Ethical recruitment

Last month the World Health Organization warned that the exodus of health professionals, particularly nurses, from lower income countries to advanced economies where the pay is much higher has worsened amid the COVID-19 pandemic.

But can you stop people from seeking greener pastures away from home? Nursing and other healthcare professions are not cheap or easy college courses to pursue. Those who invest in such courses will want a decent return within a reasonable period.

The pandemic exposed the high risks faced by health frontliners. The sector saw one of the highest infection and death rates from COVID, especially in the first year before vaccines were rolled out.

Worried about COVID death and debilitation and spreading the virus to their loved ones who were locked down at home, many health professionals opted to stop working during the pre-vaccine days. Even the top hospitals reported a significant drop in their nursing staff during that period.

Today the Philippines’ state of national calamity over COVID has lapsed, but the exodus of nurses continues as global demand remains high.

How can lower income countries make up for the loss?

One possibility, according to Department of Health (DOH) officer-in-charge Maria Rosario Vergeire, is to push for “ethical recruitment” with other governments.

This could mean that for every Filipino nurse recruited in another country, the receiving state must provide a replacement health worker or trainee that can compensate for the brain drain.

Even before the pandemic, the global demand for nurses was already so high that even some Filipino doctors were taking nursing courses so they could work overseas. This was because the requirements for work accreditation of foreign doctors were typically more stringent in Filipinos’ preferred employment destinations such as the United States.

The high global demand led to the sprouting of nursing schools or courses across the Philippines, and a subsequent glut in nursing graduates who mainly wanted to work abroad.

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There are numerous stories of new nurses getting paid lower than the minimum wage in some private hospitals, or even being made to pay for the work hours that they need in their resumé when applying for overseas placement.

Not surprisingly, there are nursing graduates who have opted to just work in call centers where the pay is much higher than in small private hospitals.

Estimates of the number of unemployed nurses in the country range from 200,000 to 300,000.

Last Wednesday, nurses staged a march to demand an increase in their entry level pay, to P50,000 from the current P32,000.

Vergeire says she will always support any measure that will raise the compensation of her fellow health professionals.

But the increase being demanded is hefty, percentage-wise. Vergeire told “The Chiefs” on Cignal TV’s One News last Wednesday that the amount would make the pay in government health facilities far higher than in many private hospitals across the country. It could lead to a further loss of nursing staff for the private hospitals – already a problem even before the pandemic – which is something that Vergeire says she does not want to see.

Vergeire says any increase must also be balanced with the many other funding requirements in the country, and the salary rates in other sectors of the government.

Maybe that’s exactly what the nurses did, and decided that if military and other uniformed personnel are making more than health professionals in pensions alone, health frontliners deserve higher pay. This is another story, but it will likely get dragged into any negotiations with the nurses on their demand for a pay hike.

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The International Organization for Migration (IMO) defines ethical recruitment as the hiring of workers “lawfully and in a fair and transparent manner that respects and protects their rights.”

A flagship initiative of the IOM is the IRIS Standard for ethical recruitment of migrant workers, which consists of two “overarching” principles. One is respect for laws, fundamental principles and rights at work. The other is respect for ethical and professional conduct.

There are also five “specific” principles: prohibition of job recruitment fees, respect for freedom of movement, respect for transparency of employment terms and conditions, respect for confidentiality and data protection, and respect for access to remedy.

The IRIS Standard was developed through extensive multi-stakeholder consultations based on global labor and human rights instruments, meant for labor recruiters, employers and state actors.

The WHO, for its part, released a Global Code of Practice on the International Recruitment of Health Personnel, which was approved by WHO member states during the 63rd World Health Assembly in 2010 in Geneva, Switzerland.

The code is purely voluntary, although WHO member states are “strongly encouraged” to use the code in the ethical international recruitment of health personnel. It declares that it takes into account the rights, obligations and expectations of source and destination countries alike as well as of migrant health personnel.

According to the WHO, the code “provides ethical principles applicable to the international recruitment of health personnel in a manner that strengthens the health systems of developing countries, countries with economies in transition and small island states.”

The code is supposed to promote international recruitment of health personnel in a way that will strengthen health systems, with special focus on developing countries.

National interest, however, is always foremost in policy-making, and the shortage of health frontliners persists worldwide. Wealthy countries are in fact easing their rules and dangling additional incentives for migrant health workers’ recruitment.

The Philippines is hoping that bilateral agreements on ethical recruitment might work.