Nursing Education Situation in the Philippines

Export of Filipino Nurses:Export of Filipino Nurses:From Brain Drain to National Hemorrhage From Brain Drain to National Hemorrhage

to NLE Leakageto NLE Leakage

Health Alliance for Democracy (HEAD)Health Alliance for Democracy (HEAD)13 September 200613 September 2006

Exporting Health Human ResourceExporting Health Human Resource

No. 1 Exporter of NursesNo. 1 Exporter of Nurses““An estimated 85% of employed Filipino nurses (more An estimated 85% of employed Filipino nurses (more than 150,000) are working internationally.” (Aiken et al than 150,000) are working internationally.” (Aiken et al 2004)2004)““70% of all Filipino nursing graduates are working 70% of all Filipino nursing graduates are working overseas.” (Bach 2003)overseas.” (Bach 2003)

No. 2 Exporter of DoctorsNo. 2 Exporter of Doctors““68% of Filipino doctors work overseas, next to India.” 68% of Filipino doctors work overseas, next to India.” (Mejia, WHO 1975)(Mejia, WHO 1975)

(NIH 2004)(NIH 2004)

Hemorrhage of Human Resources: NursesHemorrhage of Human Resources: Nurses

13,536 nurses left in 2001.13,536 nurses left in 2001. 2000-2003: approx 50,000 nurses left.2000-2003: approx 50,000 nurses left.

““Data casts doubt on the underreporting of the Philippine Data casts doubt on the underreporting of the Philippine Overseas Employment Agency (POEA) that shows only 91 Overseas Employment Agency (POEA) that shows only 91 nurses left for the USA in 2000, 304 nurses in 2001, and nurses left for the USA in 2000, 304 nurses in 2001, and 320 nurses in 2002.” (Tan 320 nurses in 2002.” (Tan et alet al 2004) 2004)

Top 5 Destinations of Filipino NursesTop 5 Destinations of Filipino Nurses

United States of AmericaUnited States of America United KingdomUnited Kingdom Saudi ArabiaSaudi Arabia IrelandIreland SingaporeSingapore

““The number of nurses that left in the last 4 The number of nurses that left in the last 4 years (50,000) far exceeds the production of years (50,000) far exceeds the production of nurses of only 20,000 in the same period.”nurses of only 20,000 in the same period.”

(NIH 2004)(NIH 2004)

Deteriorating Quality of Nursing Deteriorating Quality of Nursing EducationEducation

The number of nursing The number of nursing schools have increasedschools have increased1970s: only 401970s: only 401990s: 1701990s: 170June 2003: 251June 2003: 251April 2004: 370April 2004: 370June 2005: 441June 2005: 441June 2006: 470June 2006: 470

By June 2006, almost By June 2006, almost 200% increase in 200% increase in nursing schools nursing schools nationwide since 2003nationwide since 2003(NIH 2004)(NIH 2004)


Decreasing proportion of nursing graduates who Decreasing proportion of nursing graduates who pass the national nursing licensure examinationspass the national nursing licensure examinations

1970s and 80s: 80%-90%1970s and 80s: 80%-90%1991: below 61%1991: below 61%2001-2003: 44%-48%2001-2003: 44%-48%2004: 55.9%2004: 55.9%2005: 49.7%2005: 49.7%2006: 42.42%2006: 42.42%

(NIH 2004, PRC 2005)(NIH 2004, PRC 2005)


In 2001In 2001116 nursing schools: passing rate of <50% 116 nursing schools: passing rate of <50% 124 nursing schools: passing rate of >50%124 nursing schools: passing rate of >50%

In 2002, 150 nursing schools had a passing In 2002, 150 nursing schools had a passing rate <50%, which was already 63% of the rate <50%, which was already 63% of the 237 nursing schools then.237 nursing schools then.

In the last 3 NLE 2005, at least 20 schools In the last 3 NLE 2005, at least 20 schools consistently a consistently a <30<30% passing rate.% passing rate.

(NIH 2004)(NIH 2004)

Hemorrhage of Human Resources: Other Hemorrhage of Human Resources: Other ProfessionalsProfessionals

At least 37 Philippine nursing schools offer At least 37 Philippine nursing schools offer abbreviated 2-year courses for doctors to become abbreviated 2-year courses for doctors to become nurses.nurses.

More than 60% of nursing schools are geared More than 60% of nursing schools are geared mainly for “second coursers” (non-health mainly for “second coursers” (non-health professionals who want to take up nursing, e.g. professionals who want to take up nursing, e.g. engineers, accountants, teachers, soldiers).engineers, accountants, teachers, soldiers).

(HSA 2005, PNA 2005)(HSA 2005, PNA 2005)


Initial HEAD estimates: Initial HEAD estimates: around 30% of nursing students are “second-around 30% of nursing students are “second-coursers”coursers”at least 80% of those taking up nursing are at least 80% of those taking up nursing are planning to work abroadplanning to work abroadbetween 75%-90% of faculty members are between 75%-90% of faculty members are planning to work abroadplanning to work abroad

(HSA 2005, PNA 2005)(HSA 2005, PNA 2005)


Biggest review centers: Biggest review centers: INRESS – P10,000 for 6 weeksINRESS – P10,000 for 6 weeksGapuz – P13,400 for 3 weeksGapuz – P13,400 for 3 weeksPentagon – P14,500 from Sept to DecPentagon – P14,500 from Sept to Dec

Most nursing colleges also have compulsory “in-Most nursing colleges also have compulsory “in-house” reviews that are paid for by the students house” reviews that are paid for by the students (separate from tuition and other expenses)(separate from tuition and other expenses)

Students/graduates spend around P40,000+ just Students/graduates spend around P40,000+ just for reviewfor review

Exploited Health Human ResourcesExploited Health Human Resources

► Health workers and professionals Health workers and professionals are overworked and underpaid.are overworked and underpaid.

Exploited Health Human ResourcesExploited Health Human Resources► Doctor to patient ratio (population)Doctor to patient ratio (population)

Cuba 1:225Cuba 1:225USA 1:450USA 1:450Philippines 1:10,000-26,000Philippines 1:10,000-26,000WHO (Ideal) 1:600WHO (Ideal) 1:600

► Nurses to patient ratioNurses to patient ratioPGH 1:15-26 per shift PGH 1:15-26 per shift Davao del Sur 1:44-45 per shiftDavao del Sur 1:44-45 per shiftIdeal 1:4 per shiftIdeal 1:4 per shiftPhilippines 1:16,000 (population)Philippines 1:16,000 (population)

(AHW 2004, HealthWrights 2004)(AHW 2004, HealthWrights 2004)

The Unhealthy Philippine Health Care SystemThe Unhealthy Philippine Health Care System

““A health care system that cannot maintain A health care system that cannot maintain its own health human resource its own health human resource

is not healthy at all.”is not healthy at all.”

The Nursing Exam LeakageThe Nursing Exam Leakage

The Nursing Licensure Examination (NLE)The Nursing Licensure Examination (NLE)Given by the PRC twice a yearGiven by the PRC twice a yearExam questions are prepared by members Exam questions are prepared by members of the Board of Nursingof the Board of NursingHas 5 parts: Test I (Community Nursing), Has 5 parts: Test I (Community Nursing), Test II (Maternal and Child), Test III (Medical-Test II (Maternal and Child), Test III (Medical-Surgical Nursing), Test IV (Fundamentals), Surgical Nursing), Test IV (Fundamentals), Test V (Psychiatric Nursing)Test V (Psychiatric Nursing)


Basic chronology of the NLE leakBasic chronology of the NLE leakA few days before the June 2006 NLE, A few days before the June 2006 NLE, INRESS held an “final coaching” at one INRESS held an “final coaching” at one of the cinemas in SM North EDSAof the cinemas in SM North EDSAShortly after the NLE, the leakage was Shortly after the NLE, the leakage was exposed in Baguio City. PRC-CAR exposed in Baguio City. PRC-CAR immediately informed PRC national immediately informed PRC national office.office.

The Nursing Exam LeakageThe Nursing Exam Leakage Basic chronology of the NLE leakBasic chronology of the NLE leak

PRC initially said it would investigate before PRC initially said it would investigate before releasing the list of those who passed. releasing the list of those who passed. Mass resignation of the Technical Mass resignation of the Technical Committee on Nursing Education (TCNE) on Committee on Nursing Education (TCNE) on July 7, citing “that CHED has instead (of July 7, citing “that CHED has instead (of implementing past memos) buckled down implementing past memos) buckled down to pressure from poor performing schools, to pressure from poor performing schools, politicians and Malacañang, politicians and Malacañang, sacrificing sacrificing quality for mediocrity and business quality for mediocrity and business interestinterest.” .”


Basic chronology of the NLE leakBasic chronology of the NLE leakBut even without an investigation, But even without an investigation, the PRC released the list of those the PRC released the list of those who passed and stated there was no who passed and stated there was no leak involved.leak involved.PNA President George Cordero also PNA President George Cordero also lobbied the PNA chapter in Baguio to lobbied the PNA chapter in Baguio to keep the matter under wraps as it keep the matter under wraps as it might jeopardize the country’s might jeopardize the country’s request to be made an NCLEX center.request to be made an NCLEX center.


Basic chronology of the NLE leakBasic chronology of the NLE leakNursing groups were formed to pressure Nursing groups were formed to pressure the PRC. The UST-led group called for a the PRC. The UST-led group called for a nullification of the entire NLE and a re-take.nullification of the entire NLE and a re-take.The nursing community became embroiled The nursing community became embroiled and divided on the re-take debate.and divided on the re-take debate.The PRC allowed the oath-taking of those The PRC allowed the oath-taking of those who passed even after promising the who passed even after promising the ADPCN that it will defer such action.ADPCN that it will defer such action.


Basic chronology of the NLE leakBasic chronology of the NLE leakThe UST-led group filed a TRO against the The UST-led group filed a TRO against the PRC for the oath-taking. The processing of PRC for the oath-taking. The processing of papers also stopped. papers also stopped. The Senate and the HOR Committees on The Senate and the HOR Committees on Health began conducting their respective Health began conducting their respective investigations, but the gov’t agencies investigations, but the gov’t agencies involved did not attend the hearings.involved did not attend the hearings.Witness testimonies already point to the Witness testimonies already point to the involvement of key leaders/members of the involvement of key leaders/members of the PNA and BON.PNA and BON.

The Nursing Exam LeakageThe Nursing Exam Leakage Major groups implicatedMajor groups implicated

Dr. George Cordero: owner of INRESS and Dr. George Cordero: owner of INRESS and Philippine Colleges of Health Sciences Philippine Colleges of Health Sciences (PCHS); President of the Philippine Nurses (PCHS); President of the Philippine Nurses Association (PNA)Association (PNA)BON members Anesia B. Dionisio and BON members Anesia B. Dionisio and Virginia D. MadejaVirginia D. MadejaGapuz and Pentagon Review centersGapuz and Pentagon Review centersPRC Chair Leonor Tripon-Rosero PRC Chair Leonor Tripon-Rosero

The Nursing Exam LeakageThe Nursing Exam Leakage Major government agencies involvedMajor government agencies involved

Professional Regulation Commission (PRC)Professional Regulation Commission (PRC)Board of Nursing (BON)Board of Nursing (BON)Commission on Higher Education (CHED)Commission on Higher Education (CHED)Dante Ang (Commission on Overseas Dante Ang (Commission on Overseas Filipino and Presidential Task Force on the Filipino and Presidential Task Force on the National Licensure Exam/EO 550)National Licensure Exam/EO 550)National Bureau of Investigation National Bureau of Investigation

The Nursing Exam LeakageThe Nursing Exam Leakage Major groups of stakeholdersMajor groups of stakeholders

Association of Deans of Philippine Colleges Association of Deans of Philippine Colleges of Nursing (President Carmelita of Nursing (President Carmelita Divinagracia, Dean UERM CN)Divinagracia, Dean UERM CN)PNA and PNA-CARPNA and PNA-CARConcerned Nurses… (UST, FEU)Concerned Nurses… (UST, FEU)ANSWER (broad inter-school alliance) ANSWER (broad inter-school alliance) BSN (Bukluran ng mga Samahang Nurses)BSN (Bukluran ng mga Samahang Nurses)Health Alliance for Democracy (HEAD)Health Alliance for Democracy (HEAD)

The Nursing Exam LeakageThe Nursing Exam Leakage Positions regarding the issuePositions regarding the issue

PRC: “No Leakage” PRC: “No Leakage” No Re-take No Re-take Voluntary re-take for free Voluntary re-take for free Bonus 2% Bonus 2%Dante Ang/Arroyo admin: Compulsory Re-Dante Ang/Arroyo admin: Compulsory Re-take take Compulsory re-take of Tests III and V Compulsory re-take of Tests III and VPNA: Re-take all PNA: Re-take all No re-take No re-takeUST, UE, UP: Compulsory re-take of Tests III, UST, UE, UP: Compulsory re-take of Tests III, VVCHED: “Wala kaming kinalaman dyan!”CHED: “Wala kaming kinalaman dyan!”


HEAD analysisHEAD analysis• Leakage is only a symptom of a Leakage is only a symptom of a

long-standing deterioration of the long-standing deterioration of the nursing educationnursing education

• Like other exams given by the PRC, Like other exams given by the PRC, the NLE has been fraught with the NLE has been fraught with leakages that have exemplified the leakages that have exemplified the collusion between gov’t officials and collusion between gov’t officials and big businessbig business


HEAD analysisHEAD analysis• Gov’t agencies (PRC, CHED, BON) Gov’t agencies (PRC, CHED, BON)

have eroded the quality of nursing have eroded the quality of nursing education and the integrity of the education and the integrity of the nursing professionnursing profession

• The actions of gov’t agencies are The actions of gov’t agencies are divisive and meant to distract divisive and meant to distract stakeholders from the main issue stakeholders from the main issue


HEAD analysisHEAD analysis• The commercialization of nursing The commercialization of nursing

education has worsened the quality of education has worsened the quality of nursing education nursing education

• This commercialization is rooted in the This commercialization is rooted in the Labor Export Policy of the Arroyo Labor Export Policy of the Arroyo regimeregime

• Rather than seek solutions, the Arroyo Rather than seek solutions, the Arroyo gov’t seeks to centralize everything gov’t seeks to centralize everything (e.g. regulate review centers under (e.g. regulate review centers under gov’t control) to increase its revenuesgov’t control) to increase its revenues

Health Under the Arroyo RegimeHealth Under the Arroyo Regime

Filipino nurses have become a Filipino nurses have become a commodity: subject to TRADE and commodity: subject to TRADE and

PROFITSPROFITS

The national government has The national government has ABANDONED its responsibility toABANDONED its responsibility to

ensure the HEALTH of their PEOPLEensure the HEALTH of their PEOPLE

WHAT WE WANTHEAD proposals: IMMEDIATEHEAD proposals: IMMEDIATE• Conduct a speedy, thorough, impartial, and Conduct a speedy, thorough, impartial, and

independent investigation of the leakageindependent investigation of the leakage• Identify and prosecute the guiltyIdentify and prosecute the guilty• Completely revamp the PRC, BON, and CHEDCompletely revamp the PRC, BON, and CHED• Allow those who have passed to seek jobs Allow those who have passed to seek jobs

without discriminationwithout discrimination

WHAT WE WANTHEAD proposals: LONG-TERMHEAD proposals: LONG-TERM• Review and uphold the recommendations set Review and uphold the recommendations set

by the TCNE. Set the standards for nursing by the TCNE. Set the standards for nursing schools to operate and ensure complianceschools to operate and ensure compliance

• Ensure the quality of education through a Ensure the quality of education through a thorough review of the curricula and quality thorough review of the curricula and quality of nursing facultyof nursing faculty

• Ensure the integrity of the conduct of Ensure the integrity of the conduct of examinations and other tests pertinent to examinations and other tests pertinent to the competence of Filipino nurses the competence of Filipino nurses

WHAT WE WANTHEAD calls:HEAD calls:• Unite and Uphold the Integrity of the Nursing Unite and Uphold the Integrity of the Nursing

Profession!Profession!• Conduct a Speedy, Thorough, and Conduct a Speedy, Thorough, and

Independent Investigation! Identify and Independent Investigation! Identify and Prosecute the Guilty!Prosecute the Guilty!

• Stop the Commercialization of Nursing Stop the Commercialization of Nursing Education!Education!

• Stop the Arroyo Administration’s Labor Export Stop the Arroyo Administration’s Labor Export Policy!Policy!

HEAL. STRUGGLE.LIBERATE.

Health Alliance for Democracy (HEAD)

Nursing Education Situation in the Philippines

Health & Medicine

Transcript of Nursing Education Situation in the Philippines