A study to be presented at Stanford this spring asks why the Philippines sends so many of its health workers abroad, and what the country loses and gains by doing so. Over the past four decades about 74,000 healthcare professionals have left the Philippines, 84 per cent of them nurses, according to the research, which is led by the economist Marjorie Pajaron. Roughly 13,000 newly qualified nurses go overseas each year as temporary migrant workers, the study says.
A workforce built for export
For decades the Philippines has been one of the world’s most reliable suppliers of nurses, and the numbers show how far that reaches, the study says. The 74,000 who left went to wealthier health systems abroad over four decades, and the yearly outflow of about 13,000 nurses keeps that pipeline full. Filipino nurses are a mainstay of health systems that cannot staff themselves, the study says. For a country that also wants to draw patients of its own, that is the central tension. The staff a medical tourism destination needs are the same staff its recruiters send abroad.
Brain drain, or brain gain
The research weighs a loss against a possible gain, the study says. On one side is brain drain, a health system stripped of trained staff, with shortages and uneven cover at home. At home the loss falls first on rural areas and public hospitals, which struggle to replace the nurses they train. On the other side is what economists call brain gain, the idea that migration can enlarge a country’s stock of skills rather than shrink it. Remittances are part of that case, the study says, because money sent home can pay for schooling and pull more students into nursing. Remittances can also seed the training of the next generation of health workers, the study says. Some migrants return with skills they could not have got at home, adding to a system that let them go. Which effect wins is the question the research sets out to weigh, and the study does not yet claim an answer. Pajaron treats remittances as the hinge between drain and gain.
Climate as a new push
What sets the research apart is climate. By one measure the Philippines ranks third in the world for exposure to climate change risks, the study notes, and it treats that exposure as one more force pushing health workers to leave. Storms and floods that wreck hospitals and homes, the argument runs, add to the reasons a nurse might take a job overseas. Extreme weather can thin the very workforce a country is trying to keep, the study says. The work is at an early stage, and its findings are preliminary rather than settled.
What to watch
The research is led by Marjorie Pajaron, a visiting scholar at Stanford this spring who has studied health, migration and climate. Pajaron is an associate professor at the University of the Philippines in Diliman and earned her doctorate at the University of Hawaii at Manoa. She is due to present the work at Stanford’s Shorenstein Asia-Pacific Research Center on 8 April, with the health economist Karen Eggleston in the chair. The wider tests are slower and countable. Whether the yearly nurse outflow stays near 13,000, whether the remittances migrants send home turn into more trained staff, and whether returning workers bring back skills the system keeps will decide whether the Philippines is draining its workforce or compounding it. That shortage is not the Philippines’ alone. It is a global one, and Filipino nurses are prized recruits wherever health systems are short.