Philippines nurse exodus leaves hospitals short-staffed

• Filipino nurses leave for better pay, working conditions
• Nurses remittances a big earner for Philippines
• The country needs 127,000 new nurses

MANILA - Ronald Ignacio became a nurse at the height of the Philippines' nursing boom in 2008, when there were not enough jobs in the health system for the many thousands of newly qualified nurses.

At first, he struggled to find a job, so instead worked on a farm for two years. Ignacio eventually landed a job as a nurse in a private hospital in the capital, Manila, in 2010.

"But the situation is very different now," said Ignacio.

Just as Filipino nurses grapple with meagre pay, poor working conditions, and low nurse-to-patient ratios, rich countries have become more aggressive in tempting them abroad.

Hospitals and health facilities in the Philippines are now struggling to keep their best nurses and fill new positions.

Several wards are closed in the hospital where Ignacio now works because of a shortage of nurses. Even emergency patients have to wait days for a bed.

"Expert nurses – the lifeblood of hospitals – have accepted job offers abroad because their salaries here are no longer commensurate with their work," Ignacio, an emergency care nurse, told Context.

Without senior nurses to guide them, he said, new hires often quit after a few months due to the excessive workload and low pay, or because of highly appealing job packages abroad.

The World Health Organization recommends a ratio of 27 nurses per 10,000 population. In the Philippines, there are only 16 nurses per 10,000.

The southeast Asian country would need an additional 127,000 nurses to meet the WHO target, the Health Ministry said.

Entry-level nurses in private hospitals take home between 15,000 ($271) and 25,000 Philippine pesos ($452) a month, about the same as new teachers, but less than junior police officers.

But it is a far cry from nurses' average monthly salary of $3,000 in the US and 2,000 pounds ($2,530) in the UK.

"You studied for four years to become a nurse and worked hard to obtain your license only to get paid a salary that could no longer be called a living wage. Where's justice in that?" Ignacio asked.

Nurses tempted by job offers

Since the 1950s, money sent home by nurses abroad has been a big earner for the Philippines economy. At the end of 2021, around a third of the more than 900,000 registered nurses in the Philippines were working abroad, according to the advocacy group Filipino Nurses United.

Remittances from nurses bring in around $8 billion to the economy every year, about 25% of all remittances, which together account for some 9% of gross domestic product.

At the end of 2022, some 170,000 nurses were working in private and public health facilities in the country, while more than 290,000 licensed nurses had left for other careers, the Health Ministry said.

Despite domestic shortages, the Philippines is not included in the WHO's list of countries with a shortage of healthcare workers. Foreign employers are discouraged from recruiting nurses from nations on the list.

Jocelyn Andamo, secretary-general of Filipino Nurses United, said that recruitment practices of importing countries had become more creative after the pandemic.

She said German recruiters had proposed sponsoring students before they had qualified as nurses, and relocating them and their families.

"Who would say no to that kind of offer?" Andamo asked.

The German ambassador to the Philippines has defended her country's programme to recruit nurses abroad, calling it a "great success". Germany's development agency says the programme "takes into consideration those countries which have a surplus of well-trained nurses".

Howard Catton, chief executive officer of the International Council of Nurses, a global federation of nurses' associations, was alarmed that even health officials in the Philippines are now "expressing concern about shortages at home".

India and the Philippines are the top two sources of foreign nurses in Britain, which is seeking to fill staff shortages in its National Health Service.

"A lot of countries that the UK has looked to recruit from already have worse shortages, and that means that when they lose nurses, it really can have a detrimental impact on the ability of those countries to provide healthcare to their own people," said Catton.

Even when a government-to-government agreement allows active recruitment from certain countries, Catton said "that doesn't automatically mean that it compensates the source country for the loss that they experienced".

Jean Franco is a political science professor at the University of the Philippines who has studied nurse migration in Asia. She said inter-governmental agreements could be useful in setting ethical recruitment standards.

However, she believes most of them "are just really focusing on facilitating recruitment" and often lack provisions on reducing the impact of the brain drain in  the Philippines.

"Is the government really monitoring these bilateral agreements? Perhaps we need to enhance them with greater transparency and cooperation with Filipino nurses' unions and migrant groups to ensure that their concerns are being addressed," she said.

Nurses demand more pay to stay

Philippine President Ferdinand Marcos Jr said the country was "competing with the rest of the world" for its nurses and should immediately address the shortage caused by migration.

The Health Ministry supports an annual overseas deployment cap, limiting the number of nurses, doctors, and other medical workers who can work abroad. Franco said the proposed cap was "an unsound policy to prevent them from going abroad because it violates their right to travel to work."

The Philippines would continue to lose nurses, she said, if conditions remained poor and other countries offered much higher wages.

Nurses' unions are pushing for a bill that would increase the starting salary for nurses to 50,000 pesos, even while the government still owes around 20,000 private healthcare workers more than 1.9 billion pesos in pandemic allowances and benefits.

What the government should be doing, said Franco, was to take care of nurses like Ignacio who, despite offers to work abroad, had chosen to serve the country's health system.

Ignacio urged the Philippine government to show the world that nursing was still a dignified profession by improving conditions. He believes nurses like him should never have to leave the country to feed their families.

"That's the only way we can produce a new generation of Filipino nurses whose careers are not dependent on foreign land," he said.

($1 = 55.2600 Philippine pesos)

($1 = 0.7906 pounds)

(Reporting by Mariejo Ramos. Additional reporting by Beatrice Tridimas in London. Editing by Jon Hemming.)