Etd 0826110 115026

Graduate School of International Affairs
Ming Chuan University

Masters Thesis
Advisor: Dr. Nathan K. H. LIU
Nurse Migration: The Case of the Republic

of the Philippines
Graduate Student: Cristine Cia B. Clasara
June, 2010
Abstract
Remittance flows include money sent by migrants to relatives in their home
countries, financial investments in real estate or business, and saving in bank in their
country of origin. In recent years, such flows have been increasingly viewed as a
mechanism for funding development in the Global South
and for achieving
the
Millennium Development Goals (MDGs). Hence, remittances have become the new
development mantra. However, discourses on the positive effects of remittances on
development often neglect one important aspect: the costs borne by migrants in the
process of generating them.
According to the World Health Organization , the Philippines is the largest

exporter of nurses in foreign countries. Moreover, the organization also estimated that
the migration was expected to continue until 2015, due to the annual demand for medical
workers in the United States and Europe is estimated to be 800,000. He also mentioned
that this phenomenon
will have
a huge impact
on
the Philippines
health
infrastructure. To understand more clearly, in 2001 13,536 left the country whereas
only 4,780 graduated.
This study analyzes the link between remittance dependency and the governments
policy and action towards the nurse migration. Qualitative approach was applied in this
study.
Secondary sources of data were gathered as
the
primary source.
The
remittance depend cycle to proved that the Philippines has been dependent to the
remittances and has been passive in solving the continuous nurse migration.
Key Words: Nurse Migration, Remittances, Remittance Dependency Cycle
iv
List of Contents
Abstract
iv
List of Contents
List of Tables
vii
List of Figures
viiii
Chapter 1 Introduction
1.1 Motivation
1.2 Research Background
1.3 Research Objectives
Chapter 2 Review of Related Literature

2.1 Demography of International Migration
2.1.1
Net distribution
5
5
2.2 Causes of nurse migration
2.2.1
Demography and Health
2.2.2
Remuneration and work environment
2.2.3
Personal and Security
11
2.3 Consequences of nurse migration
11
2.3.1
Migrants and family
11
2.3.2
National Health Status
12
2.3.3
Education and public Subsidy
12
2.4 Remittances and Development

2.4.1
13
The migration optimist: development and

neo-classical view
2.4.2
13
The migration pessimists: historical structure

and dependency views
2.4.3
14
Pluralist perspectives: new economics of

labor migration and livelihood approaches
Chapter 3 Methodology
15
18
3.1 Introduction
18
v
3.2 Research Design
18
3.3 Data Analysis
19
3.4 Research Area and Limitations
20
Chapter 4 Nurse Migration
21
4.1 Overview of the health workers migration

4.1.1
Demographic and socio-economic indicators
21
4.1.2
Stock and distribution of health workers
23
4.1.3
Nurse Migration & global nursing
26
4.2 Cost of migration
28
4.3 Governments Action
30
4.3.1
The Magna Carta for Public Health Workers

Of 1992 embodied in RA 7305
30
4.3.1.1 Overview of the Magna Carta
30
4.3.1.2 DOHs problem
31
4.3.1.3 Implementing national benefits in local governments
32
4.3.1.4 Unintended consequences
33
Chapter 5 Remittance Dependency Cycle
37
Chapter 6 Conclusion and Recommendation
42
Bibliographies
45
Appendix: Magna Carta for Public Health Nurses
49
vi
21
List of Tables
Table 2.2
Causes and consequences of medical migration
Table 4.1
Average monthly wage rates of nurses in the Government sector

(in Php)
Table 4.3
22
Regional distribution of health human resources employed

in the Government sector: Philippines 2002
vii
10
24
List of Figures
Figure 2.1
Health workers density by region
Figure 3.1
Remittance dependency cycle
Figure 4.2
(Estimated) Production of health workers annually
24
Figure 4.4
Nurse outflow, 1999-2009
27
Figure 4.5
Leading destination countries of deployed Filipino nurses,
Figure 5.1
1992-July 2003
28
Remittances, 2001-2009
38
viii
Chapter 1
INTRODUCTION
1.1 Motivation
The loss of human resources through migration of professional health staff
to developed countries usually results in a loss of capacity of health systems in
developing countries to deliver health care equitably. Migration of health workers
also undermines the ability of countries to meet global, regional and national
commitments ,such as the health-related United Nations Millennium Development
Goals, and even their own development. Data on extent and the impact of such
migration are patchy and often anecdotal and fail to shed light on the causes, such
as high unemployment rates, poor working conditions and low salaries.
World Health Organization
International migration has become an important feature of the globalized

labor markets in health care and its impact is said to be very complex for both the
health workers and the countries involved. Mainly, international migration of skilled
workers has increased importance in recent years, reflecting
the effects of
globalization, the growth in the world economy and the expansion in information
and communications technology (ICT). As a result, a number of developed countries
have liberalized their policies to admit highly skilled professionals and this has
facilitated the movement if workers from one country to another.
The Philippines us recognized as being one of the major source countries if

health worker migration. Moreover, according to the World Health Organization, the
Philippines is the largest export of Nurses to Foreign countries. And there are about
786,000 Filipino Nurses working outside the country.1
The Philippines is recognized as being one of the major source countries of

health worker migrants. For many decades, the country is consistently supplied
skilled
health workers to developed countries such as the United States and Saudi
World Health Organization.2006.Working Together. World Health Report
Arabia.
In addition, United Kingdom, the Netherlands and Ireland opened its door
for Filipino health workers.
Since the Philippines is known as one of the sending countries, most studies
made in the area aimed in providing in-depth information in the migration of Filipino
workers and the impact this has on individual migrants, their families, professions,
and nation as a whole. On the other hand, limited information with regards to the
Philippines
dependency on remittance and
its role governments action
in
addressing the exodus of skilled health workers.
1.2 Research Background

Filipino overseas migrants mirrors the socio-political and economic situation
in the Philippines. The Philippines has too few jobs for its population. The current
unemployment rate is 7.6 percent.2 As a result, the number of Filipinos working
abroad is continuously rising from 1995 to 2002 overseas deployment of workers
increased by 5.32 percent annually.3 Employment abroad provides to job-seeking
Filipinos and is a major generator of foreign exchange.4 Remittances from overseas
Filipino workers from all occupations have grown from US$290.85 million in 1978 to
US$10.7 billion in 2005.5
Filipino labor migration was originally intended to serve as a temporary

measure to ease unemployment. Based on the data given by the Department of
Foreign Affairs, there are 7.2 million Filipino migrants all over the world.6
The
number of deployment of overseas workers increased from 36, 035 in 1975 to

841,438 in 2000.7 Perceived benefits includes stabilizing the countrys balance-ofpayments position and providing alternative employment for Filipinos. However,
http://www.census.gov.ph/data/pressrelease/2009/lf0903tx.html
Tarriela, F.G. OFW Remittances:Insights. Manila Bulletin, April 11,2006
4
Ibid.
5
6
Department of Foreign Affairs (DFA) records,1999.
7
3
dependence on labor migration and international service provision had grown to the
point where there are few efforts to address domestic labor problems.8
This movement of Filipino health workers, particularly Filipino nurses as

temporary or permanent migrant started during the 1950s. During that time, the main
objective of working overseas was to gain advanced training and to return home to
improve the quality of the Philippines Health Service. However, by the late 1960s
countries in the Middle East and North America began to recruit trained health
workers. Many of those who went to North America as students stayed on as migrant
workers and were ultimately granted residency status.9 And by the mid 1990s, the
United States made the recruitment offers more attractive and more permanent,
giving green cards not only to the health worker but also to their immediate families.
The increasing number of nurses is now making the nurses the largest group
of health providers in the Philippines as a result of the domestic and foreign demand
for nurses. By this situation, there is a rapid growth of nursing colleges. According
to the Commission for Higher Education (CHED) there are about 460 nursing
colleges that offer the Bachelor of Science in Nursing (BSN) program and graduate
approximately 20,000 nurses annually. 10 Moreover, CHED also mentioned that
based on the production and domestic demand patterns, the Philippines has a net
surplus of registered nurse.11
According to the Professional Regulations Commissions (PRC) data, the

total supply of nurses who were registered as of 2003 was 332, 206.12 In addition,
out of the total number of registered nurse, it is only estimated that only 58 percent
were employed as nurses either in the Philippines or overseas. 13 Majority (84.75
percent) of registered nurses were working overseas. Among
the 15.25 percent
Villalba, M.A.C.2002.Philippines: Good Practices for the Protection of Filipino Women Migrant
Workers in Vulnerable Jobs. Working Paper No.8. Geneva: International Labour Office, February
2002.
9
Corcega,T.,F.M.Lorenzo,J.Yabes,B. De la Merced, and K. Vales. Nurse Supply and Demand in the
Philippines. The UP Manila Journal 2000;5 1: 1-7
10
Commission on Higher Education (CHED).2006 List of Nursing Schools and Permit Status
11
Ibid.
12
Professional Regulations Commission (PRC), Nurse Licensure Examination Performance by School
and Date of Examination, 2005.
13
Ibid.
employed in the Philippines, most were employed by the government agencies and
the rest worked in the private sector or in nursing institutions.14
Furthermore, doctors who have been retrained as nurses, to be able to seek

employment overseas is now a growing phenomenon. While exact numbers are not
readily available, approximately 2,000 doctors became nurse medics and by 2003,
that number increased to 3,000.15 In 2005, approximately 4,000 doctors were enrolled
in nursing schools across the country16. And in 2004, according to the Philippine
Hospital Association, 80 percent of all public sector physicians were currently or had
already retained as nurses.17
Labor migration has said to have one major impact in sending countriesby
contributing to the local economy through remittances and reduction of
unemployment. However, the migration of health workers was perceived to have a
negative impact by exhausting the pool of skilled and experienced health workers
consequently compromising the quality of the health care system.
1.3 Research Objectives

This study aims to:
(1) Give an overview on the health workers migration;
(2) Discuss the impact of health workers migration to the Philippines
health infrastructure and its economy;
(3) Assess the governments action in solving the social problem; and
(4) Link the
relationship between remittance dependency
and the
governments policy and action towards the social problem.
14
Professional Regulations Commission (PRC), Nurse Licensure Examination Performance by School

and Date of Examination, 2005.
15
Pascual, H.R.Marcaida, and V.Salvador.2003.Reasons Why Filipino Doctors Take Up Nursing: A
Critical Social Science Perspective. Paper Presented During the 1t PHSSA National Research Forum,
Kimberly Hotel, Manila, September 17,2003 Philippine Health Social Science Association
16
Galvez Tan, J.2005 The Challenge of Managing Migration, Retention and Return of Health
Professionals. Powerpoint Presentation at the Academy for Health Conference, New York.
17
Philippine Hospital Association Newsletter, November 2005.
Chapter 2
REVIEW OF RELATED LITERATURE
This literature review aims to describe clearly the historical context of
health workers migration, while highlighting key factors that influence its present
character.
2.1 Demography of International Migration

2.1.1 The Medical Migrants
Medical Migrants, as defined by World Health Organization, consists of
professionals who enjoy equivalency certification in source and destination countries.
Nurse and doctors, including high-skilled specialist, are specially sought, but also in
demand are dentists, pharmacists, and technicians. However, low-skilled migrants,
who perform cleaning and other low-paying tedious tasks in the health sector are not
included in this definition since these workers may find medically related work in
destination countries but their migration was not determined by their education or
skills.18
Moreover, in 2000, the world had about 8.5 million doctors and 15.2 million
nurses and midwives, giving an average world density of 1.4 doctors and 2.6 nurses
per 1000 population.19
18
WHO, Recruitment of Health Workers from the Developing World, WHO Executive Board
Document (Geneva, 2004a)
19
Ibid.
NorthAmerica
10.9
Europe
10.4
WestPacific
8.5
South&CentralAmerica
2.8
MiddleEastandNorthAfrica
2.7
Asia
2.3
SubSaharanAfrica
0.98
0
10
12
workersper1,000population
Figure 2.1: Health workers density by region
Figure 2.1 shows that there is a massive regional disparity of supply of health
workers. Europe is has the largest ratio of health with 10. 9 and North America is
the second to the list with 10.4
these two developed continents dominated the
production of doctors and nurses. On the other hand, Africa which inhibit about 2.7
of world population while Sub-Saharan Africa ranks the lowest with 0.98.
2.1.1.1
Net Redistribution
The movement of health workers is distorting these disparity even more. The
pool if graduates leaving the source countries and the stock of the foreign trained
health workers destination countries reflects these shifts.
The outflow of health
workers can be classified by both temporary and permanent migration. In 1970 more
Filipino nurses were registered in the USA and Canada than in the Philippines.20
Historical rates of migration also characterize Jamaica where almost two-thirds of
20
Martineau,T.,K. Decker and P. Bundred, Briefing Note on International Migration of Health

Professionals: Levelling the Playing Field for Developing Country Health Systems (Liverpool School
of Tropical Medicine, 2002).
nurses trained in Jamaica during the last twenty years., emigrated mainly to the
United States.21
Until now, migration outflow appear to be accelerating, especially in the past

decade in absolute terms.22 The migration of nurses in particular shows an increasing
trend. 23 For example, the number of non-EU nurses and midwives who have
registered in the UK has increased ten- to fifteenfold in one decade.24 Looking at
source countries, we find that even in comparison with the relatively high earlier
rates of Filipino migration, recent trends are markedly upward, with a three-to
fourfold increase over only five years.25
2.2 Causes of Nurse Migration

The causes of medical migration is complicated, most literature in this subject
classified the forces into push factors in source countries and pull factors in
destination countries. Dovlo, in his article, identified six gradients that capture
thesepush-pull factors:26
1. income (or remuneration): salaries and living conditions;

2. job satisfaction: good working environment and utilization of ones skill to the
best technical and professional ability;
3. career opportunity: for career advancement and specialization;
4. governance and work environment: political governance and administrative
bureaucracy reflected by the efficiency and fairness;
21
Dumont, J.C. and J.B. Meyer, the International Mobility of Health Professionals: An Evaluation and
Analysis Based on the Case of South Africa, in Trends in International Migration: 2003 SOPEMI
Edition, OECD (Paris,2004)
22
Cooper, R.A., 2005. Physician Migration: A challenge for America, a Challenge for the World,
Journal of Continuing Education in the Health Professions, 0894-1912
23
Buchan, J., International Recruitment of Nurses: United Kingdom Case Study, report for WHO and
International Council for Nurses and the Royal College of Nursing (Geneve, 2002)
24
Ibid.
25
Vujijic, M., P. Zurn, K. Diallo, O. Adams, and M. Dal Poz, the Role of Wages in Slowing
Migration of Health Care Professionals from Developing Countries, Human Resources for Health
Journal (2004).
26
Dovlo, D. and F. Nyonator, Migration by Graduates of the University of Ghana Medical School: A
Preliminary Rapid Appraisal, Human Resources for Health and Development Journal, 3/1 (1999):
40-51.
5. protection and risk: personal safety, security and risks- especially lack of
protective gear from HIV/AIDS in Africa;
6. social security: adequate and fair retirement security.
2.2.1
Demography and Health

The chief pull forces in destination countries function as
magnets to attract
medical migrants from source countries. The need maybe attributed to longer-term
demographic and epidemiologic transitions. 27 Changing patterns in the burden of
disease have consequences for care requirements, and does the aging populations.
The demand
for health-care workers is further highlighted by
shifts regarding
nuclear family structures, institutionalized elder- and childcare, advances in laborintensive health technologies, and changing consumer preferences.
However, some source countries need for
health workers may also be
increasing but their pull factor is weaker. In addition, the HIV/AIDS pandemic
certainly creates higher demand for medical attention. Alongside with the rapid
growth of population, an increase in education and public awareness, over time will
increase the demand for health services. Source countries, yet, are not capable to
transform their increasing need in the labor market into an ability to attract and retain
highly skilled medical professionals. The government also lacks the financing to
generate an effective demand in the labor market.
2.2.2
Remuneration and Work Environment

The most important driving force
of migration is
the wage difference
between the source and receiving countries. In source countries wages is sometimes
extremely insufficient, and public sector health wages may decrease during periods
of fiscal problems. In a WHO study of five African countries, dissatisfaction with
remuneration was the most significant determination of the decision to emigrate.28
Although many countries have unfilled vacancies, the wage differential between the
27
Ibid.
WHO, Recruitment of Health Workers from the Developing World, WHO Executive Board
Document (Geneva, 2004a)
28
source and destination countries provides a major motivation for migration. Consider
the case of the UK which needs to recruit 35,000 new nurses while 50,000 retiring
nurses will need to replaced by 2008.29 A South African nurses salary will double if
s/he moves to UK.30 Moreover, Vujicic pointed out that source-destination country
wage differentials were so large (3-15 times) that marginal increases in
source
country wages would, alone, not affect migration flows. Non-wage instruments or
non financial incentives are essential.31
29
30
Ibid.
31
Vujijic, M., P. Zurn, K. Diallo, O. Adams, and M. Dal Poz, the Role of Wages in Slowing
Migration of Health Care Professionals from Developing Countries, Human Resources for Health
Journal (2004).
Table 2.2: Causes and consequences of medical migration

Source Countries
Destination countries
Causes
1.
Demography and health
Disease burden
High
Chronic disease
Demography
Youthful
Aging
Income
Low
High
Job satisfaction
Low
Variable
Career opportunity
Limited
Prospects
Management
Rigid, unfair
Variable
Personal
Family preferences
Childrens future
Security
Safety, HIV risk
Protective practices
Financial
Remittances
Higher living standard
Social
Higher Status
Immigrant- variable
Paralysis, collapse
Public
2.
3.
Remuneration and work environment
Personal and security
Consequences
4.
5.
Migrant and Family
Health Systems
sector,
backward regions
Health Status
6.
Reduced
Education and Public Subsidy
Education curriculum
Export Oriented
Public institution
Loss products
Private education
Growth for export
Public financing
Lost
Captured
10
Increased
2.2.3
Personal and Security

For some, the motivation to emigrate may arise primarily from a desire to
join family or to increase the opportunities for children or simply to experience

living abroad. Another cause has to do with risks of infection, vulnerability to
physical violence, and other kinds of hazards. Health workers in Sub-Saharan Africa
increasingly complain of the risk of HIV/AIDS infection.32 A study done by ILO
suggested
18-41 per cent of health workers in sub-Saharan Africa were HIV-
positive.33
2.3 Consequences of Medical Migration

The consequences
of migration would be expected to differs between
individuals and source destination societies. That winners and losers are generated
seems likely.
Moreover, most
nurse medical migration, at least three areas of
consequences should be considered34:
1. migrant and family;

2. national health status;
3. education and public subsidy.
2.3.1
Migrants and Family

Since professional migrants are able to obtain employment with much higher
compensation, better working environments, opportunities for career advancement,

and prospects of personal and family satisfaction. It is concluded that the biggest
winners in medical migration are the migrants and their immediate families, both
those who accompany them and those who receive remittances at home.
32
International Labour Organization (1997-2002), Economically Active Population, 1950-2010

(Geneva:ILO)
33
Ibid.
34
40-51.
11
2.3.2

In the country level, the winners are destination countries while the losers are
source countries. As migrants enhanced the health workforce in destination countries,

emigration exacerbates the shortage of skilled health workers, thus compromising
the national health in the source country. Many would argue that is the lack of
employment opportunities that generated nurse migration.
Vacancy rates among departments of health in many source countries reflects

these shortages. In 2002, the South African department of health reported more than
4,000 unfilled vacancies for physicians and 32,000 vacancies for nurses more than
a quarter of total vacancies.35 Moreover, in Ghana, in 2002, 47 per cent of doctors
posts were unfilled, and 57 percent of the registered nursing posts were vacant as
well.36
As argued by Dumont and Meyer, migration may simply be an aggravating

factor rather than a root cause: [f]or example, there are approximately 7,000 South
African expatriate nurses in the main OECD destination countries; at the same time
there 32,000 vacancies in the public sector, and 35,000 registered nurses in South
Africa are either inactive or unemployed.37
2.3.3
Education and Public Subsidy

The effects of migration on educational institutions can be two- sided. On the
one hand, home institutions suffer from the loss of its graduates to national service
in terms of morale prestige, and national contribution. On the other hand, it can be
35
36
40-51.
37
12
argued that educational institutions that successfully
export graduates demonstrate
their quality and competitiveness. It improves its attractiveness to potential students

seeking international opportunities.
One explicit negative consequences of international migration is financial.

Governments invest in medical education to strengthen their national health capacity.
In 24 Sub- Saharan African countries have one medical school and has one has no
medical school at all.38 It is clear that emigration drains these investments away from
the health needs of the national population.
In addition, these costs can be
considerable. These estimated cost of training a South African doctor approximates

$97,000; nurses approximate $42,000 39 . Thus overall loss from investments in
medical education maybe estimated at around US $ billion, equivalent to
approximately one-third of the public development aid received by South Africa
between 1994 and 2000.40 At the same time, the prospect of emigration may attract
students to medical education who have, from the start, the intention to emigrate,
rather than the commitment to serve domestic needs.
2.4 Remittances and Development

2.4.1
The migration optimists: Development and

neoclassical views
During the developmentalist era of the 1950s and 1960s, large-scale labor
migration from developing countries began to gain momentum. Many developing

countries became involved in the migration process amidst these expectations of the
dawning of a new era.41 Government of developing countries started to explicitly
encourage emigration since they deemed it as one of the major mechanism to
advance national development.
38
Hagopian, A., MJ Thompson, M. Fordyce, K.E.Johnson and L.G. Hart, The Migration of Physicians
from Sub- Saharan Africa to the United States of America: Measure of the Afrcan Brain Drain,
Human Resources for Health, 2/17 (2004).
39
40
Ibid.
41
Papademetriou, Demetrios G. 1985. Illusions and reality in international migration: Migration and
development in post- World War II Greece. International Migration, Volume. 23, No.2, pp.211-223.
13
Developmentalist migration optimists perceived that migration leads to a

North-South transfer of investment capital and accelerates the exposure of traditional
communities
to liberal, rational and democratic ideas, modern knowledge and
education. From this perspective, return migrants are seen as important agents of
change, innovators and investors. The general expectation was that the flow of
remittances- as well as experience, skills and knowledge that migrants would
acquire abroad before returning would be of great help developing countries in
their economic growth.42
Moreover, the neoclassical economists view migration as a positive manner .

However, it is noteworthy to mention that the neoclassical migration theory doesnt
include the importance of remittances.43 In addition, the neoclassical advocates see
migration as a process that contributes to the optimal allocation of production factors
for the benefit of all, in which the process of factor price equalization will lead to
migration ceasing once wage levels are equal at both the origin and destination. From
this perspective the re-allocation of labor from rural, agricultural areas to urban,
industrial sectors in considered as an essential prerequisite for economic growth and,
hence, as an integral component of the whole development process.44
2.4.2
The migration pessimist: historical structure and

dependency views
An increasing number of academic studies seemed to support the hypothesis
that migration sustains or even reinforces problems of underdevelopment instead of

reverse.45 Migration pessimist argued that migration causes the withdrawal of human
capital. This would result
to the development of passive, non-productive and
remittance-dependent communities. The massive departure of young, able-bodied
42
Penninx, Rinus. 1982 A critical review of theory and practice: the case of Turkey. International
Migration Review, Vol.16, No.4, pp. 51-72
43
Taylor, J.Edward. 1999.The New Economics of Labour Migration and the role of remittances in the
migration process. International Migration, Vol.37, No.1, pp.63-68
44
Tadoro, Michael P. 1969. A model of labor migration and urban unemployment in less-developed
countries. American Economic Review, Vol. 59, No.1, pp. 59-68
45
Almeida, Carlos C. 1973, Emigration, espace et sous-development. International Migration, Vol.
11, No.3, pp. 112-117.
14
men and women from rural areas is typically blamed for causing a critical shortage
of agricultural and other labor, depriving areas of their most valuable workforce.46
Migration pessimists have also that remittances were mainly spent
on
consumption and consumptive investments such as housing, and rarely invested in

productive enterprises. 47 Skepticism about the use of migrant remittances for
productive
development
investments became the common thread of the migration and

debate.
48
Besides weakening local economies and increasing
dependency, increased consumption and land purchases by migrants

49
were also
50
reported to provoke inflationary pressures and soaring land prices.
From this perception, South-North Migration was perceived as discouraging

instead
encouraging
countries.
51
the autonomous
Such views
economic growth
of migrant-sending
conform to the historical-structuralist paradigm on
development that perceives migration as one among many other expressions of the
developing
worlds increasing
dependency
on the global
political system
dominated by powerful states.52
2.4.3
Pluralist perspectives: New economics of labor

migration and livelihood approaches
During the 1980s to 1990s, the new economics of labor
and migration
(NELM) materialized as a response to the developmentalist and neoclassical
46
Rubenstein, H.1992. Migration, development and remittances in rural Mexico, International

Migration, Vol. 30, No.2, pp. 127-153.
47
Entzinger, Han. 1985.Return Migration in Western Europe: Current policy trends and their
implications, in particular for the second generation. International Migration, Vol. 23, No.2, pp. 263290.
48
Massey, Douglas S., Joaquin Arango, Graeme Hugo, Ali Kouaouci, Adela Pellegrino and J. Edward
Taylor.1998. Worlds in Motion: Understanding International Migration at the end of the Millennium.
Clarendon Press, Oxford.
49
Russel, Sharon Stanton.1992,Migrant remittances and development Vol. 30, No.3/4, pp. 267-288.
50
Appleyard, Reginald. 1989. Migration and development: Myths and reality International
51
Durand, J., W Kandel, E.A. Parrado and D.S. Massey.1996a. International migration and
development in Mexican communities. Demography,Vol.3,No. 3,pp.313-330.
52
Massey, Douglas S., Joaquin Arango, Graeme Hugo, Ali Kouaouci, Adela Pellegrino and J. Edward
Taylor.1998. Worlds in Motion: Understanding International Migration at the end of the Millennium.
Clarendon Press, Oxford.
15
theories
and structuralist theory.
determinist
These approached seemed
unyielding
to deal with the complex realities of migration and
and
development
interactions. On the other hand, NELM, offered more subtle view of migration and
development, which links causes and consequences of migration more clearly.
Oded Stark53, for instance, reinforced the academic thinking on migration
from the developing world by including the behavior of individual migrants within
a wider societal context and considering the householdrather the individualas the
most appropriate decision- making unit.54 This new approach models migration as
the risk-sharing behavior households. Better than individuals, households see able to
diversify resources such as labor in order to minimize income risks.55 Moreover,
this approach integrates motives other than individual income maximization that play
a role in migration decision making. Migration is perceived as a household response
o income risks since migrant remittances serves as income insurance for households
of origin.56
In addition, NELM scholars argued that
migration plays a vital role in
providing a potential source of investment capital, which is especially important in

the context of the imperfect credit (capital) and risk (insurance) markets that prevail
in most developing countries.57 Therefore, migration can be considered as a livelihood
strategy to overcome various market constraints, potentially enabling households to
invest in productive activities and improve their livelihoods. This went well along
with the fundamental criticism on the weak methodological foundations, poor
analytical quality or empiricist character of much prior research, which is often failed
to take into account the complex, often indirect, positive impacts of migration and
53
54
Taylor, J.Edward. 1999.The New Economics of Labour Migration and the role of remittances in the
migration process. International Migration, Vol.37, No.1, pp.63-68
55
Stark, Oded and David Levhari.1982. On migration and risk in LDCs. Economic and Development
Cultural Change, Vol. 31, NO.1,pp.191-196.
56
Lucas, Rober E.B. and Oded Stark.1985 Motivations to remit: Evidence from Botswana. Journal
of Political Economy, Volume.93, NO.5,pp.901-918.
57
Stark, Oded and David Levhari.1982. On migration and risk in LDCs. Economic and Development
Cultural Change, Vol. 31, NO.1,pp.191-196.
16
remittances on migrant-sending communities as a whole, including non-migrant

households.58
NELM scholars also argued that poor people cannot be seen only as a passive
victims of global capitalist forces, but also trying
to actively
improve their
livelihoods within the constraining conditions which they live.59
58
Taylor, J. Edward, Joaquin Arango, Graeme Hugo, Ali Kouaouci, Douglas Massey and Adela
Pellegrino, 1996. International migration and community development. Population index, Vol. 62,
No.3, pp. 397-418.
59
Lieten, G.K and Olga Nieuwenhuys.1989. Introduction: Survival and emancipation. In G.K. Lieten,
Olga Nieuwenhuys and Loes Schenk- Sandbergen (eds,) Women, Migrants and Tribals: Survival
Strategies in Asia. Manohar, New Delhi.
17
Chapter 3
METHODOLOGY
3.1 Introduction
This chapter elaborates and explains the data gathering, research design,
method analysis; and area and limitations of the study.
3.2 Research Design

Theory:
The migration
pessimist: historical
structure and
dependency views
Remittance
Social Problem:
Governments
Action
Nurse Migration
Remittance
Dependency
Figure 3.1 (constructed by the researcher)
The study used qualitative approach, as John Creswell put it, qualitative
approach is fundamentally interpretative.60 Nurse migration, as social problem, is
the case in point of this study.
The Figure 3.1, demonstrates the flow of this study. The theory testing
approach is the guide for this study, which is seen by Yin as being at the heart of case
studies, begins with a theory, or a set of rival
60
theories, regarding a particular
JohnW.Creswell,ResearchDesign:Qualitative,Quantitative,andMixedMethodsApproaches,2nd
Edition(California:SagePublications,Inc.,2003),p.182
18
phenomenon.61 This study will use the migration pessimist: historical structure and
dependency views since it give a clear outline with regards to the dynamics of nurse
migration costs and benefit, and the governments dependency to remittance which
has an impact with the governments action in addressing the social problem.
3.3 Data analysis

In order to analyze the Philippines dependency on remittance, this study
used the Remittance dependency cycle62, as shown in Figure 3.2
Government
Passivity
Lessgovernment
Spendingon
welfare
More
migration
Highdependence
onremittance
Remittance
Lessinvestment
Limtedjob
creation
No
institutional
reform
Increased
consumergoods
Increased
imports
Figure 3.2 Remittance Dependency Cycle
Secondary data was used in the study. These secondary sources are gathered
through related references comprising of books, journals articles, research findings,
61
Yin,R.K.CaseStudyResearch:DesignandMethods.BeverlyHillsandLondon.,1989
VogiazidesL.(2008).TheuseofremittancesasadevelopmentstrategybytheWorldBank:Causes
andImplications.Manchester:UniversityofManchester.
62
19
articles, and documents think-tanks and from related government offices. With these
data the researcher carefully filled the items or variables in the cycle and
examined their linkages with one another.
3.4 Research Area and Limitation

This study provides information on health workers migrant, however, it
focuses only nurse migration. Nurse medics63 is not included in the study.
On the other hand, the major constraints of this study is data gathering. The
availability and quality of records and statistical problem is said to be the problem
due to the lack of records. Some offices, agencies, and institutions did not keep track
of such record and statistics as they were mandated by the central authorities.
In line with the remittances, the Philippines is not equipped with any tool in
determining whether the remittances are coming from the nurses overseas or from
other profession. However, it should be noted that nurses, doctors, engineers, among
others were sent abroad, and they now account for the bigger share of
deployments.64
And in analyzing the Governments action, the researcher singled out and
carefully scrutinizing the Magna Carta for Public Health Workers, among other laws
implemented, since its comprehensively addressed their policy issues on the quality
of life, quality of service, and motivation for the retention of health care workers
specially in the poor areas.
63
64
Doctorsturnednurses
http://www.congress.gov.ph/download/cpbd/fnfofw.pdf
20
Chapter 4
Nurse Migration
The Philippines is well known as a source country
for nurse migration.
Filipino overseas migration reflects the issue of the countrys socio-political and
economic life. Overseas migration results the loss of million and unskilled Filipino
workers to first world countries due to the limited employment opportunities and
relatively low wage in the country.
4.1 Overview of health workers migration

4.1.1
Demographic and socio-economic key indicators

The Population of the Philippines is 88.57 million (as of August 2007)65 with
an annual growth rate of 2.4 percent.66 About 39 per cent of the population is under
15 years old 67 and those aged 65 years and over are accounted for roughly 5.8
percent of the population in 2007.68
The Philippines is still mostly rural. However, urbanized areas are increasing
and offering a wide range of economic, educational, recreational and other facilities
that is for responsible for the increasing number the rural-urban migration.
Even for many Filipinos who have jobs, the situation is not ideal. One out of
every five employed workers is underemployedunderpaid, working part-time or
employed below his or her potential.69
65
http://www.census.gov.ph/data/pressrelease/2008/pr0830tx.html
Ibid.
67
http://www.census.gov.ph/data/sectordata/datalfs.html
68
Ibid.
66
69
Villalba, M.A.: Philippines: Good practices for the protection of Filipino women migrant
workers in vulnerable jobs, Working Paper No. 8 (Geneva, ILO, 2002).
21
Based on the record of the Department of Foreign Affairs, there are 7.2
million Filipino migrants all over the world.70 Deployment levels in the number of
overseas increased from just 36,035 in 1975 to 841,438 in 2000. From 1995 to 2000,
overseas deployment continued to increase by 5.32 per cent annually.
Table 4.1 Average monthly wage rates of nurses in the government sector
(in pesos)
Year
Nominal Wage
1992
3,102
1993
3,102
1994
3,902
1995
4,902
1996
6,103
1997
7,309
1998
8,605
1999
8,605
2000
9,466
2001
9,939
2002
9,939
2003
9,939
2004
9,939
2005
9,939
2005
9,939
2006
9,939
2007
10,933
2008
10,933
2009
10,933
In contrast, based on some migration researches, the monthly pay for nurses ranges
from 3000-4000 USD a month, compared to the 169 USD average pay in most cities
70
22
in the country, as seen in Table 4.1. Moreover, in rural areas, nurses received lower,
ranging from 77 to 95 USD a month.
There are a number of macro-level factors can be seen as push factors: high
unemployment rates; low wages and per capita/GNP income; deteriorating economic
conditions; scarcity of foreign exchange and institutional policies.71 In addition, at
the micro-level, factors might include personal and social factors. But, it should be
pointed out that financial concern is the main motivation for some. Push factors are
the economy of the country which does not effectively absorb all nurses; income
differentialis said to be the strongest factor influencing migration, as nurses
salaries of nurses are better overseas; and the value of the of the salary increases when
remitted to the Philippines.72
On the other hand,
the pull factors
that persuade migration are the
opportunity for all professional and personal growth, the chance for better
remuneration.
4.1.2
Stock and distribution of health workers

In the Philippines, there are nurses, midwives, dentist, doctors, and physical
and occupational therapist. Figure
4.2 reveals us that the most numerous health
worker produced are nurses and the category with the least number produced are
occupational therapist.
71
Philippine Overseas Employment Agency (POEA), 2003.
72
Dela Cuesta, R.: Filipino nurses in the United Kingdom: Analysis of their work experience,
MAN Thesis, College of Nursing, University of the Philippines, Manila, May 2002.
23
(Estimated)productionofhealthworkersannually,2004
12000
10000
8000
6000
4000
2000
0
Figure 4.2: (Estimated) production of health workers annually.

Sources:
National Statistical
Coordination Board (NSCB),
Philippine
Regulatory Commission (PRC), and Commission on Higher Education.
Table 4.3:
Regional Distribution of Health Human Resources Employed in
the
Government Sector: Philippines 2002
Health Human Resources in Government

Region
CAR
Doctors
Dentists
Nurses
Midwives
85
33
159
579
658
540
745
1,165
158
96
203
1033
175
58
267
801
297
161
382
1,573
350
256
648
2,282
CordilleraAdministrative Region
NCR
National Captital Region
Region 1
Ilocos Region
Region 2
Cagayan Valley
Region 3
Central Luzon
Region 4
24
CALABARZON & MIMAPORA

Region 5
190
85
338
1,026
226
112
433
1,791
229
115
379
1,473
153
109
233
887
90
55
196
675
99
71
189
803
79
71
161
791
84
32
158
671
79
54
130
613
69
23
99
371
3,021
1,871
4,720
16,534
Bicol Region
Region 6
Western Visayas
Region 7
Central Visayas
Region 8
Eastern Visayas
Region 9
Zamboanga Peninsula
Region 10
Northern Mindanao
Region 11
Davao Region
Region 12
SOCCSKSARGAN
Region 13
CARAGA
ARMM
Autonomous Region of Muslim
Mindanao
Total
Table 4.3 shows that most medical technologist, midwives and baranggay
health workers worked in the rural areas whereas the physical and occupational
therapist are mostly worked in the rural areas. Given this, it is clear that inequality
in the distribution of health workers in the Philippines.
According to the Department of Health, the Philippines produced 337,939

registered nurses from 1991 to 2000.73 This was about 400 times the number of
nurses produced in the 1907s.74 The manning of nurses in domestic health facilities
was broken down as follows in 2000:
73
74
Department of Health (DOH) records, 2001.

Ibid.
25
17, 547 in various government agencies;
7,535 in privately run health facilities;
2,078 in nursing educational institutions.75
However, in 2001 estimate, the demand for Filipino nurses consisted of 178,
045 positions in local and international markets.76 Of these, 150, 865 jobs or 84.75
percent were attributed to the international market while only 27, 160 or 15.25
percent were demanded in the domestic market.77
4.1.3
Nurse
migration and global nursing
shortage
The outflow of health workers can be classified
by both temporary and
permanent migration. There is an almost equal ratio between those who migrate on a
permanent or temporary basis.
In the 1970s, there were almost 40,000 registered nurses in the Philippines,
but by the end of 1998 this total had increased to approximately 306,000.78
Nurses have said to be the most impacted by the health workers migration
because of the global nursing shortages. Highly publicized shortages in first world
countries and other nations up to 2020 have stimulated very high interest in nursing
education and nursing recruitment.
75
Ibid.
Corcega, T. Nurse Supply and demand in the Philippines, The UP Manila Journal, 2002, Vol. 5,
No.1.
77
Ibid.
78
Corcega, T. Nurse Supply and demand in the Philippines, The UP Manila Journal, 2002, Vol. 5,
No.1.
76
26
16000
No.ofFilipinoOverseas
14000
12000
10000
8000
6000
4000
2000
0
Figure 4.4: Nurse Outflow, 1992-2009
Recent data from the POEA, as shown in Figure 4.4, that in 2006 alone, the
Philippines had deployed 13,524 nurses. This numbered were considered by the
POEA to represent an unusually high demand and can be explained
that it was
during 2000 to 2004 that the high demand for nurses in the United Kingdom put
together with the deployment in the Netherlands and other European countries, and
the United States.
As shown in Figure 4.5 the top three destination countries of Filipino nurses
for the last decade comprises of Saudi Arabia, the United States, and the United
Kingdom. Libya, United Arab Emirates, Ireland, Singapore, Kuwait, Qatar, and
Brunei are also said to be a preferred destination.79
Saudi Arabia accounts for 57
per cent of all Filipino nurse deployment while the US and UK have 14 percent
and 12 per cent of the Filipino nurse deployment.
According to the Trade Union Congress of the Philippines (TUCP), the

countrys biggest labor federation, in 2007 over 21,000 new Filipino nurses sought a
job in the United States.
79
POEA 2003
27
Also, Trade Union of Congress of the Philippines (TUCP) spokesperson

Alex Aguilar said a total of 21,499 Filipinos took the US National Council Licensure
Examination (NCLEX) for nurses for the first time (excluding repeaters) from
January to December 2007.
The Philippines topped the five countries with the most number of nationals
taking the
NCLEX for the first time in 2007. India came second, with 5,370
examinees; followed by the South Korea, 1,906; Canada, 888; and Cuba, 673.
Moreover, traditional markets such as the Middle East still continue to demand
high numbers of skilled nurses. On the other hand, new markets such as Europe and
Japan have started to emerge as a possible destination.
50000
45000
40000
35000
30000
25000
20000
15000
10000
5000
0
47596
11468
10265
2955
2760
2749
2228
1901
664
69
Figure 4.5: Leading Destination Countries of Deployed Filipino Nurses,

1992- July 2003
4.2
Cost of Migration
As most labor migration literature would often concluded, the receiving country
benefits from migration as it provides much-needed labor when there is scarcity of
jobs. On the other hand, the source county of origin
28
relies on labor migration to
lessen unemployment rate and receives hard currency
through remittances and
benefits.
Migration
can have
diverse
negative effects on source countries.
An
excessive loss of domestic labor, is said to be, can lead the brain drain of young,
highly skilled labor, a depletion of the work force and a severe reduction in the
availability and quality of services. If only less skilled workers remain in a country,
this can lead to
a reduction in productivity
which might restrict economic
development.80
In the case of Filipino nurses, concerns are also rising about the shortage of
skilled and experienced nurses. Most if the recent graduates who are still in the
Philippines are relatively unskilled and inexperienced, and go overseas after a year or
two after gaining experience.
This poses serious implications for the quality of
health care that they provide.
The international standard for the ideal ratio of nurses to patients in hospital is
1:4 but due to the exodus, the situation became even more undesirable. According to
Dr. Jaime Galvez Tan, the Philippine General Hospital, the leading sate in the
country, the ratio to patients averages from 1:15 up to 1:25.81 In Davao de Sur and
in most other public hospitals, the ratio would even reach 1:50 up to 1:100.82 In even
worse condition, in the Don Susano Rodriguez Memorial Medical Center, integrated
as the psychiatry department of the Bicol Medical Center in Naga City, Albay, a
nurse has to attend to more than 300 in-house mentally-ill patients.
Aside from the patient overload, nurses and doctors also work extended duty
hours.
In urban centers with 100-bed capacity is said to be 40 hours a per week.
Then again, health workers work 56 hours a week and sometimes mandatory 16
hours straight a day whenever there is no reliever.
80
Findalay, A. and Lowel, L.: Migration of highly skilled persons from developing countries: Impact
and Policy Responses. International migration Papers, No. 43. (Geneva, ILO).
81
Dr. Jaime Galvez Tan, Former Undersecretary of the DOH, 2006.
82
Ibid.
29
The undesirable working conditions, as the result of the nurse migration, has
become a push factor for nurses who were left behind.
4.3
Governments action
4.3.1
The Magna Carta for Public Health Workers of

1992 embodied in RA 7305
4.3.1.1
Overview of the Magna Carta
The Magna Carta for Public Health Workers of 1992 was a pioneering
legislation that attempted to comprehensively address the policy issues on the
quality of life, quality of service, and motivation for the retention of health care
workers especially in remote and poor areas.
The law hoped to provide benefits for all health workers as defined:
Health workers shall mean all persons who are engaged
in health and
health-related work, and all persons employed in hospitals, sanitaria, health

infirmaries, health centers, rural health units, baranggay health stations,
clinics and other health related establishments owned and operated by the
Government of its political subdivisions with original charters and shall
include medical allied professionals, administrative,
and support personnel employed regardless of their employment statues.
(Section 3)
The Congress passed the law to give health workers increased benefits
through two mechanisms: outright, across-the-board salary increases for all rural
doctors, and laundry and subsistence allowances for all other health workers.
Over a five-year period, the DOH was also authorized to increase other
benefits such as medico-legal fees, overtime pay, hazard pay and hardship allowances
for health workers laboring under difficult circumstances.
30
Under the law, the DOH would set up a mechanism for managing health
worker and management issues through multi-level consultative councils. The law
also provided a code of conduct by health workers, with penalties and violations.
By 1997, a national consultative council had been in operation for three years,
but local government participation in the consultative process remained poor or, in
some cases, only token in nature. During its early years of implementation, it was
clear that if implemented, the magna carta would create the highest paid sectoral
workforce in the Philippines civil service.
4.3.1.2 DOHs dilemma

The law overlaps with the decentralization of public health services to the
local government which quickly brought things to a head. Would local governments
agree to implement the law once the transfer of health workers had occurred the
consequences of the transfer.
The civil service in the Philippines covers all government workers in national
and local agencies. But the salaries in local governments are up to thirty percent
lower than their national counterparts. Salaries in local governments are tied to the
income classification of their local governments who are classified from 1st to 6th
class. One could readily anticipate the difficulty of running local government which
would have to implement two salary scales. It was particularly infuriating that the
newcomers, would be getting nationally pegged, higher salaries.
As the DOH started to implement the Magna Carta before the actual transfer,
local governments quickly realized that health workers in particular would be
transferring with salaries even higher than most other government workers. In 1993,
transferred health workers were the highest paid workers in the civil service (for their
salary grade, which had only recently been standardized for national agencies).
31
When the implementers of the LGC went around the country in early 1993,
mayors regularly confronted them with the realization that the rural doctors would be
getting higher salaries. Only a directive from President Ramos in June 1993, ordering
the
implementation of the LGC, could persuade the most difficult mayors and
governors to accept the transfer. By the end of 1993, the transfer was complete and
only 217 out of 45,000 health workers were rejected by local governments for reasons
of redundancy.83
The DOH realized in the 1992, that the lack of funds would hinder the
implementation of Magna Carta, therefore the health secretary
ordered that the
implementation of the benefits would be phased over the past five years, upto 1997.
4.3.1.3 Implementing national benefits in local governments

After
the transfer, the health workers continued to appeal to the DOH for
their benefits initially granted in 1992, consisting of the subsistence allowance and the
laundry allowance.
Both allowances totaled 1,000 pesos (around USD 35), about one-tenth of the
average health workers salary. Rural doctors were more persistent, particularly
because their benefits were more substantial, which included a salary increase
(roughly a 30% increase, from P7,000
to P10,125) and representation and
transportation allowances (P2,200).
Other benefits like hazard, overtime, medico-legal and on-call pay were
deemed for later implementation. Local governments would raised a protest about
arbitrary increases in health worker benefits during the period of transition.
As most local government units (LGUs) felt that the Magna Carta was an
imposition by national government (an unfunded mandate), magna carta benfits
were given lower priorities in their budgets.
Local officials also readily gave
83
DepartmentofHealth.BulletinonDevolutionNo.9,October15,1993.
32
certifications that they were short of funds and therefore eligible for augmentation
funds from the DOH.
4.3.1.4 Unintended consequences

During the
first two years of implementation of the magna carta, many
agencies thought of it as the DOHs problem, but soon they realized that the health
workers are present in most government agencies outside DOH. The phenomenon of
health-related agencies also quickly proliferated, to qualify for Magna Carta.
When hazard pay was implemented for health-related reasons, more agencies
clamored to have their offices certified as hazardous. The DOH created a hazard
evaluation committee for this purpose in 1995, headed by an assistant secretary to
give it importance. Non-payment of hazard pay became the cause of demonstrations
in some hospitals in Manila.
These incidents provided impetus for the national government to implement

another round of salary standardization increases for all workers. While the initial
round of salary increases was meant to keep government pay competitive with the
private sector, this second round was partially attributable to the impact of Magna
Carta was having on most government workers.
The unabated clamor of health workers for their lost benefits led to development
of a series of interlocking augmentation funds coming from national government to
assist local governments in paying magna carta benefits. The national government
imposed a policy that would annually reduce the level of support, by the 1997 the
local governments would have to shoulder the entire amount for magna carta.
Table 4.6 Level of National and Local share for Magna Carta
Year
National
Million Peso
1993
423.0
Local
Million Peso
100.00
33
Total
%
(million Peso)
0
423.0
1994
662.0
100.00
662.0
1995
400.4
54.74
331.0
45.26
731.4
1996
434.9
32.12
496.5
67.88
731.4
1997
69.4
9.49
662.0
90.51
731.4
However, by December 1994, President Ramos, facing a different election

in the following year, decreed that no new benefits for Magna Carta would be
allowed until t the LGUs could bear the financial cost. Ramos effectively frose the
benefits to those being implemented to that year. This was met by dismay by the
health workers who expected that 1995 would be the year when hazard pay would be
implemented with an accompanying 10-20% salary increase. Ramos mitigated the
blow by announcing a 50 million Pesos augmentation fund for devolved health
workers.
The DOH also committed its savings at the end of every year as a fund to
further augment salaries as a measure of solidarity with its former colleagues in the
national agency.
Surveys in the past two years indicate that the policy may be working: the
level of implementation by local governments has increased from 73% in 1995 to
77% in 1996. Support for salary standardization has also been increasing to 83% in
1996.84
The level of dissatisfaction is still pronounced among devolved health workers

because relatively few municipalities are able to fully implement either Magna Carta
or salary standardization.
The level of frustration has also increased among local governments who are
now asking that the devolved workers be supported by the national government. If the
84
Local Government Assistance and Monitoring Service, Department of Health. Report from the
Quick Response System Group. Manila Department of Health, 1997.
34
national government is unable to do so, they contend, the national agencies should
find a way to get them back.85
The more discerning local executives, however, are beginning to ask questions
aboutthe budgets of national agencies and the sources of support for salary increases
that areavailable for national agencies but closed to local governments.
Local governments are increasingly moving away from the position of

absolute autonomy that was apparent in the early years of decentralization into
agreements to coordinate with national agencies.
Lost in the debate of providing for health worker benefits is the fact that
benefits for health workers are only half the story of the Magna Carta: the law also
provides for a Code of Conduct for Public Health Workers. The Code of Conduct
discusses the values that a health worker must adopt as well as a set of duties and
obligations to the community, the clientele, co-workers and to the government86
Some health workers have brought some local executives (mayors, governors)
to court for non-payment of benefits with varying degrees of success. In other areas,
an interagency committee (Regional Transition Action Team, RTAT), created in the
post-devolution period to mediate disputes between local governments and devolved
workers, has had an impact in helping health workers get their benefits.
The year 1997 has seen increased efforts by many sectors to review the LGC
and provide amendments. The experience of the health workers in the implementation
of Magna Carta inevitably is discussed in the context of compensation for local
officials.
As a result, Many health workers, mostly public, were disappointed to this

policy.
The policy should bring about the greater satisfaction on the job and
consequently
facilitating
retention of public health workers. However, due to
85
Ibid.
DepartmentofHealth.Implementing Rules and Regulations/Code of Conduct for the Magna Carta
for Public Health Wokers (R.A. 7305).Manila:DepartmentofHealth,1992.
86
35
implementation problems it causes a wider health worker dissatisfaction and fueled

the increase of both domestic and international migration.
The Magna Carta for Public Health Workers was poorly implemented since it
overlaps with the decentralization of public health services to the local governments
in 1995.
The responsibilities of implementation was transferred from the national
government to the local governments who were then mandated to grant that law
provided for. Many local governments does not have enough budget and could not
simply afford to pay these benefits. Moreover, Many local officials showed no
political will to
enforce the law since they feared
that
law may generate
compensation imbalance across different categories if local government workers

who had no comparable benefits.
Some
provinces implemented the law while others did not which
consequently led to a general dissatisfaction among health workers who did not
benefited from the Magna Carta. As observed many health workers transferred to
national health department offices or to private sector from the municipal and
provincial health system
and, as expected, ended in migration abroad.
consequence, this result to the deterioration of health services.
36
As a
Chapter 5
Remittance Dependency Cycle
We intend to take care of [Filipino nurses] but was we encourage
this migration, I repeat, we will now encourage the training of all nurses
because as I repeat, this is a market that we should take advantage of.
Instead of stopping the nurses from going abroad why dont we produce
more nurses? If they want nurses we produce a thousand more.
-President Ferdinand Marcos, 197387
Migrant remittances and savings represent the most direct and measurable
benefits of international migration in migrant sending countries. Evidence indicates
that they contribute directly and indirectly
to income
in remittance-receiving
households and that this income contribution may be substantial.
Declining remittances heavily affect developing countries. Nevertheless, even

when available, remittances should not be considered as a sustainable development
strategy. This chapter is allotted in discussing, as argued, the Philippines dependency
in remittance.
After India, the Philippines alongside with China and Mexico is the biggest
remittance recipient-countries worldwide. According to Bangko Sentral ng Pilipinas
the net remittance of overseas Filipinos in 2006 amounted to US$ 13.4 billion.88
This numbers includes remittances through formal channels, such as banks, and other
informal ways such as courier services. These monies, which represented a large
portion of the national income- 10 per cent of the Gross National Product (GNP) in
the last five years and have fueled domestic consumption, economic growth and
boosted the local currency to a four-year high against the U.S dollars.
87
Choy,C.C.(2003)EmpireCare:NursingandMigrationinFilipinoAmericanHistory.Durham,NC:
DukeUniversity
88
Bangko Sentral ng Pilipinas (2006)
37
20,000
18,000
16,000
14,000
12,000
10,000
inUS$Billion
8,000
6,000
4,000
2,000
0
2001
2002
2003
2004
2005
2006
2007
2008
2009
Figure 5.1: Remittances, 2001-2009

http://www.bsp.gov.ph/Statistics/keystat/ofw.htm
Moreover, according to Labor Secretary Marianito Roque overseas Filipino

workers remittances will likely to hit the record of US$ 18 billion this year, with
the bulk inflows coming from the United States, Canada, Saudi Arabia, United
Kingdom, Japan, Singapore, United Arab Emirates, Italy and Germany.89
Remittances also serve as a major source of foreign exchange earnings or

currency inflows
that result
in significant reduction in princes of imported
necessities like oil, food, and farm products.90
89
www.ofwngayon.com/?tag=overseasemployment
Opiniano, J. (2004). Our Future Beside the Exodus: Migration and Development Issues in the
Philippines.
90
38
18
16
14
12
10
NetFDIas%GDP
remittanceas%ofGDP
6
4
2
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
Figure 5.2 remittance as percentage of GDP and FDI
At the micro level, the favorable effects of remittances on
the overseas
workers income and savings are enormous. Most research conducted concluded that,
these remittances have sent children and siblings to reputable schools, paid for
relatives medical needs, built decent houses, and acquired appliances.
A recent
study concluded that educational expenditure in origin households increased with

remittances.91
Remittances have become a measure of the economic condition of OFWs and

their families. A national survey found that an increasing number of Filipino families
survived on income from abroad.92 Such money flows into the Filipino homes have
consequently resulted in a lower incidence of poverty in certain regional grouping. In
year 2000, the National Capital Region, which had the lowest poverty incidence
among all Philippine regions (5.7 per cent), had the bulk of families receiving cash
gifts or assistance abroad.93 According to the Asian Development Bank estimates, in
2006, remittances maintained 4.3 million people out of poverty in the Philippines.94
91
Yang, Dean. 2004. International Migration, Human Capital, and Entrepreneurship: Evidence from
Philippine Migrants Exchange Rate Shocks, University of Michigan, Ann Arbor.
92
National Statistics Office (2003).
93
NSO (2002). 2000 Family Income and Expenditures Survey
94
Balea 2009
39
However, such of remittances
does not create many jobs which would
boost incomes and possibly prevent new migration flows. And in the case of Filipino
nurses, many perceived that the scale of deployment of Filipino nurses abroad is
mainly due to unavailable nursing positions in the country. Many nurses currently
working in the system as volunteers or casuals without any permanent plantilla
positions. The positions do not provide benefits such as health insurance and security
tenure and are considered exploitative.95 Migrante International has pointed out that
if public nurses were be given positions in local government units, and these were
divided by the total population and number of baranggays, a substantial number if
additional nursing positions could be added to the present demand. This would result
in a more favorable nurse to population ratio of one nurse every 16,723 Filipinos and
approximately one nurse for nine baranggays.96
The income
remittance- receiving
provided by remittances may also absolve

countries
from their responsibility
governments in
to develop long-term
economic and social policies to address poverty and inequality, which are the main
causes of emigration.97 From an economic perspective, Glytsos explained that the
comfortable finance of deficits by remittances relaxes governments from adopting
long-term economic policies for changing the structure of the economy to make it
more competitive against the rest of the world.98 Thus, high remittance flow might
relax governments from investing in the areas of social
and welfare provision,
especially as remittances are often higher than social spending.
For example, the Philippines national health care spending continued to

increase in nominal terms but there was a decline in the percentage share of total
government on health. The total health expenditure of the country reached Php
180.8 billion in 2005, growing at a slower rate of 9.4 percent compared to 11.9
percent in 2004. The share of health expenditure to GDP was lower at 3.3 percent in
95
Opiniano, J.: Health experts, nurse call for policies to curb effects of migration on
localhealth system., OFW Journalism Consortium, Apr. 2003.
96
Opiniano, J.: Health experts, nurse call for policies to curb effects of migration on localhealth
system., OFW Journalism Consortium, Apr. 2003.
97
Philipps, N. (2009). Migration as development strategy? The new political economy of
dispossession and inequality in the Americas. Review of International Political Economy, 16(2):231259.
98
Glystos, N. (2002). The Role of migrant remittances in development: Evidence from
Mediterranean countries. International Migration, 40(1):1-25
40
2005 and still below the 5 percent standard set by the World Health Organization
(WHO) for developing countries. On the other hand, the share health expenditure to
GNP remained at 3.1 percent which is within the National Objective for Health
(NOH) target of 3-4 percent.
Subsequently, the share of government on health expenditure declined to 29

percent which is below the target of 40 percent
based on Health Sector Reform
Agenda (HSRA). Also. The governments target to depend less on out-of pocket
payments and provide more social health insurance is still far from being realized as
the share of out-of-pocket payments even increased to 49 percent while the share of
social insurance payments increased only slightly to 11 percent in 2005. Based on
the HSRA, the target for out- of- pocket is 20 percent while the target for social
insurance is 30 percent.
Moreover,
as discussed in the previous chapter,
the share of
local
governments in health expenditures has increased has increased right after the
devolution. However, the LGUs are spending less than what the national government
used to spend for local health services before the devolution. Such reduction in
spending in health resulted to a marked decline in the quality of health services.
A countrys dependency, like the Philippines, on remittances can
easily
become a vicious cycle as reductions in public spending may lead to more

migration and thus more remittances. 99 As shown, in the previous chapters, the
decision to migrate may be motivated by poor welfare coverage, as well as few
employment opportunities, resulting to the passivity
of the government. Lack of
employment opportunities are aggravated by the fact that remittances are primarily
spent on the consumption
rather than invested
productively. To sum up, high
reliance on remittances fuels government passivity and hampers private investment,

which in turn, affects the labor market and leads to more migration and, thus more
remittances.
99
Hernandez, E. and Coutin, S.B (2006). Remitting subjects: Migrants, money and states. Economy
and Society, 35(2):185-208.
41
Chapter 6
Conclusion and Recommendations
Migration of Filipino workers is characterized by short-term or long term
migration. Moreover, migration is said to be beneficial as it improved the quality of
life and secured the feature of the health workers migrants and their family and
boosting the countrys economy. In the light of the countrys weak economy which
is unable to provide sustainable employment to those in age productive group this is
said to be a very important benefit. Moreover, according to the
World
Bank-
commissioned paper:
Overseas Filipino work in dozens in foreign countries which experienced

sudden changes in exchange rates
due to the 1997 Asian Financial Crisis.
Appreciation of a migrants currency against the Philippine peso leads to increase

in household remittances
received from overseas. The
estimated elasticity of
Philippine peso remittances with respect to the Philippine/foreign exchange rate is

0.60. In addition, these positive income shocks lead to enhanced human capital
accumulation and entrepreneurship in origin household. Favorable migrant shocks
lead to a greater child schooling, reduced child labor, and increased education
expenditure in origin households. More favorable exchange rate shocks also raise
hours worked in self employment and lead to greater entry to relatively capitalintensive enterprise by migrants origin household.100
The issue of losses from nurse migration conclusive, the health care system
was more fragile as a result of rapid turnover and permanent loss of skilled and
experienced health workers.
While remittances do contribute to poverty reduction,
they should not be
seen as a solution for development. The Philippine Governments should seek to

break the cycle of remittance dependency by ensuring good welfare coverage and
100
Yang, D.: International migration, human capital and entrepreneurship: Evidence from Philippine
migrants exchange rate shocks (Washington DC, World Bank, 2005).
42
a secure investment climate. This would allow
remittances
to be increasingly
invested in the local economy which would generate more jobs and decrease the
pressure to migrate.
The promotion of remittances should be only one part of a
countrys development
strategy, accompanied by states policies
aimed at
guaranteeing effective public services, such as health and education, improving

social security, and making the country safe for investment.
The
weaknesses
inherent in development strategies based on remittances have come to light as a result

of the current economic downturn. The Philippine Governments should also put
forward the development benefits of migration and remittances in international
arenas, such as the WTO and UN meetings.
closely cooperate with
In addition, the Government should
the source countries
to ensure respect for migrants
fundamental rights.
Drawing from the issues and main knowledge a

recommended
by
this study may affect migration
production and utilization, and public sector
policy
framework
patternsnamely
rational
personnel compensation and
management strategies.
1. The need to ensure that government policies and programs are brought
together
into a coherent
health
worker
migration policy.
The active
participation of the private sector is highly encouraged in transforming

national policies into action.
2. Health organizations such as the Philippine Nurses Association (PNA),

Philippine Hospital Association (PHA), Philhealth,
Philippine Medical
Association (PMA), in cooperation with professional and regulatory bodies

such as the Board of Nursing, should police to avoid domestic work-related
exploitation.
3. The implementation of National Health Service Act (NHSA), that call upon
graduates, specifically from the state-run health science schools, to serve in
the Philippines for 2 years before they leave the country. The practice of
requiring recent graduates to give years of service in return for their training
43
has been adopted
by the developing economies. In Ghana, for example,
doctors have to give 5 years of service to their country to defray the costs of
training or pay a fine if they do not comply. Moreover, developed countries
like Singapore also maintain bonds as a prerequisite
for medical graduates
going overseas on government grants for further training.101
4. Extension of the Philippines (sending country) tax authority to migrants

living outside the home country. This migration policy came a proposal from
a trade economists Jagdish Bhagwati. Bhagwati argued that the country of
ones citizenship represents all its citizens and therefore citizens who avoid
paying taxes by virtue of emigration are beneficiaries
of representation
without taxation. This form of claim certainly lowers the bar in terms of
arguments against a Bhagwati tax, leaving only the admittedly difficult task
of specifying how such tax could be effectively and fairly administered.
Moreover, this issue of fairness and feasibility have always been a problem
for the solution like Bhagwati tax, nevertheless they are not unachievable.
101
GFMD(2007)Highly Skilled Migration: Balancing Interests and Responsibilities.GlobalForumon

MigrationandDevelopment,Brussels.
44
Bibliographies
Books
Castles, S. and Miller, M.J.2003. The Age of Migration: International Population
Movements in the Modern World, 3rd ed. New York: Guilford.
Massey, Douglas S., Joaquin Arango, Graeme Hugo, Ali Kouaouci, Adela Pellegrino
and J.
Edward Taylor.1998. Worlds in Motion: Understanding International
Migration at the end of the Millennium. Clarendon Press, Oxford.

Periodicals
Almeida, Carlos C. 1973, Emigration, espace et sous-development. International
Appleyard, Reginald. 1989. Migration and development: Myths and reality
International Migration, Vol. 23, No.3, pp. 486-499.
Buchan, J., International Recruitment of Nurses: United Kingdom Case Study, report
for WHO and International Council for Nurses and the Royal College of Nursing
(Geneve, 2002)
Cooper, R.A., 2005. Physician Migration: A challenge for America, a Challenge for
the World, Journal of Continuing Education in the Health Professions, 08941912
Corcega, T. Nurse Supply and demand in the Philippines, The UP Manila Journal,
2002, Vol. 5, No.1.
Corcega,T.,F.M.Lorenzo,J.Yabes,B. De la Merced, and K. Vales. Nurse Supply and
Demand in the Philippines. The UP Manila Journal 2000;5 1: 1-7
Dovlo, D. and F. Nyonator, Migration by Graduates of the University of Ghana
Medical School: A Preliminary Rapid Appraisal, Human Resources for Health
and Development Journal, 3/1 (1999): 40-51
Dr. Jaime Galvez Tan, Former Undersecretary of the DOH, 2006.
Dumont, J.C. and J.B. Meyer, the International Mobility of Health Professionals: An
Evaluation and Analysis Based on the Case of South Africa, in Trends in
International Migration: 2003 SOPEMI Edition, OECD (Paris,2004)
45
Durand, J., W Kandel, E.A. Parrado and D.S. Massey.1996a. International migration
and development in Mexican communities. Demography,Vol.3,No. 3,pp.313330.
Entzinger, Han. 1985.Return Migration in Western Europe: Current policy trends
and their implications, in particular for the second generation. International
Findalay, A. and Lowel, L.: Migration of highly skilled persons from developing
countries: Impact and Policy Responses. International migration Papers, No. 43.
(Geneva, ILO).
Glystos, N. (2002). The Role of migrant remittances in development: Evidence
from Mediterranean countries. International Migration, 40(1):1-25
Hagopian, A., MJ Thompson, M. Fordyce, K.E.Johnson and L.G. Hart, The
Migration of Physicians from Sub- Saharan Africa to the United States of America:
Measure of the Afrcan Brain Drain, Human Resources for Health, 2/17 (2004).
Hernandez, E. and Coutin, S.B (2006). Remitting subjects: Migrants, money and
states. Economy and Society, 35(2):185-208.
International Labour Organization (1997-2002), Economically Active Population,
1950-2010 (Geneva:ILO)
Lieten, G.K and Olga Nieuwenhuys.1989. Introduction: Survival and emancipation.
In G.K.
Lieten, Olga Nieuwenhuys and Loes Schenk- Sandbergen (eds,) Women, Migrants
and Tribals: Survival Strategies in Asia. Manohar, New Delhi.
Lucas, Rober E.B. and Oded Stark.1985 Motivations to remit: Evidence from
Botswana. Journal of Political Economy, Volume.93, NO.5,pp.901-918
Martineau,T.,K. Decker and P. Bundred, Briefing Note on International Migration of
Health Professionals: Levelling the Playing Field for Developing Country Health
Systems (Liverpool School of Tropical Medicine, 2002).
Opiniano, J.: Health experts, nurse call for policies to curb effects of migration on
localhealth system., OFW Journalism Consortium, Apr. 2003.
46
Papademetriou, Demetrios G. 1985. Illusions and reality in international migration:

Migration and development in post- World War II Greece. International
Migration, Volume. 23, No.2, pp.211-223.
Penninx, Rinus. 1982 A critical review of theory and practice: the case of Turkey.
International Migration Review, Vol.16, No.4, pp. 51-72
Philippine Hospital Association Newsletter, November 2005.
Philipps, N. (2009). Migration as development strategy? The new political economy
of dispossession and inequality in the Americas. Review of International
Political Economy, 16(2):231-259.
Rebullida, Ma. Lourdes G. and Lorenzo, Fely Marilyn E., Health Human Resource
Development: Policies and Effects on the Health Professions. Monograph
National Institutes of Health, University of the Philippines, Manila 2002.
Rubenstein, H.1992. Migration, development and remittances in rural Mexico,
International Migration, Vol. 30, No.2, pp. 127-153.
Russel, Sharon Stanton.1992,Migrant remittances and development Vol. 30, No.3/4,
pp. 267-288.
Stark, Oded and David Levhari.1982. On migration and risk in LDCs. Economic
and Development Cultural Change, Vol. 31, NO.1,pp.191-196.
Tadoro, Michael P. 1969. A model of labor migration and urban unemployment in
less-developed countries. American Economic Review, Vol. 59, No.1, pp. 59-68
Taylor, J. Edward, Joaquin Arango, Graeme Hugo, Ali Kouaouci, Douglas Massey
and Adela Pellegrino, 1996. International migration and community
development. Population index, Vol. 62, No.3, pp. 397-418.
Taylor, J.Edward. 1999.The New Economics of Labour Migration and the role of
remittances in the migration process. International Migration, Vol.37, No.1,
pp.63-68
Villalba, M.A.: Philippines: Good practices for the protection of Filipino women
migrant
47
Villalba, M.A.C.2002.Philippines: Good Practices for the Protection of Filipino

Women Migrant Workers in Vulnerable Jobs. Working Paper No.8. Geneva:
International Labour Office, February 2002.
Vujijic, M., P. Zurn, K. Diallo, O. Adams, and M. Dal Poz, the Role of Wages in
Slowing Migration of Health Care Professionals from Developing Countries,
Human Resources for Health Journal (2004).
WHO, Recruitment of Health Workers from the Developing World, WHO Executive
Board Document (Geneva, 2004a)
World Health Organization.2006.Working Together. World Health Report
Yang, Dean. 2004. International Migration, Human Capital, and
Entrepreneurship: Evidence from Philippine Migrants Exchange Rate Shocks,
University of Michigan, Ann Arbor.
Documents
Commission on Higher Education (CHED).2006 List of Nursing Schools and Permit
Status
Department of Health (DOH) records, 2001.
Philippine Overseas Employment Agency (POEA), 2003.
Professional Regulations Commission (PRC), Nurse Licensure Examination
Performance by School and Date of Examination, 2005.
Vogiazides L. (2008). The use of remittances as a development strategy by the
World Bank: Causes and Implications. Manchester: University of Manchester.
Internet
http://www.census.gov.ph/data/pressrelease/2009/lf0903tx.html
http://www.census.gov.ph/data/pressrelease/2008/pr0830tx.html
http://www.census.gov.ph/data/sectordata/datalfs.html
http://www2.doh.gov.ph/bhfs/hosp/provcitgovthosp2005.pdf
48
APPENDIX:
REPUBLIC ACT NO. 7305
THE MAGNA CARTA OF PUBLIC HEALTH WORKERS
SECTION 1. Title. - This Act shall be known as the "Magna Carta of Public Health
Workers."chan robles virtual law library
SEC. 2. Declaration of the Policy. - The State shall instill health consciousness among
our people to effectively carry out the health programs and projects to the government
essential for the growth and health of the nation. Towards this end, this Act aims:
(a) to promote and improve the social and economic well-being of the health workers,
their living and working conditions and terms of employment;
(b) to develop their skills and capabilities in order that they will be more responsive
and better equipped to deliver health projects and programs; and
(c) to encourage those with proper qualifications and excellent abilities to join and
remain in government service.
SEC. 3. Definition. - For purposes of this Act, "health workers" shall mean all persons
who are engaged in health and health-related work, and all persons employed in all
hospitals, sanitaria, health infirmaries, health centers, rural health units, barangay
health stations, clinics and other health-related establishments owned and operated by
the Government or its political subdivisions with original charters and shall include
medical, allied health professional, administrative and support personnel employed
regardless of their employment status.
SEC. 4. Recruitment and Qualification. - Recruitment policy and minimum
requirements with respect to the selection and appointment of a public worker shall be
developed and implemented by the appropriate government agencies concerned in
accordance with policies and standards of the Civil Service Commission: Provided,
That in the absence of appropriate eligibles and it becomes necessary in the public
49
interest to fill a vacancy, a temporary appointment shall be issued to the person who
meets all the requirements for the position to which he/she is being appointed except
the appropriate civil service eligibility: Provided, further, That such temporary
appointment shall not exceed twelve (12) months nor be less than three (3) months
renewal thereafter but that the appointee may be replaced sooner if (a) qualified civil
service eligible becomes available, or (b) the appointee is found wanting in
performance or conduct befitting a government employee.chan robles virtual law
library
SEC. 5. Performance Evaluation an Merit Promotion. - The Secretary of Health, upon
consultation with the proper government agency concerned and the ManagementHealth Workers Consultative Councils, as established under Section 33 of this Act,
shall prepare a uniform career and personnel development plan applicable to all public
health personnel. Such career and personnel development plan shall include
provisions on merit promotion, performance evaluation, inservice training grants, job
rotation, suggestions and incentive award system.
The performance evaluation plan shall consider foremost the improvement of
individual employee efficiency and organizational effectiveness: Provided, That each
employee shall be informed regularly by his/her supervisor of his/her performance
evaluation.
The merit promotion plan shall be in consonance with the rules of the Civil Service
Commission.
SEC. 6. Transfer or Geographical Reassignment of Public health Workers.
(a) a transfer is a movement from one position to another which is of
equivalent rank, level or salary without break in service;
(b) a geographical reassignment, hereinafter referred to as "reassignment," is a
movement from one geographical location to another; and
(c) a public health worker shall not be transferred and or reassigned, except
when made in the interest of public service, in which case, the employee
concerned shall be informed of the reasons therefore in writing. If the public
health worker believes that there is no justification for the transfer and/or
50
reassignment, he/she may appeal his/her case to the Civil Service Commission,
which shall cause his/her reassignment to be held in abeyance; Provided, That
no transfer and/or reassignment whatsoever shall be made three (3) months
before any local or national elections: Provided, further, That the necessary
expenses of the transfer and/or reassignment of the public health worker and
his/her immediate family shall be paid for the Government.c
SEC. 7. Married Public Health Workers. - Whenever possible, the proper authorities
shall take steps to enable married couples, both of whom are public health workers, to
be employed or assigned in the same municipality, but not in the same office.
SEC. 8. Security of Tenure. - In case of regular employment of public health workers,
their services shall not be terminated except for cause provided by law and after due
process: Provided, That if a public health workers is found by the Civil Service
Commission to be unjustly dismissed from work, he/she shall be entitled to
reinstatement without loss of seniority rights and to his/her back wages with twelve
percent (12%) interest computed from the time his/her compensation was withheld
from his/her up to time of reinstatement.
SEC. 9. Discrimination Prohibited. - A public worker shall not be discriminated
against with regard to gender, civil status, civil status, creed, religious or political
beliefs and ethnic groupings in the exercise of his/her profession.
SEC. 10. No Understaffing/Overloading of Health Staff. - There shall be no
understaffing or overloading of public health workers. The ratio of health staff to
patient load shall be such as to reasonably effect a sustained delivery of quality health
care at all times without overworking the public health worker and over extending
his/her duty and service. Health students and apprentices shall be allowed only for
purposes of training and education.
In line with the above policy, substitute officers or employees shall be provided in
place of officers or employees who are on leave for over three (3) months. Likewise,
the Secretary of Health or the proper government official shall assign a medico-legal
officer in every province.
51
In places where there is no such medico-legal officer, rural physicians who are
required to render medico-legal services shall be entitled to additional honorarium and
allowances.
SEC. 11. Administration Charges. - Administrative charges against a public health
worker shall be heard by a committee composed of the provincial health officer of the
province where the public health worker belongs, as chairperson, a representative of
any existing national or provincial public health workers organization or in its
absence its local counterfeit and a supervisor of the district, the last two (2) to be
designated by the provincial health officer mentioned above. The committee shall
submit its findings and recommendations to the Secretary of Health within thirty (30)
days from the termination of the hearings. Where the provincial health officer is an
interested party, all the members of the committee shall be appointed by the Secretary
of Health.
SEC. 12. Safeguards in Disciplinary Procedures - In every disciplinary proceeding,
the public health worker shall have;
(a) the right to be informed, in writing, of the charges;
(b) the right to full access to the evidence in the case;
(c) the right to defend himself/herself and to be defended by a representative
of his/her choice and/or by his/her organization, adequate time being given to
the public health worker for the preparation of his/her defense;
(d) the right to confront witnesses presented against him/her and summon
witnesses in his/her behalf;chan robles virtual law library
(e) the right to appeal to designated authorities;
(f) the right to reimbursement of reasonable expenses incurred in his/her
defense in case of exoneration or dismissal of the charges; and
(g) such other rights as will ensure fairness and impartiality during
proceedings.
SEC. 13. Duties and Obligations. - The public health workers shall:
(a) discharge his/her duty humanely wit conscience and dignity;
52
(b) perform his/her duty with utmost respect for life; and race, gender, religion,
nationality, party policies, social standing or capacity to pay.
SEC. 14. Code of Conduct. - Within six (6) months from the approval of this Act, the
Secretary of Health, upon consultation with other appropriate agencies, professional
and health workers organization, shall formulate and prepare a Code of Conduct for
Public Health Workers, which shall be disseminated as widely as possible.
SEC. 15. Normal Hours of Work. - The normal of wok of any public health worker
shall not exceed eight (8) hours a day or forty (40) hours a week. Hours worked shall
include:
(a) all the time during which a public health worker is required to be on active
duty or to be at a prescribed workplace; and
(b) all the time during which a public health worker is suffered or permitted to
work. Provided, That the time when the public health worker is place on "On
Call" status shall not be considered as hours worked but shall entitled the
public health worker to an "On Call" pay equivalent to fifty percent (50%) of
his/her regular wage. "On Call" status refers to a condition when public health
workers are called upon to respond to urgent or immediate need for
health/medical assistance or relief work during emergencies such that he/she
cannot devote the time for his/her own use.
SEC. 16. Overtime Work. - Where the exigencies of the service so require, any public
health worker may be required t render, service beyond the normal eight (8) hours a
day. In such a case, the workers shall be paid an additional compensation in
accordance with existing laws and prevailing practices.
SEC. 17. Work During Rest Day. (a) Where a public health worker is made to work on his/her schedule rest day,
he/she shall be paid an additional compensation in accordance with existing
laws; and
53
(b) Where a public health worker is made to worm on any special holiday
he/she shall be paid an additional compensation in accordance with existing
laws. Where such holiday work falls on the workers scheduled rest day,
he/she shall be entitled to an additional compensation as may be provided by
existing laws.
SEC. 18. Night-Shift Differential. (a) Every public health worker shall be paid night-shift differential of ten
percent (10%) of his/her regular wage for each hour of work performed during
the night-shifts customarily adopted by hospitals.
(b) Every health worker required to work on the period covered after his/her
regular schedule shall be entitled to his/her regular wage plus the regular
overtime rate and an additional amount of ten percent (10%) of such overtime
rate for each hour of work performed between ten (10) oclock in the evening
to six (6) oclock in the morning.
SEC. 19. Salaries. - In the determination of the salary scale of public health workers,
the provisions of Republic Act No. 6758 shall govern, except that the benchmark for
Rural Health Physicians shall be upgraded to Grade 24.
(a) Salary Scale - Salary Scales of public health workers shall be provided
progression: Provided, That the progression from the minimum to maximum
of the salary scale shall not extend over a period of ten (10) years: Provided,
further, That the efficiency rating of the public health worker concerned is at
least satisfactory.
(b) Equality in Salary Scale - The salary scales of public health workers whose
salaries are appropriated by a city, municipality, district, or provincial
government shall not be less than those provided for public health workers of
the National Government: Provided, That the National Government shall
subsidize the amount necessary to pay the difference between that received by
nationally-paid and locally-paid health workers of equivalent positions.
(c) Salaries to be Paid in Legal Tender. - Salaries of public health workers
shall be paid in legal tender of the Philippines or the equivalent in checks or
treasury warrants: Provided, however, That such checks or treasury warrants
54
shall be convertible to cash in any national, provincial, city or municipal

treasurers office or any banking institution operating under the laws of the
Republic of the Philippines.chan robles virtual law library
(d) Deductions Prohibited - No person shall make any deduction whatsoever
from the salaries or public health workers except under specific provision of
law authorizing such deductions: Provided, however, That upon written
authority executed by the public health worker concerned, (a) lawful dues or
fees owing to any organization/association where such public health worker is
an officer or member, and (b) premium properly due all insurance policies,
retirement and medicare shall be considered deductible.
SEC. 20. Additional Compensation. - Notwithstanding Section 12 of Republic Act No.

6758, public workers shall received the following allowances: hazard allowance,
subsistence allowance, longevity pay, laundry allowance and remote assignment
allowance.
SEC. 21. Hazard Allowance. - Public health worker in hospitals, sanitaria, rural health
units, main centers, health infirmaries, barangay health stations, clinics and other
health-related establishments located in difficult areas, strife-torn or embattled areas,
distresses or isolated stations, prisons camps, mental hospitals, radiation-exposed
clinics, laboratories or disease-infested areas or in areas declared under state of
calamity or emergency for the duration thereof which expose them to great danger,
contagion, radiation, volcanic activity/eruption occupational risks or perils to life as
determined by the Secretary of Health or the Head of the unit with the approval of the
Secretary of Health, shall be compensated hazard allowance equivalent to at least
twenty-five percent (25%) of the monthly basic salary of health workers receiving
salary grade 19 and below, and five percent (5%) for health workers with salary grade
20 and above.
SEC. 22. Subsistence Allowance. - Public health workers who are required to render
service within the premises of hospitals, sanitaria, health infirmaries, main health
centers, rural health units and barangay health stations, or clinics, and other healthrelated establishments in order to make their services available at any and all times,
shall be entitled to full subsistence allowance of three (3) meals which may be
55
computed in accordance with prevailing circumstances as determined by the Secretary

of Health in consultation with the Management Health Workers Consultative
Councils, as established under Section 33 of this Act: Provided, That representation
and travel allowance shall be given to rural health physicians as enjoyed by municipal
agriculturists, municipal planning and development officers and budget officers.
SEC. Longevity Pay. - A monthly longevity pay equivalent to five percent (5%) of the
monthly basic pay shall be paid to a health worker for every five (5) years of
continuous, efficient and meritorious services rendered as certified by the chief of
office concerned commencing with the service after the approval of this Act.
SEC. 24. Laundry Allowance. - All public health workers who are required to wear
uniforms regularly shall be entitled to laundry allowance equivalent to one hundred
twenty-five pesos (P125.00) per month: Provided, That this rate shall be reviewed
periodically and increased accordingly by the Secretary of Health in consultation with
the appropriate government agencies concerned taking into account existing laws and
prevailing practices.
SEC. 25. Remote Assignment Allowance. - Doctors, dentists, nurses, and midwives
who accept assignments as such in remote areas or isolated stations, which for reasons
of far distance or hard accessibility such positions had not been filed for the last two
(2) years prior to the approval of this Act, shall be entitled to an incentive bonus in the
form of remote assignment allowance equivalent to fifty percent (50%) of their basic
pay, and shall be entitled to reimbursement of the cost of reasonable transportation to
and from and during official trips.
In addition to the above, such doctors, dentists, nurses, and midwives mentioned in
the preceding paragraph shall be given priority in promotion or assignment to better
areas. Their tour of duties in the remote areas shall not exceed two (2) years, except
when there are no positions for their transfer or they prefer to start in such posts in
excess of two (2) years.
SEC. 26. Housing. - All public health workers who are in tour of duty and those who,
because of unavoidable circumstances are forces to stay in the hospital, sanitaria or
56
health infirmary premises, shall entitles to free living quarters within the hospital,
sanitarium or health infirmary or if such wuarters are not available, shall receive
quarters allowance as may be determined by the Secretary of Health and other
appropriate government agencies concerned: Provided, That this rate shall be
reviewed periodically and increased accordingly by the Secretary of Health in
consultation with the appropriate government agencies concerned.chan robles virtual
law library
For purposes of this Section, the Department of Health is authorized to develop

housing projects in its own lands, not otherwise devoted for other uses, for public
health workers, in coordination with appropriate government agencies.
SEC. 27. Medical Examination. - Compulsory medical examination shall be provided

free of charge to all public health workers before entering the service in the
Government or its subdivisions and shall be repeated once a year during the tenure of
employment of all public health workers: Provided, That where medical examination
shows that medical treatment and/or hospitalization is necessary for those already in
government service, the treatment and/or hospitalization including medicines shall be
provided free either in a government or a private hospital by the government entity
paying the salary of the health worker: Provided, further, That the cost of such
medical examination and treatment shall be included as automatic appropriation in
said entitys annual budget.
SEC. 28. Compensation of Injuries. - Public health workers shall be protected against
the consequences of employment injuries in accordance with existing laws. Injuries
incurred while doing overtime work shall be presumed work-connected.
SEC. 29. Leave Benefits for Public Health Workers. - Public health workers are
entitled to such vacation and sick leaves as provided by existing laws and prevailing
practices: Provided, That in addition to the leave privilege now enjoyed by public
health, women health workers are entitled to such maternity leaves provided by
existing laws and prevailing practices: Provided, further, That upon separation of the
public health workers from services, they shall be entitled to all accumulated leave
credits with pay.
57
SEC. 30. Highest Basic Salary Upon Retirement - Three (3) prior to the compulsory
retirement, the public health worker shall automatically be granted one (1) salary
range or grade higher than his/her basic salary and his/her retirement benefits
thereafter, computed on the basis of his/her highest salary: Provided, That he/she has
reached the age and fulfilled service requirements under existing laws.
SEC. 31. Right to Self-Organization. - Public health workers shall have the right to
freely from, join or assist organizations or unions for purposes not contrary to law in
order to defend and protect their mutual interests and to obtain redness of their
grievances through peaceful concerned activities.
However, meanwhile the State recognizes the right of public health workers to
organize or join organization, public health workers on-duty cannot declare, stage or
join any strike or cessation of their service to patients in the interest of public health,
safety or survival of patients.
SEC. 32. Freedom from Interference or Coercion. - It shall be unlawful for any
person to commit any of the following acts of interference or coercion:
(a) to require as a condition of employment that a public health worker shall
not join a health workers organization or union or shall relinquish
membership therein;
(b) to discriminate in regard to hiring or tenure of employment or any item or
condition of employment in order to encourage or discourage membership in
any health workers organization or union;
(c) to prevent a health worker from carrying out duties laid upon him/her by
his/her position in the organization or union, or to penalize him/her for the
action undertaken in such capacity;
(d) to harness or interfere with the discharge of the functions of the health
worker when these are calculated to intimidate or to prevent the performance
of his/her duties and responsibilities; and
(e) to otherwise interfere in the establishment, functioning, or administration
of health workers organization or unions through acts designed to place such
organization or union under the control of government authority.
58
SEC. 33. Consultation With Health Workers Organization. - In the formulation of

national policies governing the social security of public health workers, professional
and health workers, organizations or unions as well as other appropriate government
agencies concerned shall be consulted by the Secretary of Health. For this purpose,
Management Health Workers Consultative Councils for national, regional and other
appropriate
levels
shall
be
established
and
operationalized.
SEC. 34. Health Human Resource Development/Management Study. - The

Department
of
Health
shall
conduct
periodic
health
human
resource
development/management study into, among others, the following areas;chan robles

virtual law library
(a) adequacy of facilities and supplies to render quality health care to patients
and other client population;
(b) opportunity for health workers to grow and develop their potentials and
experience a sense of worth and dignity in their work. Public health workers
who undertake postgraduate studies in a degree course shall be entitled to an
upgrading in their position or raise in pay: Provided, That it shall not be more
than every two (2) years;
(c) mechanisms for democratic consultation in government health institutions;
(d) staffing patterns and standard or health care to ensure that the people
receive-quality care. Existing recommendations on staffing and standards of
health care shall be immediately and strictly enforced;
(e) ways and means of enabling the rank-and-file workers to avail of education
opportunities for personal growth and development;
(f) upgrading of working conditions, reclassification positions and salaries of
public health workers to correct disparity vis-a-vis other professions such that
positions requiring longer study to upgrade and given corresponding pay scale;
and
59
(g) assessment of the national policy on exportation of skilled health human

resource to focus on how these resources could instead be utilized productivity
for the countrys needs.
There is hereby created a Congressional Commission on Health (HEALTHCOM) to

review and assess health human resource development, particularly on continuing
professional education and training and the other areas described above. The
Commission shall be composed of five (5) members of the House of Representatives
and five (5) members of the Senate. It shall be co-chaired by the chairperson of the
Committee on health of both houses. It shall render a report and recommendation to
Congress which shall be the basis for policy legislation in the field of health. Such a
congressional review shall be undertaken once every five (5) years.chan robles virtual
law library
SEC. 35. Rules and Regulations. - The Secretary of Health after consultation with
appropriate agencies of the Government as well as professional and health workers
organizations or unions, shall formulate and prepare the necessary rules and
regulations to implement the provisions of this Act. Rules and regulations issued
pursuant to this section shall take effect thirty (30) days after publication in a
newspaper of general circulation.
SEC. 36. Prohibition Against Double Recovery of Benefits. - Whenever other laws
provide for the same benefits covered by this Act, the public health worker shall have
the option to choose which benefits will be paid to him/her. However, in the event
that the benefits chosen are less than that provided under this Act, the worker shall be
paid only the difference.
SEC. 37. Prohibition Against Elimination and/or Diminution. - Nothing in this law
shall be construed to eliminate or in any way diminish benefits being enjoyed by
public health workers at the time of the effectivity of this Act.
SEC. 38. Budgetary Estimates. - The Secretary of health shall submit annually the
necessary budgetary estimates to implement the provisions of this Act in staggered
basis of implementation of the proposes benefits until the total of Nine hundred forty60
six million six hundred sixty-four thousand pesos (P964,664,000.00) is estimated

within five (5) years.
Budgetary estimates for the succeeding years should be reviewed and increased
accordingly by the Secretary of Health in consultation with the Department of Budget
and Management and the Congressional Commission on Health (HEALTHCOM).
SEC. 39. Penal Provision. - Any person shall willfully interfere with, restrain or
coerce any public health worker in the exercise of his/her rights or shall in any
manner any act in violation of any of the provisions of this Act, upon conviction, shall
be punished by a fine of not less than Twenty thousand pesos (P20,000.00) but not
more than one (1) year or both at the discretion of the court.
If the offender is a public official, the court, in addition to the penalties provided in
the preceding paragraph, may impose the additional penalty of disqualification from
office.
SEC. 40. Separability Clause. - If any provision of this Act is declared invalid, the
remainder of this Act or any provision not affected thereby shall remain in force and
effect.
SEC. 41. Repealing Clause. - All laws, presidential decrees, executive orders and
their implementing rules, inconsistent with the provisions of this act are hereby
repealed, amended or modified accordingly.
SEC. 42. Effectivity. - This Act shall take effect fifteen (15) days after its publication
in at least two (2) national newspapers of general circulation
61

Etd 0826110 115026

Enviado por

Dados do documento

Descrição original:

Título original

Direitos autorais

Formatos disponíveis

Compartilhar este documento

Compartilhar ou incorporar documento

Opções de compartilhamento

Você considera este documento útil?

Este conteúdo é inapropriado?

Direitos autorais:

Formatos disponíveis

Etd 0826110 115026

Enviado por

Direitos autorais:

Formatos disponíveis

Graduate School of International Affairs

Ming Chuan University

Advisor: Dr. Nathan K. H. LIU

Nurse Migration: The Case of the Republic

Graduate Student: Cristine Cia B. Clasara

and for achieving

According to the World Health Organization , the Philippines is the largest

Secondary sources of data were gathered as

Key Words: Nurse Migration, Remittances, Remittance Dependency Cycle

1.2 Research Background

1.3 Research Objectives

Chapter 2 Review of Related Literature

2.2 Causes of nurse migration

Demography and Health

Remuneration and work environment

Personal and Security

2.3 Consequences of nurse migration

Migrants and family

National Health Status

Education and public Subsidy

2.4 Remittances and Development

The migration optimist: development and

The migration pessimists: historical structure

Pluralist perspectives: new economics of

3.2 Research Design

3.3 Data Analysis

3.4 Research Area and Limitations

Chapter 4 Nurse Migration

4.1 Overview of the health workers migration

Demographic and socio-economic indicators

Stock and distribution of health workers

Nurse Migration & global nursing

4.2 Cost of migration

4.3 Governments Action

The Magna Carta for Public Health Workers

4.3.1.1 Overview of the Magna Carta

4.3.1.2 DOHs problem

4.3.1.3 Implementing national benefits in local governments

4.3.1.4 Unintended consequences

Chapter 5 Remittance Dependency Cycle

Chapter 6 Conclusion and Recommendation

Appendix: Magna Carta for Public Health Nurses

Causes and consequences of medical migration

Average monthly wage rates of nurses in the Government sector

Regional distribution of health human resources employed

Health workers density by region

Remittance dependency cycle

(Estimated) Production of health workers annually

Nurse outflow, 1999-2009

Leading destination countries of deployed Filipino nurses,

International migration has become an important feature of the globalized

The Philippines us recognized as being one of the major source countries if

The Philippines is recognized as being one of the major source countries of

World Health Organization.2006.Working Together. World Health Report

for Filipino health workers.

dependency on remittance and

its role governments action

addressing the exodus of skilled health workers.

1.2 Research Background

Filipino labor migration was originally intended to serve as a temporary

number of deployment of overseas workers increased from 36, 035 in 1975 to

This movement of Filipino health workers, particularly Filipino nurses as