Managing Migration of Human Resources for Health: The Philippine Perspective

Purpose:

While there are varied perspectives on the ethics concerning migration, health professionals continue to pursue opportunities with significant ramifications on both source and receiving countries. As migration continues to be a global phenomenon, both the source and receiving countries need to establish equitable partnerships in the management of migration. This qualitative research aims to present a critical social perspective as a form of discourse in the management of migration.

Methods:

Interviewed individuals knowledgeable of human resources for health. Purposively chosen key informants (KIs) included doctors, nurses, midwives, and physical/occupational therapists who formed  participants of the 32 KIIs; plus 3 Group Interviews; 2 FGDs. They represent a range of stakeholder interests from national government agency officials; health regulatory bodies; health professional associations and advocacy groups; private sector employees; public health facilities/employers; teaching institutions; recruitment agencies. Interviews were transcribed and translated following approved ethical procedures. The data collected was analyzed simultaneously via systematic, documented procedures of thematic and constant comparative analysis using Nvivo and  manual procedures.

Results:

Data revealed that the Philippines has made the following strides in addressing this necessary intervention: bilateral agreements, tracking of health professionals, and improving the educational system.

Bilateral Agreements: The Philippines continues to produce world class doctors, nurses, midwives, and other health professionals who are highly specialized and sought after in countries across the globe. However, migration has not come without cost for both the country and the migrant workforce. On the local front, despite the need for specialized health professionals in many of the poorest parts of the country, the Philippines continues to lose health professionals to better opportunities abroad. At the same time, while the host countries benefit from the excellent care provided by the migrating health professionals, our health professionals are also subjected to discrimination and exploitation, either undervalued and not receiving the same wages as the locals or either under-skilled and forced to work in positions not commensurate to their skill level. The Philippines is now in official negotiations with several receiving countries to establish mutual recognition agreements to protect both country and migrant workforce. In addition to measures on ethical recruitment guidelines, it is being proposed that receiving countries should also take strides to help the source countries. For a certain number of doctors or nurses that a country will hire, the receiving country should also pay for the training of a proportionate number of health professionals in the Philippines, or provide support through upgrading of a health facility in the poorest regions. Receiving countries should also be willing to allow migrant health professionals to return to the Philippines every so often at cost to the host country to share training and skills they have learned while abroad as a means of transfer of technology, so that instead  of a “brain drain” there will be “brain circulation” instead.

Tracking of Health Professionals: Data and statistics on Filipino health professionals in the Philippines and abroad are often only estimates and the exact number and location of Filipino health professionals are still unclear. Different agencies have their own data and figures but there is still no centralized database. Government agencies are proposing collaborations in order to establish a more efficient tracking system. This tracking system will help not only for collection of data, but will also enable better protection of rights of health professionals and also for better allocation and mobilization of resources.

Improving the Educational System: The demand for migrant health professionals saw a sudden increase in the number of medical and nursing schools hoping to capitalize on the trends. However, a significant number of these schools have not been at par with technical standards, resulting in an increased number of doctors and nurses with inadequate skills and competencies who have thus been unable to find job opportunities. In addition, receiving countries have assessed the local training system for some health professionals as inadequate, such that health professionals who want to work abroad have to pursue additional training to fulfill these requirements. As a response, educational institutions have reassessed and revised their curriculum to reach set standards. Regulatory boards have cracked down on substandard medical and nursing schools to improve or close down. By improving the local curriculum to be at par with international standards, the Philippines will be in a better position to negotiate for equitable partnerships with receiving countries.  There is also a call for “transformative education” with focus on the health needs for the country and sense of service, such that students will not enter into courses with the intention to migrate but rather to stay and serve.

The study has revealed other key issues that may not be apparent but will have significant implication in the future. While migrant health workers provide health care for others abroad, there have been reports that their own personal health has been neglected. Migrant workers may return home with illnesses of their own, and in some instances have died because of illness abroad. The illnesses they face and the conditions behind this may be interest for further study.

Conclusion:

Health professionals will continue to choose to migrate abroad if the conditions which force them to seek opportunities elsewhere are not addressed. The glaring reality that the local socio-political-economic atmosphere is rife with problems of unjust wages and inadequate career opportunities among other issues must be given priority. Unless health professionals will have better opportunities for economic and personal advancement, staying in the Philippines will not be considered a viable option and migration will continue. Thus, the study brought forward key mesages: migration as a human right, international human rights instruments, migration and development, social determinants of migration, rights-based approach to migration, and the “ethical” in ethical recruitment.  It is necessary to recognize migration as a human right. But what underlies this argument is the inherent human right to freedom of movement. One of the basic principles of human rights is that all rights are interrelated. The recognition of migration as a basic human right entails the recognition of other rights an individual is entitled to. International human rights instruments have already been established to secure the respect and recognition of migrant workers’ rights. These instruments recognize the significant contributions of migrant workers in development, both for the source and destination countries. Moreover, these instruments provide us a viable approach – the rights-based approach – that could mitigate the negative impacts of economic development to migrant workers. All these human rights instruments recognize that migrant workers are significant contributors to development. They contribute to the development of their countries of origin through remittances and increase in domestic consumption as well as the transfer of skills. They contribute to the development of their destination countries through their skills and by augmenting its existing labor force. But an approach to international migration that only focuses on their contributions on development would inevitably dehumanize migrant workers. Migration should not be looked at from an economic perspective but instead, a rights-based approach is necessary. In addition, this approach can be used to analyze the policy of ethical recruitment. Again, this approach is based on the freedom of movement, labor rights, and the right to health of source country, in case of HHR migration. Hence, ethical recruitment is that which recognizes these three foundations.