overview_for_australian_delegates

The Health Human Resources Development in the Philippines: 2009 Situationer Jaime Z. Galvez Tan MD, MPH President, Health Futures Foundation Inc. Professor, University of the Philippines College of Medicine

The Philippines at a Glance  Total Population: 90 million (NSO     

est. 2009) Population growth rate: 2.02% (NSO 2007) 1.5 million added annually; 4,110 babies a day Average family size: 5 Proportion of population below 15 years of age: 37% Proportion above 65 years old: 3.8%



Total labor force: 35 Million



Total Unemployment Rate: 10.1% (LFS Oct. ’03)



Total Underemployment Rate: 15.7% ( LFS Oct. ’03)



Annual average family income: US$2,619 (FIES 2000)



Poverty incidence: 34% or 25.8 million people (NEDA 2001)



Budget deficit 2009: US$5B or 35% of the national budget



% of National Budget for debt servicing: 30%-35%

Philippine Health at a Glance Access to Health Care:

Vital Health Statistics:

 % of death medically attended:

 Under-five mortality rate: 34





   

40% (NSO 2005) % of children born at home: 56% (NDHS 2008) % of births attended by health professionals: 62% (NDHS 08) % of population with full access to essential drugs: 60% % of children 12-23 mos. Fully immunized: 80% (NDHS 2008) Contraceptive prevalence rate: 51%



 

(NDHS 2008) Infant mortality rate: 25 (NDHS 2008) Maternal mortality ratio: 172 per 100,000 births (1998) i.e. 10 mothers dying everyday due to pregnancy and childbirth related causes % of national budget for health: 2% (2009) % of health expenditures to GDP: 3.1% (2002)

Health Human Resources: The No. 1 Philippine Health Export No. 1 exporter of NURSES “An estimated 85 percent of employed Filipino nurses (more than 150,000) are working internationally.” (Aiken et al. 2004) “70 per cent of all Filipino nursing graduates are working overseas” (Bach, 2003)

“The Philippines is the top exporter of nurses to the world with 85% of all Filipino nurses working in 46 countries.” (Corcega et. al, 2003)

No. 2 exporter of DOCTORS “68 per cent of Filipino doctors work overseas, next to India.”

(Mejia, WHO, 1979)

Newsweek, Oct. 4, 2004, “Philippines: Workers for the World”, pp. 31-33

Why Such Human Resources Policy?

2003 - Overseas Filipino Workers (OFWs) brought in a total of US$ 7.6 billion remittances.

2008 – Remittances from OFWs totaled US$14.3 billion

(Source: Central Bank of the Philippines, 2008)

YEAR

VOLUME

1994

6,699

1995

7,584

1996

4,734

1997

4,242

1998

4,591

1999

5,413

2000

7,683

2001

13,536

2002

11,911

2003

18,450

16,000

TOTAL

84,843

Average (10year period)

8,931 nurses/year

12,000 10,000 8,000

If all data accounted for, at least 100,000 Nurses left in the last 10 ten years – the highest volume in Philippine history Deployment of Filipino Nurses, 1994-2003 20,000 18,000 14,000

6,000

Note: full USA data not accounted for Source: Philippine Overseas Employment Agency, 2004

4,000 2,000 0 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 VOLUME

ď‚— While the market for nurses in the USA was closed

due to the recent economic crisis, Canada, Finland, Japan, Australia and Bahrain are emerging to become the top destination countries for our nurses.

ď‚— Due to the global demand, the number of nursing

schools have risen from 175 in 2000 to 479 today (Philippine Inquirer, 2008). ď‚— The quality of nursing education has been adversely affected with a less than 50% passing rate in the Nursing Licensure Examination since 1999.

Number of Philippine Nurse Examinees 1994-2009 90,000 80,000 70,000 60,000 50,000 40,000 30,000 20,000 10,000 0

Number of examinees 77901 64909 64459

41,459 38,689

40147

25,32525,951 25,163 19,546 17,101 15,624 13,152 9,351 8,281 9,453

Passing Rate in the Philippine Nursing Licensure Examinations 1994-2009

Passing Rates 70 60 50 40 30 20 10 0

61.45

58.24

54.22

55.79 50.02

49.86 49.2

53.5 44.75

48.18 49.68

51.6

49

48.18 43.07 41.9

Performance of Philippine Nursing Schools 2000-2005 ď‚— In a compilation of statistics on the performance of

schools in the NLE from 2000-2005 made by CHEd and the Professional Regulatory Commission, only 12 out of the 479 nursing schools had passing rates of 90% and higher. ď‚— Only 25 of the of the 479 schools have passing rates of 85% and higher

Name of School

Passing Rate

University of the PhilippinesManila

100%

St. Paul College Iloilo

99.57%

Siliman University 98.39% - Dumaguete

Name of School

Passing Rate

Mindanao State 95% University Marawi St. Paul College Dumaguete

93.38%

Pamantasan ng Lungsod ng Maynila

92.53%

St. Mary’s University-Nueva Vizcaya

91.02%

West Visayas State University

97.06%

University of Santo Tomas

96.67%

St. Paul College Manila

90.81%

St. Louis University - 95.05% Baguio

University of the East Ramon Magsaysay Memorial Medical Center

90.57%

ď‚— The Commission on Higher Education has been urged

to close down 177 nursing programs who have 0% passing rate for the past 5 years.

• In a meeting hosted by Philippine Senator Pia

Cayetano last October 2008 attended by the top 25 nursing schools, the Global Circle of Nursing Competence and Compassion was formed with a commitment to maintaining quality education • It was also created to provide equitable overseas job opportunities for graduates of these 25 Philippine nursing schools through managed migration and ethical recruitment.

Consequences of the Increasing Global Demand for Nurses

 A total estimate of 9,000 Filipino doctors have

become nurses from 1999-2008.  In 2003-2005, more than 4,000 physicians took the Philippine Board of Nursing Licensure Examinations.  Around 6,000 doctors have left as nurses since 2000

Consequences of the Increasing Global Demand for Nurses

VOLUME 9000

8268

8000 7000 6000 5000

5049

5360

6121 6245 6192 5853 5814 5730 5948

6043 4475

4000 3000 2000

4250

4070

4886

VOLUME 2912

1000

9 0 2

8 0 2

7 0 2

6 0 2

5 0 2

4 0 2

3 0 2

0 2

1 0 2

0 2

9 1

8 9 1

7 9 1

6 9 1

5 9 1

4 9 1

0

 200 hospitals have closed down within the past two

years – no more doctors and nurses (PHA, November 2005)  800 hospitals have partially closed (with one to two wards closed) – lack of doctors and nurses (PHA, November 2005)

 Nurse to patient ratios in provincial and district

hospitals now 1:40-1:60  Loss of highly skilled nurses in all hospitals across the country

 Proportion of Filipinos dying without medical

attention has reverted to its 1975 levels of 60% of deaths unattended during the height of nurse & nursing medics migration 2002-2005. (NSO 2005)  Contraceptive Prevalence Rates have remained stagnant

from 1998-2009 (NSO-NDHS 2008)  Health services coverage declining e.g. immunization

coverage down (NDHS, MCH Survey, NSO 1993-2003)

Consequences of the Brain Drain: MDG Goal #5 Imperiled - Progress in reducing MMR has been slow 250 203

209

200

197

191

186

180 172

162

150 100

52. 5

50 0 1990

1991

1992

1993

1994

1995

1998

2006

2015

Source: Philippine Progress Report on the Millennium Development Goals 2003, 2006 Family Planning Survey

P r ogr ess M ade

P r ogr ess Needed

MMR has been reduced by just 22%. Target 2015 is 75%

The Queensland-Philippines Partnership in Global Health Care

So What Can Be Done?  Can the Global Health Community develop strategic

solutions to the mass migration of Filipino nurses?

 What can a country like the Philippines do?  What actions should countries like Australia in need

of international nurses take?

Goals of Global Migration Strategies  Tame the mass exodus to North countries  Achieve a rational programmed departure or our

health professionals  Secure a win-win situation for the Philippines and the receiving countries  Note: These do not aim to prevent health professionals from

leaving the country

 A Win-Win Bilateral Agreement  An Ethical Framework for Recruitment  A Transparent and Accountable Partnership  An Equitable, Just and Fair Arrangement

Queensland and the Philippines

 Both Queensland and the Philippines would

receive mutual benefits from each other  Both Australia and the Philippines respect each other’s rights as nation states  Both recognize the legitimate interests held by all Queensland and Filipino stakeholders to provide care for their patients and communities

 Queensland needs international nurses now and in the

future to provide adequate health care for its population  The Philippines guarantees international nurses for

Queensland.  But without compromising the need to further improve

its health care system for greater equity.

Queensland and the Philippines

Based on International Ethical Principles Currently in Practice

 Autonomy: freedom of individual and freedom

of movement; freedom to determine one’s own destiny

 Cooperation: protection of inputs from

multiple interested parties

 Favors dispute resolution through bilateral and

multilateral organizations

Based on International Ethical Principles Currently in Practice

 Social Justice:

fair labor practices equitable workplace non-discrimination protection of public health maintenance of an equitable allocation of nursing resources  minimization of existing inequities in health care resources  provision of language skills     

 Responsible Recruitment:  fair and transparent, with accountability  Respect for the rights of nation states:  recognition of the legitimate interests held by all

stakeholders to provide care to their patients and communities

 Compensation to source countries:  Facilitating economic and educational benefits that

result from emigration and return

Queensland and the Philippines

 Just and fair benefits to the Philippines from

Queensland:  Facilitating health sciences educational benefits and

health care management services that result from emigration  Ensuring direct positive consequences to the health care delivery system of the Philippines

 Benefits from Queensland facilitated through a

Queensland – Mindanao Philippines Foundation  Benefits focused in a defined geographical set of

provinces with equivalent population for greater effects and impact on health care ex. Queensland (population 4.25M) -Northern Mindanao (population 3.95M)

As The Philippines and Queensland Learn From Each Other As New Partners in International Health Care

Based on I.L.O.’s Promotion of Decent & Productive Work

#1 An ethical recruitment approach to “migration management” protecting basic rights of migrants, combating exploitation and trafficking, enforcement of minimum national employment conditions standards in all sectors of activity

Based on I.L.O.’s Promotion of Decent & Productive Work

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

Based on I.L.O.’s Promotion of Decent & Productive Work

#3 A Plan of Action against discrimination and xenophobia to sustain social cohesion #4 Institutional mechanisms for consultation and coordination with social partners in policy elaboration and practical implementation

In the Field of Nursing Education and Nursing Education Policies

#1 Development of reciprocities in policies and equivalence standards of nursing education and training between Queensland and the Philippines

#1 Migration Watch: Partnerships between Philippine and Australian universities and nongovernment organizations monitoring for ethical framework from recruitment to employment. #2 Health Development Watch: Partnerships also monitor health systems and facility improvement in Mindanao partner region

Headed to the Future Together

ď‚— The Queensland-Philippines Partnership in Health

Human Resources Management will be a FIRST in the world to ensure a fair, just, ethical framework in the recruitment of international nurses

ď‚— Beyond the boundaries of Australia and the Philippines,

the Queensland-Philippine Partnership will be the Global Trailblazer and International Model for all countries of the world to emulate

Thank you very much!

Salamat Po! Mabuhay!