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
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
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DOI：
10.1186/s12960-017-0198-z
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发表时间：
2017-03-31
影响因子：
4.5
通讯作者：
Bourgeault, Ivy Lynn
中科院分区：
文献类型：
--
作者：
Castro-Palaganas, Erlinda;Spitzer, Denise L.;Bourgeault, Ivy Lynn
背景：来自菲律宾等发展中国家的卫生人力资源（HRH）移民的急剧增加可能会对卫生系统的可持续性产生影响。在本文中，我们追踪卫生工作者从菲律宾外流的情况，找出其关键原因和后果，并确定相关的政策应对措施。 方法：这项混合方法研究采用了分散的比较方法，涉及三个阶段：(a) 对卫生工作者从菲律宾移民的相关政策文件和学术文献进行范围界定审查；以及 (b) 37 个主要利益相关者的主要数据收集，以及 (c) 对 7 名医生、329 名护士、66 名助产士和 18 名物理治疗师进行的家庭调查。结果：菲律宾卫生工作者的移徙最好在该国政治、经济和历史/殖民遗产的宏观、中观和微观层面因素的背景下进行了解。卫生系统资金不足、失业或就业不足是移民的推动因素，此外还有对菲律宾安全、全面执业能力或职业发展机会的担忧。卫生工作者的移徙对菲律宾卫生系统及其卫生工作者既有消极的影响，也有积极的影响。利益相关者关注人才流失、增益和流通以及知识和技术转让机会等问题。与此同时，移民导致了人力资本投资的损失。卫生工作者供应的缺口影响了提供的护理质量，特别是在农村地区。海外机会的开放使健康教育商业化，降低了其质量，并剥夺了该国熟练的学习辅导员。移徙的社会成本影响了移民及其家人。在家庭层面，移民加剧了消费主义和物质主义，并加剧了对海外汇款的依赖。解决这些差距需要时间和资源。然而，与此同时，移民被一些人视为专业成长和提高的机会，以及起草针对卫生保健人员流动的更有效的国家和国家间政策应对措施的窗口。结论：除非社会经济条件得到改善并且为卫生专业人员提供更好的激励措施，否则留在菲律宾将不是一个可行的选择。专门针对外流人口的教育和培训的大规模扩张创造了国内卫生工作者的供应，而资金不足的系统无法吸收这些卫生工作者。这导致了服务不足的矛盾，特别是在农村和偏远地区，同时也出现了就业不足和人口外流。对这一悖论的政策反应尚未适当调整，以捕捉这些交叉现象的多层次和复杂性质。
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 emigres 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.