‘RP health service in crisis’

The Philippines has become one of the biggest suppliers of healthcare workers in the world but the exodus of nurses and doctors in the last five years for higher paying jobs overseas has left the country’s health system in a state of near collapse.

At a summit of health care professionals called by the Philippine Medical Association recently, delegates were told in a conference paper: "The crisis in medical human resources is now upon us. The delivery of health services is being compromised. We have to address the problem before the health system completely collapses."

Jossel Ebesate, general secretary of the Alliance of Health Workers, said the situation had become so bad that the country’s healthcare system would collapse within the next two to three years.

Former health secretary Jaime Galvez Tan, who has been studying the exodus of doctors over the past five years, told Agence France Presse: "We are facing a serious problem and we need to address it now before it is too late."

He said the demand for nurses, especially in the United States, is outpacing supply.

"Doctors are leaving for a variety of reasons: political instability, low pay, corruption, poor working conditions and the threat of malpractice. But above all they don’t see much hope for the future and the future of their children," he said.

Tan said the fact that doctors were leaving the Philippines was not a new trend.

"Since the 1970s the Philippines has been a major source for health professionals for many countries," he said.

"The only difference today is that doctors are retraining as nurses. For many doctors, it is the easiest and quickest way out."

Many developed countries have less stringent conditions for accepting Filipino nurses than they do for doctors.

This year, the government set aside just 1.1 percent of its national budget on health. The World Health Organization’s advised minimum is five percent.

By comparison Vietnam spent 4.5 percent of its national budget on health in 2002, the last year for which figures are available, while Thailand spent 7.6 percent last year.

Tan’s study on the health system, "The Brain Drain Phenomenon and its Implications to Health," estimated that some 100,000 nurses have left the Philippines to work abroad since 1994.

Some 50,000 left in the last five years, but nursing schools, which have mushroomed in recent years, have only managed to produce 33,370 new nurses over the same period.

The study found Britain and the United States offered the best working conditions for Filipino nurses with visas for spouses and children and, in some cases, subsidized housing.

But above all, the study found, salaries were a major factor, averaging between $3,000 and $4,000 a month compared with $180 to $220 a month in the Philippines.

"While Filipino doctors have been migrating to the United States since the 1960s and to the Middle East countries since the 1970s in steady flows, the more recent outflows is more disturbing because they are no longer migrating as medical doctors but as nurses," the study said.

Medical schools closing

ore than 3,500 doctors have left the country as nurses since 2000, Tan said. Between 2002 and 2003 some 1,500 doctors passed the nursing licensing examination and this year some 4,000 doctors are enrolled in nursing schools.

He said it was worrying that those leaving to become nurses came from all medical professionals across the board with the hardest hit sector being anesthesiology.

"What is more disturbing, however, is that the number of students enrolling in medical school has been down on average by 14 percent a year from 2002," he said.

"As a result medical schools are now closing down because they don’t have the students. Also the pass rate has fallen dramatically over the last 10 years from 86 percent in 1994 to 52.9 percent in 2004."

Tan said salaries were another problem with public health doctors earning an average of $300 to $350 a month, private sector doctors earning $800 to $3,000 a month and "super specialists" like neurosurgeons and heart surgeons being paid $18,000 plus for one operation.

"But even the specialists are looking elsewhere," he said.

According to Tan roughly 80 percent of the estimated 70,000 doctors working in the Philippines today are in the private sector.

"Working conditions in hospitals have deteriorated where it is almost impossible to administer the basics of health care in some provincial hospitals," he said. — AFP