Political, economic and historical factors push out-migration of Filipino health workers

The migration of health workers has negative and positive effects on the Philippine health system and its health workers. (Photo by AR Morta)

The migration of highly skilled health professionals from developing to developed nations has increased dramatically in the last 10 years in response to a range of social, economic and political factors.

The consequences of this shift in health human resources can be critically important to the overall sustainability of health systems in many of these source countries. These consequences have become much more salient in the ongoing debate about the reliance of some high income countries on health workers who migrate from low and middle income countries. Few studies examine these trends and their consequences from a comparative approach; those that do typically focus on macro health indicators which do not allow for a broader investigation of the range of implications the migration of health workers has for patients, providers and health systems.

Further, an almost exclusive focus has been on medical and nursing practitioners while disregarding the roles of other highly skilled health professionals who are also critical to the sustainability of developing health systems. Research to date has also given less attention to the range of responses that various policy decision-makers can implement — and have implemented — to stem the tide of emigrating workers.

An Examination of the Causes, Consequences, and Policy Responses to the Migration of Highly Trained Health Personnel from the Philippines: The High Cost of Living/Leaving — A Mixed Method Study was written by Dr. Erlinda Castro-Palaganas and Ruel Caricativo of the Department of Economics and Political Science, UP Baguio to explore the departure of Filipino health personnel.

Published in Human Resources for Health, it answered four main questions.

First, what is the present picture of/recent historic trends in the migration of highly skilled health personnel from the Philippines?

Second, according to various stakeholders on the ground in these countries, what are the most critical consequences of the migration of highly skilled health workers?

Third, how could these consequences be measured optimizing the potential for comparative policy analysis?

Fourth, what is the range of policy responses that have been considered, proposed and implemented to address the critical causes and consequences of health worker migration from these countries, and what have been some of the outcomes of these responses?

The mixed method study employed a decentered, comparative approach that involved three phases: a scoping review on health workers’ migration of relevant policy documents and academic literature on health workers’ migration from the Philippines, primary data collection with 37 key stakeholders, and household surveys with seven doctors, 329 nurses, 66 midwives and 18 physical therapists.

Filipino health worker migration is best understood within the context of macro-, meso-, and micro-level factors that are situated within the political, economic, and historical/colonial legacy of the country.

Underfunding of the health system, and unemployment and underemployment were push factors for migration, as were concerns for security in the Philippines, the ability to practice to full scope or to have opportunities for career advancement.

The migration of health workers has both negative and positive consequences for the Philippine health system and its health workers. Stakeholders focused on issues such as brain drain, gain and circulation, and on opportunities for knowledge and technology transfer.

Concomitantly, migration has resulted in the loss of investment in human capital. The gap in the supply of health workers has affected the quality of care delivered especially in rural areas. The opening of overseas opportunities has commercialized health education, compromised its quality, and stripped the country of skilled learning facilitators. The social cost of migration has affected émigrés and their families. At the household level, migration has engendered increased consumerism and materialism and fostered dependency on overseas remittances. Addressing these gaps requires time and resources.

But migration is also seen by some as an opportunity for professional growth and enhancement, and as a window for drafting more effective national and inter-country policy responses to HRH mobility.

Unless socioeconomic conditions improve and health professionals are provided with better incentives, staying in the Philippines will not be a viable option. The massive expansion in education and training designed specifically for out-migration creates a domestic supply of health workers who cannot be absorbed by a system that is underfunded. This results in a paradox of underservice, especially in rural and remote areas, at the same time as underemployment and out-migration. Policy responses to this paradox have not yet been appropriately aligned to capture the multilayered and complex nature of these intersecting phenomena.

(Article by Erlinda Castro-Palaganas and Ruel Caricativo. Edited by ARM.)