Despite warnings of nursing glut, PHL still producing too many nurses

With 490 nursing colleges in the country, the Philippines is producing up to 100,000 nurses every year—way beyond its needs. At a recent roundtable discussion on Universal Health Care, Dr. Marilyn Lorenzo of the UP Manila College of Public Health said this exemplifies the irrational production of health professionals — a category that also includes doctors and midwives — in the country. "This is way too much,” Lorenzo said. “The Commission on Higher Education and the technical committee on nursing education is in the process of shutting down these [nursing] schools." Lorenzo said there are only about 36,000 official positions for nurses in the country in both the private and public sector. A moratorium on new nursing schools has been declared by CHED as  early as 2004, according to a 2009 report by the VERA Files. In 2012, the Professional Regulatory Commission (PRC) expressed concern over the quality of nursing education in the country. The report also noted that according to the PRC, the December 2011 board exam passing rate of 33.92 percent was even lower than December 2010’s 35.25 percent, which the CHED said was the lowest in history. Overseas employment Despite this, many Filipinos still opt to take up nursing in college, most of them with an eye on overseas employment. Labor Undersecretary Danilo Cruz said it is important to orient students even before they choose their career paths. He noted that even if you create local jobs for nurses, these will not be financially comparable to offers from overseas companies. "Hindi pa nagiging nurse, nag-aaral pa lang, ang laman na ng utak is to work overseas. 'Yung talagang sincere desire to serve the health needs of the country, mukhang hindi nabibigyan ng pansin," he said. Barriers in achieving Universal Health Care Lorenzo said every year 35 medical colleges produce 2,000 doctors; 129 schools produce 1,500 midwives; 35 pharmacy colleges produce 1,500 pharmacists; and 95 physical therapy and occupational therapy colleges produce about 1,000 physical therapists and 200 occupational therapists. Lorenzo explained that irrational production and deployment, unmanaged migration and the contractualization of health professionals are three critical human resource barriers to achieving universal health care. She also said the production rates do not make sense, as the top causes of morbidity in the country are non-communicable diseases such as cancer, cardiovascular diseases and diabetes. "What we need for the rehabilitation is skilled physical therapists and occupational therapists, especially for those patients that are post-stroke. But if you were to look at our production and our deployment, we do not keep plantilla positions for physical therapists outside of Metro Manila. Even government medical centers don't have regular positions for them," Lorenzo said. Radical changes Former Health Secretary Alberto Romualdez said that in order to achieve universal health care in the Philippines, radical changes must be introduced into the different components of the health system, particularly in human resources for health. "We need to introduce radical changes in production and regulation... So far what we have heard are actually conventional proposals for regulation, for managing, for introducing rationality in our system. But what we really require is a radical change in the entire system," he said. Romualdez explained that the minimum threshold of 23 doctors, nurses and midwives per 10,000 population—which was established by World Health Organization as necessary to deliver essential maternal and child health services—is such because the focus should not be on the professions. "Unfortunately, baliktad 'yung ating views of health workers. We are looking at the supply side all the time, we don't look at the needs," he said, adding that as a result, each profession only looks at its own requirements in lobbying for laws. "The doctors lobby for a medical act that will prevent nurses from usurping their functions. The nurses lobby for a nursing act that will prevent midwives from usurping their functions, and so forth and so on down the line," said Romualdez, who stressed that a more integrated, holistic approach is needed. "The universal health care study group suggestion is to take all of these bills together and have one omnibus regulatory approach to all the professions and perhaps take a look at the labor aspect, the foreign affairs aspect," he said. According to Dr. Ernesto Domingo of the UP-National Institute of Health Universal Healthcare Study Group, a universal health care system requires more control in developing human resources for health. "Even to the point of government dictating on how many you should train, how will you train them and how you are going to deploy them," he said. — Carmela Lapeña/KBK, GMA News