Written by: Layne Caballero and Shari Estillore
On September 29, 2022, the Department of Health declared a 106,000-nurse shortage in both public and private hospitals, with a startling 1:20-50 nurse to patient ratio, exceeding the prescribed 1:12 ratio. Regardless, officer-in-charge Maria Rosario Vergeire blames the recent shortage on migration, thus the government’s imposition of a 7,500 deployment cap on nurse outmigration in 2020.
Since the pandemic began, over 40% of nurses at private hospitals have been reported to quit. Some nurses went abroad where they are appreciated, while others who remained in the country left the healthcare industry to free themselves from the grueling work environment in hospitals.
The mass outmigration of Filipino nurses is not new. As a matter of fact, the Philippines began exporting nurses to the United States in 1948, among other reasons, to meet the nursing shortage following World War II. After experiencing a prosperous life in the U.S., or in any other developed countries, many nurses have used working abroad as a pathway to permanent residency and eventual citizenship. Because of this, despite the obvious necessity for nurses to work locally to provide quality healthcare for Filipinos during the pandemic, many still opt to venture abroad.
Surge in global demand for healthcare services
As demand for healthcare services surged around the world, developed countries prioritized boosting their healthcare workforce by outsourcing nurses to maintain quality and quantity of healthcare. Countries such as Germany, Saudi Arabia, Australia, the United States, and many more sought Filipino nurses in particular for their exceptional care and attitude, enticing them with high remuneration and benefits unrivaled by the Philippine government.
Uncared for healthcare workers
Despite producing “world-class” nurses, the country’s average wage for its nurses only amounts to P8,000 up to P13,500 a month for private hospitals and P30,000 for public hospitals, as reported by DOLE. This is incomparable to the U.S.’ $3,000 or P200,000 and the U.K.’s £2,000 or P100,000 entry-level wage per month. The Philippines categorized as a developing country may justify the clear wage disparity with its developed counterparts. However, by its own standards, these wages are still unjustifiably low compared to other demanding professions within the country.
To compensate, the government often promises to increase benefits and to frequently disburse bonuses, creating an illusion of an unproblematic healthcare system. However, these are rarely fulfilled, oftentimes kept behind an elaborate bureaucratic red tape, which adds to local nurses’ indignation. According to Filipino Nurses United (FNU), COVID-19 benefits and compensation have yet to be received by 60 percent of healthcare employees.
Furthermore, the pandemic exposed the government’s failure to prioritize the healthcare system. The insufficient provision of equipment such as PPEs and oxygen tanks at the height of the pandemic created hazardous working conditions which forced nurses to proceed with makeshift solutions. Healthcare groups claim to forfeit their lunch and bathroom breaks to save on PPEs.
The deliberate delay in remuneration, bonus payments, benefits, and lack of appreciation demonstrate the overall neglect of the government for health-care personnel, further disincentivizing nurses to work locally.
Impacts of Nurse Outmigration on Philippine healthcare system
The ceaseless nurses’ exodus led to the overall diminution in the quality and quantity of service, resulting in a compromised Philippine healthcare system. Some crucial consequences are delays in essential services, a high rate of unattended deaths at 41.2 percent, and lower immunization rates.
The insufficiency of trained nurses also became costly for hospitals due to the continual hiring of new staff. This cycle of hiring prompts hospitals to invest constantly in the training of staff replacement to maintain quality healthcare services as compensation for the skills lost to migration.
Additionally, the shortage of nurses extended the working hours of remaining healthcare workers. During the COVID-19 pandemic, their straining situation was further exacerbated by suboptimal protective equipment making them more vulnerable to infection and, therefore, affecting the delivery of quality and immediate care services to COVID-19 patients.
This also affected the psychological well-being of healthcare workers wherein 70.24 percent of Filipino health care workers had anxiety symptoms and 50.97 percent experienced depressive symptoms due to the fear of contracting the COVID-19 virus, affecting the quality of service they provide.
Attempting to appease discontented nurses, DMW Secretary Susan Ople and President Marcos Jr. favor the easing of deployment cap on nurse outmigration. Nevertheless, both recognize that the government should still prioritize the overall improvement of working conditions, increase in wages, decreasing wage disparity between public and private hospitals, and additional benefits for nurses over band-aid solutions.
To prevent shortage of nurses in the future, Senator Imee Marcos proposes pledge-of-service in scholarships for nursing students. She also recommends legislating laws that standardize benefits for HCWs.
On paper, these proposed solutions may foster the increase of nurses working locally. However, without proper implementation, these may only remain theoretical. The government must also repair its fractured relations with its local HCWs, starting by overseeing their welfare and making the improvement of the overall healthcare system as one of its top priorities.
Abarca, C. M. F. (2022, March 11). Most PH healthcare workers suffered psychological stress due to Covid-19 pandemic – expert. Manila Bulletin. https://mb.com.ph/2022/03/11/most-ph-healthcare-workers-suffered-psychological-stress-due-to-covid-19-pandemic-expert/
Acacio. K. (2007). Producing the “World-Class” Burse: the Philippine System of Nursing Education and Supply. HRH Global Resource Center. https://www.hrhresourcecenter.org/node/2609.html
Alibudbud, R. (2022). When the “heroes” “don’t feel cared for”: The migration and resignation of Philippine nurses amidst the COVID-19 pandemic. Journal of Global Health. https://jogh.org/2022/jogh-12-03011
Bacelonia, W. (2022, October 27). Imee wants pledge-of-service included in scholarships for nurses. Philippine News Agency. https://www.pna.gov.ph/articles/1187184
Cachero, P. (2011, May 30). From AIDS to COVID-19, America’s medical system has a long history of relying on Filipino nurses to fight on the frontlines. Time. https://time.com/6051754/history-filipino-nurses-us/
de Vera, A. (2022, September 29). PH short of 106,000 nursing staff- DOH. Manila Bulletin. https://mb.com.ph/2022/09/29/ph-short-of-100000-nursing-staff-doh/
de Villa, K. (2022, May 1). Health workers hit DOH over benefits. Inquirer.net. https://newsinfo.inquirer.net/1590401/health-workers-hit-doh-over-benefits
de Villa, K. (2022, May 20). DOH far from done paying COVID-hit frontliners. Inquirer.net. https://newsinfo.inquirer.net/1599889/doh-far-from-done-paying-covid-hit-front-liners
Lorenzo, F. M. E., Galvez-Tan, J., Icamina, K., & Javier, L. (2007). Nurse Migration from a Source Country Perspective: Philippine Country Case Study. Health Services Research, 42(3.2), 1406-1418. doi: 10.1111/j.1475-6773.2007.00716.x
Magsambol, B. (2022, September 3). Philippines lacks 106,000 nurses – DOH. Rappler. https://www.rappler.com/nation/philippines-shortage-nurses-hospitals-doh/
Maralit, K. (2022, October 4). Act on health workers shortage, govt urged. Manila Times. https://www.manilatimes.net/2022/10/04/news/national/act-on-health-workers-shortage-govt-urged/1860842
Pazzibugan, D. Z. (2022, November 2). Ease cap on nurses’ deployment, DOH urged. Inquirer.net. https://newsinfo.inquirer.net/1688161/ease-cap-on-nurses-deployment-doh-urged
Philippine Daily Inquirer. (2022, July 22). Lifeline for PH nurses. https://opinion.inquirer.net/155306/lifeline-for-ph-nurses
Robredo, J. P., Ong, B, Eala, M. A., & Naguit, R. J. (2022). Outmigration and unequal distribution of Filipino physicians and nurses: An urgent call for investment in health human resource and systemic reform. The Lancet Regional Health – Western Pacific, 25. https://doi.org/10.1016/j.lanwpc.2022.100512
Sarao, Z. (2022, September 09). Health workers slam proposed 2023 health budget. Inquirer.net. https://newsinfo.inquirer.net/1661023/health-workers-slam-proposed-2023-health-budget
Sarao, Z. (2022, September 7). Health workers ask for unreleased benefits, higher pay. Inquirer.net. https://newsinfo.inquirer.net/1659575/health-workers-stage-protest-over-unreleased-benefits-to-increase-health-budget-in-2023
Wong, D. J. (2022, September 13). Filipino nurses now highly sought after in these developed nations. Mashable SE Asia. https://sea.mashable.com/life/21376/filipino-nurses-now-highly-sought-after-in-several-developed-nations