Who would have thought that the Philippines, the world’s top exporter of nurses, will eventually find itself confronted by a nursing shortage amid a global health crisis?
With rising coronavirus disease (COVID-19) cases and the threat of a more infectious Deltavariant, nurses and other healthcare workers have begun walking out of hospitals. Now, the Philippines must brace itself for the potential collapse of its healthcare system should the government remain unresponsive to the plight of these frontline workers.
Where have Filipino nurses gone?
Overworked and underpaid, about 40% of private hospital nurses across the country have resigned since the onset of the COVID-19 pandemic. The continuing surge of COVID-19 cases has forced an additional 5 to 10% of the remaining staff nurses to leave private hospitals in April 2021.
Public hospitals face similar challenges, worsened by the government’s scarce provision of personal protective equipment and the delayed release of special risk allowances and other benefits.
The call for just compensation and better working conditions for Filipino nurses is along-standing fight that has never been won. For the most part, this defeat explains the prominence of a Filipino nursing diaspora.
It is estimated that two out of five passers of the nursing licensure examination eventually work overseas. A case study on Philippine nurse migration has found out that “national opinion has generally focused on the improved quality of life for individual migrants and their families, and on the benefits of remittances to the nation.”
While Filipino nurses working abroad act as major generators of foreign exchange, their absence has drained the local workforce, making the health sector short-handed — especially in this time of the COVID-19 pandemic. The government even had to implement a travel ban on healthcare workers. What makes it even more difficult for the country to combat the nursing crisis is the fact that only 50-60% of nursing graduates become licensed, the remainder opting to enter non-nursing jobs.
It is argued then that there is no actual shortage of nurses in the country but rather, a maldistribution. In fact, around 9,000 nurses are employed under the Philippine National Police doing non-nursing jobs, while others work under the Department of Education, Bureau of Fire, and Bureau of Correction.
The steep increasein salaries of uniformed personnel, a priority of President Rodrigo Duterte’s administration, has created not only income disparity but an imbalance in the labor force as well. In turn, making it difficult for the health sector to attract nurses to stay home and work for Philippine hospitals.
Melbert Reyes, president of the Philippine Nurses Association, said that it is the low pay and poor benefits that push many nurses to work in non-nursing fields.
“It’s because of the compensation and benefits primarily and it’s because of the value that the government is giving our nurses,” he said.
While fully aware of this, Philippine Hospital Association President Dr. Jaime Almora emphasized that increasing the salary of nurses to be at par with other countries will also increase Filipinos’ hospital bills. As a result, contradicting the aims and purposes of the country’s Universal Healthcare law.
It is this gap that lawmakers should use as a springboard in shaping future policies that concern not only the accessibility of healthcare to every Filipino but also the fair and just treatment of nurses in the country.
A looming collapse
While healthworkers from both private and public hospitals are assured of benefits under Bayanihan 1 and Bayanihan 2 (as long as the state of national emergency declared by President Duterte in relation to COVID-19 remains ineffect), its implementation is not without issues and delays.
Nurses alongside other health workers have gone to the streets and online to strengthen their calls for the release of meager special risk allowances and other benefits. Groups have warned of the looming collapse of the country’s public healthcare system given these circumstances.
In a statement, the Philippine Department of Health said it is “taking the issue of delayed benefits very seriously” and that it will “develop solutions to improve the delivery of services and expedite processes.”
As of August 31, the Philippines ranked second to the last in Nikkei Asia’s Recovery Index, calling for a swifter, informed, and comprehensive pandemic response. Specifically, it demands aggressive contact tracing and increased vaccination rate — goals that are quite difficult to hurdle given the current nursing crisis.
The non-allocation of funds for the special risk allowance of health care workers in the 2022 budget will make it even more challenging to retain nurses and other frontline workers in hospitals, vaccination sites, and isolation and quarantine facilities.
It is common knowledge that before the pandemic hit, our health sector had long failed our nurses. But now in the face of COVID-19, another thing has been made clear: our blatant disregard for the hard work and sacrifices of those working in the frontlines.
Where do we go from here?
The World Health Organization’s State of the World’s Nursing Report - 2020, projected a 249,843 shortfall of nurses by 2030 should the government fail to invest more to retain Filipino nurses. This number equates to a considerably huge fraction of the Philippine population being denied healthcare services.
Now more than ever, it is important for the Philippines to tackle the current maldistribution of nurses as the future of nursing in the country remains bleak. It is high time that lawmakers expedite the crafting of sustainable policies that address the status quo and can brave through the complex challenges of the country’s health labor market.
House Bill 9389 or the New Philippine Nursing Practice Act, which will repeal the Philippine Nursing Act of 2002, has just passed the House of Representatives. While it aims to “further protect and develop the nursing profession in the country,” it seems to have a long way to go before fully realized.
Hence, in the meantime, measures must be developed to create balance in the production of appropriately trained nurses and equitable distribution. Increased investments in nursing training and institutionalizing better pay and favorable working conditions for nurses will foster improvements in health outcomes.
The Philippine government, as well as the private sector, must work to promote career development in nursing by providing decent jobs and local opportunities. It is only through bringing these changes to life that Filipino nurses can be encouraged to stay in the country, that every Filipino can be assured they receive the healthcare they deserve.
When I began my nursing school journey last year, I was overwhelmed by so many uncertainties. To be completely honest, those uncertainties have not completely been resolved yet. But I am more hopeful now knowing that I have the power and platform to write about what it takes and what it should take to be a nurse in the Philippines.