From Brain Drain to National Hemorrhage The Global Migration of PhilippineTrained Nurses: Causes, Im

1
From Brain Drain to National Hemorrhage The
Global Migration of Philippine-Trained Nurses
Causes, Impacts and Future Prospects

• Erlinda Castro-Palaganas PhD, RN
• University of Ottawa, Nov. 3, 2008

2
References

• Several researches on the PHILIPPINE NURSING
  MIGRATION by Dr. Fely Marilyn Lorenzo, Dr. Jaime
  Galvez Tan, PNA, ADPCN, HEAD, PHM

3
Outline of Presentation

• Philippine Health Care Context
• Philippine Basic Indicators
• The Government Responses
• - Privatization as a Government Policy
• - Labor Export Policy
• Nurses and Migration
• - Migration Situation
• - Migration Issues and Concerns
• - Policy Implications
• Challenges

4
What could be the reason/s?
5
Philippine Health Care System Context

• Philippines composed of 7,150 islands organized
  into 3 main island groups
• Population 87million growing annually by 2.3
• Productive age group estimated to be 42 of 34.2
  million
• Labor Force is 67 of all Filipinos in
  reproductive age
• Only 8.83 are estimated to comprise human health
  resources

6
Philippine Health Care System Context

• Rapidly growing population , steady employment
  rates
• Unemployment rates around 12
• 1 out of 5 Filipinos underemployed
• Job opportunities have not increased
  correspondingly with population increase
• Labor productivity stagnant over last 12 years
• Every year about 800,000 young people begin
  looking for work in a contracting and job-scarce
  economy

7
Philippine Health Care System Context

• Devolved health care system since 1995
• DOH lead agency that safeguards health and
  maintains specialty hospitals, regional
  hospitals, and medical centers
• All other hospitals and field health units
  maintained by local governments
• Private sector involvement in health care is
  enormous 60 of 1,600 hospitals in country are
  private
• Problems of access and equity hampered by high
  costs and physical and soci-cultural barriers

8
Philippine Health Care System Context

• Health Sector Reform launched in 2000 covering
• Hospital
• Local Health Systems Development
• Public Health Programs
• Health Regulation
• Social Health Insurance
• No attention given to development of Health Human
  Resources

9
Philippine Basic Indicators

• 4 million unemployed and 7.3 million
  underemployed in 2006
• in the past six years, 11.3 unemployment rate
  and 18.5 underemployment rate
• 70 of Filipinos consider themselves poor (IBON
  survey)
• around 3,000 Filipinos daily forced overseas to
  work
• source IBON

10
Philippine Basic Indicators

• P100 billion estimated government deficit
• P278 billion target raised through higher taxes,
  fees, rates public service charges
• P721.7 billion target to be repaid to creditors
  in 06 or P6,391 per Filipino
• Real public spending per Filipino on education is
  P1,296 health P120

Source 2006 The Economics of Hype, IBON
Foundation, published in bulatlat.com,
11
Philippine Basic Indicators

• The Philippines ranked 83rd of 177 nations (down
  from 77th in 2002) in the quality-of-life survey
  (GDP, life expectancy, adult literacy, growth in
  school enrollment, environmental protection)
• - 2004 UN Human Development Index

12
Health Sector Reform the Philippines

• Privatization as a Government Health Policy

13
Health Sector Privatization

• Health Sector Reform Agenda
• Fiscal autonomy for govt hospitals
• Promote health insurance schemes with private
  sector
• Tokenism in public health programs, community
  health and development of local health systems
• FOURmula ONE for Health (2005-2010)
• Integrated public health into hospital services
• Medical tourism
• Innovative financing arrangements

14
Health Services for Sale Medical Tourism

• Principally being promoted by the Philippine
  government using the public health care system
• Linked to the issue of organ trade (i.e. sale of
  kidneys for US3,000-4,000)
• Expected revenues US 10B in 5 years

15
Medical Terrorism Growing military presence
16
Labor Export Policy This decline in the quality
of life is due to the worsening economic and
political crisis in the country.

• Due to widening unemployment, the Philippine
  government has resorted to a Labor Export Policy
  (LEP) to
• defuse social tension by exporting its vast
  numbers of unemployed and underemployed people
  abroad
• to rake in the much needed dollar remittances to
  prop up a falling peso, pay balance of trade
  deficits and onerous foreign loans.

17
The fact that millions of Filipinos are forced
to work abroad is proof of governments economic
failure. - Manila Archbishop Gaudencio Rosales,
July 2004
18
Labor Export Policy

• The Philippines Labor Export Policy is rooted in
  the failure of its government to chart its own
  economic and political development through
  genuine agrarian reform and the creation of a
  modern industrial base to make the local market
  vibrant, prosperous and stable.
• This resulted into dependence on foreign
  technology and markets, political subservience to
  foreign policy dictates of the dominant economic
  powers.
• Without a sustainable and self-reliant domestic
  economic base, the Philippine government will
  perpetually export its human resources to foreign
  masters in exchange for much-needed revenue at
  the expense of the rights and welfare of its
  workers.

19
The development of the labor export program (LEP)

• Since 1974, when the Labor Code was first
  revised, the export of Filipino workers
  overseas has intensified and become increasingly
  systematic
• Creation of successive government agencies that
  institutionalized and intensified the export of
  Filipino workers overseas
• Overseas Workers Welfare Administration,
  Philippine Overseas Employment Administration
• Government target of 1 million workers overseas
  per year

20
Organized Philippine Overseas Deployment System

• Goals
• Maximize gains of overseas employment for
  migrants and sending countries
• Monitoring and Protection of OFW welfare
• Components
• Managing overseas deployment Finding , managing
  new markets, maintaining current partners
• Welfare Protection Ensuring rights are protected
  during recruitment, pre-departure and in overseas
  workplaces
• Migrant workers reintegration into society

21
Organized Philippine Overseas Deployment System

• Six major government agencies involved in
  migration process
• 1.DOLE- Department of Labor and Employment
• 2. POEA- Phil. Overseas Employment Administration
• 3. OWWA- Overseas Workers Welfare Administration
• 4. BSP- Bangko Sentral ng Pilipinas (Central
  Bank)
• 5. DFA Department of Foreign Affairs
• 6. CFO- Commission on Filipinos Overseas

22
Key Migration Management Tools

• Migrant and Overseas Filipinos Act (RA 8042)
• Contains policies, rights , obligations,
  sanctions and regulations that govern overseas
  employment.
• POEA- handles documentation of land-based and
  sea-based contract workers recruited mostly by
  private recruiters, regulates recruiters manages
  information on migrant and remittance flows to
  assist with policy formulation
• OWWA- responsible for promoting welfare of OFWs
  and dependents through implementation of welfare
  programs for migrants and dependents includes
  health or repatriation assistance, livelihood
  loans, skills training, scholarships, and
  reintegration incentives
• POLOs Philippine Overseas Labor Offices
  attached to Phil. embassies and consulates

23
Labor Export

• 36,000 Filipinos were deployed to other
  countries in 1975.
• In 2006, the Arroyo administration exported a
  record 1.08 million Filipinos and received US14
  billion in remittances of overseas Filipinos.
• Of the 308,142 deployed OFWs as new hires,
  184,454 or 60 were females compared to 123,688
  males in 2006.

• 2006 Top 10 OFW destination countries
• Saudi Arabia 223,359
• UAE 99,212
• Hong Kong 96,929
• Kuwait 47,917
• Qatar 45,795
• Taiwan 39,025
• Singapore 28,369
• Italy 25,413
• UK 16,926
• Korea 13,984
• Others 151,041
• Landbased 788,070
• Seabased 274,497
• Total 1,062,657
• Source POEA, 2006

24
Top Ten Occupational Group by Sex For the Year
2006
25
Intensified export of Filipino migrants
Overseas Filipino Workers should stay where they
are and not think of coming home. President
Gloria, August 2002 during dinner with OFWs in
Kuala Lumpur.
26
Labor Export Policy

• For the last 30 years, the Philippine economy,
  and all administrations have been propped up by
  the remittances of overseas Filipinos. The
  countrys economy is saved from eventual collapse
  by the remittances of Filipinos abroad.
• Last year, close to 10 million Filipinos overseas
  remitted a total of US12.8 billion to the
  Philippines, US2.2 billion higher than the US
  10.6 billion total of 2005. This is aided by the
  governments pursuit of its labor export program
  that targets one (1) million Filipinos deployed
  annually.

27
State exactions dollar remittances
Annual remittances
State exactions
Source Central Bank COURAGE
28
Lucrative labor export program

• 2005 Remittances of US10.7 billion (P545.7
  billion) amounted to
• More than the five top 2005 merchandise
  exports
• More than ½ of the 2005 national budget
  (P907 B)
• 100 times more than all Foreign Direct
  Investments
• 10 of the GDP
• 9.5 of the GNP
• 3 times more than 2001 US military aid

29
Overseas Filipinos

• More than 8.5 million or 10 of Philippine
  population are in over 196countries
• Mostly from peasant and worker families
• Overseas Filipinos include immigrants and
  naturalized citizens undocumented workers
  refugees and contract workers (est. 3.5 million,
  DFA)

30
Exporting Health Human Resource

• No. 1 Exporter of Nurses
• An estimated 85 of employed Filipino nurses
  (more than 150,000) are working internationally.
  (Aiken et al 2004)
• 70 of all Filipino nursing graduates are
  working overseas. (Bach 2003)
• No. 2 Exporter of Doctors
• 68 of Filipino doctors work overseas, next to
  India. (Mejia, WHO 1975)
• (NIH 2004)

31
Hemorrhage of Human Resources Nurses

• 13,536 nurses left the country in 2001.
• 2000-2003 approx 50,000 nurses left.
• Data casts doubt on the underreporting of the
  Philippine Overseas Employment Agency (POEA) that
  shows only 91 nurses left for the USA in 2000,
  304 nurses in 2001, and 320 nurses in 2002. (Tan
  et al 2004)

32
Source Philippine Overseas Employment
Administration (POEA)
33
Source Philippine Overseas Employment
Administration (POEA)
34
Total Number of Nurses in the Country

• Total Registered Nurses (1960-2003) 333, 581
• Estimated Deaths 1, 375.20
• Estimated Current Stock of Nurses 332, 205.80
• SUPPLY AND DEMAND
• Supply 332, 206
• Demand 193, 223
• Oversupply 138, 983

35
(No Transcript)
36
Estimated HRH Production Trends

• Nurses (10,000-15,000/year) from 475 nursing
  colleges
• Doctors (2,000/year) from 30 medical colleges
• Midwives (1,500/year) from 129 schools
• Dentists (2,000/year) from 31 dental schools
• Pharmacists (1,500/year from 35 pharmacy colleges
• Physical Therapists (1,000/year) from 95 PT/OT
  colleges
• Occupational Therapists (200/year) from 95 PT/OT
  colleges

37
Top 5 Destinations of Filipino Nurses

• United States of America
• United Kingdom
• Saudi Arabia
• Ireland
• Singapore
• (NIH 2004)

38
Markets

• Traditional Markets Middle East, North America
• New Markets Europe especially UK, Netherlands,
  High Income Asia
• Emerging Markets Japan and Nurse Education
  abroad

39
Profile of Nurse Migrants

• Mostly Women
• Age Range of 20-30 years old
• Middle-Income Group
• Basic Professional Educ/with Masters Degree
• Specialized in areas ICU, ER, and OR
• Served 1-10 years before migration

40
Profile of Nurse Medics

• Increasing number about 1000/year from 2000 to
  2003- estimated to triple in 2005
• From survey of 100 volunteer respondents (doctors
  currently taking nursing courses) in different
  regions of the Philippines
• Gender Distribution 45 female, 30 male, 25
  no info
• Marital Status - 24 single, 76 married
• Age 37 years old and above
• Annual Income Bracket P 120, 000 to P 480, 000
• Specializations Internal/General Medicine
  (30), Pediatrics (14), Family Medicine (13),
  Surgery (8), Pathology (6), Others (29)
• 63 were practicing doctors for more than 10
  years

41
Hemorrhage of Human Resources Doctors

• MD-NURSES More than 9,000 MDs have already left
  as nurses in 2002-2005.
• Around 80 of public health physicians have taken
  up or are enrolled in nursing.
• Obstetricians and anaesthesiologists are fast
  depleting, followed by pediatricians and
  surgeons.
• (NIH 2004, PMA 2005)

42
Hemorrhage of Human Resources Doctors

• In some areas, the local PMA chapter facilitates
  the nursing education of its members
• Decrease in enrollment of first year medical
  students of 10 to 55 in the last 2 years.
• Decrease in applicants for residency positions
• (NIH 2004, PMA 2005)

43
Hemorrhage of Human Resources Other Professionals

• At least 37 Philippine nursing schools offer
  abbreviated 2-year courses for doctors to become
  nurses.
• More than 60 of nursing schools are geared
  mainly for second coursers (non-health
  professionals who want to take up nursing, e.g.
  engineers, accountants, teachers, soldiers).
• (HSA 2005, PNA 2005)

44
Hemorrhage of Human Resources Other Professionals

• HEAD estimates that there are between
  30,000-40,000 second-coursers currently taking
  up nursing.
• TESDA has trained over 50,000 caregivers in the
  last 5 years and over 24,000 have been deployed
  abroad.
• (HSA 2005, PNA 2005)

45
Reasons Why Filipino Nurses Leave the Country

• Push Factors
• Economic low salary at home, no overtime and
  hazard pay, low coverage of health insurance
• Job-related work overload or stressful working
  environment, slow promotion
• Socio-political and economic environment limited
  opportunities for employment, decreased health
  budget, peace and order situation in the
  Philippines

46
Reasons Why Filipino Nurses Leave the Country

• Pull Factors
• Economic higher income, better benefits and
  compensation package
• Job-related Lower nurse to patient ratio, more
  options in working hours
• Individual/Family-related Chance to upgrade
  nursing skills, acquisition of immigrant visa and
  opportunity for family to migrate, opportunity to
  travel and learn other cultures, influence from
  peers and relatives
• Socio-political and Economic environment
  Advanced technology, better peace and order
  situation

47
Reasons Why Doctors Migrate as Nurse Medics

• PUSH FACTORS
• very low compensation and salaries,
• feeling of hopelessness about the Philippine
  current situation,
• political instability and graft and corruption,
• poor working conditions and
• the threat of malpractice law
• PULL FACTORS
• more socio-politico- economic security abroad,
• attractive salaries and compensation packages
  (High salaries, benefits, compensation)
• more job opportunities and career growth.

48
Reasons Why Filipino Nurses Return

• Personal Reasons
• To get married
• To raise children in homeland
• To take a vacation
• Homesickness and depression
• To retire
• To get family
• Professional Reasons
• To share expertise
• For professional stability

49
Reasons Why Filipino Nurses Return

• Financial Reasons
• Nurse has saved enough money
• To set up a business at home
• Job-related Reasons
• To buy a house or a car
• Social Reasons
• Contract has expired
• Plans to retire back home

50
Perceived Impact of Migration

• Health Care System and Quality of Health Care
• Positive Effects
• Health care is enhanced.
• Availability of more aggressive staff
  replacements who are eager to learn.
• Negative Effects
• Continuity of programs/services is adversely
  affected.
• Quality of care is compromised.
• People in the community are deprived of health
  services.
• Improvement of the hospital is delayed when
  resources are used to train staff replacement.

51
Perceived Impact of Migration

• Economy
• Positive Effects
• Economy improves with the remittances from
  workers abroad.
• Philippines posts 5th largest remittance
  earnings globally (WB) projected to be 30 B
• Unemployment is reduced.
• Negative Effects
• Loss of government resources used in education
  and training.
• Resources are spent on training of staff
  replacements.
• Reduced government income of the province and
  country from taxes of health professionals.

52
Social Net Benefits

• Winners
• Nurse migrants and their families- greater child
  schooling, reduced child labor , increased
  educational expenditure,
• Economy remittances, raise hours worked in
  self-employment and lead to relatively
  capital-intensive enterprises by migrants
  hoouseholds

53
Social Net Benefits

• Losers
• Health Care System
• Loss of skilled trained health staff
• Rendered health system fragile
• Extended Families
• Social support
• Philippine Nursing
• Ability to renew and further nursing development
  is hampered

54
Deteriorating Quality of Nursing Education

• The number of nursing schools have increased
• 1970s only 40
• 1990s 170
• June 2003 251
• April 2004 370
• June 2005 441
• June 2006 470
• In the last 3 years, there has been an 87
  increase in nursing schools nationwide
• (NIH 2004)

55
Deteriorating Quality of Nursing Education

• Decreasing proportion of nursing graduates who
  pass the national nursing licensure examinations
• 1970s and 80s 80-90
• 1991 below 61
• 2001-2003 44-48
• 2004 55.9
• 2005 49.7
• 2006 41
• (NIH 2004, PRC 2006)

56
Deteriorating Quality of Nursing Education

• In 2001
• 116 nursing schools passing rate of lt50
• 124 nursing schools passing rate of gt50
• In 2002, 150 nursing schools had a passing rate
  lt50, which was already 63 of the 237 nursing
  schools then.
• In the last 3 NLEs, at least 20 nursing schools
  consistently had a 0 passing rate.
• (NIH 2004, PRC 2006)

57
Source PRC, 2005
58
Nurses and Severe Exploitation and Discrimination

• Canada the Live-in Caregiver Program (LCP) for
  nurses
• United Kingdom 2,000 payment to employer or
  recruiter, yet start at the lowest rung (
  healthcare assistant)
• Saudi Arabia the visit of DOLE Sec. Patricia
  Sto. Tomas pushed for lower wages for Filipino
  nurses in order to maintain competitiveness.
• (AHW 2004, MIGRANTE INTL 2005)

59
Exploited Health Human Resources

• Health workers and professionals are overworked
  and underpaid.
• Average monthly wages for nurses is between Php
  5,500 to 16,500 and for doctors is between Php
  9,700 to 23,500. (Lorenzo et al, 2004)

60
Exploited Health Human Resources

• Doctor to patient ratio (population)
• Cuba 1225
• USA 1450
• Philippines 110,000-26,000
• WHO (Ideal) 1600
• Nurses to patient ratio
• PGH 115-26 per shift
• Davao del Sur 144-45 per shift
• Ideal 14 per shift
• Philippines 116,000 (population)
• (AHW 2004, HealthWrights 2004)

61
Reasons for the Continuing Exodus

• Commercialized health education.
• The average tuition fee for a 5-year medical
  course is Php 500,000 for school fees alone.
• Labor export policy.
• The national government earned USD 7.6B from
  OFW remittances in 2003 and USD 8.5B in 2004. It
  expects to earn an estimated USD 10B in 2005.

62
Reasons for the Continuing Exodus

• Economic and political instability.
• The fiscal crisis and the ballooning national
  debt the unbridled corruption and lack of
  accountability and the political crisis that
  worsen daily amid the incapacity of government to
  address these with long-term, definitive
  solutions.
• Globalization policies.
• The phenomenon of human trafficking across
  states, even under the guise of globalizing labor
  and human resource development, is still within
  the framework of privatization, deregulation, and
  liberalization.

63
The Unhealthy Philippine Health Care System

• A health care system that cannot maintain
• its own health human resource
• is not healthy at all.

64
Health is a basic human right. It is the
responsibility of the state to ensure that the
people have access to quality health care.
65
RIGHT TO HEALTH OF THE PEOPLE
66
Worsening State Neglect
67
Health Financing Sources of Funds
40 government
49 out of pocket
11 Shared-Risk Schemes Including National Health
Insurance (PhilHealth)
Total Health Expenditure P0.25 per Filipino per
day
68
Increasing private burdens
69
Decreasing Spending on Social Services
Debt payments increased by 101
Health decreased by 19
Military increased by 11
Nota ay inflation-adjusted per capita, tsart
ay nominal
70
Uses of Funds (In Percent)
Administrative Costs and Regulatory Functions
10
10
80
Public Health Interventions
Individual Healthcare
(Romualdez, 2008)
71

• HEALTH has become a commodity subject to TRADE
  and PROFITS
• National Governments have ABANDONED their
  responsibility to ensure the HEALTH of their
  PEOPLE.

72

• In these
• trying times,
• WHAT ARE WE
• TO DO?

73
Important Considerations

• Temporary migration most beneficial for sending
  country
• Permanent migration beneficial to individual
  migrants and families and receiving country
• Nursing most popular profession now due to job
  and career opportunities
• Nursing and HRH development are on national
  policy agenda -controversial

74
Important Considerations

• Nursing development has not benefited from
  rollercoaster trends of migration
• Health Care system has not benefited from
  migration related transactions
• Nursing and health sectors need to manage
  relationships with trade and economic managers in
  private and government sectors
• Philippines has not utilized remittances to
  leverage job creation and domestic employment
  development

75
Health Worker Migration Policy Issues

• Areas that need attention recruitment,
  retention, policy, education and strain on
  current nurses
• Funding of the education and training of health
  workers
• Employment situation within the source country
  and the degree to which health professionals
  would have been gainfully employed in their home
  country
• Consequences for the workers that remain in the
  country as their colleagues depart for employment
  abroad
• Whether movements reflect temporary or permanent
  shift in location

76
Policy Analysis

• Local Policies mainly regulate and manage
  domestic employment
• Many incompletely implemented or not implemented
• Does not manage outflow of workforce
• Does not adequately clarify standards of
  staffing and compensation

77
Policy Provisions

• International Policies
• Provides models of regulating scope of practice
  and licensure, recruitment, entry
• Safeguards quality of health systems and health
  care in destination countries
• Few contain safeguards from source countries

78
Migration has to be managed by

• Addressing protection of both health and human
  rights.
• - Dampening push forces by retaining talent in
  sending countries
• - Reducing pull forces by aiming for
  educational self sufficiency in destination
  countries
• JLI Secretariat 2004

79
Managed Migration

• Should facilitate both
• - development goals of source countries and
• - efficiency goals of destination countries
• Involves national
• - policy reforms
• - international agreements
• - cooperative education program by source and
  destination country institutions
• Health sector development projects
• (Commonwealth Secretaiat, 2005)

80
Migration Related Policy Categories

• Recruitment, Entry, and Citizenship Policies
• Welfare and Human Resource Development and
  Retention
• Re-entry of Migrants (Brain Gain)
• - Permanent
• - Temporary (Brain Circulation)
• Licensure and Scope of Practice
• Skill Mix
• Poverty Alleviation and Social Development

81
Policy Development Criteria

• Mutually Beneficial
• - economic standpoint (social return)
• - development status (professional and
  social)
• - financial (private returns)
• - cultural
• - health systems
• Should achieve equity and efficiency
• Promote policy coherence
• Protection and safety human outcomes

82
Policy Goals

• Equity Nurse Distribution
• Effectiveness
• Efficiency
• Security/Safety ensuring local/domestic health
  outcomes

83
Policy Recommendations

• International Policies
• Bilateral Migration Management Policies
• Provision of Progressive Incentives
• HRH retention for destination countries
• Incentives for reintegration for Recruiting
  countries

84
Policy Recommendations

• Domestic Policies
• Creation of incentives for return migration
• Positions for return migrants
• Development of Framework for maximizing the
  utilization of those with skills, experience
• Incentives for investments/ temporaryreintegration
  

85
Policy Recommendations

• Within organizations
• Creation of Position that provide incentives for
  longevity
• Career Path Development
• Ensure continuing development
• Improve work conditions

86
Policy Options

• Five Core Elements for National and Bilateral
  Policy on Labor Migration and Related Support
  Measures
• An informed and transparent labor migration
  admissions system designed to respond to
  measured, legitimate labor needs, taking into
  account domestic concerns as well.
• A standards-based approach to migration
  management protecting basic rights of all
  migrants and combating exploitation and
  trafficking.

87

• Enforcement of minimum national employment
  conditions standards in all sectors of activity.
• A plan of action against discrimination and
  xenophobia to sustain social cohesion.
• Institutional mechanisms for consultation and
  coordination with social partners in policy
  elaboration and practical implementation.

88
Future Outlook

• Achieve mutually beneficial migration
  arrangements if reintegration programs are
  effective

89
But we should not loose sight of more empowering
and actions towards social transformation.
90
The State of the Nations Health A Summary

• Peoples health and welfare overall as the result
  of economic and political conditions
• Poor health outcomes, especially for the poorest
• Dysfunctional and fragmented health care delivery
  system
• Privatization as the states key health policy
• Systemic and worsening poverty and inequities
  urgently need to be address

91
Migration

• Everyday, more than 3,000 Filipinos are forced
  to work overseas - P480,000 (approx. US 8,900.)
  in government revenue daily.
• Labor export program commodifies and exports
  Filipino workers abroad
• As the national economic and political crisis
  intensifies so too will the export of workers
  because of the increased dependence on dollar
  remittances and inability to create jobs in the
  Philippines
• Abuses against migrants range from contract
  violations, physical and mental abuses and death

92
Assert People's Control

• Collective action to uphold and defend people's
  rights
• Health
• Land
• Living wages
• Social Equity

93
Assert People's Control

• Rescind detrimental government policies

94
Social OBLIGATION VS. PROFIT
95
What Needs to Be Done?

• Short Term/Immediate Intervention
• Increase wages
• Increase budget for health
• Hold national consultations with all
  stakeholders
• Improve regulation of medical and nursing
  schools
• Rescind commitments to General Agreement in
  Trade in Services (GATS)

96
What Needs to Be Done?

• Long Term/Strategic Intervention
• Review the overall health care system
• Formulate a pro-people health policy and program
  
• Discontinue labor export policy
• Review and rescind WTO commitments
• Discontinue globalization policies
  (deregulation, liberalization, and privatization)
• Draw up independent political and economic
  policies

97
Challenges ahead

• Alma Ata vs. Alana Ata?
• Social determinants of health
• Ethical recruitment of nurses vs. labor export
  policy
• Universal health care? Socialized health care?
• Medical tourism and sale of organs
• WTO and health as a matter of trade and
  investment
• Globalization and health privatization

98
Continuing advocacies

• Health as a matter of right and state
  responsibility
• Health in the framework of equity, not equality
• Access to medicine as part of access to health
• Health not just the absence of disease or
  adequate services but as a peoples overall
  well-being economic, political, social, cultural
• Health as a public service, not a business or
  trade investment
• Health in the context of a truly independent and
  democratic society

99
Medicine has imperceptibly led us into the
social field and placed us in a position of
confronting directly the great problems of our
time. For if medicine is really to accomplish
its great task, it must intervene in political
and social life. It must point out the hindrances
that impede the normal social functioning of
vital processes, and effect their removal.

• Dr. Rudolf Virchow (1821-1902)

100

• I dont deserve to be treated like this. I care
  about my job, SIR. I care about you!!!"
• Sharon Cuneta
• Artist, Caregiver

101
WHAT WE WANT

• Defend and Uphold Peoples Right to Health
• Resist the Commodification of Health
• WTO OUT of Health

102
WHAT WE WANT

• Health for ALL,
• Health in the Hands of the People
• Genuine Freedom and Democracy

103
Migration Does it bridge the north and south
problem? Is it ethical? Should it be supported?
Constrained? Regulated?
104

• HEAL.
• STRUGGLE.
• LIBERATE.
• Health Alliance for Democracy (HEAD)

Council for Health and Development
Maraming Salamat po.Thank you.