Wednesday, February 07, 2007

Migration of Health Professionals: Boon or Bane?

The current wave of health professional migration sweeping developing countries is another black spot in the global health system. Today, the high number of health professionals leaving for more lucrative jobs abroad is straining the public health care systems of the affected source countries.

Exporting Health Professionals

The migration of health professionals is not an entirely new phenomenon, but the latest wave is producing a more pronounced adverse impact on source countries due to the unusually high number of migrating health professionals.

In the Philippines, 85 percent of registered nurses are working abroad. The demand has also spawned a phenomenon unique to the Philippines: doctors are leaving their profession to become nurses. There is an estimated 4,000 Filipino doctors who are currently enrolled in nursing course. In Fiji, the number of registered nurses leaving for jobs abroad exceeds the number of new nursing graduates. According to Fiji Nursing Association secretary-general Kuini Lutea, the Pacific island produces between 150 to 160 new nursing graduates, but almost 50 percent of these are migrating to other countries.

Doctors are also prime labor export. India is currently the top exporter of doctors; there are more Indian doctors in America than in India. The ratio of Indian doctors to American patients is 1:1325, while the ratio of Indian doctors to Indian patients is 1:2400. Pharmacists, medical technologists, and other allied medical professionals are also in demand.

Impact on source countries

On the upside, remittances from migrant workers are keeping the source countries’ economies afloat. The downsides, however, far outweigh the benefit. The mass migration of health professionals is further worsening the already dismal health care delivery of the source countries.

In the Philippines, data from the Philippine Hospital Association showed that 200 hospitals have already closed down due to lack of medical personnel and 800 more are partially closed down. As a result, health services become even more inaccessible. The National Statistics Office 2003 Report stated that seven in ten Filipinos are dying without ever receiving medical treatment.

The gap also affects the quality of health services since those who have left are often experienced nurses and doctors. Today, it is no longer unthinkable to have novice nurses assigned to sensitive posts, such as in the operating room or intensive care units.

Medical personnel who are left behind also feel the pinch since they have to take the slack. At the Asia Pacific Nursing Congress held in Australia, Lutea reported that in 2004 alone, they have documented eight cases of nurses who have died due to stress-related diseases caused by their almost impossible workload.

The primary push factor for the migration of health professionals is finances. Source countries are often developing countries that present limited opportunities. Health professionals in these countries are often underpaid and overworked. In the above-mentioned countries, the average monthly salary of health professionals is between US$200 – US$300. In contrast, host countries offer as much as US$ 4000 per month. Another often cited push factors is the lack of opportunity for career growth in the source country. Lynnette Baquial, a Filipino medical technologist working at Florida Hospital Ormond Memorial, cited this factor. She said that in the US, there is a compensation for hard work, unlike in the Philippines where health professionals can only get a raise if they are promoted.

For host countries, the shortage is due in part to ageing population, as well as the sharp decrease in the number of people entering the medical profession.


The migration of health professionals is a complicated issue as it encompasses socio-political and economic factors. Despite the alarm sounded by health experts in source countries, most governments are only too eager to export its highly-skilled workers.

One of the most often discussed solution is to compensate the source countries for the costs of educating its health professionals. However, this solution alone will not address the basic problem of inaccessible health care. A lasting solution would only come when governments would start to respect the people’s inherent right to health and start to take care of its own health professionals.

Article written by Ross Mayor for Health Alert Asia Pacific (Issue No. 8), a newsletter on health and development published by HAIN


Philippines: The Challenge of Managing Migration, Retention and Return of Health Professionals, Dr. Jaime Galvez-Tan