The Philippines: Sun, Sand and a Sea of Healthcare Workers Presidents Forum on International Health

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Sun, Sand and a Sea of Healthcare
WorkersPresidents Forum on International Health
The Philippines

• Rey Vivo, MD
• Assistant Professor of Medicine
• Texas Tech University Health Sciences Center

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The Islands

• 7,107 islands making up an archipelago
• Climate Tropical
• Area 115,831 sq mi
• 72 in the world
• Population 91 million
• 12 in the world
• Capital Manila
• Currency Peso
• (PhP47 US1)

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The History

• Negritos Malay aboriginals
• 13th century Islam
• 1521 Ferdinand Magellan discovers the islands
• Manila is established as capital of the new
  Spanish colony
• Christianity
• 1880s Propaganda Movement, Katipunan
• 1898 US defeats Spain First Philippine
  Republic
• 1935 Philippine Commonwealth then WWII
• 1946 Independence from US
• The Marcos dictatorship, People Power
  revolution(s)

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300 years in the convent and 100 years in
Hollywood
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The People

• Manila is 11th most populous metro in the world
• Literacy rate 93
• Language Filipino and English gt180 dialects
• Labor force 34.2 million

11 million (11) overseas largest diaspora
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The Culture

• Spanish names, language, religion/customs,
  food, architecture
• a Latin American country transported to the
  Orient
• American fast food, music, movies, pop culture
• Brown Americans

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The Culture

• Harmonious social interaction
• Debt of gratitude
• Colonial mentality
• Hospitality

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Healthcare Issues
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Health and healthcare

• Top causes of mortality cardiovascular, cancer,
  accidents, pneumonia, tuberculosis
• 1940s-1980s infectious diseases led all causes
• PhilHealth national health insurance program
• Out-of-pocket share emphasizes inequality
• 75 pharmaceuticals imported

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Diaspora
Crisis

• 2001 2004 gt5,000 physicians left
• 30 medical schools
• 2000 2003 51,850 nurses migrated
• 350 medical schools
• Approx. 1,000 hospitals have closed in the last 5
  years

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Physicians

• Top countries of medical education for IMG
  physicians

American Medical Assn., 2007
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Why leave?

• Harsh realities Compensation/month for resident
  MDs

Philippines
South Africa
USA
4,000
1,000
300
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Why leave?

• Other limitations
• Poor working/training conditions, quality of life
• Govt budget for health
• MD to person ratio US 1150
• Cuba.
  1225
• Phil... 1gt10,000
• Poor job prospects, difficulties in establishing
  practice
• Specialties
• Research
• Local political/economic forecast

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Challenges

• USMLE
• Cost
• Visas/Immigration laws
• Post-training employment opportunities
• Healthcare differences
• Disrupted families/relationships

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Diaspora

• 2001 2004 gt5,000 physicians left
• 2000 2003 51,850 nurses migrated
• Nursing schools are mushrooming everywhere
• 40 50 of nursing students are
  second-coursers
• At present 6,000 doctors are enrolled in nursing
  schools, all wanting to leave for greener
  pastures abroad
• gt50,000 caregivers have trained about half have
  left for jobs overseas

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Nurses
Percent of Hospitals Hiring Foreign-educated
Nurses by Country from which They Recruited, 2006
American Hospital Assn., 2007
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Nurses compensation
USA
Canada
Philippines
200
200
200
Daily
Daily
Monthly
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From MD to RN

• 2000 2004 5,000 MDs left to work abroad as RNs
• 2004 2005 gt2,400 MDs took the nursing boards
• Currently, gt4,000 MDs enrolled in nursing schools
• Generalists and specialists aged 25-60 years
• Retrogression

Alliance of Health Workers
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Pros and Cons

• Remittances from overseas workers
• Reduced unemployment
• Technology transfer
• Healthcare cultural diversity

• Expedited but suboptimal training
• Demoralization of MDs
• Brain drain

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Brain drain

• Filipino-born nurses and Indian-born doctors each
  represent about 15 percent of all nurses and
  doctors in the Organization for Economic
  Cooperation and Development (OECD).
• The migration of doctors and nurses from the
  developing to the developed world has only a
  limited impact on the crisis in health care in
  poor countries.

AFP
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Govt solutions

• Manage migration
• Mandatory government service
• Career advancement programs
• Knowledge exchange

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JAMA. 20082991753-4.
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• http//www.youtube.com/watch?vYdBANriBrlw

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Thank you