Export of Filipino Nurses: From Brain Drain to National Hemorrhage to NLE Leakage Health Alliance for Democracy (HEAD) 13 September 2006

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)

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)

Hemorrhage of Human Resources: Nurses 13,536 nurses left in 2001. 2000-2003: 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)

13,536 nurses left in 2001.

2000-2003: 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)

Top 5 Destinations of Filipino Nurses United States of America United Kingdom Saudi Arabia Ireland Singapore “ The number of nurses that left in the last 4 years (50,000) far exceeds the production of nurses of only 20,000 in the same period.” (NIH 2004)

United States of America

United Kingdom

Saudi Arabia

Ireland

Singapore

“ The number of nurses that left in the last 4 years (50,000) far exceeds the production of nurses of only 20,000 in the same period.”

(NIH 2004)

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 By June 2006, almost 200% increase in nursing schools nationwide since 2003 (NIH 2004)

The number of nursing schools have increased

1970s: only 40

1990s: 170

June 2003: 251

April 2004: 370

June 2005: 441

June 2006: 470

By June 2006, almost 200% increase in nursing schools nationwide since 2003

(NIH 2004)

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% 2001-2003: 44%-48% 2004: 55.9% 2005: 49.7% 2006: 42.42% (NIH 2004, PRC 2005)

Decreasing proportion of nursing graduates who pass the national nursing licensure examinations

1970s and 80s: 80%-90%

1991: below 61%

2001-2003: 44%-48%

2004: 55.9%

2005: 49.7%

2006: 42.42%

(NIH 2004, PRC 2005)

Deteriorating Quality of Nursing Education In 2001 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 NLE 2005, at least 20 schools consistently a <30 % passing rate. (NIH 2004)

In 2001

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 NLE 2005, at least 20 schools consistently a <30 % passing rate.

(NIH 2004)

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)

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)

Hemorrhage of Human Resources: Other Professionals Initial HEAD estimates: around 30% of nursing students are “second-coursers” at least 80% of those taking up nursing are planning to work abroad between 75%-90% of faculty members are planning to work abroad (HSA 2005, PNA 2005)

Initial HEAD estimates:

around 30% of nursing students are “second-coursers”

at least 80% of those taking up nursing are planning to work abroad

between 75%-90% of faculty members are planning to work abroad

(HSA 2005, PNA 2005)

Hemorrhage of Human Resources: Other Professionals Biggest review centers: INRESS – P10,000 for 6 weeks Gapuz – P13,400 for 3 weeks Pentagon – P14,500 from Sept to Dec Most nursing colleges also have compulsory “in-house” reviews that are paid for by the students (separate from tuition and other expenses) Students/graduates spend around P40,000+ just for review

Biggest review centers:

INRESS – P10,000 for 6 weeks

Gapuz – P13,400 for 3 weeks

Pentagon – P14,500 from Sept to Dec

Most nursing colleges also have compulsory “in-house” reviews that are paid for by the students (separate from tuition and other expenses)

Students/graduates spend around P40,000+ just for review

Exploited Health Human Resources Health workers and professionals are overworked and underpaid.

Health workers and professionals are overworked and underpaid.

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)

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)

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

“ A health care system that cannot maintain

its own health human resource

is not healthy at all.”

The Nursing Exam Leakage The Nursing Licensure Examination (NLE) Given by the PRC twice a year Exam questions are prepared by members of the Board of Nursing Has 5 parts: Test I (Community Nursing), Test II (Maternal and Child), Test III (Medical-Surgical Nursing), Test IV (Fundamentals), Test V (Psychiatric Nursing)

The Nursing Licensure Examination (NLE)

Given by the PRC twice a year

Exam questions are prepared by members of the Board of Nursing

Has 5 parts: Test I (Community Nursing), Test II (Maternal and Child), Test III (Medical-Surgical Nursing), Test IV (Fundamentals), Test V (Psychiatric Nursing)

The Nursing Exam Leakage Basic chronology of the NLE leak A few days before the June 2006 NLE, INRESS held an “final coaching” at one of the cinemas in SM North EDSA Shortly after the NLE, the leakage was exposed in Baguio City. PRC-CAR immediately informed PRC national office.

Basic chronology of the NLE leak

A few days before the June 2006 NLE, INRESS held an “final coaching” at one of the cinemas in SM North EDSA

Shortly after the NLE, the leakage was exposed in Baguio City. PRC-CAR immediately informed PRC national office.

The Nursing Exam Leakage Basic chronology of the NLE leak PRC initially said it would investigate before releasing the list of those who passed. Mass resignation of the Technical Committee on Nursing Education (TCNE) on July 7, citing “that CHED has instead (of implementing past memos) buckled down to pressure from poor performing schools, politicians and Malacañang, sacrificing quality for mediocrity and business interest .”

Basic chronology of the NLE leak

PRC initially said it would investigate before releasing the list of those who passed.

Mass resignation of the Technical Committee on Nursing Education (TCNE) on July 7, citing “that CHED has instead (of implementing past memos) buckled down to pressure from poor performing schools, politicians and Malacañang, sacrificing quality for mediocrity and business interest .”

The Nursing Exam Leakage Basic chronology of the NLE leak But even without an investigation, the PRC released the list of those who passed and stated there was no leak involved. PNA President George Cordero also lobbied the PNA chapter in Baguio to keep the matter under wraps as it might jeopardize the country’s request to be made an NCLEX center.

Basic chronology of the NLE leak

But even without an investigation, the PRC released the list of those who passed and stated there was no leak involved.

PNA President George Cordero also lobbied the PNA chapter in Baguio to keep the matter under wraps as it might jeopardize the country’s request to be made an NCLEX center.

The Nursing Exam Leakage Basic chronology of the NLE leak Nursing groups were formed to pressure the PRC. The UST-led group called for a nullification of the entire NLE and a re-take. The nursing community became embroiled and divided on the re-take debate. The PRC allowed the oath-taking of those who passed even after promising the ADPCN that it will defer such action.

Basic chronology of the NLE leak

Nursing groups were formed to pressure the PRC. The UST-led group called for a nullification of the entire NLE and a re-take.

The nursing community became embroiled and divided on the re-take debate.

The PRC allowed the oath-taking of those who passed even after promising the ADPCN that it will defer such action.

The Nursing Exam Leakage Basic chronology of the NLE leak The UST-led group filed a TRO against the PRC for the oath-taking. The processing of papers also stopped. The Senate and the HOR Committees on Health began conducting their respective investigations, but the gov’t agencies involved did not attend the hearings. Witness testimonies already point to the involvement of key leaders/members of the PNA and BON.

Basic chronology of the NLE leak

The UST-led group filed a TRO against the PRC for the oath-taking. The processing of papers also stopped.

The Senate and the HOR Committees on Health began conducting their respective investigations, but the gov’t agencies involved did not attend the hearings.

Witness testimonies already point to the involvement of key leaders/members of the PNA and BON.

The Nursing Exam Leakage Major groups implicated Dr. George Cordero: owner of INRESS and Philippine Colleges of Health Sciences (PCHS); President of the Philippine Nurses Association (PNA) BON members Anesia B. Dionisio and Virginia D. Madeja Gapuz and Pentagon Review centers PRC Chair Leonor Tripon-Rosero

Major groups implicated

Dr. George Cordero: owner of INRESS and Philippine Colleges of Health Sciences (PCHS); President of the Philippine Nurses Association (PNA)

BON members Anesia B. Dionisio and Virginia D. Madeja

Gapuz and Pentagon Review centers

PRC Chair Leonor Tripon-Rosero

The Nursing Exam Leakage Major government agencies involved Professional Regulation Commission (PRC) Board of Nursing (BON) Commission on Higher Education (CHED) Dante Ang (Commission on Overseas Filipino and Presidential Task Force on the National Licensure Exam/EO 550) National Bureau of Investigation

Major government agencies involved

Professional Regulation Commission (PRC)

Board of Nursing (BON)

Commission on Higher Education (CHED)

Dante Ang (Commission on Overseas Filipino and Presidential Task Force on the National Licensure Exam/EO 550)

National Bureau of Investigation

The Nursing Exam Leakage Major groups of stakeholders Association of Deans of Philippine Colleges of Nursing (President Carmelita Divinagracia, Dean UERM CN) PNA and PNA-CAR Concerned Nurses… (UST, FEU) ANSWER (broad inter-school alliance) BSN (Bukluran ng mga Samahang Nurses) Health Alliance for Democracy (HEAD)

Major groups of stakeholders

Association of Deans of Philippine Colleges of Nursing (President Carmelita Divinagracia, Dean UERM CN)

PNA and PNA-CAR

Concerned Nurses… (UST, FEU)

ANSWER (broad inter-school alliance)

BSN (Bukluran ng mga Samahang Nurses)

Health Alliance for Democracy (HEAD)

The Nursing Exam Leakage Positions regarding the issue PRC: “No Leakage”  No Re-take  Voluntary re-take for free  Bonus 2% Dante Ang/Arroyo admin: Compulsory Re-take  Compulsory re-take of Tests III and V PNA: Re-take all  No re-take UST, UE, UP: Compulsory re-take of Tests III, V CHED: “Wala kaming kinalaman dyan!”

Positions regarding the issue

PRC: “No Leakage”  No Re-take  Voluntary re-take for free  Bonus 2%

Dante Ang/Arroyo admin: Compulsory Re-take  Compulsory re-take of Tests III and V

PNA: Re-take all  No re-take

UST, UE, UP: Compulsory re-take of Tests III, V

CHED: “Wala kaming kinalaman dyan!”

The Nursing Exam Leakage HEAD analysis Leakage is only a symptom of a long-standing deterioration of the nursing education Like other exams given by the PRC, the NLE has been fraught with leakages that have exemplified the collusion between gov’t officials and big business

HEAD analysis

Leakage is only a symptom of a long-standing deterioration of the nursing education

Like other exams given by the PRC, the NLE has been fraught with leakages that have exemplified the collusion between gov’t officials and big business

The Nursing Exam Leakage HEAD analysis Gov’t agencies (PRC, CHED, BON) have eroded the quality of nursing education and the integrity of the nursing profession The actions of gov’t agencies are divisive and meant to distract stakeholders from the main issue

HEAD analysis

Gov’t agencies (PRC, CHED, BON) have eroded the quality of nursing education and the integrity of the nursing profession

The actions of gov’t agencies are divisive and meant to distract stakeholders from the main issue

The Nursing Exam Leakage HEAD analysis The commercialization of nursing education has worsened the quality of nursing education This commercialization is rooted in the Labor Export Policy of the Arroyo regime Rather than seek solutions, the Arroyo gov’t seeks to centralize everything (e.g. regulate review centers under gov’t control) to increase its revenues

HEAD analysis

The commercialization of nursing education has worsened the quality of nursing education

This commercialization is rooted in the Labor Export Policy of the Arroyo regime

Rather than seek solutions, the Arroyo gov’t seeks to centralize everything (e.g. regulate review centers under gov’t control) to increase its revenues

Health Under the Arroyo Regime Filipino nurses have become a commodity: subject to TRADE and PROFITS The national government has ABANDONED its responsibility to ensure the HEALTH of their PEOPLE

Filipino nurses have become a commodity: subject to TRADE and PROFITS

The national government has ABANDONED its responsibility to ensure the HEALTH of their PEOPLE

WHAT WE WANT HEAD proposals: IMMEDIATE Conduct a speedy, thorough, impartial, and independent investigation of the leakage Identify and prosecute the guilty Completely revamp the PRC, BON, and CHED Allow those who have passed to seek jobs without discrimination

HEAD proposals: IMMEDIATE

Conduct a speedy, thorough, impartial, and independent investigation of the leakage

Identify and prosecute the guilty

Completely revamp the PRC, BON, and CHED

Allow those who have passed to seek jobs without discrimination

WHAT WE WANT HEAD proposals: LONG-TERM Review and uphold the recommendations set by the TCNE. Set the standards for nursing schools to operate and ensure compliance Ensure the quality of education through a thorough review of the curricula and quality of nursing faculty Ensure the integrity of the conduct of examinations and other tests pertinent to the competence of Filipino nurses

HEAD proposals: LONG-TERM

Review and uphold the recommendations set by the TCNE. Set the standards for nursing schools to operate and ensure compliance

Ensure the quality of education through a thorough review of the curricula and quality of nursing faculty

Ensure the integrity of the conduct of examinations and other tests pertinent to the competence of Filipino nurses

WHAT WE WANT HEAD calls: Unite and Uphold the Integrity of the Nursing Profession! Conduct a Speedy, Thorough, and Independent Investigation! Identify and Prosecute the Guilty! Stop the Commercialization of Nursing Education! Stop the Arroyo Administration’s Labor Export Policy!

HEAD calls:

Unite and Uphold the Integrity of the Nursing Profession!

Conduct a Speedy, Thorough, and Independent Investigation! Identify and Prosecute the Guilty!

Stop the Commercialization of Nursing Education!

Stop the Arroyo Administration’s Labor Export Policy!

HEAL. STRUGGLE. LIBERATE. Health Alliance for Democracy (HEAD)

HEAL.

STRUGGLE.

LIBERATE.

Health Alliance for Democracy (HEAD)