The first thing that almost any student from my university will tell you, when pressed about the Return Service Agreement (RSA), is that service shouldn’t be for sale.
One of the most contentious issues of UP Manila life is how every student of a health sciences program who has lost sleep over an exam the next day, who has done their rotations in the Philippine General Hospital running on faith and coffee, and who would do these things and more all over again to achieve their dream of serving the underserved, is required to render 2-3 years of service in the country within 5 years of graduation once they have earned 60 units towards the completion of their degree. Those who do not comply are slapped with hefty fines which are seen as a way to compensate the university, and by extension the Filipino people, for turning their back on their mandate to use their skills where they are needed most.
At first glance, it seems like a solid solution to the problem of brain drain – paying forward the resources invested in you by fellow taxpayers and the state by giving back to them. It’s only fair, they will tell you when you first enter, especially in a country where getting an education at a prestigious public university while paying little to nothing in tuition fees is an opportunity many do not get to experience.
However, it only takes a year on campus to see that while the noblest of intentions may be behind the policy, it is still a band-aid solution. What an ill-fitting piece of gauze is to an infected lesion, so the RSA is to the Philippine healthcare system. Seeing the way it actually plays out, instead of the way the university administration wants it to play out, shows that it does very little to fix a deeply flawed healthcare system. At the root of this issue is not the selfishness of individual healthcare workers, as many would like to frame it, but a labor-export oriented economy which led to the mass exodus of professionals in the first place.
Like the systemic ills of many other nations, brain drain continues to ail people today but has its roots in policies enacted years before many of those affected now were even born. Economic migration is nothing new for Filipinos – many leave the Philippines to look for higher-paying employment elsewhere, or go to other countries to attend university, then decide to settle abroad permanently after graduation when the time for job-hunting comes, feeling their skills and intellect will be valued more outside their home country. Economic migration within the country’s borders is quite commonplace as well, with many students and young professionals leaving their hometowns in rural areas to seek their fortune in the cities, especially in the capital.
However, the current model of labor export policy that heightened brain drain to the extent we experience now began in earnest under Ferdinand Marcos’s administration in the 1970s. The years under the dictatorial Marcos regime are often misrepresented as a golden age, especially for the Philippine economy, and it’s easy to see why. The pre-Martial Law years of the regime appear to show a surge in economic growth and in the building of infrastructure at first glance, but digging deeper, many researchers have discovered this growth was driven by debt owed to institutions like the World Bank that Filipinos still haven’t paid in full decades later. Many of the projects completed under the auspices of the government also came at the cost of massive human rights violations for the workers whose labor, not the supposed genius of politicians, was the driving force behind the achievements credited to the Marcoses – the sad story behind the construction of the Manila Film Center comes to mind.
The labor export policies pushed under this administration are yet another example of those false promises that seemed like a good idea at the outset. As unemployment at home began to rise, largely due to the aforementioned national debt, exporting human capital seemed like an attractive option. The boom in foreign economies, in particular the rising value of oil in the Middle East, led to the creation of a Labor Code that made labor export a priority for the Philippines to an extent largely unseen elsewhere, even if it was initially presented as a temporary measure to alleviate the economic issues of the day. The Labor Code did this by setting up several institutions under the Department of Labor and Employment (DOLE) that made it easier for Filipinos to find jobs abroad that suited them; that provided financial services to the families of overseas Filipino workers (OFWs); and that assisted Filipinos who permanently settled abroad or acquired foreign citizenship. Today, these are known as the Philippine Overseas Employment Administration (POEA), the Overseas Workers Welfare Administration (OWWA), and the Commission on Filipinos Overseas (CFO).
It is interesting to note that POEA and OWWA are not government-funded, with OWWA in particular running on the mandatory contributions from foreign employers and from OFWs themselves. This shows just how much money Filipino migrant workers bring it, seen in how the seeming success of the Philippines’s labor export policies are not just enough to support government bureaucracies, but practically the entire economy. OFWs contribute a sizable amount to the country’s GDP, with their remittances totalling 33.5B USD last year, one of the highest values yet.
When labor export policies appear to be this beneficial, not just to the macro-level economy, but on a micro scale as well with many OFWs using the opportunities they find abroad to better provide for and support their loved ones back home, it’s easy to see why succeeding presidents did little to shift the focus of the Philippine economy. Under the Arroyo administration in the early 2000s, it became clear that labor export was no longer seen as a temporary fix, but as a feasible, long-term solution to perceived underdevelopment. Filipinos were encouraged to work abroad, and Arroyo has been described by many writers as practically begging other countries to accept more OFWs.
It took serious human rights violations later towards OFWs, such as the case of Flor Contemplacion in the ’90s, and the case of Mary Jane Veloso in the late 2010s, for policymakers to rethink the focus on labor export as one of the main drivers of the economy. Even if some attempts have been made to lessen our dependence on OFWs, they have not been enough to solve the abuse of migrant workers abroad, nor have they been enough to encourage more Filipinos at home to stay here. Earlier moves by previous regimes to export human capital came at the price of deprioritizing national industrialization, genuine agrarian reform, and the creation of jobs at home – a consequence that will likely take several more presidents to undo, even in the best case scenario.
The feeling of a lack of opportunity at home is the main factor that drives many Filipino workers, including highly educated professionals such as nurses who are often seen as one of our foremost exports, to leave the home they know in the hopes they’ll strike gold abroad. Looking at the disparity between starting salaries on average of nurses here (around 160-266 USD a month, with pay skewing lower for nurses in rural hospitals or health centers and skewing higher for those employed in private hospitals or major public hospitals) and their average starting salary abroad (3800 USD a month in the United States, where many Filipino nurses go to work), which the official DOLE website makes no bones about when one looks up its page on nurses, it is easy to see why many would choose to take this risk. The official DOLE website even lays out the likely amount that aspiring nurses will have to set aside to pay the tuition for their university education, and in a country where nurses’ fight for higher salaries is consistently ignored by the state, one cannot blame them for considering the option of going abroad even when faced with the ramifications this choice has for the issue of brain drain.
Even if nurses are the clearest example of health professionals who go abroad not out of a lack of desire to serve the people, but largely out of a sense of disillusionment with working conditions at home, the same logic applies to doctors, therapists, and practically anybody who works in the field of health sciences. Healthcare and the very real people who provide it have never been high on the government’s list of priorities, and this is apparent in how the Duterte administration is dealing with the pandemic it has on its hands. Hazard pay for frontliners is barely enough, just like their salary was to begin with before the pandemic; there appear to be no plans to put in place mass testing and more accessible treatment for COVID-19 patients; and Duterte chooses to see this latest national crisis from a military lens instead of a medical one, with an increasingly repressive lockdown enforced by the police and the military that has little scientific study to back it up.
As with any poorly thought out national policy, it is people on the ground who are left to pick up the pieces and suffer. News of hospital workers walking to work and being given a hard time at checkpoints is nothing new by this point. Nor are reports of ordinary people being brutalized and killed by police for allegedly violating lockdown guidelines even if they only happened to be in the wrong place at the wrong time while policemen get away with holding birthday parties.
One of the points experts bring up when discussing how unprepared the Philippines is for a pandemic is how understaffed our hospitals are. Inevitably, the conversation turns to how health professionals have a duty to stay at home – not in the sense of self-quarantine after exposure to COVID-19 patients (although this is a reality for many as well), but in the sense of remaining in the country where they are needed most. Even if the issue of brain drain ultimately lies in the individual choices of many, many health professionals, it is unfair to place the burden squarely on their shoulders without realizing the need for systemic change.
This burden-push, coupled with the lack of newer, more sustainable, and more humane policies, is what makes temporary fixes like the RSA so unfair. Instilling pro-people values in students is one thing, forcing their hand in the face of good reasons they have to stray from the path laid out for them is another.
The consequences handed down to those who do not comply with its terms do not take into account the many valid reasons why students – many of whom are hardly older than children when they first apply to university and choose their degree program – may shift out of their original course of study. Some students go with a health sciences program because they are pressured by family who only see the prestige and high salary of a medical profession (a view that carries the implicit expectation that you will eventually work abroad – for the chances of achieving those things as a health worker at home are slim) without understanding the mental and emotional toll of the training on a young mind that was never interested in it in the first place.
Even those who go into it of their own volition may eventually succumb to burnout and realize they aren’t cut out for medicine. Even those who graduated from a health sciences program of their own choosing with their sanity intact have good reasons for preferring uncertainty abroad than the certainty of low wages at home. No matter what a student’s reason for opting out of the RSA is, adding millions of pesos in debt to their worries will not push them to make the pro-people choices that we need them to make. Good public health policy hinges not on shaming, but on valuing, the medical workers, present and future, who make it happen. Maybe when those policies that address the causes of labor export policies and of brain drain in status quo, and not just the symptoms, are created, maybe we’ll find a cure for all our social ills. Maybe more of them will choose to stay.
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