Draining the Filipino health service

Public health leaders in the Philippines are warning that their health system is on the brink of collapse due to health workers abandoning the Philippines for higher salaries in Ireland and other rich countries.

Liam Doran, general secretary of the Irish Nurses Organisation, said the Irish healthcare system is reliant on Filipino nurses to keep health services going, with over 5,000 currently working in Ireland.

Liam Doran said: "If we were to lose this supply of nurses, this would affect our health service expansion, the number of extra beds we would be able to provide. We recruited massively overseas in 2001, 2002 and 2003. Based on the last four or five years our recruitment practices would have to change. Our health service is being maintained by overseas nurses. We've lost 9,000 Irish nurses in the last six years and brought in 13,000 from overseas."

Dr Jane Pillinger, an independent policy analyst who has carried out research for the International Labour Organisation on this issue and has recently returned from the Philippines, said, "Part of the difficulty is that in the Philippines there is an industry of nurse training as an export industry.

"What is happening is that countries such as Ireland and the UK want nurses with two years' experience. I saw that the best-skilled nurses are disappearing. Public hospitals are relying on inexperienced nurses that have no experience. I visited a hospital in Manila and there was an American company recruiting at the hospital. I said to the director, 'Isn't this a contradiction?' He said that they pay him so much money it is the only way he can keep the hospital open."

Dr Jaime Galvez Tan, a former health secretary in the Philippines, said the government must now consider stemming the flow of health workers out of the country. He has proposed a compulsory government service for graduates and the introduction of programmes to retain staff.

Jaime Galvez Tan described the situation in the Phillipines currently: "Hospitals are closed. I've seen hospitals abandoned over the last few years. We're back to the 1950s when there were no rural doctors available, no rural nurses. This is the impending collapse, the looming crisis."

Experts have estimated that at least 100,000 doctors and nurses have left since 1994 to work in Ireland, Europe and other richer Asian countries and America. In the Philippines, doctors can expect to earn just $800 a month, while nurses receive as little as $250.

Public health leaders have said the situation is equivalent to that in the Philippines in the 1950s and have suggested that a change in the law may need to be introduced to stop workers leaving the country. There have been calls for Ireland to change its policy of recruiting from developing countries' health services.

The Philippines has been exporting health workers since the 1960s and the government there has encouraged the practice, with remittances contributing substantially to the economy.

According to the World Health Organisation (WHO), the Philippines is the largest exporter in the world of foreign nurses, with an estimated 786,000 working in 116 countries worldwide. In April, the WHO called for more ethical recruitment policies from countries employing foreign staff and called for rich countries to recognise that this practice will have an adverse effect on developing countries.

The WHO said the "serious shortage of health workers in 57 countries is impairing provision of essential, life-saving interventions such as childhood immunisation, safe pregnancy and delivery services for mothers, and access to treatment for HIV/AIDS, malaria and tuberculosis".

The UK has recently introduced a policy of not recruiting from countries where recruitment would have a direct negative impact on the country.

Warren Swords