Health Care in Free Fall as Medical Staff Flee Country
Danny Chan
With Philippine health care workers heading overseas for higher-paying jobs, the country’s health system is being stretched to its limits and patients are unable to attain basic health care. Experts have also warned that the country’s health care network risks imminent collapse.
According to a representative of the Private Hospitals Association of the Philippines, the mass exodus of medical professionals from the Philippines has resulted in the closure of as many as 1,000 private hospitals over the past five years. Speaking at the association’s annual convention in Manila on Nov. 22, Dr Antonio Chang said approximately 700 private hospitals remain across the Philippine archipelago.
“We fear for the health of the people, especially those living in the countryside,” Dr Chang said, adding that 12 private hospitals have closed in the last month alone. At Saint Anthony’s Hospital on the island of Masbate, only one doctor works full-time in the 50-bed facility. Other hospitals have had to resort to training college graduates without any medical education to work as “caregivers” or medical aides.
Physicians at private hospitals receive a monthly take-home pay of up to P18,000 while nurses are paid P12,000. A nurse working in the United States or Europe could earn tens of thousands of dollars. A growing number of Filipino doctors have moreover opted to return to school to obtain nursing degrees due to a dearth of qualified nurses abroad.
At a recent conference, the Philippine Medical Association stated in a paper, “The crisis in medical human resources is now upon us. The delivery of health services is being compromised. We have to address the problem before the health system completely collapses.”
Jaime Galvez Tan, a former Philippine health secretary, told reporters: “We are facing a serious problem and we need to address it now before it is too late.” He cautioned that physicians are leaving the country for several reasons, including political instability, low wages, corruption, poor working conditions and the threat of malpractice. But the predominant reason for the exodus is a lack of future for their children.
“The only difference today is that doctors are retraining as nurses. For many doctors it is the easiest and quickest way out,” he said. His report on the country’s health system, “The Brain Drain Phenomenon and its Implications to Health,’ estimates that 100,000 nurses have left the country to work overseas since 1994, with about half that number leaving in the past five years. Nursing schools, which have increased in number during the past several years, have trained only 33,370 nurses in that period. His report also found that over 3,500 doctors have retrained as nurses since 2000, while 4,000 doctors in the country are currently attending nursing school.
“What is more disturbing, however, is that the number of students enrolling in medical school has been down on average by 14 per cent a year from 2002,” he said, adding that medical schools are closing down while the graduation rate at schools that remain has dropped from 86 per cent in 1994 to 52.9 per cent in 2004.
Mr Tan’s reports also found working conditions have fallen to the point where providing basic health care has become an unachievable goal. In theory, the ratio of nurses to patients should be around 1:6. But in practice, the ratio is around 1:50 in rural areas and 1:20 in urban centers.
A Philippine surgeon with 25 years experience as a lung specialist, who requested that his name be withheld, is among the growing number of doctors who are retraining as nurses. He said the Philippine medical system is in terminal decline.
“It was different back then. Medicine was a respected profession and money was being spent on health care. But what we have today is a health system in terminal decline,” he said. He added that over one-third of the 40 doctors from his graduating class 25 years ago have since left the country; the problem is compounded by a lack of recruits into the profession.
“I don’t know of anyone who is happy. It seems like everyone is leaving and the government for its part doesn’t see that it has a problem,” he said. “We are just another statistic among a growing list of professionals who see no future in this country.” Although his monthly salary comes out to about P100,000 ($1,780), he insists that factors other than money have spurred him to move abroad.
“I have just lost faith in the ability of our political elites to run the country and run it efficiently. You don’t have to be a rocket scientist to see that this country is just marking time,” he said. Another doctor, a 35-year-old obstetrician who also requested that her name be withheld, said about half of her class of 300 has since left the Philippines.
“Medicine is my life,” she said. “I think you enter this profession wanting to make a difference. But here in the Philippines we just don’t have the tools to administer quality health care.” She said her hospital has a 78-bed maternity ward but only 50 beds. Sometimes three women have to share one hospital bed, she added.
Dr Armando Crisostomo of the Philippine College of Surgeons told Agence France Presse that the underlying cause of the exodus may be more than economic reasons. He noted that neighboring English-speaking countries, such as India, Sri Lanka and Bangladesh, are able to retain their health care professionals.
“One of the main reasons facing doctors to leave is a general sense of hopelessness in the country. There is no long-term government planning. All they see is a government planning to survive. How can you make plans for the next 5-10 years if you are just planning to survive in government?” he said. Dr Crisostomo added that while the Department of Health appealed to doctors’ sense of nationalism, others saw the diaspora as national heroes whose remittances keep the Philippine economy afloat.
The government this year earmarked 1.1 per cent of its budget for health, far short of the 5 per cent minimum recommended by the World Health Organization. Vietnam, by contrast, allocated 4.5 per cent of its budget on health in 2002 (the last year in which figures are available) while Thailand spent 7.6 per cent of its budget on health care last year.
