The coronavirus pandemic tested the health care systems of practically all countries worldwide, including affluent western and European nations. According to a recent report released by the International Council of Nurses (ICN), there is already a global shortage of almost six million nurses prior to the pandemic, and became more acute due to the virus. Demand for international nurses from the usual destination countries is likely to continue if pre-COVID-19 nursing shortages persist.

According to ICN’s State of the World’s Nursing (SOWN) report, the Philippines is often described adopting a “train for export” model of nurse education, facilitated by the Philippine Overseas Employment Administration (POEA). This, ICN added, is to enable local nurses to move and work abroad, where pay and career opportunities are much more attractive, and for them to then remit part of their foreign currency earnings back to their family.

Most nursing schools in the Philippines are in the private sector, with nursing students paying for their education, often with the express intention of moving abroad to practice when they graduate.

The ICN report said the outflow of nurses from the Philippines has been around 15,000 to 20,000 per annum in recent years. In the Organization for Economic Cooperation and Development (OECD) alone, almost 240,000 local nurses are working in OECD countries. A significant number of local nurses are also posted in Saudi Arabia, Europe (UK and Ireland) and Asia/Australasia (Singapore, New Zealand, Australia). The United States is also reported to be the home for almost 150,000 Filipino nurses, earning as much as 20 times what they were making back home.

The remittances flowing back into the country from the migrant nurses help boost the Philippine economy and support the local population. Total remittances to the Philippines have grown substantially in recent years and reached $34 billion in 2018, with much of these funds coming from service workers, especially nurses.

The unremitting migration of local nurses elsewhere to seek greener pastures in recent years has significantly depleted the country’s nursing workforce. The effect of this outflow was greatly felt when the pandemic hit the country, as the government appealed to health care workers in the provinces and those returning from abroad to help beef up the frontline workforce in the capital in the fight against the dreaded virus.

During the early months when the pandemic hit the country, the Department of Labor and Employment (DoLE) issued a temporary suspension order preventing nurses from going overseas. This order put nurses with existing employment contracts with hospitals overseas in a precarious situation of missing tremendous opportunity to earn higher pay and perks that they would not receive if they choose to stay at home.

While the number of COVID cases in the country continues to increase, it was a huge relief for health care workers, nurses in particular, when the President stepped in and ordered the lifting of the suspension order for health workers and new hires who secured requirements by 31 August to leave the country.

Despite the move to allow health care workers with contracts to travel overseas, the President appealed to the remaining frontliners and volunteers to take care of COVID-19 patients and help in the fight against the dreaded virus.

In an attempt to entice local nurses to stay and serve the country first, the DoLE recently urged the government to increase the salary of nurses. Labor Secretary Silvestre Bello III said a significant salary upgrade for nurses is long overdue, adding that this is the reason why some 200,000 local nurses are unemployed despite the Department of Health’s (DoH) emergency hiring program.

Bello said we cannot blame nurses from the private sector from leaving the country. They work from eight to 16 hours, with the average salary ranging only from P9,000 to P18,000 as compared to public hospital nurses’ proposed minimum take home pay of P32,000 a month.

Echoing Bello’s call, Filipino Nurses United’s (FNU) head Maristela Abenojar said we cannot blame private hospital nurses from leaving the country, adding that the government needs to improve their working conditions and increase their salaries for them to stay.

While public hospital nurses are set to receive adjusted salary packages under the Department of Budget and Management’s Circular 2002-4 issued on 17 July, FNU is desolate that the private sector nurses were not included.

The FNU said some nurses in the private sector cannot even afford their own basic needs because their salary is “way below” the minimum wage. These overworked nurses, FNU added, are made to handle a patient load beyond the DoH-set standard of 1:12 patients with no additional pay for overtime or extended work.

Abenojar said nurses’ work in private hospitals is not valued in the country, adding that it is an example of the neglect and exploitation our nurses face.

FNU’s call is now being addressed as concrete actions are being taken care of by relevant government agencies to enhance the working conditions of health care workers. The urgent task is to agree on the terms, start aligning and operationalizing whatever changes will be formalized.

My take right now is for Bello and Health Secretary Francisco Duque III to lobby at Congress for the urgent deliberation and passing of the law that would increase the salaries of nurses working in both public and private hospitals.

Moving forward, the government must give serious consideration to maintaining the attractiveness of nursing as a career by the provision of fair pay and conditions of employment and career prospects in order to ensure that the mid- to long-term supply of new nurses is not compromised.

Indeed, 2020 is the Year of the Nurse. At times like this, we are all reminded of the important role all of our health care heroes play in caring for people in crisis. I will continue to salute our health care workers and be grateful for the work they are doing. They are the country’s real heroes, no doubt.