Nurse migration from a source country perspective: Philippine country case study

Health Services Research, June, 2007 by Fely Marilyn E. Lorenzo, Jaime Galvez-Tan, Kriselle Icamina, Lara Javier

This case study provides information on Philippine nurse migration patterns and presents a sending-country perspective on the benefits and costs of this phenomenon. Our aim is to identify strategies that will ensure that international nurse migration is beneficial for both sending and receiving countries.

The Philippines is the largest exporter of nurses worldwide. For many decades, the country has consistently supplied nurses to the United States and Saudi Arabia. In recent years, other markets have emerged and opened for nurses including the United Kingdom, the Netherlands, and Ireland. This case study synthesizes existing information and reports on new findings to establish the magnitude and patterns of nurse migration and explore debates within the country regarding the impact of this phenomenon.

Data from a health worker migration case study commissioned by the International Labor Organization (ILO) was reanalyzed to focus specifically on nurses (Lorenzo et al. 2005). Literature review, records review, and focus groups comprised of health workers from five geographic districts were also conducted. Previous studies on Filipino worker migration were reviewed and integrated with available data from government and other field records to validate study results and make the study more robust. In addition, key informant interviews were conducted with selected stakeholders including professional leaders and policy makers to determine their perceptions of nurse migration, describe current migration management programs, and explore lucre policy directions for nursing and health human resource development in the Philippines.

Precise figures on nurse migration are difficult to obtain because many of those who seek work overseas are recruited privately and not officially documented by Philippines Overseas Employment Agency (POEA). Moreover, Department of Foreign Affairs data are also incomplete as many people leave as tourists and subsequently become overseas workers. We therefore suspect that the data we present on both migration of all occupations and nurse migration specifically are generally underreported.

CONTEXT OF NURSE MIGRATION

The Philippines has too few jobs for its population. The unemployment rate has steadily increased from 8.4 percent in 1990 to 12.7 percent in 2003 (BLES 2003). Even for those with jobs, conditions are difficult. One out of every five employed workers is underemployed, underpaid, or employed below his/her full potential. As a result, the number of Filipinos working abroad has steadily risen and from 1995 to 2000; overseas deployment of workers increased by 5.32 percent annually. Employment abroad provides work to job-seeking Filipinos and is a major generator of foreign exchange. Remittances from overseas Filipino workers of all occupations have grown from U.S.$290.85 million in 1978 to U.S.$10.7 billion in 2005 (Tarriela 2006). A large portion of this comes from international service providers, with nurses constituting the largest group of professional workers abroad.

Filipino labor migration was originally intended to serve as a temporary measure to ease unemployment. Perceived benefits included stabilizing the country's balance-of-payments position and providing alternative employment for Filipinos. However, dependence on labor migration and international service provision has grown to the point where there are few efforts to address domestic labor problems (Villalba 2002).

Movement of health workers from the Philippines as temporary or permanent migrant workers can be traced back to the 1950s. At that time, the objective of working overseas was generally to obtain more advanced training and return home to improve the quality of Filipino health services. Beginning in the late 1960s, countries in the Middle East and North America began to actively recruit health workers. Many of those who went to North America as students stayed on as migrant workers and were ultimately granted residency status (Corcega et al. 2000). By the late 1990s, in the face of widespread global nursing shortages, recruitment conditions changed and destination countries like the United States made recruitment offers both more attractive and more permanent, creating strong "pull factors."

There are an estimated 1,600 hospitals in the country, about 60 percent of which are private. The government is the biggest employer of nurses with an estimated 16,000 jobs at the national and government facilities. There is no reliable estimate for the number of nursing positions at small local or private institutions (DBM 2005). Both the conditions and the quality of care provided by the small and private hospitals vary greatly and poor working conditions and low pay at many of these institutions also impact nurse migration by creating "push factors." As a result, the Philippines has begun to experience massive migration of nurses and other health workers to the point that domestic demand for these workers is not being met.

PATTERNS OF NURSE MIGRATION