from brain drain to national hemorrhage the global migration of philippine-trained nurses: causes,...

From Brain Drain to National From Brain Drain to National HemorrhageHemorrhage

The Global Migration of The Global Migration of Philippine-Trained Philippine-Trained

Nurses: Nurses: Causes, Impacts Causes, Impacts and Future Prospectsand Future Prospects

Erlinda Castro-Palaganas PhD, RNErlinda Castro-Palaganas PhD, RN

University of Ottawa, Nov. 3, 2008University of Ottawa, Nov. 3, 2008

ReferencesReferences

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

Outline of PresentationOutline of Presentation

Philippine Health Care ContextPhilippine Health Care Context Philippine Basic IndicatorsPhilippine Basic Indicators The Government Responses:The Government Responses:

- Privatization as a Government Policy- Privatization as a Government Policy

- Labor Export Policy- Labor Export Policy Nurses and MigrationNurses and Migration

- Migration Situation- Migration Situation

- Migration Issues and Concerns- Migration Issues and Concerns

- Policy Implications- Policy Implications ChallengesChallenges

What could be the reason/s?What could be the reason/s?

Philippine Health Care Philippine Health Care System ContextSystem Context

Philippines composed of 7,150 islands organized into 3 Philippines composed of 7,150 islands organized into 3 main island groupsmain island groups

Population : 87million growing annually by 2.3%Population : 87million growing annually by 2.3%

Productive age group estimated to be 42% of 34.2 Productive age group estimated to be 42% of 34.2 millionmillion

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

Only 8.83% are estimated to comprise human health Only 8.83% are estimated to comprise human health resourcesresources


Rapidly growing population , steady employment Rapidly growing population , steady employment ratesrates

Unemployment rates around 12%Unemployment rates around 12% 1 out of 5 Filipinos underemployed1 out of 5 Filipinos underemployed Job opportunities have not increased Job opportunities have not increased

correspondingly with population increasecorrespondingly with population increase Labor productivity stagnant over last 12 yearsLabor productivity stagnant over last 12 years Every year about 800,000 young people begin Every year about 800,000 young people begin

looking for work in a contracting and job-scarce looking for work in a contracting and job-scarce economyeconomy


Devolved health care system since 1995Devolved health care system since 1995 DOH lead agency that safeguards health and DOH lead agency that safeguards health and

maintains specialty hospitals, regional hospitals, maintains specialty hospitals, regional hospitals, and medical centersand medical centers

All other hospitals and field health units All other hospitals and field health units maintained by local governmentsmaintained by local governments

Private sector involvement in health care is Private sector involvement in health care is enormous – 60% of 1,600 hospitals in country enormous – 60% of 1,600 hospitals in country are privateare private

Problems of access and equity: hampered by Problems of access and equity: hampered by high costs and physical and soci-cultural barriershigh costs and physical and soci-cultural barriers


Health Sector Reform launched in 2000 Health Sector Reform launched in 2000 covering :covering : HospitalHospital Local Health Systems DevelopmentLocal Health Systems Development Public Health ProgramsPublic Health Programs Health RegulationHealth Regulation Social Health Insurance Social Health Insurance

No attention given to development of No attention given to development of Health Human Resources Health Human Resources

Philippine Basic IndicatorsPhilippine 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: IBONsource: IBON


P100 billion estimated P100 billion estimated government deficitgovernment deficit

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

P721.7 billion target to be P721.7 billion target to be repaid to creditors in ’06 or repaid to creditors in ’06 or P6,391 per FilipinoP6,391 per Filipino

Real public spending per Real public spending per Filipino on education is Filipino on education is P1,296; health P120P1,296; health P120

Source: “2006: The Economics of Hype”, IBON Foundation, published in bulatlat.com,


The Philippines ranked The Philippines ranked 8383rdrd of 177 nations of 177 nations (down from 77(down from 77th th in 2002) in 2002) in the quality-of-life in the quality-of-life survey (GDP, life survey (GDP, life expectancy, adult expectancy, adult literacy, growth in literacy, growth in school enrollment, school enrollment, environmental environmental protection)protection)

- 2004 UN Human - 2004 UN Human Development IndexDevelopment Index

Health Sector Health Sector Reform the Reform the PhilippinesPhilippines

Privatization as a Government Privatization as a Government Health PolicyHealth Policy

Health Sector PrivatizationHealth Sector Privatization

““Health Sector Reform Agenda”Health Sector Reform Agenda” ““Fiscal autonomy” for govt hospitalsFiscal autonomy” for govt hospitals Promote health insurance schemes with private Promote health insurance schemes with private

sectorsector Tokenism in “public health programs”, “community Tokenism in “public health programs”, “community

health” and “development of local health systems”health” and “development of local health systems”

““FOURmula ONE for Health” (2005-2010)FOURmula ONE for Health” (2005-2010) Integrated public health into hospital servicesIntegrated public health into hospital services Medical tourismMedical tourism ““Innovative financing arrangements”Innovative financing arrangements”

Health Services for Sale: Medical Health Services for Sale: Medical TourismTourism

Principally being Principally being promoted by the promoted by the Philippine government Philippine government using the public health using the public health care systemcare system

Linked to the issue of Linked to the issue of organ trade (i.e. sale of organ trade (i.e. sale of kidneys for US$3,000-kidneys for US$3,000-4,000)4,000)

Expected revenues: Expected revenues: US$ 10B in 5 yearsUS$ 10B in 5 years

““Medical Terrorism”: Growing military Medical Terrorism”: Growing military presencepresence

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.

Labor Export Policy

This decline in the quality of life is due to the worsening economic and political crisis in the country.

“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 PolicyLabor 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 development of the labor export program the labor export program

(LEP)(LEP)• Since 1974, when the Labor Code was first revised, Since 1974, when the Labor Code was first revised,

the “export” of Filipino workers overseas has the “export” of Filipino workers overseas has intensified and become increasingly systematicintensified and become increasingly systematic

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

• Overseas Workers Welfare Administration, Overseas Workers Welfare Administration, Philippine Overseas Employment AdministrationPhilippine Overseas Employment Administration

• Government target of 1 million workers overseas per Government target of 1 million workers overseas per yearyear

Organized Philippine Overseas Organized Philippine Overseas Deployment SystemDeployment System

Goals:Goals: Maximize gains of overseas employment for migrants Maximize gains of overseas employment for migrants

and sending countriesand sending countries Monitoring and Protection of OFW welfareMonitoring and Protection of OFW welfare

Components:Components: Managing overseas deployment: Finding , managing Managing overseas deployment: Finding , managing

new markets, maintaining current partners;new markets, maintaining current partners; Welfare Protection: Ensuring rights are protected Welfare Protection: Ensuring rights are protected

during recruitment, pre-departure and in overseas during recruitment, pre-departure and in overseas workplacesworkplaces

Migrant workers’ reintegration into societyMigrant workers’ reintegration into society

Organized Philippine Organized Philippine Overseas Deployment Overseas Deployment

SystemSystemSix major government agencies involved in migration Six major government agencies involved in migration

process :process :

1.DOLE- Department of Labor and Employment1.DOLE- Department of Labor and Employment

2. POEA- Phil. Overseas Employment Administration2. POEA- Phil. Overseas Employment Administration

3. OWWA- Overseas Workers Welfare Administration3. OWWA- Overseas Workers Welfare Administration

4. BSP- Bangko Sentral ng Pilipinas (Central Bank)4. BSP- Bangko Sentral ng Pilipinas (Central Bank)

5. DFA – Department of Foreign Affairs5. DFA – Department of Foreign Affairs

6. CFO- Commission on Filipinos Overseas6. CFO- Commission on Filipinos Overseas

Key Migration Management Key Migration Management ToolsTools

Migrant and Overseas Filipinos Act (RA 8042)Migrant and Overseas Filipinos Act (RA 8042) Contains policies, rights , obligations, sanctions and Contains policies, rights , obligations, sanctions and

regulations that govern overseas employment.regulations that govern overseas employment. POEA- handles documentation of land-based and sea-based POEA- handles documentation of land-based and sea-based

contract workers recruited mostly by private recruiters, contract workers recruited mostly by private recruiters, regulates recruiters; manages information on migrant and regulates recruiters; manages information on migrant and remittance flows to assist with policy formulationremittance flows to assist with policy formulation

OWWA- responsible for promoting welfare of OFWs and OWWA- responsible for promoting welfare of OFWs and dependents through implementation of welfare programs for dependents through implementation of welfare programs for migrants and dependents; includes health or repatriation migrants and dependents; includes health or repatriation assistance, livelihood loans, skills training, scholarships, and assistance, livelihood loans, skills training, scholarships, and reintegration incentivesreintegration incentives

POLOs – Philippine Overseas Labor Offices attached to Phil. POLOs – Philippine Overseas Labor Offices attached to Phil. embassies and consulatesembassies and consulates

Labor ExportLabor Export

• 36,000 Filipinos were 36,000 Filipinos were “deployed” to other “deployed” to other countries in 1975.countries in 1975.

• In 2006, the Arroyo In 2006, the Arroyo administration exported a administration exported a record 1.08 million Filipinos record 1.08 million Filipinos and received US$14 billion and received US$14 billion in remittancein remittancess of overseas of overseas Filipinos. Filipinos.

• Of the 308,142 deployed Of the 308,142 deployed OFWs as new hires, OFWs as new hires, 184,454 or 60% were 184,454 or 60% were females compared to females compared to 123,688 males in 2006.123,688 males in 2006.

2006 Top 10 OFW destination countries:

1. Saudi Arabia 223,359

2. UAE 99,212

3. Hong Kong 96,929

4. Kuwait 47,917

5. Qatar 45,795

6. Taiwan 39,025

7. Singapore 28,369

8. Italy 25,413

9. UK 16,926

10. Korea 13,984

Others 151,041

Landbased 788,070

Seabased 274,497

Total 1,062,657

Source: POEA, 2006

2006 Top 10 OFW destination countries:

1. Saudi Arabia 223,359

2. UAE 99,212

3. Hong Kong 96,929

4. Kuwait 47,917

5. Qatar 45,795

6. Taiwan 39,025

7. Singapore 28,369

8. Italy 25,413

9. UK 16,926

10. Korea 13,984

Others 151,041

Landbased 788,070

Seabased 274,497

Total 1,062,657

Source: POEA, 2006

Top Ten Occupational Group byTop Ten Occupational Group by SexSexFor 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 workers

375 7,456 7.831 2.5%

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 Intensified export of Filipino migrantsmigrants

0100200300400500600700800900

1000

1984 1989 1994 1999 2004

“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 PolicyLabor Export Policy

For the last 30 years, the Philippine economy, and For the last 30 years, the Philippine economy, and all administrations have been propped up by the all administrations have been propped up by the remittances of overseas Filipinos. The country’s remittances of overseas Filipinos. The country’s economy is saved from eventual collapse by the economy is saved from eventual collapse by the remittances of Filipinos abroad. remittances of Filipinos abroad.

Last year, close to 10 million Filipinos overseas Last year, close to 10 million Filipinos overseas remitted a total of US$12.8 billion to the remitted a total of US$12.8 billion to the Philippines, US$2.2 billion higher than the US$ Philippines, US$2.2 billion higher than the US$ 10.6 billion total of 2005. This is aided by the 10.6 billion total of 2005. This is aided by the government’s pursuit of its labor export program government’s pursuit of its labor export program that targets one (1) million Filipinos deployed that targets one (1) million Filipinos deployed annually. annually.

04/18/23 27

State exactions & dollar remittancesState exactions & dollar remittances

19841984 US$659 US$659 millionmillion

19891989 US$973 US$973 millionmillion

19941994 US$2.9 US$2.9 billionbillion



20042004 US$8.5 US$8.5 billion billion

20052005 US$10.7 US$10.7 billion billion


76 Signatures 76 Signatures

(P100/signature)(P100/signature)

P 7,600P 7,600

PassportPassport P 550P 550

POEA fee POEA fee P 7,500P 7,500

OWWA fee (US$25 OWWA fee (US$25 per contract)per contract)

P 1,375P 1,375

Medicare (annual)Medicare (annual) P 900P 900

TotalTotal P17,925P17,925

P17,925 x 3,000 P17,925 x 3,000 OFWs = P53.77 OFWs = P53.77 million dailymillion daily

P19.6 P19.6 billion billion per yearper year

State exactions:

Annual remittances:

Source: Central Bank; COURAGE

04/18/23 28

Lucrative labor export Lucrative labor export programprogram

2005 Remittances of US$10.7 2005 Remittances of US$10.7 billion billion (P545.7 billion)(P545.7 billion) amounted to: amounted to:

• More than the five top 2005 More than the five top 2005 merchandise exports merchandise exports • More than ½ of the 2005 national More than ½ of the 2005 national

budget (P907 B)budget (P907 B)• 100 times more than all Foreign 100 times more than all Foreign

Direct InvestmentsDirect Investments• 10% of the GDP10% of the GDP• 9.5% of the GNP9.5% of the GNP• 3 times more than 2001 US 3 times more than 2001 US military aidmilitary aid

Overseas FilipinosOverseas Filipinos• More than 8.5 million or More than 8.5 million or

10% of Philippine 10% of Philippine population are in over population are in over 196countries 196countries

• Mostly from peasant and Mostly from peasant and worker familiesworker families

• Overseas Filipinos Overseas Filipinos include immigrants and include immigrants and naturalized citizens; naturalized citizens; undocumented workers; undocumented workers; refugees; and contract refugees; and contract workers (est. 3.5 million, workers (est. 3.5 million, DFA)DFA)

Exporting Health Human ResourceExporting Health Human Resource No. 1 Exporter of NursesNo. 1 Exporter of Nurses

““An estimated 85% of employed Filipino nurses An estimated 85% of employed Filipino nurses (more than 150,000) are working internationally.” (more than 150,000) are working internationally.” (Aiken et al 2004)(Aiken et al 2004)

““70% of all Filipino nursing graduates are working 70% of all Filipino nursing graduates are working overseas.” (Bach 2003)overseas.” (Bach 2003)

No. 2 Exporter of DoctorsNo. 2 Exporter of Doctors

““68% of Filipino doctors work overseas, next to 68% of Filipino doctors work overseas, next to India.” (Mejia, WHO 1975)India.” (Mejia, WHO 1975)

(NIH 2004)(NIH 2004)

Hemorrhage of Human Resources: Hemorrhage of Human Resources: NursesNurses

13,536 nurses left the country in 2001.13,536 nurses left the country in 2001. 2000-2003: approx 50,000 nurses left.2000-2003: approx 50,000 nurses left.

““Data casts doubt on the underreporting of the Philippine Data casts doubt on the underreporting of the Philippine Overseas Employment Agency (POEA) that shows only 91 Overseas Employment Agency (POEA) that shows only 91 nurses left for the USA in 2000, 304 nurses in 2001, and nurses left for the USA in 2000, 304 nurses in 2001, and 320 nurses in 2002.” (Tan 320 nurses in 2002.” (Tan et alet al 2004) 2004)

57476744 6699

7584

47344242 4591

5413

7683

13536

11911

8968

Yr 1992

Yr 1993

Yr 1994

Yr 1995

Yr 1996

Yr 1997

Yr 1998

Yr 1999

Yr 2000

Yr 2001

Yr 2002

Yr 2003

Nu

mb

er

of F

ilip

ino

Nu

rse

sFigure 1. Trend in Deployment of Filipino Nurses

Abroad, 1992-2003

Source: Philippine Overseas Employment Administration (POEA)

Figure 2. Trend of Deployment of Health Workers Abroad, 1992-2003

0

2000

4000

6000

8000

10000

12000

14000

16000

18000

20000

Popu

latio

n

DENTISTS

DIETITIANS AND PUBLICHEALTH NUTRITIONISTS

DOCTORS MEDICAL

MIDWIVES PROFESSIONAL

NURSES PROFESSIONAL

OPTOMETRISTS ANDOPTICIANS

PHARMACISTS

PHYSIOTHERAPISTS ANDOCCUPATIONALTHERAPISTSTECHNICIANS MEDICAL X-RAY

CAREGIVERS ANDCARETAKERS

Source: Philippine Overseas Employment Administration (POEA)

Total Number of Nurses in the Total Number of Nurses in the CountryCountry

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

Estimated Deaths = 1, 375.20Estimated Deaths = 1, 375.20

Estimated Current Stock of Nurses = 332, 205.80Estimated Current Stock of Nurses = 332, 205.80

SUPPLY AND DEMAND:SUPPLY AND DEMAND:

Supply = 332, 206Supply = 332, 206

Demand = 193, 223Demand = 193, 223

Oversupply = 138, 983Oversupply = 138, 983

Table 6. Estimated Number of Employed Filipino Nurses By Work Setting, 2003

Work SettingNumber Percentag

e

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 Estimated HRH Production TrendsTrends

Nurses (10,000-15,000/year) from 475 nursing Nurses (10,000-15,000/year) from 475 nursing collegescolleges

Doctors (2,000/year) from 30 medical collegesDoctors (2,000/year) from 30 medical colleges Midwives (1,500/year) from 129 schoolsMidwives (1,500/year) from 129 schools Dentists (2,000/year) from 31 dental schoolsDentists (2,000/year) from 31 dental schools Pharmacists (1,500/year from 35 pharmacy Pharmacists (1,500/year from 35 pharmacy

collegescolleges Physical Therapists (1,000/year) from 95 PT/OT Physical Therapists (1,000/year) from 95 PT/OT

collegescolleges Occupational Therapists (200/year) from 95 Occupational Therapists (200/year) from 95

PT/OT collegesPT/OT colleges

Top 5 Destinations of Filipino Top 5 Destinations of Filipino NursesNurses

United States of AmericaUnited States of America United KingdomUnited Kingdom Saudi ArabiaSaudi Arabia IrelandIreland SingaporeSingapore

(NIH 2004)(NIH 2004)

MarketsMarkets

Traditional Markets: Middle East, North Traditional Markets: Middle East, North AmericaAmerica

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

Emerging Markets: Japan and Nurse Emerging Markets: Japan and Nurse Education abroad Education abroad

Profile of Nurse MigrantsProfile of Nurse Migrants

Mostly WomenMostly Women Age Range of 20-30 years oldAge Range of 20-30 years old Middle-Income GroupMiddle-Income Group Basic Professional Educ/with Master’s Basic Professional Educ/with Master’s

DegreeDegree Specialized in areas ICU, ER, and ORSpecialized in areas ICU, ER, and OR Served 1-10 years before migrationServed 1-10 years before migration

Profile of Nurse MedicsProfile of Nurse Medics

Increasing number – about 1000/year from 2000 to 2003- Increasing number – about 1000/year from 2000 to 2003- estimated to triple in 2005estimated to triple in 2005

From survey of 100 volunteer respondents (doctors From survey of 100 volunteer respondents (doctors currently taking nursing courses) in different regions of currently taking nursing courses) in different regions of the Philippines:the Philippines:

Gender Distribution – 45% female, 30% male, 25% no Gender Distribution – 45% female, 30% male, 25% no infoinfo

Marital Status - 24% single, 76% marriedMarital Status - 24% single, 76% married Age – 37 years old and aboveAge – 37 years old and above Annual Income Bracket – P 120, 000 to P 480, 000Annual Income Bracket – P 120, 000 to P 480, 000 Specializations – Internal/General Medicine (30%), Specializations – Internal/General Medicine (30%),

Pediatrics (14%), Family Medicine (13%), Surgery (8%), Pediatrics (14%), Family Medicine (13%), Surgery (8%), Pathology (6%), Others (29%)Pathology (6%), Others (29%)

63% were practicing doctors for more than 10 years63% were practicing doctors for more than 10 years

Hemorrhage of Human Resources: Hemorrhage of Human Resources: DoctorsDoctors

MD-NURSES: More than 9,000 MDs have MD-NURSES: More than 9,000 MDs have already left as nurses in 2002-2005.already left as nurses in 2002-2005.

Around 80% of public health physicians Around 80% of public health physicians have taken up or are enrolled in nursing.have taken up or are enrolled in nursing.

Obstetricians and anaesthesiologists are Obstetricians and anaesthesiologists are fast depleting, followed by pediatricians fast depleting, followed by pediatricians and surgeons.and surgeons.

(NIH 2004, PMA 2005)(NIH 2004, PMA 2005)

Hemorrhage of Human Resources: Hemorrhage of Human Resources: DoctorsDoctors

In some areas, the local PMA chapter In some areas, the local PMA chapter facilitates the nursing education of its facilitates the nursing education of its members members

Decrease in enrollment of first year medical Decrease in enrollment of first year medical students of 10% to 55% in the last 2 years.students of 10% to 55% in the last 2 years.

Decrease in applicants for residency positionsDecrease in applicants for residency positions

(NIH 2004, PMA 2005)(NIH 2004, PMA 2005)

Hemorrhage of Human Resources: Hemorrhage of Human Resources: Other ProfessionalsOther Professionals

At least 37 Philippine nursing schools offer At least 37 Philippine nursing schools offer abbreviated 2-year courses for doctors to abbreviated 2-year courses for doctors to become nurses.become nurses.

More than 60% of nursing schools are More than 60% of nursing schools are geared mainly for “second coursers” (non-geared mainly for “second coursers” (non-health professionals who want to take up health professionals who want to take up nursing, e.g. engineers, accountants, nursing, e.g. engineers, accountants, teachers, soldiers).teachers, soldiers).

(HSA 2005, PNA 2005)(HSA 2005, PNA 2005)

Hemorrhage of Human Resources: Hemorrhage of Human Resources: Other ProfessionalsOther Professionals

HEAD estimates that there are between HEAD estimates that there are between 30,000-40,000 “second-coursers” 30,000-40,000 “second-coursers” currently taking up nursing.currently taking up nursing.

TESDA has trained over 50,000 caregivers TESDA has trained over 50,000 caregivers in the last 5 years and over 24,000 have in the last 5 years and over 24,000 have been deployed abroad.been deployed abroad.

(HSA 2005, PNA 2005)(HSA 2005, PNA 2005)

Reasons Why Filipino Nurses Reasons Why Filipino Nurses Leave the CountryLeave the Country

Push FactorsPush Factors

EconomicEconomic: low salary at home, no overtime and hazard : low salary at home, no overtime and hazard pay, low coverage of health insurancepay, low coverage of health insurance

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

Socio-political and economic environmentSocio-political and economic environment: limited : limited opportunities for employment, decreased health budget, opportunities for employment, decreased health budget, peace and order situation in the Philippinespeace and order situation in the Philippines

Reasons Why Filipino Nurses Reasons Why Filipino Nurses Leave the CountryLeave the Country

Pull FactorsPull Factors

EconomicEconomic: higher income, better benefits and compensation : higher income, better benefits and compensation packagepackage

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

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

Socio-political and Economic environmentSocio-political and Economic environment: Advanced : Advanced technology, better peace and order situationtechnology, better peace and order situation

Reasons Why Doctors Migrate Reasons Why Doctors Migrate as Nurse Medicsas Nurse Medics

PUSH FACTORSPUSH FACTORS very low compensation and salaries,very low compensation and salaries, feeling of hopelessness about the Philippine current feeling of hopelessness about the Philippine current

situation,situation, political instability and graft and corruption, political instability and graft and corruption, poor working conditions and poor working conditions and the threat of malpractice law the threat of malpractice law

PULL FACTORSPULL FACTORS more socio-politico- economic security abroad, more socio-politico- economic security abroad, attractive salaries and compensation packages (High attractive salaries and compensation packages (High

salaries, benefits, compensation)salaries, benefits, compensation) more job opportunities and career growth.more job opportunities and career growth.

Reasons Why Filipino Nurses Reasons Why Filipino Nurses Return:Return:

Personal ReasonsPersonal Reasons To get marriedTo get married To raise children in homelandTo raise children in homeland To take a vacationTo take a vacation Homesickness and depressionHomesickness and depression To retireTo retire To get familyTo get family

Professional ReasonsProfessional Reasons To share expertiseTo share expertise For professional stabilityFor professional stability

Reasons Why Filipino Nurses Reasons Why Filipino Nurses ReturnReturn

Financial ReasonsFinancial Reasons Nurse has saved enough moneyNurse has saved enough money To set up a business at homeTo set up a business at home

Job-related ReasonsJob-related Reasons To buy a house or a carTo buy a house or a car

Social ReasonsSocial Reasons Contract has expiredContract has expired Plans to retire back homePlans to retire back home

Perceived Impact of Perceived Impact of MigrationMigration

Health Care System and Quality of Health Care System and Quality of Health CareHealth Careo Positive EffectsPositive Effects

Health care is enhanced.Health care is enhanced. Availability of more aggressive staff replacements who are Availability of more aggressive staff replacements who are

eager to learn.eager to learn.

o Negative EffectsNegative Effects Continuity of programs/services is adversely affected.Continuity of programs/services is adversely affected. Quality of care is compromised.Quality of care is compromised. People in the community are deprived of health services.People in the community are deprived of health services. Improvement of the hospital is delayed when resources are Improvement of the hospital is delayed when resources are

used to train staff replacement.used to train staff replacement.

Perceived Impact of Perceived Impact of MigrationMigration

EconomyEconomyo Positive EffectsPositive Effects

Economy improves with the remittances from workers abroad.Economy improves with the remittances from workers abroad. Philippines posts 5th largest remittance earnings globally Philippines posts 5th largest remittance earnings globally

(WB) projected to be $30 B(WB) projected to be $30 B Unemployment is reduced.Unemployment is reduced.

o Negative EffectsNegative Effects Loss of government resources used in education and training.Loss of government resources used in education and training. Resources are spent on training of staff replacements.Resources are spent on training of staff replacements. Reduced government income of the province and country from Reduced government income of the province and country from

taxes of health professionals.taxes of health professionals.

Social Net BenefitsSocial Net Benefits

Winners – Winners – Nurse migrants and their families- greater Nurse migrants and their families- greater

child schooling, reduced child labor , child schooling, reduced child labor , increased educational expenditure, increased educational expenditure,

Economy – remittances, raise hours worked Economy – remittances, raise hours worked in self-employment and lead to relatively in self-employment and lead to relatively capital-intensive enterprises by migrants’ capital-intensive enterprises by migrants’ hoouseholdshoouseholds

Social Net BenefitsSocial Net Benefits

Losers – Losers – Health Care SystemHealth Care System

Loss of skilled trained health staffLoss of skilled trained health staff Rendered health system fragile Rendered health system fragile

Extended FamiliesExtended Families Social supportSocial support

Philippine NursingPhilippine Nursing Ability to renew and further nursing development is Ability to renew and further nursing development is

hampered hampered

Deteriorating Quality of Nursing Deteriorating Quality of Nursing EducationEducation

The number of nursing The number of nursing schools have increasedschools have increased

1970s: only 401970s: only 40

1990s: 1701990s: 170

June 2003: 251June 2003: 251

April 2004: 370April 2004: 370

June 2005: 441June 2005: 441

June 2006: 470June 2006: 470

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

(NIH 2004)(NIH 2004)


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

1970s and 80s: 80%-90%1970s and 80s: 80%-90%

1991: below 61%1991: below 61%

2001-2003: 44%-48%2001-2003: 44%-48%

2004: 55.9%2004: 55.9%

2005: 49.7%2005: 49.7%

2006: 41%2006: 41%(NIH 2004, PRC 2006)(NIH 2004, PRC 2006)


In 2001In 2001116 nursing schools: passing rate of <50% 116 nursing schools: passing rate of <50% 124 nursing schools: passing rate of >50%124 nursing schools: passing rate of >50%

In 2002, 150 nursing schools had a passing In 2002, 150 nursing schools had a passing rate <50%, which was already 63% of the rate <50%, which was already 63% of the 237 nursing schools then.237 nursing schools then.

In the last 3 NLEs, at least 20 nursing In the last 3 NLEs, at least 20 nursing schools consistently had a 0% passing rate.schools consistently had a 0% passing rate.

(NIH 2004, PRC 2006)(NIH 2004, PRC 2006)

Nursing Licensure Board Passers

61.45 58.2454.22

50.0255.79

49.86 49.253.5

44.75 48.18 49.68 51.6

010203040506070

Year

board passers

Source: PRC, 2005

Nurses and Severe Exploitation and Nurses and Severe Exploitation and DiscriminationDiscrimination

Canada: the Live-in Caregiver Program (LCP) for Canada: the Live-in Caregiver Program (LCP) for nursesnurses

United Kingdom: £ 2,000 payment to employer or United Kingdom: £ 2,000 payment to employer or recruiter, yet start at the lowest rung (~ recruiter, yet start at the lowest rung (~ healthcare assistant)healthcare assistant)

Saudi Arabia: the visit of DOLE Sec. Patricia Sto. Saudi Arabia: the visit of DOLE Sec. Patricia Sto. Tomas pushed for lower wages for Filipino nurses Tomas pushed for lower wages for Filipino nurses in order to maintain “competitiveness”. in order to maintain “competitiveness”.

(AHW 2004, MIGRANTE INT’L 2005)(AHW 2004, MIGRANTE INT’L 2005)

Exploited Health Human ResourcesExploited Health Human Resources

Health workers and professionals are Health workers and professionals are overworked and underpaid.overworked and underpaid.““Average monthly wages for nurses is between Php Average monthly wages for nurses is between Php 5,500 to 16,500 and for doctors is between Php 9,700 5,500 to 16,500 and for doctors is between Php 9,700 to 23,500.”to 23,500.” (Lorenzo (Lorenzo et alet al, 2004), 2004)

Exploited Health Human Exploited Health Human ResourcesResources

Doctor to patient ratio (population)Doctor to patient ratio (population)Cuba 1:225Cuba 1:225USA 1:450USA 1:450Philippines 1:10,000-26,000Philippines 1:10,000-26,000WHO (Ideal) 1:600WHO (Ideal) 1:600

Nurses to patient ratioNurses to patient ratioPGH 1:15-26 per shift PGH 1:15-26 per shift Davao del Sur 1:44-45 per shiftDavao del Sur 1:44-45 per shiftIdeal 1:4 per shiftIdeal 1:4 per shiftPhilippines 1:16,000 (population)Philippines 1:16,000 (population)

(AHW 2004, HealthWrights 2004)(AHW 2004, HealthWrights 2004)

Reasons for the Continuing Reasons for the Continuing ExodusExodus

Commercialized health education.Commercialized health education.

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

Labor export policy.Labor export policy.

““The national government earned USD 7.6B The national government earned USD 7.6B from OFW remittances in 2003 and USD 8.5B in from OFW remittances in 2003 and USD 8.5B in 2004. It expects to earn an estimated USD 10B 2004. It expects to earn an estimated USD 10B in 2005.”in 2005.”

Reasons for the Continuing ExodusReasons for the Continuing Exodus

Economic and political instability.Economic and political instability.

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

Globalization policies.Globalization policies.

““The phenomenon of human trafficking across states, even The phenomenon of human trafficking across states, even under the guise of globalizing labor and human resource under the guise of globalizing labor and human resource development, is still within the framework of privatization, development, is still within the framework of privatization, deregulation, and liberalization.”deregulation, and liberalization.”

The Unhealthy Philippine Health Care The Unhealthy Philippine Health Care SystemSystem

““A health care system that cannot maintain A health care system that cannot maintain

its own health human resource its own health human resource

is not healthy at all.”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

National government health budget, 1978-2007p (as % of NG budget)

0

1

2

3

4

5

6

Year

% o

f N

G b

ud

get

Worsening State NeglectWorsening State Neglect

Health Financing: Sources of Health Financing: Sources of FundsFunds

Total Health Expenditure P0.25 per Filipino Total Health Expenditure P0.25 per Filipino per dayper day

49% 49% out out of of pocketpocket

40% 40% governmentgovernment

11% 11% Shared-Risk Shared-Risk Schemes Schemes Including Including National Health National Health Insurance Insurance (PhilHealth)(PhilHealth)

Comparative Health Expenditures, 1993-2004 (in million pesos)

50,104

77,524

0

20,000

40,000

60,000

80,000

100,000

1993 1995 1997 1999 2001 2003

Government (national and local) Out-of-Pocket

Source: 2004 Philippine National Health Accounts

Increasing private burdensIncreasing private burdens

Selected NG expenditures, 1986-2006p (P billion)

125.649164.5

205.396 227.843274.439

357.959

470

542.2

674.114721.668

0

100

200

300

400

500

600

700

800

1997 1998 1999 2000 2001 2002 2003 2004 2005p 2006p

Year

P bi

llion

Total debt serv ice

Education

Health

Housing

Defense

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

Military: increased by 11++%

Decreasing Spending on Social Services

Nota: “%” ay inflation-adjusted per capita, tsart ay nominal

Administrative Costs andAdministrative Costs andRegulatory FunctionsRegulatory Functions

Public HealthPublic HealthInterventionsInterventions Individual HealthcareIndividual Healthcare

Uses of Funds (In Percent)Uses of Funds (In Percent)

10%

10%10%

80%80%

(Romualdez, 2008)(Romualdez, 2008)

HEALTH has become a commodity: HEALTH has become a commodity: subject to TRADE and PROFITSsubject to TRADE and PROFITS

National Governments have National Governments have ABANDONED their responsibility ABANDONED their responsibility

to ensure the HEALTH of their to ensure the HEALTH of their PEOPLE.PEOPLE.

In these

trying times,

WHAT ARE WE

TO DO?

Important Important ConsiderationsConsiderations

Temporary migration most beneficial for sending Temporary migration most beneficial for sending countrycountry

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

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

Nursing and HRH development are on national Nursing and HRH development are on national policy agenda -controversialpolicy agenda -controversial

Important Important ConsiderationsConsiderations

Nursing development has not benefited from Nursing development has not benefited from rollercoaster trends of migrationrollercoaster trends of migration

Health Care system has not benefited from Health Care system has not benefited from migration related transactionsmigration related transactions

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

Philippines has not utilized remittances to leverage Philippines has not utilized remittances to leverage job creation and domestic employment developmentjob creation and domestic employment development

Health Worker Migration Policy Health Worker Migration Policy IssuesIssues

Areas that need attention: recruitment, retention, policy, Areas that need attention: recruitment, retention, policy, education and strain on current nurseseducation and strain on current nurses

Funding of the education and training of health workersFunding of the education and training of health workers

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

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

Whether movements reflect temporary or permanent shift in Whether movements reflect temporary or permanent shift in locationlocation

Policy AnalysisPolicy Analysis

Local Policies – mainly regulate and Local Policies – mainly regulate and manage domestic employment manage domestic employment Many incompletely implemented or not Many incompletely implemented or not

implementedimplemented Does not manage outflow of workforceDoes not manage outflow of workforce Does not adequately clarify standards of Does not adequately clarify standards of

staffing and compensation staffing and compensation

Policy ProvisionsPolicy Provisions

International PoliciesInternational Policies Provides models of regulating scope of Provides models of regulating scope of

practice and licensure, recruitment, entrypractice and licensure, recruitment, entry Safeguards quality of health systems and Safeguards quality of health systems and

health care in destination countrieshealth care in destination countries Few contain safeguards from source Few contain safeguards from source

countriescountries

Migration has to be Migration has to be managed by:managed by:

Addressing protection of both health and Addressing protection of both health and human rights. human rights.

- Dampening push forces by retaining talent - Dampening push forces by retaining talent in sending countriesin sending countries

- Reducing pull forces by aiming for - Reducing pull forces by aiming for educational self sufficiency in destination educational self sufficiency in destination countries countries

JLI Secretariat 2004JLI Secretariat 2004

Managed MigrationManaged Migration Should facilitate bothShould facilitate both

- development goals of source countries and- development goals of source countries and

- efficiency goals of destination countries- efficiency goals of destination countries Involves nationalInvolves national

- policy reforms- policy reforms

- international agreements- international agreements - cooperative education program by source and - cooperative education program by source and

destination country institutionsdestination country institutions Health sector development projectsHealth sector development projects

(Commonwealth Secretaiat, 2005)(Commonwealth Secretaiat, 2005)

Migration Related Policy Migration Related Policy CategoriesCategories

Recruitment, Entry, and Citizenship PoliciesRecruitment, Entry, and Citizenship Policies Welfare and Human Resource Development and Welfare and Human Resource Development and

RetentionRetention Re-entry of Migrants (Brain Gain)Re-entry of Migrants (Brain Gain)

- Permanent- Permanent

- Temporary (Brain Circulation)- Temporary (Brain Circulation) Licensure and Scope of PracticeLicensure and Scope of Practice Skill MixSkill Mix Poverty Alleviation and Social DevelopmentPoverty Alleviation and Social Development

Policy Development Policy Development CriteriaCriteria

Mutually BeneficialMutually Beneficial

- economic standpoint (social return)- economic standpoint (social return)

- development status (professional and social)- development status (professional and social)

- financial (private returns)- financial (private returns)

- cultural- cultural

- health systems- health systems Should achieve equity and efficiencyShould achieve equity and efficiency Promote policy coherencePromote policy coherence Protection and safety human outcomesProtection and safety human outcomes

Policy GoalsPolicy Goals

Equity – Nurse DistributionEquity – Nurse Distribution Effectiveness Effectiveness EfficiencyEfficiency Security/Safety – ensuring local/domestic Security/Safety – ensuring local/domestic

health outcomeshealth outcomes

Policy RecommendationsPolicy Recommendations International PoliciesInternational Policies

Bilateral Migration Management PoliciesBilateral Migration Management Policies Provision of Progressive IncentivesProvision of Progressive Incentives

HRH retention for destination countriesHRH retention for destination countries Incentives for reintegration for Recruiting countriesIncentives for reintegration for Recruiting countries

Policy Recommendations Policy Recommendations

Domestic PoliciesDomestic Policies Creation of incentives for return migration:Creation of incentives for return migration:

Positions for return migrantsPositions for return migrants Development of Framework for maximizing the Development of Framework for maximizing the

utilization of those with skills, experienceutilization of those with skills, experience Incentives for investments/ temporaryreintegration Incentives for investments/ temporaryreintegration

Policy Recommendations Policy Recommendations

Within organizationsWithin organizations Creation of Position that provide incentives for Creation of Position that provide incentives for

longevitylongevity Career Path Development Career Path Development Ensure continuing developmentEnsure continuing development Improve work conditionsImprove work conditions

Policy OptionsPolicy OptionsFive Core Elements for National and Bilateral Five Core Elements for National and Bilateral

Policy on Labor Migration and Related Policy on Labor Migration and Related Support Measures:Support Measures:

An informed and transparent labor migration An informed and transparent labor migration admissions system designed to respond to admissions system designed to respond to measured, legitimate labor needs, taking into measured, legitimate labor needs, taking into account domestic concerns as well.account domestic concerns as well.

A standards-based approach to “migration A standards-based approach to “migration management” protecting basic rights of all management” protecting basic rights of all migrants and combating exploitation and migrants and combating exploitation and trafficking.trafficking.

Enforcement of minimum national employment Enforcement of minimum national employment conditions standards in all sectors of activity.conditions standards in all sectors of activity.

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

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

Future OutlookFuture Outlook

Achieve mutually beneficial Achieve mutually beneficial migration arrangements if migration arrangements if reintegration programs are reintegration programs are effectiveeffective

But we should not loose sight But we should not loose sight of more empowering and of more empowering and

actions towards social actions towards social transformation….transformation….

The State of the Nation’s Health: A The State of the Nation’s Health: A SummarySummary

People’s health and welfare overall as the result People’s health and welfare overall as the result of economic and political conditionsof economic and political conditions

Poor health outcomes, especially for the poorestPoor health outcomes, especially for the poorest

Dysfunctional and fragmented health care Dysfunctional and fragmented health care delivery systemdelivery system

Privatization as the state’s key health policyPrivatization as the state’s key health policy

Systemic and worsening poverty and inequities Systemic and worsening poverty and inequities urgently need to be addressurgently need to be address

Migration…Migration… Everyday, more than 3,000 Filipinos are forced to Everyday, more than 3,000 Filipinos are forced to

work overseas - P480,000 (approx. US$ 8,900.) in work overseas - P480,000 (approx. US$ 8,900.) in government revenue daily.government revenue daily.

Labor export program commodifies and exports Labor export program commodifies and exports Filipino workers abroadFilipino workers abroad

As the national economic and political crisis As the national economic and political crisis intensifies – so too will the export of workers intensifies – so too will the export of workers because of the increased dependence on dollar because of the increased dependence on dollar remittances and inability to create jobs in the remittances and inability to create jobs in the PhilippinesPhilippines

Abuses against migrants range from contract Abuses against migrants range from contract violations, physical and mental abuses and deathviolations, physical and mental abuses and death

Assert People's ControlAssert People's Control

Collective Collective action to action to uphold and uphold and defend defend people's rights people's rights HealthHealth LandLand Living wagesLiving wages Social EquitySocial Equity

Assert People's ControlAssert People's Control

Rescind detrimental government policiesRescind detrimental government policies

Social OBLIGATION Social OBLIGATION VS.VS. PROFITPROFIT

What Needs to Be Done?What Needs to Be Done?

Short Term/Immediate InterventionShort Term/Immediate Intervention

Increase wagesIncrease wages

Increase budget for healthIncrease budget for health

Hold national consultations with all stakeholdersHold national consultations with all stakeholders

Improve regulation of medical and nursing schoolsImprove regulation of medical and nursing schools

Rescind commitments to General Agreement in Trade in Rescind commitments to General Agreement in Trade in Services (GATS) Services (GATS)

What Needs to Be Done?What Needs to Be Done?

Long Term/Strategic InterventionLong Term/Strategic Intervention

Review the overall health care systemReview the overall health care system

Formulate a pro-people health policy and program Formulate a pro-people health policy and program

Discontinue labor export policyDiscontinue labor export policy

Review and rescind WTO commitmentsReview and rescind WTO commitments

Discontinue globalization policies (deregulation, Discontinue globalization policies (deregulation, liberalization, and privatization)liberalization, and privatization)

Draw up independent political and economic policiesDraw up independent political and economic policies

Challenges aheadChallenges ahead

• Alma Ata vs. “Alana Ata?”Alma Ata vs. “Alana Ata?”• Social determinants of healthSocial determinants of health• ““Ethical” recruitment of nurses vs. labor export Ethical” recruitment of nurses vs. labor export

policypolicy• Universal health care? Socialized health care?Universal health care? Socialized health care?• Medical tourism and sale of organsMedical tourism and sale of organs• WTO and health as a matter of trade and WTO and health as a matter of trade and

investment investment • Globalization and health privatization Globalization and health privatization

Continuing advocaciesContinuing advocacies

• Health as a matter of right and state responsibilityHealth as a matter of right and state responsibility• Health in the framework of equity, not equalityHealth in the framework of equity, not equality• Access to medicine as part of access to healthAccess to medicine as part of access to health• Health not just “the absence of disease” or Health not just “the absence of disease” or

adequate services but as a people’s overall well-adequate services but as a people’s overall well-being: economic, political, social, culturalbeing: economic, political, social, cultural

• Health as a public service, not a business or trade Health as a public service, not a business or trade investmentinvestment

• Health in the context of a truly independent and Health in the context of a truly independent and democratic society democratic society

““MedicineMedicine has imperceptibly led us into has imperceptibly led us into the the social fieldsocial field and placed us in a position of and placed us in a position of confronting confronting directly the great problems of our timedirectly the great problems of our time.”.”

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

Dr. Rudolf Virchow (1821-1902)Dr. Rudolf Virchow (1821-1902)

““I don’t deserve to be I don’t deserve to be treated like this. I care treated like this. I care about my job, SIR. I about my job, SIR. I care about you!!!" care about you!!!"

Sharon CunetaSharon Cuneta

Artist, “Caregiver”Artist, “Caregiver”

WHAT WE WANTDefend and Uphold People’s Right to Defend and Uphold People’s Right to

HealthHealth

Resist the Commodification of HealthResist the Commodification of Health

WTO OUT of HealthWTO OUT of Health

WHAT WE WANTHealth for ALL,Health for ALL,

Health in the Hands of the PeopleHealth in the Hands of the People

Genuine Freedom and DemocracyGenuine 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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