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

Abstract

BackgroundDramatic increases in the migration of human resources for health (HRH) from developing countries like the Philippines can have consequences on the sustainability of health systems. In this paper, we trace the outflows of HRH from the Philippines, map out its key causes and consequences, and identify relevant policy responses.MethodsThis mixed method study employed a decentered, comparative approach that involved three phases: (a) a scoping review on health workers’ migration of relevant policy documents and academic literature on health workers’ migration from the Philippines; and primary data collection with (b) 37 key stakeholders and (c) household surveys with seven doctors, 329 nurses, 66 midwives, and 18 physical therapists.ResultsFilipino 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 un- or 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 on 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. At the same time, migration is, however, 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.ConclusionsUnless socioeconomic conditions are improved 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 outmigration 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 outmigration. Policy responses to this paradox have not yet been appropriately aligned to capture the multilayered and complex nature of these intersecting phenomena.

Nurses' use of mobile instant messaging applications: A uses and gratifications perspective

“…On the other hand, MIM applications were also used for catharsis. Since nurses in the Philippines experience unfavourable working conditions (eg, low salary, heavy workload, and stressful workplace) (Castro‐Palaganas et al, ), it is only natural for them to find avenues where their grievances can be heard. As staff nurses are unlikely to inform their grievances directly to their superiors, MIM applications provide a digital space to discuss grievances among fellow staff nurses.…”

Predictors and outcomes of nurse professional autonomy: A cross‐sectional study

“…This island is located in Central Philippines and is considered as the third largest island in the country. Nurses in the Samar Island constitute 4.8% of the total nurses in the country (Castro‐Palaganas et al, ). As with the rest of the country, the island has suffered from a drastic turnover of nurses which was attributed to a variety of factors such as poor working conditions, low salary, lack of career advancement and opportunities, heavy workloads, and lack of organizational support (Labrague et al, ; Perrin et al, ).…”

“…Annually, many nurses voluntarily leave the country in order to look for a greener pasture abroad, and this often leads to the loss of skilled and experienced nurses (Labrague, McEnroe Petitte, et al, , Labrague, McEnroe Petitte, et al, ). In the literature, several factors were identified to influence this movement such as dismal working conditions, limited career opportunities, low salary, high workloads, influences of organizational politics, lack of organizational support, and weak enforcement of nursing laws (Castro‐Palaganas et al, ; Labrague et al, ; Perrin, Hagopian, Sales, & Huang, ). This is further aggravated by the current work environment of nurses characterized by higher workloads but with lesser benefits and significantly lower pay (Labrague, McEnroe‐Petitte, Tsaras, et al ).…”

Perceptions of organizational support and its impact on nurses’ job outcomes

“…There are 200,000 unemployed nurses in the country and yet those who work in government and private hospitals are overworked and underpaid . Because of the inadequate organizational support, in local and national magnitude, Filipino nurses will always experience burnout, job dissatisfaction and high turnover rate; and unless these problems are not addressed, they will continually leave . This has had adverse consequences on the provision of healthcare services in the Philippines.…”