The Philippine nursing workforce is highly regarded globally for its skill, dedication, and professionalism. However, over the past decades, the country has faced significant challenges due to the large-scale migration of nurses abroad, leading to concerns about “brain drain.” This phenomenon, defined as the emigration of skilled professionals to foreign countries, has had a considerable impact on the healthcare system in the Philippines. This review synthesizes the literature on migration trends, the causes and effects of brain drain, and the policy responses aimed at mitigating its impact.
Overview of Nurse Migration from the Philippines
Migration of nurses from the Philippines has been a significant trend since the 1960s. The country is one of the world’s top exporters of healthcare professionals, particularly nurses, with countries like the United States, United Kingdom, Canada, Saudi Arabia, and other Middle Eastern countries being major destinations (Lorenzo et al., 2007; Aiken, 2007). The demand for Filipino nurses abroad has been driven by aging populations, shortages in the healthcare workforce in destination countries, and the high quality of education and training provided by nursing schools in the Philippines (Li et al., 2014).
According to the Philippine Overseas Employment Administration (POEA), approximately 19,000 nurses left the country annually in the early 2000s, reaching peaks during times of global health crises or increased demand (Lorenzo et al., 2007). This migration has resulted in a paradox: while the Philippines produces a large number of nurses annually, it struggles with nursing shortages within its own healthcare system due to the high emigration rates (Masselink & Lee, 2013).
Push and Pull Factors of Nurse Migration
Several factors drive the migration of nurses from the Philippines. The “push” factors include low wages, poor working conditions, limited career advancement opportunities, and insufficient healthcare infrastructure within the Philippines (Ordinario, 2020). Filipino nurses face relatively lower salaries compared to their counterparts abroad, contributing to the allure of overseas employment where salaries can be up to 10 times higher (Aiken, 2007). Additionally, hospitals in the Philippines are often understaffed and underfunded, placing significant burdens on healthcare professionals, which further exacerbates their desire to leave.
On the other hand, “pull” factors include attractive salary packages, better working conditions, opportunities for professional development, and the possibility of securing permanent residency in developed countries (Masselink & Lee, 2013). Countries like the U.S. and Canada have specific immigration pathways for healthcare professionals, which have made it easier for Filipino nurses to migrate (Lorenzo et al., 2007).
Brain Drain and Its Consequences on the Philippine Healthcare System
The brain drain of nurses from the Philippines has had several detrimental effects on the country’s healthcare system. The most significant consequence is the shortage of skilled healthcare professionals, particularly in rural areas, where medical facilities are often understaffed. The outflow of nurses has led to an imbalance in the healthcare workforce, with hospitals struggling to meet patient demands and provide quality care (Buchan et al., 2006).
A study by Galvez-Tan (2006) indicated that while the Philippines produces around 20,000 new nursing graduates annually, a significant proportion of these graduates immediately seek employment abroad. This exodus of talent results in a loss of experienced professionals who could have contributed to the strengthening of the local healthcare system (Galvez-Tan, 2006). As a consequence, patient-to-nurse ratios in hospitals have worsened, with some reports showing a ratio of 1 nurse to 40 or more patients in public hospitals (Ordinario, 2020). This has raised concerns about the quality of care and patient safety within the country (Masselink & Lee, 2013).
Furthermore, the departure of skilled nurses has created a vacuum in nursing education and mentorship. Experienced nurses who could have served as educators or mentors to new graduates are often the ones migrating, resulting in a lack of experienced professionals to guide the next generation of nurses (Galvez-Tan, 2006).
Positive Effects of Nurse Migration
Despite the challenges posed by brain drain, there are some positive aspects of nurse migration. Remittances sent by Filipino nurses working abroad contribute significantly to the Philippine economy. In 2020, overseas Filipino workers (OFWs) remitted over $30 billion, with healthcare professionals accounting for a substantial portion of this amount (Bangko Sentral ng Pilipinas, 2020). These remittances help improve the living standards of families left behind and contribute to local economic development.
Moreover, some scholars argue that the migration of nurses leads to the exchange of knowledge and skills. Filipino nurses exposed to advanced healthcare systems abroad acquire new competencies and expertise, which they may bring back to the Philippines if they return (Cohen, 2007). However, the number of returning nurses remains relatively low, limiting the potential benefits of this “brain gain.”
Government Policies and Interventions
The Philippine government has implemented several policies aimed at mitigating the negative impact of nurse migration. For instance, the Department of Health (DOH) has introduced initiatives such as the Nurse Deployment Program (NDP), which aims to place unemployed or underemployed nurses in underserved areas within the country (Ordinario, 2020). This program seeks to address the shortages in rural healthcare facilities and provide job opportunities for nurses who may otherwise consider working abroad.
Additionally, the government has negotiated bilateral agreements with several destination countries to ensure the protection and welfare of Filipino nurses working overseas. These agreements include provisions for fair wages, safe working conditions, and opportunities for professional development (Li et al., 2014). However, while these initiatives have helped alleviate some of the pressures caused by brain drain, they have not fully addressed the root causes of nurse migration.
The migration of Filipino nurses has created both challenges and opportunities for the Philippine healthcare system. While remittances from overseas nurses provide economic benefits, the loss of skilled professionals has strained the country’s healthcare infrastructure. Addressing the brain drain requires a multi-faceted approach, including improving local working conditions, offering competitive salaries, and investing in healthcare infrastructure. Moreover, policies aimed at encouraging the return of migrant nurses and facilitating the transfer of knowledge and skills are essential for turning the brain drain into a brain gain.
References
- Aiken, L. H. (2007). U.S. nurse labor market dynamics are key to global nurse sufficiency. Health Services Research, 42(3), 1299–1320. https://doi.org/10.1111/j.1475-6773.2007.00714.x
- Bangko Sentral ng Pilipinas. (2020). Remittances rise to US$30.13 billion in 2020. https://www.bsp.gov.ph/SitePages/MediaAndResearch/MediaAndResearch.aspx
- Buchan, J., Jobanputra, R., Gough, P., & Hutt, R. (2006). Internationally recruited nurses in London: A survey of career paths and plans. Human Resources for Health, 4(14). https://doi.org/10.1186/1478-4491-4-14
- Cohen, J. E. (2007). The brain drain: A new frontier for population research. International Migration, 45(2), 3–29. https://doi.org/10.1111/j.1468-2435.2007.00360.x
- Galvez-Tan, J. Z. (2006). The exodus of health professionals: Philippine migration and the consequences for the health system. Global Public Health, 1(2), 153–170. https://doi.org/10.1080/17441690600684353
- Li, H., Nie, W., & Li, S. (2014). The benefits and caveats of international nurse migration. Nursing Ethics, 21(4), 457–468. https://doi.org/10.1177/0969733013502804
- Lorenzo, F. M., Galvez-Tan, J., Icamina, K., & Javier, L. (2007). Nurse migration from a source country perspective: Philippine country case study. Health Services Research, 42(3), 1406–1418. https://doi.org/10.1111/j.1475-6773.2007.00716.x
- Masselink, L. E., & Lee, S. Y. D. (2013). Nurses, Inc.: Expansion and commercialization of nursing education in the Philippines. Social Science & Medicine, 96, 204–211. https://doi.org/10.1016/j.socscimed.2013.07.001
- Ordinario, C. (2020). Philippine government eyes reforms to stem nurse migration. BusinessMirror. https://businessmirror.com.ph
