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By Patricia L. Adversario, Senior Reporter
Last of three parts
(In the second installment yesterday, it
noted that the quality of nursing education has gone down because
there are too many nursing schools rushing to produce graduates
eager to work abroad. Some teachers hold down several teaching
positions and spread themselves too thinly. But that is just part of
the bigger picture.)
CONFUSING policies within the government are
impeding any coherent agenda on managing the outflow of health
professionals without prejudicing the quality of local health care.
“Agencies like the labor department and the
Philippine Overseas Employment Administration want the dollars,
while the health department is concerned about human resources and
their development,” said Dr. Jaime Z. Galvez Tan, vice chancellor
for research at the University of the Philippines in Manila.
Tan advocates the creation of a national
commission that would develop a human resource development policy
for health and a national policy research agenda for human resources
in health care.
Taking the lead for coordinating these policies
should be the Office of the President and the National Economic
Development Authority because the lack of a national agenda for
healthcare workers ultimately affects the economy, he said.
Nurses should also be consulted and they must
participate in consultations, said Tan, who is also executive
director of the National Institute of Health Philippines.
One major task for the proposed commission would
be to compile a database of professionals in the health care sector.
With regards to the nursing profession, there is a need to determine
the current demand and supply, nursing standards and the
distribution of nursing personnel.
There’s no available information on the number
of nurses who are still here, the number of those who have left and,
of this, the percentage of those who have left on immigration visas,
said Dr. Marilyn E. Lorenzo, director of the Institute of Health
Policy and Development Studies and a professor at the UP College of
Public Health.
Lorenzo said information on the number of those
who are leaving is needed for any strategy to rationalize demand and
supply. “There needs to be a system where we can anticipate the
needs of other countries and determine the proportion of what the
country can supply.
“We can’t stop globalization,” said
Lorenzo. “If we have to participate in it, we should participate
meaningfully. Since we have the valuable resource, we should have
the say and be in control. Otherwise, we would be killing ourselves
by wanting too much too soon.”
“While we acknowledge the human right to
determine where an individual wants to work, it should not be at the
detriment of our country. We need to regulate the departure so we
still have good people serving here,” she added.
Regulating the departure
In this regard, Tan proposes a National Health
Service Act that will enable the country to program the exit of
health professionals to ensure a steady pool in all health
facilities, rural and urban.
Tan says the Philippines is one of the few
countries in Southeast Asia that still doesn’t have a
National Health Service Act. This is a compulsory requirement for
all licensed health professionals to serve anywhere within the
country for a specified period that’s equal to the number of years
it took them to finish their degree.
He proposes a mandatory service of three years
for graduates from state universities. For graduates from private
schools, he is proposing two years or whatever is appropriate to the
private sector.
The education of health professionals who
graduated from state universities, schools and colleges was
“heavily subsidized with taxes paid by the Filipino people. It is
only fair that they repay the country with their services equivalent
to the number of years of subsidy. Graduates from private schools
can have a modified scheme under the act,” he said.
Attempts to have such a law passed were met with
objections because they were against the individual’s human rights
to move freely and practice their profession where they want.
“But with globalization and the active trading
of health human resources and the inevitability of a severe brain
drain to hit the Philippines, the country’s collective interest
and collective rights should now prevail,” argued Tan.
“It’s a mortal sin for them to leave
immediately. Magsilbi naman sa bayan,” he said.
Sharing the cost
The government can also initiate high-level
bilateral negotiations with countries that import Filipino nurses on
how they could share the cost of training these nurses.
Tan proposes that the Philippine government hold
bilateral discussions with the United States, the United Kingdom,
Ireland, The Netherlands, and Saudi Arabia. He said current
arrangements on the importation of Filipino nurses have been
“lopsided and advantageous only to such countries.”
Some 13,000 nurses left for the US while 7,000
left for the United Kingdom in 2001. These countries could include
in their aid package, funding for training nurses, upgrading nursing
education, health services, and nursing scholarships. The Usaid, for
example, could give an additional $10 million for training nurses,
said Tan.
Hospital to hospital partnership agreements
could also be arranged where recruiting hospital institutions could
share the cost of training by providing financial grants for every
Filipino nurse that joins its staff.
It costs about $4,000 to $7,000 to educate and
produce a nurse that will pass the Philippine nursing licensure
examinations, said Tan.
The Philippine General Hospital, for example,
could enter into a partnership agreement with the Johns Hopkins
University Hospital in the US for the latter to donate a negotiated
amount to the PGH for every nurse that it recruits from the PGH.
Tan proposes that the grant be used to improve
salaries, training and nursing practice, upgrade hospital and
educational facilities.
“Hospitals from countries of the North do not
spend a single centavo in the production, development, education and
licensure of Filipino nurses. At the very least, they should be able
to pay partially, if not fully, the cost of development since they
are going to benefit from the services of that nurse for at least 25
years,” said Tan.
Virginia C. Alinsao, US-based director of
international nursing recruitment at the Johns Hopkins
Health System said in an interview in Manila
that “subsidized training has its merits and we’re willing to
explore that proposal.” She said arrangements should not
only explore monetary assistance.
“US hospitals could also provide training
grants, fellowships, or internships as knowledge transfer to beef up
the training here. We could also provide training materials,” said
Alinsao.
Salary increase
Too much attention has been on addressing the
global shortage, and not enough on the local shortage and improving
the working conditions of nurses who are still here, said Ma.
Isabelita C. Rogado, head of the department of nursing education at
the Philippine Heart Center.
A key issue is the salary. According to Ruth
Padilla, the average pay of nurses in the cities is still P9,000 a
month. Nurses in government hospitals are paid slightly higher. In
the rural areas, the average pay ranges from P4,000 to P5,500 a
month.
The new nursing law (Republic Act 9173) pegs the
minimum basic pay of nurses in public health and institutions at
P13,300.
National nurse groups decry the fact that the
law does not provide the same guarantees to nurses who work in
private hospitals. Some nurses here, even in Metro Manila, are paid
only from P2,500 to P3,000 a month.
At a recent nursing forum, an informal survey
among nurses said if their salaries are raised to a minimum of
P30,000 a month, they will stay. Easier said than done. At current
rates, even nursing directors don’t even earn close to that.
Nursing in the Philippines is still seen as a
“nonrewarding career choice, a non exciting, risky profession to
practice,” said Dr. Teresita I. Barcelo, vice chancellor for
academic affairs of the UP-Open University and a professor at the UP
College of Nursing.
“This poor image will continue to push young
nurses to migrate to other countries. There’s a need to improve
this image of nurses so they will be motivated to practice their
profession here,” she said.
It is ironic that the Philippines, which is one
of the world’s major suppliers of nurses, has yet to give due
recognition to those who choose to serve here.
Part 1
| Part 2
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