An examination of the causes, consequences, and policy responses to the migration of highly trained health personnel from the Philippines: the high cost of living/leaving-a mixed method study.

BACKGROUND: Dramatic increases in the migration of human resources for health (HRH) from developing countries like the Philippines can have consequences on the sustainability of health systems. In this paper, we trace the outflows of HRH from the Philippines, map out its key causes and consequences, and identify relevant policy responses. METHODS: This mixed method study employed a decentered, comparative approach that involved three phases: (a) a scoping review on health workers' migration of relevant policy documents and academic literature on health workers' migration from the Philippines; and primary data collection with (b) 37 key stakeholders and (c) household surveys with seven doctors, 329 nurses, 66 midwives, and 18 physical therapists. RESULTS: Filipino health worker migration is best understood within the context of macro-, meso-, and micro-level factors that are situated within the political, economic, and historical/colonial legacy of the country. Underfunding of the health system and un- or underemployment were push factors for migration, as were concerns for security in the Philippines, the ability to practice to full scope or to have opportunities for career advancement. The migration of health workers has both negative and positive consequences for the Philippine health system and its health workers. Stakeholders focused on issues such as on brain drain, gain, and circulation, and on opportunities for knowledge and technology transfer. Concomitantly, migration has resulted in the loss of investment in human capital. The gap in the supply of health workers has affected the quality of care delivered, especially in rural areas. The opening of overseas opportunities has commercialized health education, compromised its quality, and stripped the country of skilled learning facilitators. The social cost of migration has affected émigrés and their families. At the household level, migration has engendered increased consumerism and materialism and fostered dependency on overseas remittances. Addressing these gaps requires time and resources. At the same time, migration is, however, seen by some as an opportunity for professional growth and enhancement, and as a window for drafting more effective national and inter-country policy responses to HRH mobility. CONCLUSIONS: Unless socioeconomic conditions are improved and health professionals are provided with better incentives, staying in the Philippines will not be a viable option. The massive expansion in education and training designed specifically for outmigration creates a domestic supply of health workers who cannot be absorbed by a system that is underfunded. This results in a paradox of underservice, especially in rural and remote areas, at the same time as underemployment and outmigration. Policy responses to this paradox have not yet been appropriately aligned to capture the multilayered and complex nature of these intersecting phenomena.

Nursing, nightingale and beyond: Voices, dialogues and talks of the future

@#<p style="text-align: justify;"><strong>PURPOSE:</strong>This research explored the voices of nurses in contemporary times and unraveled nurses' situations for the purpose of generating a substantive theory to guide and refine nursing practice.<br /><strong>METHOD:</strong>The  grounded  theory  methodology  of  qualitative  research  was  utilized patterned mainly in the works of Glaser and Strauss. Criterion sampling was used in the selection of 31 participants and the basis for selection was employment in the hospital, academe, and community and being part of different levels of management (nurses from top, middle, first, and staff levels). Theoretical sampling also informed the final list of study informants and was conducted by snowballing that consisted of 10  participants.  The  data  gathering  procedures  included  the  combination  of interviews, observations, and document and literature analysis. <br /><strong>FINDINGS:</strong>The study revealed three major themes: (1)nursing as a profession,(2)Nightingale in the 21st century:life of a nurse in today's context,and (3)the challenges and opportunities to quality of nursing care.<br /><strong>CONCLUSION:</strong>Nursing   is   dynamic,   complex,   diverse,   expanding   and   highly contextualized. Nursing is a field that grows with time and nurses are adaptive to the widening demands of their profession. The goal of nursing remains a Nightingale's pledge  and  an  endeavor  amidst  nurses'  constant  battle  between  motivations  and challenges.  The  Integrated  Systems  Approach  to  Nursing  Care  model  was developed to be used as a framework for sound decision-making in nursing practice.Nursing,  nightingale  and  beyond  is  a  picture  of  struggles,  success,  and  potential solutions to the predicaments surrounding the nursing profession.<br /><strong>CLINICAL RELEVANCE:</strong>The  study  has  potential  to  help  health  managers  and  policy implementers in providing assistance to nurses in enhancing their knowledge and skills, increasing their emotional and psychological resilience and in revitalizing their commitment to the nursing profession.It may also aid in  the  reconsideration  of institutional policies and set-ups toward collaborative and enabling work environment. In addition, it may serve as a guide in creating proactive health governance, in facilitating nurses' work motivation  and  retention  through  the  due  implementation  of nursing law and other statures for the welfare of health workers, in providing additional plantilla position for nurses in the country, and in increasing funding for health programs to create more learning and practice environment for nurses. Lastly, the utilization of the theory  can  be  used  in  developing  a  more  responsive  nursing practice.</p>

Learning with communities: Structures and mechanisms for reproductive health programs among indigenous peoples of the Cordilleras

@#<p style="text-align: justify;">This paper attempts to capture how the principles of Participatory Action Research (PAR) were put into life in the integrated reproductive health (RH) programme in the Cordilleras, Northern Philippines. Document review and interviews of program staff were utilized to learn from the field and data were derived from participatory methods such as Group and Team Dynamic Methods, Interviewing and Dialogue Methods, Sampling Methods, and Visualization and Diagramming Methods. Results show that Community Needs Assessment (CNA) as a baseline for integrated planning of programme partners, laid a PAR framework for the entire development process. With the guidance of the integrated RH framework, the CNA ensured relevant and correct interpretation and analysis of data which then led to meaningful plans, actions and partnership, having gained the acceptance of communities. Community structures - People's Organizations with Health Committees that oversee income generating projects and RH education activities in the barangays (villages), were strengthened; partnerships with the Barangays Councils (BC) and the Barangay Health Stations (BHS) are continually enhanced to make policy formulation and service delivery more responsive to RH needs. Through this, the community was presented as a powerful unit of identity that builds on the strengths and resources of the community. The experience revealed that co-learning and capacity building can be promoted, and knowledge generation and intervention is integrated. The experience also emphasized the local relevance of public health problems (RH in this case) and the multiple determinants of health and disease including biomedical, social, economic, and physical environmental factors. To the researchers, it has been an inspiring and empowering experience to grow and learn with the people.</p>

Analytical study of the nurses licensure examination performance of graduates of Philippine Colleges of Nursing

@#<p style="text-align: justify;">Performance in the eight Nurse Licensure Examinations from December 2006 to December 2010 was analyzed to describe how graduates of colleges of nursing nationwide performed in the tests and to determine the factors that correlate with the examinees' scores. The study included all the graduates of colleges of nursing who participated in the eight Nurse Licensure Examinations. Data were collected through a review of secondary data from the Professional Regulation Commission - the passing percentage and average rating of schools, testing centers in the subjects tested and type of examinees. The variables from each NLE were categorized into Examinee variables, Institutional variables, and Program and Other variables. Based on the NLE results, the study concluded that those who took the examination for the first time (first timers) performed better, had higher passing percentage and significantly higher average rating than repeaters in all the NLEs. Among the repeaters, those who took the examination for at most two times showed higher passing percentage and average rating. Examinees from accredited schools also had higher passing percentage and average rating than examinees from non-accredited schools. Those from government-owned schools showed higher passing percentage in all NLEs and significantly higher average ratings in six (6) out of the eight (8) NLEs than examinees from non-government-owned schools. The study found that the accredited and government-owned schools had higher passing percentage and average rating compared to non-accredited and non-government-owned schools. Significant differences were found in the passing percentage and average rating of the examinees across regions and testing centers. Of the five subjects tested, the examinees performed best in Nursing Practice I and III. Their lowest passing percentage and average rating was in Nursing Practice IV. Number of examinees per school appeared not to have affected nor influenced either the passing percentage or average rating of schools in the eight (8) NLEs. The study reveals significant findings that correlate the performance of graduates of Philippine colleges of nursing in the 8 NLEs with selected variables and these findings may provide a better understanding of the issues and problems concerning the performance of examinees in the NLE.</p>