In the course of the past decade, nurses have been flocking outside the country for greener pastures. Most of the young generation today enters the profession with a plan of eventually leaving the Philippines and finding work abroad. This out flux of health nurses leaves our health system crippled with an overworked and understaffed nursing workforce. Reflecting on this situation, I asked – what is the fundamental need that is being fulfilled when nurses go abroad? Answer – basic necessities. More than the monetary incentives found abroad is the ability for a Filipino to avail of basic necessities. What are these? Housing, education and healthcare are a few. In going out of the country, they are able to help lift their families and themselves – it truly is a shot at a better life.
This proposed incentive based model targets one basic necessity at a time and a person’s benefit package may expand as he/she goes along with the program. As such, the model can be shifted to be able to target other basic necessities as long as there are agencies to back up the newly targeted industry.
Our incentive based cycle starts with those nurses who are leaving. I strongly believe in the idea that Filipinos should give back something to the country that bore them, educated them and helped them get to where they are. As such, the first stage is to implement a regulation – any Filipino nurse who is leaving the country must pay a bond with the Philippine health system worth an indigent’s health insurance premium for the next 3 years. Value (at prices today) would be at 100 pesos per month. That’s 1,200 pesos or 25.5 dollars (at 47 peso exchange rate) a year. The nurse will pay this by leaving a series of postdated checks deposited into an account. If the nurse doesn’t comply, then the nursing board or regulatory agency in the Philippines will release warnings and eventually termination of license.
Assuming 10,000 nurses (from 2001-2003 we are averaging about 11,000 nurses, the sum total for the 3 years was at 33,000) left the Philippines in year 1 that would amount to a 12,000,000 peso guarantee fund every year. The guarantee fund will be explained later.
Pag-ibig or any other basic necessity provider will then be tapped to bring basic necessities to the nurses. Pag-ibig is a housing loans government subsidiary. They loan people money at lower than average interest rates designed in order for low income to middle income workers to purchase a house.
Pledge pool is a pool of nurses who have pledged, under certain conditions, to stay in the Philippines for the next 5 years. Out migration pool and the renewed pledge pool is the final step of the program where pledge pool participants have the choice of either to renew their pledge for more incentives or opt out of the cycle and instead work abroad.
The idea of this model is to create an incentive based program for nurses who will promise to stay in the country for at least 5 years. Lets assume the situation of a fresh nursing graduate – she is young, about 24 years old, she might be in love and wants to start a family, she wants to give something back to her parents for educating her, she needs work experience before she can work abroad and she needs time for all her paper work to be processed. Assuming all this, let’s try enrolling her to the program. We approach explaining that – we offer in exchange for your promise to stay in the country for the next five years to provide you a fast track loan from Pag-ibig fund making you eligible to buy your own house. This fast track loan has several components:
1) Interest rate will be lower - from a 5% interest rate to a 3% interest rate.
2) Loan will be processed in under 6 months from a normal rate of 1 year or more.
3) Upon completion of the 5 years, loan will be reverted to the normal Pag-ibig interest rate under the following conditions:
- Pledge nurse has not extended his/her pledge
Pag-ibig will think this outrageous for us to ask for such a privilege but backing these fast track loans is the guarantee fund. We will tell Pag-ibig to release only the number of loans that can be covered by the guarantee fund. In case of default by the nurse who pledged, the loan will be paid for by the fund. For Pag-ibig it is a no lose situation. They have 0% risk because of the guarantee.
If a nurse avails of this incentive package he/she will have to sign a contract with the following conditions:
1) Breach of pledge will incur penalties and reverting of the interest rate to normal.
2) In the duration of the 5 years, pledged nurse will be closely monitored by superiors in his/her hospital to evaluate for work efficiency and effectivity.
3) If at any point during the pledged years the nurse is laid off, the Philippine health system will absorb and place the pledged nurse to one of its many health service providers.
4) Upon 3 years of completion of the pledge the pledged nurse will be given the option to
- Renew the contract for an even lower interest rate or for more basic needs packages
- Be processed for migration
Renewing the contract would be the first option given. Second option though is for the nurse to be able to be processed at once for migration so that upon completion of her fifth year of service she may immediately leave for another country.
Option A would lead us to our goal of limiting the migration of nurses. Option B will help feed back more money into the system so that more loans can be released for would-be pledge nurses which in effect would also limit migration at the very least for five years.
Dynamics and Possibilities
- The program is not locked to just housing – it can also be applied to educational plans, health insurance and other basic necessities that firms are willing to loan money for.
- Rationale of the program is not for nurses to be locked in the country, in fact the program realizes the difficulties in the country’s economy – the program just encourages nurses to stay for a little bit more time so that the next batches of nursing graduates may be able to fill the gap.
- If the program succeeds we will see an army of fresh nursing grads that pledge to stay for five years every year – as such the health system will not have ‘shocks’ where their population of nurses erratically depletes.
- This program is not only applicable to nurses, with a bit of fine-tuning it can be applied to all migrating health professionals.
- Because of the program’s extensive use of various dimensions of the country’s resources there is a need for legislative and political will for this to occur.
- If at any point, the migration of nurses has depleted and is not paying enough premiums to support the fast track loans, then the project can be called a success.