The first event took place at the Ateneo de Manila University graduate school in Makati. It featured an international tele-conference participated in by the health secretary, three former health secretaries (including the current WHO Director of Human Resources for Health), concerned officials of the WHO Regional Office in Manila, human resources and policy officials of DOH, as well as academics from UP Manila and other health professional institutions.

As might be expected, such a high-powered meeting dealt with human resource and health policies at national and international levels. The DOH for example presented a 25-year human resource master plan developed from the perspective of studies done with the cooperation of major academic institutions. WHO staff dealt with the international issues and similar problems faced by a growing number of developing countries, especially in Africa.

The second event was held in Iloilo City - the convention of the Association of Municipal Health Officers of the Philippines (AMHOP). The participants were the front-liners of the government's health care delivery system. In the main, these mainly rural doctors were eager to hear from their invited resource speakers some answers to pressing and very personal problems that are driving many of them to depart for much more congenial posts in developed countries.

Also as expected, the views of most participants at this meeting were more down to earth and relevant to the issue of providing care for the majority of Filipinos who are economically disadvantaged. Resource speakers ranged from the Philippine Civil Service Commission to Congress, the Department of Interior and Local Government to members of academe discussing very specific clinical issues.

Many of the proposals for action at the two meetings were valid and addressed various components of a multi-faceted and extremely complex problem unique to the Philippines. The fact is that it will take major efforts by disparate groups, agencies, institutions as well as individuals to work together to address a crisis that has just now come to a head but has been percolating for decades.

The proportions of the Philippines' health manpower crisis are truly disquieting. Figures from the Philippine Overseas Employment Agency (POEA) - almost certainly understated - show that in the last five years the number of nurses departing for jobs abroad has reached over fifty thousand and still continues to grow. While the number of doctors who are able to leave for physician jobs is much lower (in the hundreds each year), almost three thousand of them have left the profession to take nursing jobs overseas.

Despite the exodus, nursing experts believe that there is no real shortage of this profession because nursing schools are producing enough graduates to satisfy both local and international demands. These experts point out however that the nurses who leave are the more highly skilled and experienced members of the private and public health service institutions. Quality of nursing care locally is therefore adversely affected. But even more worrisome is the deterioration in the quality of nursing education, which in the long term will affect the ability of the Philippines to "export" nursing manpower. Already, the country is facing stiff competition from India, the African countries, and even such countries as China and Korea.

The problem of doctors leaving the profession to become nurses "for export" has caused actual shortages. Residency positions in training hospitals, keenly competitive just five years ago, are largely unfilled - to the extent that in some institutions consultants have to go on duty for 24 hours (a phenomenon unnecessary in the past and rarely resorted to). It is estimated that at present, 4,500 physicians are taking nursing courses to qualify them for the nursing jobs available abroad. In the province of Iloilo, it is said that around 80 percent of municipal health officers (the backbone of first level health services) are either already qualified and waiting for "their papers" or reviewing for the boards to take them and qualify.

As well, enrollment in schools of medicine is dropping rapidly as nursing schools proliferate. Almost all colleges of medicine (with the exception of the University of the Philippines) have trouble admitting their allocated slots for admissions.

As usual, it is the poor majority of Filipinos who will pay in terms of deteriorating health if this crisis is not addressed with alacrity. The roots of the crisis are complex and multifaceted. Solutions will require coordinated approaches by many sectors, agencies, institutions, organizations and concerned individual professionals.