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By Dr. Marilyn E. Lorenzo, Special To The
Manila Times
THE Philippines holds the record for the most dramatic increase in
migration worldwide since the 1980s.
With an estimated seven million Filipinos
working or living abroad, it has a central role in the political
economy of migration.
In the global exchange of health workers, the
Philippines is the largest source of registered nurses working
overseas.
In 2001, for the first time, the Philippines
became the major source of nurses and midwives in the United
Kingdom.
The global shortage of nurses is a recurring
phenomenon that has stimulated massive temporary and permanent
migration.
The benefits are generous, including an enhanced
quality of life and earning capacity and substantial remittances
that boost the country’s GNP. Migration is also a safety net to
provide alternatives to un- and underemployment at home.
The social cost is heavy. Migrants are usually
those with prior training, experience and qualifications. At the
time of recruitment, they are usually employed and leave a skills
void that is difficult to replace right away.
Recent studies show hard evidence that patient
well-being is compromised when there are nursing shortages. Less
nursing staff can result in higher cross-infection rates, adverse
events after surgery, increased accident rates and patient injuries,
and increased rates of violence against hospital staff.
In the Philippines, observations show that the
delay in and postponement of complex procedures such as heart
transplants, dialysis and other surgeries are the result of a
massive recruitment of trained and skilled nursing teams.
The personal costs on migrants themselves and
their families have, at times, been unbearable.
Destinations
While the Middle East continues to be the
preferred destination of all temporary migrating health workers,
Singapore, Taiwan and Japan are starting to match demand.
But the dominant destinations of permanent
health worker migrants are the United States, Canada and Australia.
The United States, with its growing population,
history of migration and a health sector that has no parallel in
terms of the scale of health expenditure, is expected to play a
central role in the migration of health workers in the future.
The US has a shortage of pharmacists and nursing
staff, especially among registered nurses. It has been estimated
that a 6-percent shortfall (110,000) out of 1.89 million registered
nurses in 2000 could increase to a shortage of 800,000 registered
nurses in 2020.
At present, only about 100,000 nurses in the US
are migrants. About a quarter of doctors are graduates of foreign
medical schools.
For many Filipinos the United Kingdom is often
their stepping stone to North America. They prefer the US because
many already have relatives there.
Health worker migration is continuing. Alost
every First-World country is scrambling to find and keep nurses
because of the massive shortages they are experiencing.
Consequently, nurses are being lured from poor countries.
The International Council of Nurses notes a
shortage that spans the world, from Zambia to the Netherlands and
beyond. Canada, for example, will need 10,000 nursing graduates by
2011.
Difficulties
Not all is rosy. Many of the difficulties
confronting health workers in destination countries take the form of
a heavy workload, staff shortages, stress and violence at work,
gender and racial discrimination as well as comparatively poor pay
in relation to their level of education.
Registration and licensing procedures of host
countries are sources of potential problems. A primary concern in
Canada, for example, is the licensing cost of C$3,000. Many
Filipinos there work as “practical nurses” which receive lower
pay.
Many countries include a language test because
it is essential that health professionals communicate with patients.
Many that rely on overseas health workers have
traditionally used them to undertake low-skilled, low-paid work that
is unattractive to their own nationals.
Some recruitment agencies have been criticized
for disseminating misleading information about pay and the
employment situation in the destination country, and for charging
large fees.
Bilateral negotiations and policies with
destination countries should be explored to bring about recruitment
conditions that benefit both countries.
The Philippines might device compensatory
mechanisms to benefit the health organization from which health
workers were recruited. These could be used to improve domestic
postgraduate training, upgrade health education and increase
compensation and scholarships.
Efforts should be exerted to attract migrants
back to the home country and ensure that migration is predominantly
temporary.
Reintegration programs should be developed so
that health workers with enhanced skills might apply here what they
have learned abroad.
(Dr. Fely Marilyn E. Lorenzo is a professor
at the Department of Health Policy & Administration, College of
Public Health, University of the Philippines Manila (UPM) and the
founding director of the Institute of Health Policy &
Development Studies, UPM National Institutes of Health.)
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