1. Erlinda Castro-Palaganas PhD, RN University of Ottawa, Nov. 3, 2008
From Brain Drain to National Hemorrhage The Global Migration of Philippine-Trained Nurses: Causes, Impacts and Future Prospects
Erlinda Castro-Palaganas PhD, RN
University of Ottawa, Nov. 3, 2008

2. References
Several researches on the PHILIPPINE NURSING MIGRATION by Dr. Fely Marilyn Lorenzo, Dr. Jaime Galvez Tan, PNA, ADPCN, HEAD, PHM

3. Outline of Presentation
Philippine Health Care Context
Philippine Basic Indicators
The Government Responses:
- Privatization as a Government Policy
- Labor Export Policy
Nurses and Migration
- Migration Situation
- Migration Issues and Concerns
- Policy Implications
Challenges

4. What could be the reason/s?

5. Philippine Health Care System Context
Philippines composed of 7,150 islands organized into 3 main island groups
Population : 87million growing annually by 2.3%
Productive age group estimated to be 42% of 34.2 million
Labor Force is 67% of all Filipinos in reproductive age
Only 8.83% are estimated to comprise human health resources

6. Philippine Health Care System Context
Rapidly growing population , steady employment rates
Unemployment rates around 12%
1 out of 5 Filipinos underemployed
Job opportunities have not increased correspondingly with population increase
Labor productivity stagnant over last 12 years
Every year about 800,000 young people begin looking for work in a contracting and job-scarce economy

7. Philippine Health Care System Context
Devolved health care system since 1995
DOH lead agency that safeguards health and maintains specialty hospitals, regional hospitals, and medical centers
All other hospitals and field health units maintained by local governments
Private sector involvement in health care is enormous – 60% of 1,600 hospitals in country are private
Problems of access and equity: hampered by high costs and physical and soci-cultural barriers

8. Philippine Health Care System Context
Health Sector Reform launched in 2000 covering :
Hospital
Local Health Systems Development
Public Health Programs
Health Regulation
Social Health Insurance
No attention given to development of Health Human Resources

9. Philippine Basic Indicators
4 million unemployed and 7.3 million underemployed in 2006
in the past six years, 11.3% unemployment rate and 18.5% underemployment rate
70% of Filipinos consider themselves poor (IBON survey)
around 3,000 Filipinos daily forced overseas to work
source: IBON

10. Philippine Basic Indicators
P100 billion estimated government deficit
P278 billion target raised through higher taxes, fees, rates & public service charges
P721.7 billion target to be repaid to creditors in ’06 or P6,391 per Filipino
Real public spending per Filipino on education is P1,296; health P120
Source: “2006: The Economics of Hype”, IBON Foundation, published in bulatlat.com,

11. Philippine Basic Indicators
The Philippines ranked 83rd of 177 nations (down from 77th in 2002) in the quality-of-life survey (GDP, life expectancy, adult literacy, growth in school enrollment, environmental protection)
UN Human Development Index

12. Health Sector Reform the Philippines
Privatization as a Government Health Policy
Health Sector Reform the Philippines

13. Health Sector Privatization
“Health Sector Reform Agenda”
“Fiscal autonomy” for govt hospitals
Promote health insurance schemes with private sector
Tokenism in “public health programs”, “community health” and “development of local health systems”
“FOURmula ONE for Health” ( )
Integrated public health into hospital services
Medical tourism
“Innovative financing arrangements”

14. Health Services for Sale: Medical Tourism
Principally being promoted by the Philippine government using the public health care system
Linked to the issue of organ trade (i.e. sale of kidneys for US$3,000-4,000)
Expected revenues: US$ 10B in 5 years

15. “Medical Terrorism”: Growing military presence

16. Labor Export Policy
This decline in the quality of life is due to the worsening economic and political crisis in the country.
Due to widening unemployment, the Philippine government has resorted to a Labor Export Policy (LEP) to:
defuse social tension by exporting its vast numbers of unemployed and underemployed people abroad
to rake in the much needed dollar remittances to prop up a falling peso, pay balance of trade deficits and onerous foreign loans.

17. “The fact that millions of Filipinos are forced to work abroad is proof of government’s economic failure.”
- Manila Archbishop Gaudencio Rosales, July 2004
Last July, Archbishop Rosales went on to say that OFWs manifest the government’s acceptance of their failure to provide viable opportunities for people inside the Philippines.

18. Labor Export Policy
The Philippines’ Labor Export Policy is rooted in the failure of its government to chart its own economic and political development through genuine agrarian reform and the creation of a modern industrial base to make the local market vibrant, prosperous and stable.
This resulted into dependence on foreign technology and markets, political subservience to foreign policy dictates of the dominant economic powers.
Without a sustainable and self-reliant domestic economic base, the Philippine government will perpetually export its human resources to foreign masters in exchange for much-needed revenue at the expense of the rights and welfare of its workers.

19. The development of the labor export program (LEP)
Since 1974, when the Labor Code was first revised, the “export” of Filipino workers overseas has intensified and become increasingly systematic
Creation of successive government agencies that institutionalized and intensified the export of Filipino workers overseas
Overseas Workers Welfare Administration, Philippine Overseas Employment Administration
Government target of 1 million workers overseas per year
The Labor Export Policy began in 1974 with the revision of the Labor Code, under then Labor Sec. Blas Ople. The LEP is a component of the structural adjustment program then imposed on the Philippines by the International Monetary Fund and the World Bank
It’s aim is to offset the rising social unrest of the period, due to rising unemployment rates and an economic and political crisis; at the same time, it’s purpose is to earn dollar remittances badly needed by the Marcos administration to pay off its increasing foreign debts
Initially, Marcos administration said it was a temporary stop-gap measure; but in reality, it was far from temporary and over the decades, the creation of institutions geared towards the export of labor entrenched the policy further – so that it frames many aspects of our economic, political and social systems – including the public psyche.
So that today, when President Macapagal-Arroyo announces its target of one million overseas workers per year, some hardly blink an eye.
 How does the government earn from this labor export policy?

20. Organized Philippine Overseas Deployment System
Goals:
Maximize gains of overseas employment for migrants and sending countries
Monitoring and Protection of OFW welfare
Components:
Managing overseas deployment: Finding , managing new markets, maintaining current partners;
Welfare Protection: Ensuring rights are protected during recruitment, pre-departure and in overseas workplaces
Migrant workers’ reintegration into society

21. Organized Philippine Overseas Deployment System
Six major government agencies involved in migration process :
1.DOLE- Department of Labor and Employment
2. POEA- Phil. Overseas Employment Administration
3. OWWA- Overseas Workers Welfare Administration
4. BSP- Bangko Sentral ng Pilipinas (Central Bank)
5. DFA – Department of Foreign Affairs
6. CFO- Commission on Filipinos Overseas

22. Key Migration Management Tools
Migrant and Overseas Filipinos Act (RA 8042)
Contains policies, rights , obligations, sanctions and regulations that govern overseas employment.
POEA- handles documentation of land-based and sea-based contract workers recruited mostly by private recruiters, regulates recruiters; manages information on migrant and remittance flows to assist with policy formulation
OWWA- responsible for promoting welfare of OFWs and dependents through implementation of welfare programs for migrants and dependents; includes health or repatriation assistance, livelihood loans, skills training, scholarships, and reintegration incentives
POLOs – Philippine Overseas Labor Offices attached to Phil. embassies and consulates

23. Labor Export
36,000 Filipinos were “deployed” to other countries in 1975.
In 2006, the Arroyo administration exported a record 1.08 million Filipinos and received US$14 billion in remittances of overseas Filipinos.
Of the 308,142 deployed OFWs as new hires, 184,454 or 60% were females compared to 123,688 males in 2006.
2006 Top 10 OFW destination countries:
Saudi Arabia 223,359
UAE ,212
Hong Kong ,929
Kuwait 47,917
Qatar 45,795
Taiwan ,025
Singapore ,369
Italy ,413
UK ,926
Korea ,984
Others ,041
Landbased ,070
Seabased ,497
Total ,062,657
Source: POEA, 2006

24. Top Ten Occupational Group by Sex
For the Year 2006
Male
Female
Total
% share to total
1. Household & related workers
1,590
89,861
91,451
29.7%
2. Factory & related workers
39,544
12,690
43,234
14.0%
3. Construction workers
40,178
2,862
43,040
4. Medical & related workers
2,650
15,081
17,731
5.8%
5. Hotel & Restaurant related workers
6,210
9,483
15,693
5.1%
6. Caregivers & caretakers
842
13,570
14,412
4.7%
7. Building caretakers & related workers
2,103
10,191
12,294
4.0%
8. Engineers & related workers
10,754
415
11,169
3.6%
9. Dressmakers, tailors & related workers
375
7,456
7.831
2.5%
10. Overseas Performing Artists
709
6,722
7,431
2.4
Total deployment – new hires
123,688
184,454
308,142
100.0%

25. Intensified export of Filipino migrants
“Overseas Filipino Workers should stay where they are and not think of coming home.” President Gloria, August 2002 during dinner with OFWs in Kuala Lumpur.

26. Labor Export Policy
For the last 30 years, the Philippine economy, and all administrations have been propped up by the remittances of overseas Filipinos. The country’s economy is saved from eventual collapse by the remittances of Filipinos abroad.
Last year, close to 10 million Filipinos overseas remitted a total of US$12.8 billion to the Philippines, US$2.2 billion higher than the US$ 10.6 billion total of This is aided by the government’s pursuit of its labor export program that targets one (1) million Filipinos deployed annually.

27. State exactions & dollar remittances
Annual remittances:
1984
US$659 million
1989
US$973 million
1994
US$2.9 billion
1999
US$6.97 billion
2003
US$7.2 billion
2004
US$8.5 billion
2005
US$10.7 billion
2006
US$12.8 billion
State exactions:
76 Signatures
(P100/signature)
P 7,600
Passport P
POEA fee
P 7,500
OWWA fee (US$25 per contract)
P 1,375
Medicare (annual) P
Total
P17,925
P17,925 x 3,000 OFWs = P53.77 million daily
P19.6 billion per year
Source: Central Bank; COURAGE
4/16/2017

28. Lucrative labor export program
2005 Remittances of US$10.7 billion (P545.7 billion) amounted to:
More than the five top merchandise exports
More than ½ of the 2005 national budget (P907 B)
100 times more than all Foreign Direct Investments
10% of the GDP
9.5% of the GNP
3 times more than 2001 US military aid
4/16/2017

29. Overseas Filipinos
More than 8.5 million or 10% of Philippine population are in over 196countries
Mostly from peasant and worker families
Overseas Filipinos include immigrants and naturalized citizens; undocumented workers; refugees; and contract workers (est. 3.5 million, DFA)
SLIDE 3
In 1975, about 36,035 Filipinos worked overseas
Today, there are more than 8 million in about 182 countries
According to OWWA, the majority of landbased OFWs are from the NCR, Southern Tagalog and Central Luzon regions
Overseas Filipinos include immigrants and naturalized citizens, the undocumented workers, the refugees and the migrant workers or Overseas Filipino Workers – who are estimated by the DFA to number around 3.5 million

30. Exporting Health Human Resource
No. 1 Exporter of Nurses
“An estimated 85% of employed Filipino nurses (more than 150,000) are working internationally.” (Aiken et al 2004)
“70% of all Filipino nursing graduates are working overseas.” (Bach 2003)
No. 2 Exporter of Doctors
“68% of Filipino doctors work overseas, next to India.” (Mejia, WHO 1975)
(NIH 2004)

31. Hemorrhage of Human Resources: Nurses
13,536 nurses left the country in 2001.
: approx 50,000 nurses left.
“Data casts doubt on the underreporting of the Philippine Overseas Employment Agency (POEA) that shows only 91 nurses left for the USA in 2000, 304 nurses in 2001, and 320 nurses in 2002.” (Tan et al 2004)

32. Source: Philippine Overseas Employment Administration (POEA)

33. Source: Philippine Overseas Employment Administration (POEA)

34. Total Number of Nurses in the Country
Total Registered Nurses ( ) = 333, 581
Estimated Deaths = 1,
Estimated Current Stock of Nurses = 332,
SUPPLY AND DEMAND:
Supply = 332, 206
Demand = 193, 223
Oversupply = 138, 983

35. Table 6. Estimated Number of Employed Filipino Nurses By Work Setting, 2003
Percentage
I. Local/National
29, 467
15.25%
A. Service
1. Government Agencies
19, 052
9.86%
2. Private Agencies
8, 173
4.23%
B. Education
2, 241
1.16%
II. International
163, 756
84.75%
Total
193, 223
100.00%

36. Estimated HRH Production Trends
Nurses (10,000-15,000/year) from 475 nursing colleges
Doctors (2,000/year) from 30 medical colleges
Midwives (1,500/year) from 129 schools
Dentists (2,000/year) from 31 dental schools
Pharmacists (1,500/year from 35 pharmacy colleges
Physical Therapists (1,000/year) from 95 PT/OT colleges
Occupational Therapists (200/year) from 95 PT/OT colleges

37. Top 5 Destinations of Filipino Nurses
United States of America
United Kingdom
Saudi Arabia
Ireland
Singapore
(NIH 2004)

38. Markets Traditional Markets: Middle East, North America
New Markets: Europe especially UK, Netherlands, High Income Asia
Emerging Markets: Japan and Nurse Education abroad

39. Profile of Nurse Migrants
Mostly Women
Age Range of years old
Middle-Income Group
Basic Professional Educ/with Master’s Degree
Specialized in areas ICU, ER, and OR
Served 1-10 years before migration

40. Profile of Nurse Medics
Increasing number – about 1000/year from 2000 to estimated to triple in 2005
From survey of 100 volunteer respondents (doctors currently taking nursing courses) in different regions of the Philippines:
Gender Distribution – 45% female, 30% male, 25% no info
Marital Status - 24% single, 76% married
Age – 37 years old and above
Annual Income Bracket – P 120, 000 to P 480, 000
Specializations – Internal/General Medicine (30%), Pediatrics (14%), Family Medicine (13%), Surgery (8%), Pathology (6%), Others (29%)
63% were practicing doctors for more than 10 years

41. Hemorrhage of Human Resources: Doctors
MD-NURSES: More than 9,000 MDs have already left as nurses in
Around 80% of public health physicians have taken up or are enrolled in nursing.
Obstetricians and anaesthesiologists are fast depleting, followed by pediatricians and surgeons.
(NIH 2004, PMA 2005)

42. Hemorrhage of Human Resources: Doctors
In some areas, the local PMA chapter facilitates the nursing education of its members
Decrease in enrollment of first year medical students of 10% to 55% in the last 2 years.
Decrease in applicants for residency positions
(NIH 2004, PMA 2005)

43. Hemorrhage of Human Resources: Other Professionals
At least 37 Philippine nursing schools offer abbreviated 2-year courses for doctors to become nurses.
More than 60% of nursing schools are geared mainly for “second coursers” (non-health professionals who want to take up nursing, e.g. engineers, accountants, teachers, soldiers).
(HSA 2005, PNA 2005)

44. Hemorrhage of Human Resources: Other Professionals
HEAD estimates that there are between 30,000-40,000 “second-coursers” currently taking up nursing.
TESDA has trained over 50,000 caregivers in the last 5 years and over 24,000 have been deployed abroad.
(HSA 2005, PNA 2005)

45. Reasons Why Filipino Nurses Leave the Country
Push Factors
Economic: low salary at home, no overtime and hazard pay, low coverage of health insurance
Job-related: work overload or stressful working environment, slow promotion
Socio-political and economic environment: limited opportunities for employment, decreased health budget, peace and order situation in the Philippines

46. Reasons Why Filipino Nurses Leave the Country
Pull Factors
Economic: higher income, better benefits and compensation package
Job-related: Lower nurse to patient ratio, more options in working hours
Individual/Family-related: Chance to upgrade nursing skills, acquisition of immigrant visa and opportunity for family to migrate, opportunity to travel and learn other cultures, influence from peers and relatives
Socio-political and Economic environment: Advanced technology, better peace and order situation

47. Reasons Why Doctors Migrate as Nurse Medics
PUSH FACTORS
very low compensation and salaries,
feeling of hopelessness about the Philippine current situation,
political instability and graft and corruption,
poor working conditions and
the threat of malpractice law
PULL FACTORS
more socio-politico- economic security abroad,
attractive salaries and compensation packages (High salaries, benefits, compensation)
more job opportunities and career growth.

48. Reasons Why Filipino Nurses Return:
Personal Reasons
To get married
To raise children in homeland
To take a vacation
Homesickness and depression
To retire
To get family
Professional Reasons
To share expertise
For professional stability

49. Reasons Why Filipino Nurses Return
Financial Reasons
Nurse has saved enough money
To set up a business at home
Job-related Reasons
To buy a house or a car
Social Reasons
Contract has expired
Plans to retire back home

50. Perceived Impact of Migration
Health Care System and Quality of Health Care
Positive Effects
Health care is enhanced.
Availability of more aggressive staff replacements who are eager to learn.
Negative Effects
Continuity of programs/services is adversely affected.
Quality of care is compromised.
People in the community are deprived of health services.
Improvement of the hospital is delayed when resources are used to train staff replacement.

51. Perceived Impact of Migration
Economy
Positive Effects
Economy improves with the remittances from workers abroad.
Philippines posts 5th largest remittance earnings globally (WB) projected to be $30 B
Unemployment is reduced.
Negative Effects
Loss of government resources used in education and training.
Resources are spent on training of staff replacements.
Reduced government income of the province and country from taxes of health professionals.

52. Social Net Benefits Winners –
Nurse migrants and their families- greater child schooling, reduced child labor , increased educational expenditure,
Economy – remittances, raise hours worked in self-employment and lead to relatively capital-intensive enterprises by migrants’ hoouseholds

53. Social Net Benefits Losers – Health Care System Extended Families
Loss of skilled trained health staff
Rendered health system fragile
Extended Families
Social support
Philippine Nursing
Ability to renew and further nursing development is hampered

54. Deteriorating Quality of Nursing Education
The number of nursing schools have increased
1970s: only 40
1990s: 170
June 2003: 251
April 2004: 370
June 2005: 441
June 2006: 470
In the last 3 years, there has been an 87% increase in nursing schools nationwide
(NIH 2004)

55. Deteriorating Quality of Nursing Education
Decreasing proportion of nursing graduates who pass the national nursing licensure examinations
1970s and 80s: 80%-90%
1991: below 61%
: 44%-48%
2004: 55.9%
2005: 49.7%
2006: 41%
(NIH 2004, PRC 2006)

56. Deteriorating Quality of Nursing Education
116 nursing schools: passing rate of <50%
124 nursing schools: passing rate of >50%
In 2002, 150 nursing schools had a passing rate <50%, which was already 63% of the 237 nursing schools then.
In the last 3 NLEs, at least 20 nursing schools consistently had a 0% passing rate.
(NIH 2004, PRC 2006)

57. Source: PRC, 2005

58. Nurses and Severe Exploitation and Discrimination
Canada: the Live-in Caregiver Program (LCP) for nurses
United Kingdom: £ 2,000 payment to employer or recruiter, yet start at the lowest rung (~ healthcare assistant)
Saudi Arabia: the visit of DOLE Sec. Patricia Sto. Tomas pushed for lower wages for Filipino nurses in order to maintain “competitiveness”.
(AHW 2004, MIGRANTE INT’L 2005)

59. Exploited Health Human Resources
Health workers and professionals are overworked and underpaid.
“Average monthly wages for nurses is between Php 5,500 to 16,500 and for doctors is between Php 9,700 to 23,500.” (Lorenzo et al, 2004)

60. Exploited Health Human Resources
Doctor to patient ratio (population)
Cuba 1:225
USA 1:450
Philippines 1:10,000-26,000
WHO (Ideal) 1:600
Nurses to patient ratio
PGH 1:15-26 per shift
Davao del Sur 1:44-45 per shift
Ideal 1:4 per shift
Philippines 1:16,000 (population)
(AHW 2004, HealthWrights 2004)

61. Reasons for the Continuing Exodus
Commercialized health education.
“The average tuition fee for a 5-year medical course is Php 500,000 for school fees alone.”
Labor export policy.
“The national government earned USD 7.6B from OFW remittances in 2003 and USD 8.5B in It expects to earn an estimated USD 10B in 2005.”

62. Reasons for the Continuing Exodus
Economic and political instability.
“The fiscal crisis and the ballooning national debt; the unbridled corruption and lack of accountability; and the political crisis that worsen daily amid the incapacity of government to address these with long-term, definitive solutions.”
Globalization policies.
“The phenomenon of human trafficking across states, even under the guise of globalizing labor and human resource development, is still within the framework of privatization, deregulation, and liberalization.”

63. The Unhealthy Philippine Health Care System
“A health care system that cannot maintain
its own health human resource
is not healthy at all.”

64. “Health is a basic human right
“Health is a basic human right. It is the responsibility of the state to ensure that the people have access to quality health care.”

65. RIGHT TO HEALTH OF THE PEOPLE

66. Worsening State Neglect

67. Health Financing: Sources of Funds
40% government
49% out of pocket
11% Shared-Risk Schemes Including National Health Insurance (PhilHealth)
Total Health Expenditure P0.25 per Filipino per day

68. Increasing private burdens

69. Decreasing Spending on Social Services
Debt payments: increased by 101%
Health: decreased by 19%
Military: increased by 11++%
Nota: “%” ay inflation-adjusted per capita, tsart ay nominal

70. Uses of Funds (In Percent) Individual Healthcare
Administrative Costs and
Regulatory Functions
10%
10%
80%
Public Health
Interventions
Individual Healthcare
(Romualdez, 2008)

71. HEALTH has become a commodity: subject to TRADE and PROFITS National Governments have ABANDONED their responsibility to ensure the HEALTH of their PEOPLE.

72. In these
trying times,
WHAT ARE WE
TO DO?

73. Important Considerations
Temporary migration most beneficial for sending country
Permanent migration beneficial to individual migrants and families and receiving country
Nursing most popular profession now due to job and career opportunities
Nursing and HRH development are on national policy agenda -controversial

74. Important Considerations
Nursing development has not benefited from rollercoaster trends of migration
Health Care system has not benefited from migration related transactions
Nursing and health sectors need to manage relationships with trade and economic managers in private and government sectors
Philippines has not utilized remittances to leverage job creation and domestic employment development

75. Health Worker Migration Policy Issues
Areas that need attention: recruitment, retention, policy, education and strain on current nurses
Funding of the education and training of health workers
Employment situation within the source country and the degree to which health professionals would have been gainfully employed in their home country
Consequences for the workers that remain in the country as their colleagues depart for employment abroad
Whether movements reflect temporary or permanent shift in location

76. Policy Analysis
Local Policies – mainly regulate and manage domestic employment
Many incompletely implemented or not implemented
Does not manage outflow of workforce
Does not adequately clarify standards of staffing and compensation

77. Policy Provisions International Policies
Provides models of regulating scope of practice and licensure, recruitment, entry
Safeguards quality of health systems and health care in destination countries
Few contain safeguards from source countries

78. Migration has to be managed by:
Addressing protection of both health and human rights.
- Dampening push forces by retaining talent in sending countries
- Reducing pull forces by aiming for educational self sufficiency in destination countries
JLI Secretariat 2004

79. Managed Migration Should facilitate both
- development goals of source countries and
- efficiency goals of destination countries
Involves national
- policy reforms
- international agreements
- cooperative education program by source and destination country institutions
Health sector development projects
(Commonwealth Secretaiat, 2005)

80. Migration Related Policy Categories
Recruitment, Entry, and Citizenship Policies
Welfare and Human Resource Development and Retention
Re-entry of Migrants (Brain Gain)
- Permanent
- Temporary (Brain Circulation)
Licensure and Scope of Practice
Skill Mix
Poverty Alleviation and Social Development

81. Policy Development Criteria
Mutually Beneficial
- economic standpoint (social return)
- development status (professional and social)
- financial (private returns)
- cultural
- health systems
Should achieve equity and efficiency
Promote policy coherence
Protection and safety human outcomes

82. Policy Goals Equity – Nurse Distribution Effectiveness Efficiency
Security/Safety – ensuring local/domestic health outcomes

83. Policy Recommendations
International Policies
Bilateral Migration Management Policies
Provision of Progressive Incentives
HRH retention for destination countries
Incentives for reintegration for Recruiting countries

84. Policy Recommendations
Domestic Policies
Creation of incentives for return migration:
Positions for return migrants
Development of Framework for maximizing the utilization of those with skills, experience
Incentives for investments/ temporaryreintegration

85. Policy Recommendations
Within organizations
Creation of Position that provide incentives for longevity
Career Path Development
Ensure continuing development
Improve work conditions

86. Policy Options
Five Core Elements for National and Bilateral Policy on Labor Migration and Related Support Measures:
An informed and transparent labor migration admissions system designed to respond to measured, legitimate labor needs, taking into account domestic concerns as well.
A standards-based approach to “migration management” protecting basic rights of all migrants and combating exploitation and trafficking.

87. Enforcement of minimum national employment conditions standards in all sectors of activity.
A plan of action against discrimination and xenophobia to sustain social cohesion.
Institutional mechanisms for consultation and coordination with social partners in policy elaboration and practical implementation.

88. Future Outlook
Achieve mutually beneficial migration arrangements if reintegration programs are effective

89. But we should not loose sight of more empowering and actions towards social transformation….

90. The State of the Nation’s Health: A Summary
People’s health and welfare overall as the result of economic and political conditions
Poor health outcomes, especially for the poorest
Dysfunctional and fragmented health care delivery system
Privatization as the state’s key health policy
Systemic and worsening poverty and inequities urgently need to be address

91. Migration…
Everyday, more than 3,000 Filipinos are forced to work overseas - P480,000 (approx. US$ 8,900.) in government revenue daily.
Labor export program commodifies and exports Filipino workers abroad
As the national economic and political crisis intensifies – so too will the export of workers because of the increased dependence on dollar remittances and inability to create jobs in the Philippines
Abuses against migrants range from contract violations, physical and mental abuses and death

92. Assert People's Control
Collective action to uphold and defend people's rights
Health
Land
Living wages
Social Equity

93. Assert People's Control
Rescind detrimental government policies

94. Social OBLIGATION VS. PROFIT

95. What Needs to Be Done? Short Term/Immediate Intervention
Increase wages
Increase budget for health
Hold national consultations with all stakeholders
Improve regulation of medical and nursing schools
Rescind commitments to General Agreement in Trade in Services (GATS)

96. What Needs to Be Done? Long Term/Strategic Intervention
Review the overall health care system
Formulate a pro-people health policy and program
Discontinue labor export policy
Review and rescind WTO commitments
Discontinue globalization policies (deregulation, liberalization, and privatization)
Draw up independent political and economic policies

97. Challenges ahead Alma Ata vs. “Alana Ata?”
Social determinants of health
“Ethical” recruitment of nurses vs. labor export policy
Universal health care? Socialized health care?
Medical tourism and sale of organs
WTO and health as a matter of trade and investment
Globalization and health privatization

98. Continuing advocacies
Health as a matter of right and state responsibility
Health in the framework of equity, not equality
Access to medicine as part of access to health
Health not just “the absence of disease” or adequate services but as a people’s overall well-being: economic, political, social, cultural
Health as a public service, not a business or trade investment
Health in the context of a truly independent and democratic society

99. “Medicine has imperceptibly led us into the social field and placed us in a position of confronting directly the great problems of our time.” “For if medicine is really to accomplish its great task, it must intervene in political and social life. It must point out the hindrances that impede the normal social functioning of vital processes, and effect their removal.”
Rudolf Ludwig Karl Virchow (born October 13, 1821, in Schivelbein, Pomerania; died September 5, 1902, in Berlin) was a German doctor, anthropologist, public health activist pathologist, prehistorian, biologist and politician.
Virchow also worked as a politician to improve the health care conditions for the Berlin citizens, namely working towards modern water and sewer systems. Virchow is also credited with the founding of "social medicine", frequently focusing on the fact that disease is never purely biological, but often, socially derived.
Dr. Rudolf Virchow ( )

100. “I don’t deserve to be treated like this. I care about my job, SIR
“I don’t deserve to be treated like this. I care about my job, SIR. I care about you!!!"
Sharon Cuneta
Artist, “Caregiver”

101. WHAT WE WANT
Defend and Uphold People’s Right to Health Resist the Commodification of Health WTO OUT of Health

102. WHAT WE WANT
Health for ALL, Health in the Hands of the People Genuine Freedom and Democracy

103. Does it bridge the north and south problem? Is it ethical?
Migration…
Does it bridge the north and south problem?
Is it ethical?
Should it be supported? Constrained? Regulated?

104. Health Alliance for Democracy (HEAD) Maraming Salamat po….Thank you.
STRUGGLE.
LIBERATE.
Health Alliance for Democracy (HEAD)
Council for Health and Development
Maraming Salamat po….Thank you.