs) are taking up90% of Municipal Health Officers (MHOs) are taking upnursing and expected to leave the country.nursing and expected to leave the country.
HEAD, 2007
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Obstetricians and anesthesiologists are rapidlyObstetricians and anesthesiologists are rapidlydepleted, followed by pediatricians and surgeons.depleted, followed by pediatricians and surgeons.
At least 37 Philippine nursing schools offerAt least 37 Philippine nursing schools offerabbreviated 2abbreviated 2--year courses for doctors to becomeyear courses for doctors to become
nurses.nurses.
More than 60% of nursing schools are gearedMore than 60% of nursing schools are gearedmainly for second coursersmainly for second coursers
Pharmacists are the next target for employmentPharmacists are the next target for employmentabroadabroad
HEAD, 2007
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TESDA has trained over 50,000 caregivers in the lastTESDA has trained over 50,000 caregivers in the last5 years and over 24,000 have been deployed abroad.5 years and over 24,000 have been deployed abroad.
An estimated 15,000 health professionals leave theAn estimated 15,000 health professionals leave thecountry annually for employment abroad.country annually for employment abroad.
Decreased enrollment in medical schools of 10%Decreased enrollment in medical schools of 10%--55% in the last 2 years.55% in the last 2 years.
Hospitals closing down for lack of doctors/nurses: 200Hospitals closing down for lack of doctors/nurses: 200
completely closed, 800 partially closed (2003completely closed, 800 partially closed (2003--2005)2005)
HEAD, 2007
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Other consequencesOther consequencesDecline in the interest of young Filipinos toDecline in the interest of young Filipinos to
study medicinestudy medicine evidenced by a drop ofevidenced by a drop of53% in NMAT examinees with Yr. 2000 as53% in NMAT examinees with Yr. 2000 asbaselinebaseline
Decline in the applicants for medicalDecline in the applicants for medicalresidency positions to become specialistsresidency positions to become specialistswith an average of 50%with an average of 50%
Nurse to patient ratios in provincial andNurse to patient ratios in provincial anddistrict hospitals now 1:40district hospitals now 1:40--1:601:60
Loss of highly skilled nurses in all hospitalsLoss of highly skilled nurses in all hospitalsacross the countryacross the country
Galvez-Tan, 2003
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Lorenzo, et. Al.
InternationalInternationalDemand andDemand and
NurseNurseMigrationMigration
PatternsPatterns
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Due to increasing and aging population, there is a significant increasein the demand for skilled nurses. In USA alone, roughly half to onemillion nurses are needed between the years 2010-2020. Supply ofnurses is failing to keep pace with increasing demand.
Data Source: USA Bureau of Health Professions
US Projections of Nursing Supply Versus Demand
0
500,000
1,000,000
1,500,000
2,000,000
2,500,000
3,000,000
2000 2005 2010 2015 2020
Supply Demand
US Projected Nursing Shortage, 2000 - 2020
0
200,000
400,000
600,000
800,000
1,000,000
1,200,000
2000 2005 2010 2015 2020
Y e a r S upply D e m a nd S ho rt a ge P er c e nt
2000 1,890,700 2,001,500 -110,800 -6%
2005 1,942,500 2,161,300 -218,800 -10%
2010 1,941,200 2,347,000 -405,800 -17%
2015 1,886,100 2,569,800 -683,700 -27%
2020 1,808,000 2,824,900 -1,016,900 -36%
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More so, other countries have similardemand for skilled nurses. Respective
projected shortfall in workforce supply arein thousands by 2010.
Country Number ofRNs Predicted shortfall (shortfall year)
UK 500,000 53,000 2010
Ireland 49,400 10,000 2008Canada 230,300 78,000 2011
Australia 179,200 40,000 2010
Sub-Saharan African Countries have a short fall of morethan 600,000 nurses
Singapore, Middle East, Ireland, Finland, Japan, Australia,
New Zealand are also markets requiring skilled nurses
Source: Trends in International Nurse Migration, 2004
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This global nursing demand has attracted Filipinos to pursue nursingprofession as migration for nurses have become prominent. Philippinesthen becomes one of the largest sources of nurses around the world.
Philippines main advantage: Common educational curriculum, English as asecond native language, positive feedback on Filipino nurses work ethics abroad
Common Destination Common Source ofNursesAustralia United Kingdom, New Zealand, Philippines
Ireland United Kingdom, Philippines, South Africa
Norway Other Scandinavian Countries, Germany, Philippines
United Kingdom Philippines, South Africa, Australia
United States Philippines, Canada, South Africa, Nigeria
Middle East Philippines
Number of Nurse Migrant in the United States ofAmerica
-
1,000
2,000
3,000
4,000
5,000
6,000
7,000
1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006
Number of Nurse Migrants to Other Country of Destinations,
1996-2006
-102030405060708090
100110120130140150
1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006
Canada Australia New Zealand
Germany Japan United Kingdom
Norway
Data Source: Migrant Data, Commission on Filipinos Overseas, 2007
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Total Number of Filipino Nurse Migrants, 1996-2006
366
1569
2235
3824
5994
3983
2238
1220
314431495
0
1000
2000
3000
4000
5000
6000
7000
1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006
Year
N
o.
ofN
urseM
igrants
Indeed, there is an overall upward trend in the number of Filipinonurse migrants. On the other hand, number of deployed OFW*nurses appear to be declining. This may be attributed to Nursespreference on migration package against contractual status.
Total Nurse Overseas Contract Workers, 1999-2006
5413
7683
13536
11867
10718
80768556
8968
02000
4000
6000
8000
10000
12000
14000
16000
1999 2000 2001 2002 2003 2004 2005 2006
Year
No.
ofNurseO
FWs
*OFW means Overseas Contract Workers. Under this category, nurses cannot bring their family in the country of destination.Migration package however allows nurses to bring theirimmediate family with them in the country of destination.Data Sources: Migrant Data, Commission on Filipinos Overseas, 2007; OFW Data, Philippine Overseas Employment Agency, 2007
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Magnitude of Permanent NurseMagnitude of Permanent NurseMigration,1996Migration,1996--20062006
-
1,000
2,000
3,000
4,000
5,000
6,000
7,000
1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006
Total Number of Nurses who migrated, CFO
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-
1,000
2,000
3,000
4,000
5,000
6,000
7,000
1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006
Australia
Canada
Germany
Japan
New Zealand
Norway
United Kingdom
United States of America
Total Number of Emigrants who were nurses beforeTotal Number of Emigrants who were nurses before
migration, by Destination Country, 1996migration, by Destination Country, 1996--20062006
Source: CFO
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Magnitude of TemporaryMagnitude of TemporaryNurse Migration, 2001Nurse Migration, 2001--11stst Sem. 2006Sem. 2006
0
2,000
4,000
6,000
8,000
10,000
12,000
14,000
16,000
2001 2002 2003 2004 2005 1st sem, 2006
Total OFW Deployment, Nursing Professionals, POEA
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Year of DeploymentYear of DeploymentCOUNTRYCOUNTRY 20032003 20042004 20052005 20062006
SAUDI ARABIASAUDI ARABIA5,7405,740 5,6405,640 4,6274,627 5,6405,640
UNITED ARAB EMIRATESUNITED ARAB EMIRATES452452 218218 670670 768768
KUWAITKUWAIT102102 408408 191191 340340
IRELANDIRELAND 414414 190190 297297 248248
UNITED STATESUNITED STATES392392 373373 3,8533,853 202202
LIBYALIBYA104104 1010 2323 158158
UNITED KINGDOMUNITED KINGDOM3,0883,088 800800 546546 145145
QATARQATAR484484 318318 133133 140140
SINGAPORESINGAPORE652652 166166 129129 7373
TRINIDAD AND TOBAGOTRINIDAD AND TOBAGO-- -- 113113 6868
ALL COUNTRIESALL COUNTRIES 8,9688,968 8,5568,556 10,71810,718 8,0768,076
Distribution of Nurses by Destination Country, 2003-2006
Source: POEA
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Table 1. Number of Filipino Nurses Deployed Abroad Per Year, 1992Table 1. Number of Filipino Nurses Deployed Abroad Per Year, 1992--20032003
19921992 57475747
1993199367446744
19941994 66996699
19951995 75847584
19961996 47344734
19971997 4242424219981998 45914591
19991999 54135413
20002000 76837683
20012001 135361353620022002 1191111911
20032003 89688968
TotalTotal 8785287852
Source: Philippine Overseas Employment Administration (POEA)
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Table 2. Number Of Selected Health WorkersTable 2. Number Of Selected Health WorkersWho Left The Country And Worked Abroad 1998Who Left The Country And Worked Abroad 1998--20032003
19921992 19931993 19941994 19951995 19961996 19971997 19981998 19991999 20002000 20012001 20022002 20032003
DentistsDentists 2727 2222 3838 4848 3636 5252 3232 5656 3333 5757 6262 4040
Dietitians AndDietitians AndPublic HealthPublic HealthNutritionistsNutritionists
ndnd ndnd ndnd ndnd ndnd ndnd 9898 6666 4545 6464 9898 134134
Doctors MedicalDoctors Medical 8686 9191 5757 6969 4747 8282 5555 5959 2727 6161 129129 112112
MidwivesMidwivesProfessionalProfessional
246246 295295 126126 161161 142142 113113 149149 6666 5555 190190 312312 276276
NursesNursesProfessionalProfessional
57475747 67446744 66996699 75847584 47344734 42424242 45914591 54135413 76837683 1353613536 1186711867 89688968
Optometrists AndOptometrists AndOpticiansOpticians
ndnd ndnd ndnd ndnd ndnd ndnd 6868 9696 8080 8383 123123 5858
PharmacistsPharmacists 5252 3232 3232 5454 5757 4242 4747 5555 3030 6464 5757 7474
PhysiotherapistsPhysiotherapists
AndAndOccupationalOccupationalTherapistsTherapists
542542 608608 645645 581581 426426 289289 317317 147147 235235 330330 517517 371371
TechniciansTechniciansMedical XMedical X--RayRay
ndnd ndnd ndnd ndnd ndnd ndnd 409409 249249 223223 285285 359359 384384
Caregivers AndCaregivers AndCaretakersCaretakers
ndnd ndnd ndnd ndnd ndnd ndnd ndnd ndnd ndnd 465465 53835383 1887818878
Source: Philippine Overseas Employment Administration (POEA)
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Figure 2. Trend of Deployment of Health Workers Abroad, 1992-2003
0
2000
4000
6000
8000
10000
12000
14000
16000
18000
20000
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
Populatio
n
DENTISTS
DIETITIANS AND PUBLIC
HEALTH NUTRITIONISTS
DOCTORS MEDICAL
MIDWIVES PROFESSIONAL
NURSES PROFESSIONAL
OPTOMETRISTS AND
OPTICIANS
PHARMACISTS
PHYSIOTHERAPISTS ANDOCCUPATIONAL THERAPISTS
TECHNICIANS MEDICAL X-
RAY
CAREGIVERS ANDCARETAKERS
Lorenzo, NIH, 2003
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Estimated Number of Employed Filipino Nurses By Work Setting,Estimated Number of Employed Filipino Nurses By Work Setting,20032003
Work SettingWork Setting NumberNumber PercentagePercentage
II.. Local/NationalLocal/National 29, 46729, 467 15.25%15.25%
AA.. ServiceService
11.. GovernmentGovernment AgenciesAgencies 19, 05219, 052 9.86%9.86%
22.. PrivatePrivate AgenciesAgencies 8, 1738, 173 4.23%4.23%
BB.. EducationEducation 2, 2412, 241 1.16%1.16%
IIII.. InternationalInternational 163, 756163, 756 84.75%84.75%
TotalTotal 193, 223193, 223 100.00%100.00%
Lorenzo, NIH, 2003
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MarketsMarkets
Traditional Markets: Middle East, NorthTraditional Markets: Middle East, NorthAmericaAmerica
New Markets: Europe especially UK,New Markets: Europe especially UK,Netherlands, High Income AsiaNetherlands, High Income Asia
Emerging Markets: Japan and NurseEmerging Markets: Japan and NurseEducation abroadEducation abroad
Lorenzo, NIH, 2003
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Overseas Filipino Workers (OFWs)Overseas Filipino Workers (OFWs)RemittancesRemittances
YEARYEAR US$US$
19991999 USUS$$ 66..7979
20002000 USUS$$ 66..0505
20012001 USUS$$ 66..0303
20022002 USUS$$ 77..1919
20032003 USUS$$ 77..6464
20042004
20052005
USUS$$ 88..5050
USUS$$ 1100..88
Source: Central Bank of the Philippines, 2005Source: Central Bank of the Philippines, 2005--0606
0
2
4
6
8
10
12
1999 2000 2001 2002 2003 2004 2005
OFW Rem ittance in Billion US Dollars , 1999-2005
In Billion US$
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Reasons Why Health ProfessionalsReasons Why Health ProfessionalsLeave the CountryLeave the Country
Push FactorsPush Factors
EconomicEconomic: low salary at home, no overtime and hazard: low salary at home, no overtime and hazardpay, low coverage of health insurancepay, low coverage of health insurance
JobJob--relatedrelated: work overload or stressful working: work overload or stressful workingenvironment, slow promotionenvironment, slow promotion
SocioSocio--political and economic environmentpolitical and economic environment: limited: limitedopportunities for employment, decreased health budget,opportunities for employment, decreased health budget,peace and order situation in the Philippines, Laborpeace and order situation in the Philippines, LaborExport Policy of the government, western orientationExport Policy of the government, western orientationand high cost of health science educationand high cost of health science education
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Reasons why HealthReasons why HealthProfessionals Leave the CountryProfessionals Leave the Country
Pull Factors (Receiving Countries)Pull Factors (Receiving Countries)
EconomicEconomic: higher income, better benefits and compensation: higher income, better benefits and compensationpackagepackage
JobJob--relatedrelated: Lower nurse to patient ratio, more options in working: Lower nurse to patient ratio, more options in workinghourshours
Individual/FamilyIndividual/Family--relatedrelated: Chance to upgrade nursing skills,: Chance to upgrade nursing skills,acquisition of immigrant visa and opportunity for family to migrate,acquisition of immigrant visa and opportunity for family to migrate,
opportunity to travel and learn other cultures, influence from peersopportunity to travel and learn other cultures, influence from peersand relativesand relatives
SocioSocio--political and Economic environmentpolitical and Economic environment: Advanced technology,: Advanced technology,better peace and order situationbetter peace and order situation
Lorenzo, NIH, 2003
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Reasons Why Doctors Migrate asReasons Why Doctors Migrate asNurse MedicsNurse Medics
PUSH FACTORSPUSH FACTORSvery low compensation and salaries,very low compensation and salaries,feeling of hopelessness about the Philippine currentfeeling of hopelessness about the Philippine current
situation,situation,political instability and graft and corruption,political instability and graft and corruption,poor working conditions andpoor working conditions andthe threat of malpractice lawthe threat of malpractice law
PULL FACTORS (Receiving countries)PULL FACTORS (Receiving countries)
more sociomore socio--politicopolitico-- economic security abroad,economic security abroad,attractive salaries and compensation packages (Highattractive salaries and compensation packages (High
salaries, benefits, compensation)salaries, benefits, compensation)more job opportunities and career growth.more job opportunities and career growth.
Lorenzo, NIH, 2003
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Proposed ActionProposed Action& Challenges& Challenges
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Proposed ActionProposed Action Policy LevelPolicy Level
Scrap labor export policy (LEP)Scrap labor export policy (LEP)
Regulate the outflow of health professionalsRegulate the outflow of health professionals
Increase health budget, improve the salaries &Increase health budget, improve the salaries &
working conditions of health workers/professionalsworking conditions of health workers/professionals Reorientation of health science educationReorientation of health science education
Advocacy & MobilizationAdvocacy & Mobilization AwarenessAwareness--raising among health science studentsraising among health science students
and professionals/Exposure to social realitiesand professionals/Exposure to social realities WTO Out of Health campaignWTO Out of Health campaign
Organize Health Migrants at the National andOrganize Health Migrants at the National andInternational LevelsInternational Levels an org. for health migrantsan org. for health migrants
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ChallengesChallenges Sustained and concerted effortsSustained and concerted efforts
at the country and global levelat the country and global level
Involvement of the healthInvolvement of the health
professionals into the campaignprofessionals into the campaign