“If you take the proper nurse to patient ratio in this country more than 364,000 nurses are actually needed…but owing to the volunteer-for-a-fee practice of private health facilities, compounded by the low government budget for health… the Philippines finds itself today in a situation where it has seemingly surplus nurses but it also has a pressing need for their services.”
By MARYA SALAMAT
MANILA – After a House resolution was passed last month urging President Benigno Aquino III to halt the “exploitative practice of collecting training fees from professional and registered nurses under various forms of ‘volunteer training programs’ by public and private hospitals”, hospitals reportedly got alarmed. “They stopped for a while, but now they’re coming back with different methods of ‘volunteer training for a fee’”, said nurse Leah Paquiz, president of an organization of nurses called Ang Nars.
Some hospitals have also retaliated against young nurses who exposed the volunteer/training-for-a-fee scheme.
“Forty-six of us nurses who had paid the hospital for our ‘training’ were dismissed when we made it known to the country that we are ‘volunteers’. It’s very wrong but nurses can’t speak out for fear of being blacklisted,” said Philip So Chan. Chan has a visa and could have opted to work abroad but he chose to remain in the country to “develop health care here.” His noble intention was repaid by being forced to swalow the volunteer-for-a fee scheme so that he could gain work experience to qualify for a full-time regular nursing job.
Under the guise of specialty training, some hospitals today have continued the “volunteer for a fee training scheme,” which has been happening in the Philippines for more than a decade now. This highly irregular scheme was exposed only recently and is being opposed more strongly and openly by nurses’ groups with the support of progressive lawmakers.
This so-called volunteerism has “prostituted” the concept of bayanihan or voluntary cooperation as a Filipino tradition, said Dr Teresita I. Barcelo, president of the Philippine Nurses Association. Under the detested scheme, nurses who have already been trained and licensed are still being forced to submit to another layer of “training” in hospitals.
It is a very “clear unfair labor practice on two grounds”, said Barcelo. One, registered and licensed nurses already have “the necessary skills and knowledge to perform regular nursing functions in the hospital.” As such, undergoing a ‘volunteer for a fee’ as training is “not a prerequisite for hiring.” Two, Barcelo said, registered nurses doing volunteer work concretely augment the deficit of nursing staff in many hospitals where the standard 1 : 10 nurse-patient ratio is not being met.
Public and private hospitals are reportedly making a killing through the scheme, because they are reaping profits and they do not have to hire the required number of regular or permanent nurses. They are taking advantage, instead, of the newly licensed nursing graduates who not only work for them without salaries and hazard benefits, but even pay certain amount of fees.
The fees can cost from P1,000 ($23.11) to P10,000 ($231) per month, for a one-month to three-months “training.”
No Surplus Nurses, Only Exploited Nurses
“Too many nurses are suffering today,” said Paquiz. “All over the country, major stakeholders are private hospitals – they don’t open new positions. (They) Do not hire regular workers. Nurses could not oppose this arrangement. Often they have no choice but to submit themselves to this arrangement. From three months to three years, they work as ‘volunteers’ but they are still not absorbed as regular nurses in hospitals”.
“If you take the proper nurse to patient ratio in this country,” Paquiz said, “more than 364,000 nurses are actually needed, meaning the more than 200,000 unemployed nurses can easily be absorbed.”
All over the country, the services of nurses is needed especially in community hospitals and rural health clinics, but owing to the volunteer-for-a-fee practice of private health facilities, compounded by the low government budget for health, which had also meant reducing rather than increasing the number of employed nurses, the Philippines finds itself today “in a situation where it seemingly has surplus nurses but it also has a pressing need for their services”, said the group Nars ng Bayan.
Following the progressive partylist representatives’ series of house resolutions against the practice, Rep Edgar S. San Luis filed House Bill 767, seeking to penalize all hospitals, both public and private, which demand payment from graduate nurses in exchange for actual nursing experience gained while working in a particular hospital.
Rep Philip Pichay, also the chairman of the committee on health, promised the nurses that he would support this bill, because, he said, “For as long as we don’t remove those volunteers, the hospitals will always take advantage of them. There will always be unemployed nurses. If you’re going to still have that, and you’ll implement SSL-3, the government will lose out. It’s not as if the nurses are really being trained…. They’re being treated worse than a servant, and yet they’re the ones paying the hospital, I find that revolting,” said Pichay during the roundtable discussion with Gabriela and nurses.
Deterioration of Healthcare System, Nurses’ Working Conditions
If hospitals can find ways to save on wages and even earn from nurses, it can also find ways to scrimp on the labor cost of the regular or permanent health personnel they have. There is now also a “phenomenon of outsourcing” in the nursing profession in the country where hospitals employ lower-paid “agency hired nurses,” said Jocelyn Andamo, a registered nurse who had worked as community nurse since she graduated in 1993.
As a community nurse, Andamo said she and her fellow nurses from Nars ng Bayan (Association of Community Health Workers and People’s health Advocates) have seen first-hand the vicious cycle of poverty and ill-health and the need for nurses in many underserved communities.
“While there are thousands of qualified nurses, the irony is that many poor sectors and communities especially those in remote areas continue to be underserved and deprived of even basic health care services,” said Eleanor M. Nolasco, president of Nars ng Bayan, in a statement. The group disputed the claims of labor department secretary Rosalinda Baldoz that plantilla positions for nurses in the public health system are already filled up.
“The fact remains that there is an acute need for more nurses and other health professionals to serve in the communities and in public hospitals that are generally ill-equipped and seriously understaffed,” said Nolasco.
The nurses’ group urged Health Secretary Enrique Ona to ban outright this “illegal, unethical, and exploitative practice of ‘volunteerism for a fee’ and at the same time, to provide employment opportunities for nurses with corresponding professional development and advancement programs.”
The nurses’ groups criticized as mere stop-gap the government’s various short-term, low-paying programs supposedly to ease the nursing unemployment problem. These programs include the RN HEALS, which like its predecessor, NARS or Nurses Assigned to Rural Service, “falls short of compensation for the nurses who are expected to do critical development work and provide quality nursing care in a community setting,” said Andamo of Nars ng Bayan.
Most nurses groups are united in saying that the government should adequately increase the national health budget to ensure quality health care at the same time ensuring the just compensation for nurses and other health workers.