フィリピン人看護師・介護士の国際移動 · PDF filefrequented Northern Luzon during the pre-Spanish period, the first recorded ... instrument of both countries. Against

The Migration of Health Care Workers from the Philippines:

Philippines-Japan Conference on Migration Proceedings

日本－フィリピン間の人の移動に関する会議報告書

フィリピン人看護師・介護士の国際移動━日本への送出しの可能性━

2008年3月25日

龍谷大学アフラシア平和開発研究センターAfrasian Centre for Peace and Development Studies, Ryukoku University

研究シリーズ 8Research Series 8

Ma. Reinaruth D. Carlos, Chizuko Sato and Ruben Caragay, eds.

Japan as a Potential Host Country for Nurses and CaregiversMarch 25, 2008

研究シリーズ　

８　　　　　　日本

－

フィリピン間の人の移動に関する会議報告書　

フィリピン人看護師・介護士の国際移動

－

日本への送出しの可能性

－

龍谷大学アフラシア平和開発研究センター

ISBN 978 - 4 - 903625 - 80 - 5

　豊臣秀吉の時代以来、日本とフィリピンの間ではさまざまな形での人の移動が行われてきた。戦前には、日本の南方政策のもとでダバオのプランテーションやバギオのベンゲット道建設に従事するために多くの日本人労働者がフィリピンに移住したが、今では彼らの子孫が日系人として祖先の生まれ故郷に戻ってきている。戦後は、研究者や留学生の行き来が増加した一方で、1960年代にはフィリピン人ボクサーや音楽隊の来日が盛んになった。1980年代以降は、エンターテイナーや IT技術者のような一時的な出稼ぎを目的とする労働者の移動がフィリピンから日本への国際移動の中心を占めるようになった。さらに、日本人の配偶者として移住するフィリピン人も増え、今日、日本に住むフィリピン人はおよそ 20 万人に達する。他方、1万 4000 人を超える日本人（2007 年 10 月 1 日現在）が、NGOのボランティアやフィリピン人の配偶者、学生、ビジネスマンとしてフィリピンに暮らしている。近年では、老後の生活をフィリピンに求める日本人も増えている。　21 世紀に入り、フィリピン─日本関係は新たな段階を迎えている。2006 年 9 月、グローバル化の進展によって拡大する人的資源、モノ、サービス、投資の国境を越えた交換を包含する二国間の経済連携協定（日比経済連携協定＝ JPEPA）が、フィリピンのアロヨ大統領と日本の小泉首相によってフィンランドで調印された。2007年に日本の国会で批准され、2008年にフィリピンの上院で批准された JPEPAには、フィリピン人看護師と介護士の日本への送出しについての規定が盛り込まれていた。フィリピン人看護師や介護士に対する国際的な需要は、先進国における少子高齢化や労働者不足によってのみならず、先進国で介護労働が商品化されたことによっても増大しているが、日本もまた例外ではない。だが、この規定は、JPEPAのなかでもっとも多くの議論を呼ぶことになった。フィリピン人看護師・介護士の日本への送出しをめぐっては、情報不足あるいは事実誤認に基づくものと思われる多くの問題が日本とフィリピンそれぞれの関係者の間で未だ解決されずに残っている。　それゆえ、この会議はフィリピンからの看護師、介護士の国際移動の現状とフィリピン─日本間の看護・介護分野での人的交流についての情報を共有し、意見交換を行うことを主たる目的として開催された。両国の医療・介護部門への JPEPAの影響や日本の医療・介護施設での外国人労働者の雇用の見通しについても議論が行われた。この会議のもう一つの目的は、医療・介護問題や国際移動について研究を行っているフィリピン人研究者と日本人研究者の間での協力関係を強化し、研究成果を共有することにあった。そしてもっとも重要だったのは、会議を通じて、日本とフィリピンの両国において、政府・非政府を問わず、この問題に関係するさまざまなステークホルダーの間での議論と対話を深めることだった。われわれは、この問題についての両国間での対話がこれからも継続してゆくことを願っている。

表紙デザイン：　山中大輔・内田晴子研究シリーズ 8Research Series 8

龍谷大学アフラシア平和開発研究センター　研究シリーズ 8

日本－フィリピン間の人の移動に関する会議報告書フィリピン人看護師・介護士の国際移動

－日本への送出しの可能性－2008 年 3 月 25 日


Japan as a Potential Host Country for Nurses and Caregivers


March 25, 2008

Afrasian Centre for Peace and Development Studies, Ryukoku University

Research Series 8


　

発行日／ 2009 年３月 12 日発　行／龍谷大学アフラシア平和開発研究センター　　　　http://www.afrasia.ryukoku.ac.jp/

　　　　〒 520-2194 滋賀県大津市瀬田大江町横谷１－５　　TEL / FAX 077-544-7173印　刷／株式会社　田中プリント

PUBLISHED BY AFRASIAN CENTRE FOR PEACE AND DEVELOPMENT STUDIES,

RYUKOKU UNIVERSITY

　1-5 Yokotani, Oe-cho, Seta, Otsu City, Shiga 520-2194　TEL / FAX + (81) 77-544-7173　http://www.afrasia.ryukoku.ac.jp/

PRINTED BY TANAKA PRINT CO., LTD.

ISBN 978 - 4 - 903625 - 80 - 5







2008年3月25日



謝辞

本報告書は、文部科学省私学助成学術フロンティア事業「紛争解決と秩序・制度の構築に関する総合研究―

アジア・アフリカ研究の地平から」（平成 17～ 21年度龍谷大学）による研究助成を受けた。

This publication has been supported fi nancially by the Academic Frontier Centre (AFC) research project

at Ryukoku University “In Search of Societal Mechanisms and Institutions for Conflict Resolution”

initiated and funded by the Ministry of Education, Culture, Sports, Science and Technology (2005-2009).

　この会議および報告書において表明された見解は、それぞれの発言者または執筆者によるものであり、

龍谷大学アフラシア平和開発研究センターの立場を反映するものではありません。

The opinions expressed in this publication are those of the author and do not necessarily refl ect the

views of the Afrasian Centre for Peace and Development Studies. No part of this publication shall

be reproduced in any form without the permission of the author/s and the Afrasian Centre for Peace

and Development Studies.

－ 1－

PREFACE

Though it is not clear exactly when the fi rst bilateral human exchange between

Japan and the Philippines took place, there are many events in these two countries’

history that note the movement of people.1 While Japanese merchants had already

frequented Northern Luzon during the pre-Spanish period, the first recorded

prominent Japanese migration to the Philippines was of Lord Takayama Ukon who

settled in Manila together with 300 Japanese Christians after being persecuted by

Toyotomi Hideyoshi in the Sengoku era. In about the same period, Filipinos went to

Japan together with Spanish missionaries to preach Christianity, notably the first

Filipino saint, Lorenzo Ruiz.

Since then, several waves of migration took place between the two countries.

Japanese workers went to the Philippines to work in plantations in Davao and the

construction of Benguet Road, and now, many of their descendants, the Nikkeijin,

have chosen to settle in the birthplace of their forefathers. Filipino students were

sent to Japan during the 1940s under the Nampo Tokubetsu Ryugakusei (Southern

Asia Special Overseas Scholars) Program. In the post-World War II years, Japanese

scholars went to the Philippines to learn more about this country on exchange

or unilateral programs, while young Filipino students were granted government

scholarships to study in universities in Japan. Filipino boxers and music bands came

to Japan in the 1960s to work, while temporary workers like entertainers and IT

workers have dominated labor migration from the Philippines since 1980s. On the

grassroots level, many Filipinos have settled in Japan as spouses and dependents and

today, there are about 200,000 Filipinos living in Japan. On the other hand, while the

number is rather small (14,424 as of October 1, 2007)2, we can fi nd Japanese citizens

1 For a detailed history of Philippines-Japan Relations, see Sato, Torao (1994) “Firipin to Nihon: Kouryuu 500 Nen no Kiseki” Tokyo: Simul Publishers (in Japanese) (佐藤虎男『フィリピンと日本　交流 500年の軌跡』東京 :サイマル出版会，1994.); Ikehata, Setsuho and Yu-Jose, Lydia (editors) (2003) “Philippines-Japan Relations” Hawai’i: University of Hawai’i Press.

2 Japan Ministry of Foreign Affairs (2008) “Annual Report of Statistics on Japanese Nationals Overseas (as of Oct. 1, 2007)”. http://www.mofa.go.jp/mofaj/toko/tokei/hojin/08/pdfs/1.pdf Date accessed: Feb. 10, 2009.

PREFACE

－ 1－

－ 2－

PREFACE

living in the Philippines as NGO volunteers, spouses, students, businessmen and in

recent years, retirees.

International and domestic events since the late 20th century have ushered a

new phase in Philippines-Japan relations. Despite stricter immigration rules and

regulations, the movement of workers across national boundaries, especially those

facilitated by private recruiters and family networks, has intensified because of

greater income disparities and cheaper transportation cost. International demand

for Filipino health care workers has increased not only because of the decreasing

population and workers in developed countries but also due to the commodifi cation

of care and aging of their population. Within the context of such heightened

globalization, bilateral economic agreements which encompass exchange in human

resources, goods, services and investments have emerged as a major economic policy

instrument of both countries.

Against these backgrounds, the acceptance of Filipino nurses and care workers

became one of the main features of the Philippines-Japan Economic Partnership

Agreement (JPEPA), which was signed by President G. Arroyo and Prime Minister

J. Koizumi in Finland in September 2006, ratified in Japan in 2007 and in the

Philippines in 2008. It was also one of the most controversial components of the

treaty, and many issues, which could have been based on misinformation or lack of

it, and misconceptions from both Japanese and Filipino stakeholders, still remain

unsettled. This Conference was therefore organized mainly to disseminate and

exchange information about the current state of health migration in the Philippines

and health human resources exchange between the two countries, the expected impacts

of JPEPA on the health care sectors of both countries, and the prospect of involving

foreign workers in the health care sector in Japan. It also aimed to strengthen

collaborative relationship between Filipino and Japanese scholars of health care and

migration through sharing research results and views during the Conference. Most

importantly, this undertaking hoped to raise public discussion and dialogue among

the different stakeholders, both governmental and non-governmental, in Japan and

the Philippines.

The different stakeholders in the issue were well-represented in the Conference,

which was held on March 25 (Tuesday), 2008 from 10:00 am to 17:00 pm at the

David M. Consunji Room, 2nd Floor, UPAA Ang Bahay ng Alumni, UP Diliman

Campus, Quezon City in the Philippines. Participants from the Philippines comprised

－ 3－

PREFACE

of researchers and academics as well as some high-ranking government officials

from the Department of Health (DoH), Department of Labor and Employment

(DOLE), the Department of Foreign Affairs (DFA), the Department of Education and

Sports (DECS) and the Professional Regulatory Commission. Representatives from

professional organizations such as the Philippine Nursing Association also came

to share their views on the issue. It was also attended by representatives from the

Embassy, some academic institutions and private entities of Japan.

This Conference and the publication of its proceedings will not be possible without

the fi nancial contribution of the Japan Foundation, the Afrasia Centre for Peace and

Development Studies of Ryukoku University and Dr. Nagato Azuma. To them we

would like to extend our deepest gratitude and appreciation. We would also like to

acknowledge the support of Philippine Federation of Japan Alumni (PHILFEJA) and

Dr. Sylvano Mahiwo of the University of the Philippines and the valuable assistance

of Charito Chiuco especially in the preparations for the Conference and transcription

of the Proceedings.

Ma. Reinaruth D. Carlos

Chizuko Sato

Ruben Caragay

TABLE OF CONTENTS

10:00 - 10:15 OPENING CEREMONY

Opening Remarks …………………………………………………………………………………………… 7Mr. Tsutomu Suzuki, Director, The Japan Foundation Manila Offi ce

Welcome Remarks…………………………………………………………………………………………… 9Mr. Ernesto V. Abrenica, President, Philippine Federation of Japan Alumni (PHILFEJA)

10:15 - 12:30 MORNING SESSION “Migration of Health Care Workers from the Philippines”

The Labor Market in the Philippine Health Sector ………………………………………………… 13Dr. Ruben Caragay, University of the Philippines Manila

Nurse Migration from the Philippines and its Impact on the Country’s Health Care Sector: Comparison with South Africa ………………………………………………………………………… 21

Dr. Chizuko Sato, Ritsumeikan University, Japan

Trends in the Choice of Overseas Destination of Filipino Nurses and Caregivers …………… 31Dr. Ma. Reinaruth D. Carlos, Ryukoku University, Japan

Reactors …………………………………………………………………………………………………… 41Dr. Fely Marilyn Lorenzo, University of the Philippines Manila

Dr. Kenneth Ronquillo and Dr. Dorie Lynn Balanoba, Health Human Resource Development Bureau, Department of Health

Responses from the Presentors and Open Discussion ……………………………………………… 49

13:30 - 15:45 AFTERNOON SESSION “Philippines-Japan Relations in Human Resources and Development: The Filipino Health Care Workers in Japan”

Philippines-Japan Emergent Partnership: Prospects ……………………………………………… 57Dr. Sylvano D. Mahiwo, University of the Philippines Diliman

The Employment of Healthcare Workers in Japanese Nursing Homes:Implications on Filipino Caregivers …………………………………………………………………… 61

Prof. Hisako Nakai, Osaka University of Human Science, Japan, Prof. Yumiko Goto, Hagoromo International University, Japan and

Dr. Maria Reinaruth D. Carlos, Ryukoku University, Japan

Reactors …………………………………………………………………………………………………… 69Dr. Masaki Endo, Kobe International University, Japan

Dr. Jorge V. Tigno, University of the Philippines Diliman

16:00 - 17:00 OPEN FORUM

Guest Comments ………………………………………………………………………………………… 77Ms. Jennifer Frances de la Rosa, University of the Philippines Manila

Consul Mario L. de Leon, Jr., Offi ce of the Undersecretary for Administration, Department of Foreign Affairs

Mr. Masahiro Nakamura, Inter-Asia Company, JapanMr. Ron Vilog, Ateneo de Manila University and Global City Technical College

Open Forum ……………………………………………………………………………………………… 87

OP

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－ 7－

OPENING CEREMONY

Moderator: On behalf of the organizers, I would like to welcome everyone. For

the opening remarks, I would like to call on Mr. Tsutomu “Ben” Suzuki, Director of

The Japan Foundation Manila Office. In the field of Philippines-Japan exchanges,

especially the cultural and human exchange, the Japan Foundation has been a

forefront institution. It is our major co-sponsor in activities promoting the Philippines-

Japan relations. I think Director Suzuki does not need any further introduction

because he visits every place in the Philippines to promote Japanese culture through

the activities of the Japan Foundation. I just would like to note that in his younger

days, Director Suzuki was one of the participants in human exchange between the

two countries. In his student days, he came to the Philippines, in Mindanao and

in Manila. When he assumed his position at the Japan Foundation, he has been

instrumental directly and indirectly in policy making to promote cultural human

exchange between the two countries. Now he is taking the lead in this very important

time of our bilateral relations.

Opening RemarksMr. Tsutomu Suzuki

Director, The Japan Foundation Manila Offi ce

Thank you for your introduction. Yes I am a balikbayan, as our ambassador is.

It is my pleasure and honour to be here and make an opening remark. The topic of

this conference is very relevant for us to discuss for today, and also for The Japan

Foundation which has the mission of promoting better understandings among all

nations. We are very happy to support this conference. This issue of the migration of

health care workers has given rise to many questions, but in principle the Japanese

society should accept foreign human resources in order to cope with the problem

of super aging society and declining number of births. It is ethical to solve both

problems and look for our better future. It is true that Japan’s policy on the migration

of care workers needs to change drastically. The fl ow of human resources between the

Philippines and Japan might have a huge impact on both societies.

In the history of migration between us, the fi rst wave broke out in the early 20th

century, which was from Japan to the Philippines. Thousands of their descendants are

still living in the Philippines. Actually, we had a symposium last November here in the

University of the Philippines, Diliman, in cooperation with the Asian Center, about

－ 7－

－ 8－

the Nikkeijin – descendants of those Japanese who came before the war. The second

wave of the migration between the two countries took place in the 1980s, which arose

in consequence mainly from the increase of so-called Filipino entertainers in Japan.

This caused the problem of the so-called Japanese-Filipino children, estimated to be

100,000 in this country now. Some NGOs have just started a comprehensive research

on them, and actually we also started to coordinate with one of the NGOs that are

dealing with this problem. We are supporting to give education for these children, who

are sent to Japan to look for their fathers. Then, in the near future, we might face the

new wave of care workers.

We are not really sure when Japan will open its doors to foreign care workers.

Because, as you may know, the JPEPA is still waiting for ratifi cation by the senators

in the Philippines. But once we open, we should devote ourselves to the improvement

of the institutional structures for foreign care workers, the conditions of receiving

workers and so on. We have worked on the improvement of Japanese language

education and the whole curriculum for caregivers. Last year, we opened a new

website which is called Care Navi: Kaigo no Nihongo which means navigation guide

for Nihongo for caregivers. But I think the most important thing is to improve our

perceptions towards each nation. We are still sometimes suspicious about each other

and have some prejudice and preconceptions. The fierce debate about the JPEPA

in the mass media indicated the importance of the discussion and verification by

academics. The PHILFEJA is an association for friendship between the two countries.

Last week I visited the PHILFEJA offi ce and discussed the role of the association to

establish friendship between Japan and the Philippines. PHILFEJA is holding the

crucial key to handle those issues which we will discuss today.

Moderator: Thank you very much Director Suzuki. As a partner on the

Philippine side, may I call on Engineer Ernesto Abrenica, President of the PHILFEJA.

Engineer Abrenica is an industrialist/businessman. He works in the private sector,

which is one of the most important dimensions of the interaction of Philippines-

Japan relations in this area. Our Federation tries to include members from all sectors

of the society as much as possible. Engr. Abrenica is serving his second term as the

President of the Federation. Despite that, he is still young and energetic.

－ 9－

OPENING CEREMONY

Welcome RemarksMr. Ernesto V. Abrenica

President, Philippine Federation of Japan Alumni (PHILFEJA)

Just to add a little bit on what was mentioned about the ratification in the

Senate. As far as the JPEPA is concerned, my group PHILFEJA is in the field of

human resources development for quite a long time. The organization started in 1959.

With these technical people, we try to introduce technical training and management

training as the members are mostly engineers from the manufacturing industry. That

is why when Dr. Mahiwo mentioned about caregiving activities in Japan, I think this

is a very important topic because this will be a topic where our federation can give

more priority/importance. As regards the JPEPA, the Senate ratifi cation is on the way.

I think the Japanese people will expect very much on this ratifi cation. There will be a

chance that PHILFEJA can be involved in the decision making as we have politician

members in the federation. But anyway, Mr. Suzuki from the Japan Foundation, thank

you for the opening remarks. Dr. Caragay, thank you for the coffee this morning, and

representatives from the different universities, thank you for coming today. I was

asked to give you a short welcome remark representing the federation. So Dr. Mahiwo

prepared the speech for me.

Good morning, magandang umaga, and ohayo gozaimasu. On behalf of the

PHILFEJA, and the co-organizers of this seminar, I wish to extend my sincere

greetings of welcome to each and every one of you. The theme of the seminar is

timely and relevant to the contemporary relations between the Philippines and

Japan. The PHILFEJA, without exaggeration, is the most interested group in the

area of human resources development between our two countries. Our PHILFEJA

membership, which is distributed from the industry sector, the government and the

academe, is the most involved in the exchange of natural persons, be it in education

and training or in actual employment of persons across national boundaries. As such,

since I assumed the leadership of our alumni association, we made it a goal to focus

on human resources development between the Philippines and Japan. A centerpiece

of our research and practice is promoting human resources development for the

Republic of the Philippines-Japan relations. Therefore, it is our hope that with the

various institutions and individual participants, we will be able to gain insights and

knowledge regarding human resources development, in general, and specifically

the prospects for caregivers and nurses, in particular, in the fl ow of cooperation and

－ 10－

complementation.

Lastly I want to thank also the Japan Foundation for the leadership here of Mr.

Suzuki and for the continued support and cooperation extended to PHILFEJA. Once

again, welcome to all of you and good morning.

Acknowledgement of Participants Dr. Ma. Reinaruth D. Carlos

Ryukoku University

Thank you very much to our opening ceremony speakers. Now, I would like

to acknowledge the presence of those who are here today. I am sorry I might

miss some of the names of the institutions. From our list I would like to read the

affi liations of the participants for this conference. From the government, we have the

Department of Labor and Employment (DOLE), Department of Foreign Affairs (DFA),

TESDA, Commission on Higher Education (CHED), and the Embassy of Japan.

From other sectors, the Philippine Nurses Association (PNA), University of Santo

Tomas (UST), UP Diliman, UP Manila, Perpetual Help College, Tanay Community

Hospital, Pamantasan ng Lungsod ng Maynila, De Los Santos STI College of Health

Professionals, Miriam College, Manila Sanatorium Hospital, Kobe International

University, Family Clinic, Hagoromo International University, Manila Doctors’

College, Manila Central University, Osaka University of Human Science, Inter-Asia

Company, Philippine Women’s University, International Organization for Migration,

and The National University. I am sorry if I missed any institutions. Welcome to all of

you in this conference.

MO

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－ 13－

The title of my presentation is “The Labor Market in the Philippine Health

Sector,” and the objectives of my presentation are two-fold. First is to provide an

overview of the human resources for health (HRH) in the Philippines, and the second

is to give a broad picture of HRH migration in the Philippines.

For the first objective, I will be telling about the various categories of HRH in

the Philippines, the supply and production and distribution of HRH situation in the

Philippines. To help me during the discussion period will be Dr. Fely Marilyn Lorenzo,

because she has done several studies on migration, specifi cally on nurse migration. At

the outset, it is diffi cult for developing countries to establish accurately the stock and

distribution of health human resources. The Philippines is not an exception.

For the second objective, which is about migration of health human resources in

the Philippines, I will be dealing with some data about migration of health workers,

and I hope Dr. Lorenzo can fill in the gaps, i.e. the destination/receiving countries

where the health workers are going, some effects and impacts of migration, and

then coping with migration – countermeasures that are being done to cope with the

migration of health workers. During the reaction period we expect the reactors to give

some more information about migration in the Philippines.

With regard to health workers in the Philippines, there are 21 categories. You

have the handouts. You can open your handouts as I go along. There are 21 categories

in the list. These are the doctors, nurses, dentists, midwives, pharmacists, physical

therapists, occupational therapists, speech pathologists, optometrists, caregivers,

radiology technicians, medical/laboratory technologists, health educators, medical

The Labor Market in the Philippine Health Sector

Dr. Ruben CaragayProfessor, College of Public Health, University of Philippines Manila

Director, Institute for Health Policy and Development Studies (IHPDS)National Institutes of Health, University of the Philippines Manila

－ 13－

－ 14－

Dr. Ruben Caragay

social workers, nutritionists-dieticians, psychologists, respiratory therapists, sanitary

engineers, sanitary inspectors, community health workers and traditional healers.

Although the traditional healers are not licensed and did not go through formal

schools, they are included in the list.

For the physicians, from 1977 to 1988, there were 1,816 board passers per year

with a 72.7% passing rate per year. There were 12 medical schools in 1976 and 25

in 1988. From 2002 to 2006, there were 2,350 board passers per year with a 55.9%

passing rate per year. There were 30 schools in 2004.

For the nurses, from 1981 to 1988, there were 4,744 board passers per year with a

62.2% passing rate per year. There were between 125 to 128 schools in 1981-88. From

2002 to 2006, there were 17,450 board passers per year with a 48.2% passing rate

per year. There were 350 schools in 2004. Presently there are more than 450 nursing

schools in the Philippines.

For the dentists, from 1981 to 1988, there were 993 board passers per year with

a 51% passing rate per year. There were 7 dental schools in 1981 and 17 schools

in 1988. From 2002 to 2006, there were 1,019 board passers per year with a 35.9%

passing rate per year. There were 31 schools in 2004.

For the midwives, from 1981 to 1988, there were 2,872 board passers per year

with a 54.8% passing rate per year. There were 113 schools in 1987. From 2002 to

2006, there were 2,315 board passers per year with a 50.7% passing rate per year.

There were 129 schools in 2004.

There is an increase in board passers for all categories. But if you noticed,

there is a decreasing passing rate, maybe an indication of the decreasing quality of

graduates. The schools are increasing – for medical schools and nursing schools, there

is a three-fold increase, for dentists it is four times and for midwives there is a slight

increase. For other HRH between 2002 and 2006, I will just mention we have data for

pharmacists, medical technologists, physical therapists and occupational therapists

as shown in the slides.

So if you go back to the previous slide, you have this cartoon1. This is the ideal

1 This cartoon is the modifi cation of the second cartoon which appears below.

－ 15－


situation in any country where there is effortless production of HRH by the schools,

both private and government, and then they are licensed by the Professional

Regulation Commission (PRC). And then hopefully all these graduates will be utilized

by the health service agencies/institutions in the country. But as you can see later this

is not the case in the Philippines and other countries. This cartoon is a modifi cation of

a drawing taken from a WHO publication way back in the 1980s.

With regard to distribution, this slide shows distribution of physicians, nurses,

dentists and the midwives. This is from the ILO study, these are the graduates,

－ 16－

Dr. Ruben Caragay

whether they are in government or private sector or abroad, or others. I think Dr.

Lorenzo can explain this later. Because many of the graduates are in the category

“others”, it is really diffi cult to get data about the graduates.

In 1993, the Department of Health had a workshop on health policy formulation

with regard to human resources development and there was a consensus among

those who attended the workshop. Teachers of various health professional school

and practitioners came together and made an assessment of the supply of various

categories. According to the participants, the supply of the following HRH were

adequate – midwives, physical therapists and respiratory therapists. But they also

found that among the physical therapists, many were leaving the country. And there

was an oversupply of nurses already at that time. For doctors, there was oversupply

but there was enough in the Philippines. So was with the medical technologists.

Psychologists are being sidetracked in other professions. For example, in the

University of the Philippines, many of the graduates of the psychology course go into

medicine and then some eventually go into nursing. Then we have an oversupply of

radiology technicians. The following categories had undersupply at that time due

to migration – dentists, nutritionists-dieticians and pharmacists. There was also

undersupply among health educators, medical social workers, occupational therapists,

optometrists, sanitary engineers/inspectors and speech pathologists.

The second part of my presentation is on migration. We have early migration

data showing that there was a brain drain during the 1960s and 1970s which

was considered as unplanned donation from poor to rich countries. By 1982, the

Philippines had lost 14,000 doctors, mainly to the USA, and 89,000 nurses, which was

equivalent to billion dollars of imports of the Philippines. And then the next wave of

migration was in the 1970s and 1980s to oil-rich countries in the Middle East. From

1962 to 1967, there were more than 1,000 doctors and about 800 nurses admitted

to the US, with an annual average of 988 and 132, respectively. The Association

of Philippine Medical Colleges estimated that from 1902-1969 our 5,000 doctors

permanently migrated to the US and 750 to other countries, and there were about

3,600 temporary migrants. Many of them went to earn higher income as well as for

professional development. In 1973, 9,000 physicians were already in eight Western

countries, most of them were in the United States. Between 1966 and 1972 US-bound

immigrants averaged 700 a year while exchange visitors to the US averaged 500 a

year.

－ 17－


According to studies done by Tullao and Gupta, there were 21,023 nurses in the

US and Canada, with an average annual number of immigrants increasing from 679

in 1960-69 to 1,600 in 1970-79. POEA data from 1980 to 1987 shows that there was

an annual outfl ow of contract workers averaging 14,210 mainly to the Middle East.

The actual situation is depicted in this cartoon from a WHO publication. There

are many leaks, so we lose health workers after graduation from training institutions

and those who are licensed by the PRC. And then they enter the health services and

different agencies, but, many of them also get out of the health services, migrating

to other countries. The reasons for leaving are many. I think you are familiar with

them, there are push factors (wages, working conditions, socio-political factors) and

pull factors (fi nancial/physical security of children in the destination, good working

conditions as in professional development and high technology, and other reasons

such as social support from relatives/friends, opportunity for family migration and

citizenship) as shown in the slide. Not all are leaving though. There are the reasons for

staying, including satisfaction with the present situation, desire to serve the country

and wish to be with their families.

The destination/receiving countries vary depending on the type of migration.

For temporary migration the major destination/receiving countries are the Middle

East, Singapore, Taiwan and Japan. For permanent migration they are the USA, UK,

Source: Hornby, Ray, Shipp and Hall, Guidlines for Health Manpower Planning, WHO: Geneva, 1980

－ 18－

Dr. Ruben Caragay

Canada and Australia.

There is also maldistribution within the country. Many of the professionals stay

in the urban areas, and there are few in the rural areas.

Next, I want to discuss some of the effects/impacts of migration. For the receiving

countries, they are provided with much needed labor. Then there is financial gain

equivalent to the cost of building and maintaining professional schools. Between

1970 and 1973, the US would have had to operate 57 more medical schools to

produce the foreign medical graduates that migrated to the United States. Instead

of building the 57 medical schools, they admitted physicians from other countries,

such as the Philippines. That is the equivalent of building 57 medical schools and

you can imagine the cost of 57 medical schools being contributed by foreign countries.

The other gain is health care assistance to foreign nations. In 1967, the foreign aid

to the US is equivalent to the total cost of health assistance to foreign nations. As

regards countries of origin, migration eases employment because there is a lot of

unemployment/underemployment. For example in the Philippines, unemployment

now is about 12 percent and underemployment is about 20 percent or more. The

country of origin receives currency through remittances and the benefit from new

skills if the migrants go back to the Philippines and networks are established.

However there is a downside to migration for the sending country. First, there

may be brain drain. Second there may be a reduction in the quality of service and the

productivity, because what may be left are new trainees/graduates. Third, there is

resource that has to be spent for training replacements. And fourth, there is decreased

income from taxation because of permanent migration overseas.

For the migrant workers, the benefi ts will include improved quality of life, higher

pay and better working conditions/career/travel opportunities. But, on the negative

side, there may be heavy workload, stress and violence at work, racial discrimination

and relatively poor remuneration.

In coping with migration, there are three general measures. Preventive measures

include bringing quantitative production in line with capacity to remunerate

adequately and utilize effectively, modifying professional education more towards

national needs so that it should not be Western oriented and improving salaries,

working conditions, career development schemes, promotion opportunities and fringe

－ 19－


benefits. The second group is restorative measures, that is, inducing migrants to

return from abroad. I think Dr. Lorenzo can discuss this area later. Then, fi nally, there

are restrictive measures, which include sending countries’ refusal to issue passports/

foreign currency (an example of this is Sri Lanka), sending countries’ compulsory

service prior to emigration (we tried this in the 1970s but it failed) and recipient

countries’ stricter immigration laws, restricting professional practice to own nationals,

assigning foreign workers in underserved areas and qualifying exams for foreign

graduates.

This last slide is what should be done in the country, i.e., proper planning of

HRH. Thank you.

Source: Hornby, Ray, Shipp and Hall, Guidelines for Health Manpower Planning, WHO: Geneva, 1980

－ 21－

The morning session aims to look at international migration from the sending

country perspective. Dr. Caragay gave us an overall picture of the labor market in the

Philippine health care sector and international migration of health care workers from

the Philippines. My presentation focuses on one particular category of health care

workers, nurses, and aims to discuss the impact of recent increase of international

migration of nurses on the Philippine nursing industry. As many of today’s

participants are familiar with the nursing industry in the Philippines, probably

more than I am, I would also like to introduce the case of another sending country of

nurses, namely, South Africa.

My presentation consists of three sections. In the fi rst section, I will briefl y talk

about the recent trend of international migration of nurses from the Philippines,

and reasons of nurse migration. One of the things I would like to emphasize here

is that, although I focus on the situation in the sending countries, ultimately it is

the immigration policy of recipient/host countries that have the decisive power in

determining the trends in international migration of nurses. And to me, this is the

most worrying factor for the Philippine nursing industry. Because, it seems that the

Philippine society responded very well to the increasing demand for nurses abroad.

What will happen to the Filipino nursing students, if the overseas markets are closed?

In the second part of my presentation, I will briefl y discuss how the Philippine

society responded to the increasing overseas demand for nurses, and why this

has mixed meanings to the Philippine nursing industry. The first two parts of my

presentation are based on the joint paper with Dr. Ruth Carlos which has just come

out this month and a copy of it is included in the conference kit. So you should have a

Nurse Migration from the Philippines and its Impact on the Country’s Health Care Sector: Comparison with South Africa

Dr. Chizuko SatoPost-doctoral Fellow, Kinugasa Research Organization

Ritsumeikan University

－ 21－

－ 22－

Dr. Chizuko Sato

copy of the paper. I want to acknowledge here that our joint paper was written based

on our interviews last August and September with many people who are here today,

including Prof. Lorenzo, reactor to the morning session. Of course all the errors belong

to the authors, and I believe that one of the objectives of this conference is to report

back what we learned last summer to the people who helped us in interpreting the

situation and to be assured or to be criticized about our interpretations.

The final part of my presentation is about nursing profession and nursing

shortage in South Africa. Although the number of South African nurses who go

abroad is much less compared with the Filipinos, South Africa is also one of the chief

exporters of nurses in the world. Even before the effect of international migration of

nurses became apparent, South Africa was having a problem of shortage of nurses

due to internal migration, from public to private and from rural to urban. This

background prompted the government to devise pretty comprehensive “retention”

policy of nurses. So I want to briefl y look at it later.

First, here are some comparative facts between the Philippines and South Africa,

with regard to the nurse migration. As many of the people here today may know, at

the moment, the Philippines is the biggest exporter of nurses in the world. This is to

the extent that only 15% of Filipino registered nurses who are employed are working

domestically, while the rest (85%) are working abroad. Their major destination

countries are the US, the Middle East (Saudi Arabia, United Arab Emirates and

Kuwait), the UK and South-east Asian countries. The Philippines has been sending

nurses overseas for quite a long time. In contrast, South African nurses are relatively

newcomer to the international migration market. Basically this is the post-1994,

post-apartheid phenomenon for South Africa. The end of apartheid meant the end

of international sanction, and the international market opened to South African

nurses. That is why it is estimated that overwhelming majority of South African

nurses are still employed domestically, 95% of them work in South Africa and only 5%

work abroad. However, as I will discuss later, the domestic market is highly divided

between public and private sectors, and public sector has always complained that

private sector was poaching their nurses. The major destination countries for South

African nurses are the UK, the US, Australia, New Zealand, Canada and the United

Arab Emirates.

Chart 1 shows the number of foreign-born nurses in the OECD countries around

the year 2000. This chart is not complete, as actually the number of Filipino nurses

－ 23－


working in the OECD countries is more than 110,000, so this goes beyond 50,000.

This means that one out of six foreign-born nurses in the OECD is a Filipino. South

Africa ranks 25th at the bottom of this chart, but it is the second largest exporter of

nurses in sub-Sahara Africa, after Nigeria, with just over 6,000 South African nurses

in the OECD countries around the year 2000.

I am sure many people here are familiar with Chart 2, although it may not be

very clear in your handouts. It shows major destination countries for Filipino nurses

in the last 15 years, based on POEA data. I want to draw your attention to two peaks

we notice in this table. One is the US, the grey line with circle. There was a steady

increase in the early 1990s, but all of sudden it dropped in 1996. Another peak I want

you to look at is the UK, the darker grey line with triangle. Here we see a sharp

increase in 2000 and 2001, and an equally sharp drop in 2002 and then 2003. As

many researchers warned, the POEA statistics is not complete, as there are many

people who find employment outside the POEA process. Still, I think these sharp

increase and decrease are pretty scary and demand explanation.

Chart 1: Foreign-born Nurses in the OECD (circa 2000)Source: OECD 2007, “Immigrant Health Workers in OECD Countries in the Broader Context of Highly Skilled

Migration”, in International Migration Outlook, SOPEMI, OECD: Paris.

－ 24－

Dr. Chizuko Sato

The next slide shows the WHO data frequently used in discussing the strength

of health system of the country. This gives some idea about comparison of the

Philippines and South Africa in terms of the strengths of health system. Basically,

in terms of nurse to population rate, South African situation is much better than

the Philippines. The world average fi gure is 2.56 nurses per 1,000 population. South

Africa has 4.08 nurses per 1,000 population, while the Philippines has only 1.69

nurses per 1,000 population. In contrast, if we look at the two major destination

countries for South African and Filipino nurses, namely, the UK and the US, we fi nd

that the UK has 12.12 nurses per 1,000 population and the US has 9.37 nurses per

1,000 population. As for the physicians, the extent of the shortage seems to be the

same for the two countries. South Africa has 0.77 physicians per 1,000 population and

the Philippines has 0.58 physicians per 1,000 population.

The next slide is about the push and pull factors of the international migration

of nurses, but I will skip this slide, as Dr. Caragay briefl y touched upon the issue, and

these factors have already been discussed extensively in nurse migration literatures.

Of the push-pull factors of nurse migration already identified by other

researchers, what I think the most convincing in explaining the recent massive

increase in nurse migration is the effect of policy changes in the recipient/host

Chart 2: Major Destinations for Filipino NursesSource: Philippines Overseas Employment Agency (POEA), 2006, OFW Global Presence 2006, POEA Website.

－ 25－


countries. As we saw in the POEA data, the number of Filipino nurses who went

to the UK sharply increased in 2000 and 2001, and dropped in 2002. This will be

explained by the health policy of the UK labor government that sought to expand

the National Health Service (NHS) hospitals in the UK. For example, in early 1990s,

only 1 out of 10 new registered nurses was a foreigner in the UK. In 2000, the ratio

of foreign nurses increased to 40-50% of new registrants. That is a big increase.

But subsequently, the aggressive recruitment practices by the NHS hospitals were

criticized by many African political leaders for “poaching” their human resources, and

the UK government introduced an ethical Code of Practice in recruitment of foreign

nurses. This code of practice prohibited the NHS hospitals from actively recruiting

nurses from developing countries which are suffering from the shortage of nurses

domestically. As the UK can now produce suffi cient nurses domestically, it is no longer

as keen to recruit foreign nurses as it used to be. The UK market for foreign general

nurse is now closed.

As the policy changes in the recipient countries have decisive impact on

international migration of nurses, I found the Philippine society’s responses to the

increased overseas demand for nurses slightly disturbing. As many people here are

pretty familiar with what is happening in the Philippine nursing industry, I will go

through this section very quickly. Basically, as Dr. Caragay mentioned, I think the

Philippine society responded very well to the increased international demand for

nurses. This is illustrated in the dramatic increase in the number of nursing colleges

as well as enrolment in nursing course in the past seven years. Nursing schools in

the Philippines increased from 169 in 1998, to 251 in 2003 and 470 in 2006. The

Philippines simply produce more nurses than the domestic market can absorb.

The chief reason that explains the quick and overwhelming response of the

Philippine society to this new international demand for nurses lay in the development

strategy of the Philippine government. From the mid-1970s, the Philippine government

adopted international migration as a development strategy to alleviate unemployment

problem in the country. Originally it was intended as a temporary measure, but since

then international migration became an integral part of the Philippine society to the

extent that many Filipino families have a member of family and/or relatives working

abroad. There is a well-established migration industry in the Philippines, including

the government agency that markets Filipino workers in the overseas market, as

well as numerous recruitment agencies operating in the country. Remittance is also

important to individual households as well as to the country as a whole. In addition,

－ 26－

Dr. Chizuko Sato

several researchers found that nurses are loyal remitter. Not only that nurses tend to

remit more money, more often than other workers, they continue to send money home

even after a long period of absence from home. For instance, according to research

studies cited by Kingma (2007), more than 50% (75%+ for Filipinos and 70%+ for

South Africans) of foreign nurses surveyed in London sent money to their home

regularly. Furthermore, half of Filipino and South African nurses surveyed in London

sent more than 25% of their income to their home.

But there are a lot of disturbing aspects, too. While some nursing colleges fail

to educate nurses properly, apparently increasing number of young students take

up nursing in anticipation that it will guarantee their escape to greener pastures.

I would also like to argue that this responsiveness to the international market

actually increased vulnerability of the Philippine society to the fluctuations in the

international market. If the international market is closed for some reason, the

unemployment problem in the Philippines will get worse. Other negative impacts

are also observed in their workplace such as the high turnover rate of nurses and

an exploitation of young nurses who are willing to work even as a volunteer to get

necessary experience to work abroad, but I will not go into details here due to the

time constraint.

The Philippine nursing sector as well as the Department of Health identified

the problems associated with the international migration, and came up with several

policy proposals to rectify the situation, the most important one being the formulation

of the “Human Resources for Health Master Plan for 2005-2030”. But I will leave this

to our reactors, Dr. Lorenzo and Dr. Balanoba, as they are more knowledgeable on this

issue, because they are the ones who formulated these proposals and thus are in far

better position to talk about them.

In the remaining time, I would like to briefl y discuss the nature of the problem of

shortage of nurses in South Africa and how the government is tackling it. Basically

the main problem for nursing sector in South Africa is the shortage of nurse. This is

recognized as a problem in that country, in spite that it scores favorably in terms of

the nurse-population ratio, as we saw earlier. The shortage of nurses in South Africa

is measured by the vacancy rate, and the vacancy rate in public hospitals increased

from 20% in the early 1990s to 25% in 2001, and to 36% in 2007. Recently it has been

discovered that the problem of vacancy is not unique to the public hospitals, and even

private health care industry is facing the problem of shortage, although the extent of

－ 27－


shortage is less than in the public hospitals.

South Africa has three categories of nurses – registered nurse, enrolled nurse

and enrolled nursing auxiliary. One has to study 4 years to become a registered nurse

(RN/RM), 2 years for enrolled nurse (EN/EM), and 1 year for nursing auxiliary (ENA).

Chart 3 shows that, except for a slight decrease in the number of enrolled nurses in

the late 1990s, all three categories of nurses who registered with the nursing council

in South Africa increased in last 10 years. However, it does not mean that everyone

who is registered is working. The longitudinal data is not available, but if we take a

snapshot of the situation in 2001 based on the study by Hall et al (2003), apparently

more than 18% of nurses who were registered with the nursing council were not

working.

The next slide shows that less than half of registered nurses (professional nurses)

on the council registry are working in public hospitals. The percentage of enrolled

nurses on the council registry who are working in public hospitals is higher than 50%,

but for the registered nurses it is constantly lower than 50%.

Nurses who are not working in public hospitals are either working in private

hospitals, working overseas, or not working at all. According to the labor force

statistics for 2001, about 63% of nurses were working in public hospitals, while about

37% were working in the private hospitals. Given that only 16% of South African

Chart 3: South African Nursing Council RegisterSource: South African Nursing Council Website

－ 28－

Dr. Chizuko Sato

population belonged to medical schemes and thus can afford to go to private hospitals,

the number of population that public sector nurses have to shoulder is much bigger.

The situation is worse for doctors. Earlier we saw in the WHO data that the ratio of

doctor per 1,000 population in South Africa is 0.77. However, the ratio of doctor per

1,000 population in private hospitals in South Africa is 2.55. There is also problem of

maldistribution between urban and rural, but I will not go into details here.

While the shortage of nurses in South Africa already existed in the early 1990s,

the opening of international market for nurses after the end of apartheid in 1994

probably exacerbated the problem. As South Africa does not have an equivalent of

the POEA, it is impossible to obtain the statistics on international migration of South

African nurses, apart from the ones who declare that they are emigrating from South

Africa permanently. This is small number, only in the hundreds. Instead, what is

available is the number of requests made by South African nurses for certificates

of their qualification to the South African Nursing Council. This figure only shows

their intention to go abroad, and not the actual number of South African nurses who

went abroad. Still the increase in the number of such request after 1995 is highly

noticeable in Chart 4.

The next slide shows popular destination countries for South African nurses

from 2001 to 2004. The most popular destination for South African nurses is the UK,

followed by Australia, USA, Ireland and New Zealand. According to the registration

Chart 4: Requests for Certifi cates of Qualifi cation by South African Nurses, 1991-2002Source: OECD 2004, “The International Mobility of Health Professionals: An Evaluation and Analysis based

on the Case of South Africa”, in Trends in International Migration, SOPEMI, OECD: Paris.

－ 29－


statistics of the UK Nursing and Midwifery Council, the number of South African

nurses who registered with the UK Nursing and Midwifery Council was 599 in

1998/99, which increased to 1,460 in 1999/2000 and again to 2,114 in 2001/02, but

then it sharply dropped to 933 in 2004/05.

On the supply side, the next slide shows the growth in the number of students

who study nursing in South Africa since 2000. The number of students who study

nursing is increasing, but the dropout rate from the courses cannot be ignored. One

estimates that it is as high as 20%. Some of the reasons cited include fi nancial reasons

and teenage pregnancy. The latter is quite common in South Africa. If we compare the

annual average enrolments for nursing courses (16,718) with the graduates (5,837)

for the period of 1991-2000, we find that only less than one-third of total enrollees

completed the courses. Thus the increasing supply of nurses through educating

more nurses is considered to be not an easy task. Moreover, it is projected that the

shortage of nurses will be exacerbated due to the number of reasons, most notably

the retirement of signifi cant percentage of current nurses, as well as the decreasing

popularity of nursing as a profession due to the availability of other job opportunities

for young women.

The South African government has introduced several policies to “retain”

the existing nurses and stop further loss to private sector or overseas market,

as increasing supply is not an easy task. They introduced one year compulsory

community service to several categories of health workers. It was fi rst introduced to

doctors in 1999. For nurses it was introduced only last year (in 2007). We hear that

community service is not very popular among doctors, and they tend to perceive it as

punishment of their education. Unless you complete the community service, you are

not allowed to register with the South African Nursing Council or Health Professional

Council in South Africa, which means that you cannot practice/work in South Africa

as your trained health profession. Another signifi cant new policy is the Occupational

Specific Dispensation, which was agreed between the South African government

and health-related trade unions including the nurses’ organizations last year. With

this dispensation, the entry level salary for all categories of nurses was increased

by 20-24%, and it was agreed to be implemented retrospectively back to July 2007.

How effective this policy will be remains to be seen, but a salary increase by 20% is

defi nitely signifi cant.

In concluding remarks, I will just highlight the contrasting situation between the

－ 30－

Dr. Chizuko Sato

Philippines and South Africa. For the Philippines, migration has been long pursued

by the government as a development strategy in order to alleviate the domestic

unemployment problem. Thanks to the established migration industry, the Philippine

society was able to respond quickly and overwhelmingly to the new international

demands for nurses in late 1990s and early 2000s. However, I would argue that its

responsiveness to the international market also increased its vulnerability to the

fluctuation of the demands in the international market. On the positive side, the

current exodus of Filipino nurses sparked the debates within the country on the

salary and working conditions of nurses in the domestic market. For South Africa,

international migration of nurses is largely post-1994 phenomenon. The impact of

international migration on the nurse labor market is still limited, but the South

African public health sector already has a problem of “internal” migration in the

form of from public hospitals to private hospitals, as well as in the form of rural

hospitals to urban hospitals. The primary purpose of health human resources policy

of the South African government is to keep nurses and doctors in public sector, and to

recruit foreign doctors for rural placement.

Since the historical significance of migration as well as the scale of nurse

migration are different between these two countries, a simple comparison may not

be the best way to investigate the impact of international migration of nurses on

the nursing industry of these countries. However, both countries see international

migration of nurses as one of the reasons of weakening health system and have

embarked on formulating “retention” policy. How effective these policies will be

operated, and to what extent policies of sending countries can infl uence the trends of

out-migration of their nurses will be the next question to be explored. Thank you.

－ 31－

First please let me introduce my research on Filipino caregivers in Japan. I

started looking at the possibility of having Filipinos work as caregivers in Japan

when I did a Japan Foundation research project with De La Salle University in 2003.

At that time, talks about JPEPA had just started and the research task commissioned

to me was to look at what was happening in Japan’s aging society and what kinds of

careworkers were needed. Since then, I have sort of expanded my interests and today,

I want to talk to you about one perspective of the issue of health workers’ migration

which is concerned with the policies of the sending country. Dr. Sato shared with you

the cases of South Africa and the Philippines. Today, I will concentrate on two key

questions, both of which concern the sending country, the Philippines. First, I will

talk about the perceptions of Filipino students to work overseas and their choice

of destination; and then I will talk about these perceptions’ implications on health

workers’ migration to Japan under JPEPA. A part of my presentations comes from

my fieldwork in Cebu and Manila done under JSPS – one on human security and

migration, and the other on training curriculum for foreign caregivers in Japan.

Just to give us an overview of the explanations on migrant’s decision on

migration and the destination, we have three basic theories – the Push-Pull Factors;

the Economics of Labor Migration (NELM) and the New Economic Geography

(NEG) theories. The factors affecting the choice of migrant destination depends on

the individual (this is the push-pull factors pointed out by Harris and Todaro), and

also on the migrant’s household (this is the argument of the NELM). It is not only

the migrant himself who decides whether to go or not; where to go, or how much

to remit. It is the migrant household, because the migrant is part of a household.

The push factors affecting migration arise from the sending country, while the pull

Trends in the Choice of Overseas Destinationof Filipino Nurses and Caregivers

Dr. Ma. Reinaruth D. CarlosAssociate Professor, Faculty of Intercultural Communications,

Ryukoku University

－ 31－

－ 32－

Dr. Ma. Reinaruth D. Carlos

factors can be found existing in the destination countries. Under NELM, networking

is also an important factor for migration decisions. The third explanation – that

based on NEG, was originally used for investments and the agglomeration of fi rms –

fi rms tend to invest and agglomerate in one destination due to its distance from the

sending area and its market potential. For example, in the case of Europe, will all

nurses agglomerate in just one country, like, for example, the UK which has a large

market potential for elderly care services? I am still trying to see how I can use this

to empirically explain the international movement of nurses.

Then, I should emphasize that when we talk about migration, there are three

things that we have to keep in mind. First, it is a demand-led phenomenon, as Dr.

Sato has mentioned. It really depends on the policies of the receiving county, so

whether our nurses can work overseas depends on the host countries like the UK

and the US on when it will open its labor market for our nurses. Then, secondly, the

choice of destination is an outcome of interactions among various motivations. There

are many motivations and what I will look at are the motivations for our nursing

students and caregiver students to go to a specifi c destination.

Third, we should realize also the importance of information. Dr. Sato and I found

out that asymmetric information and lack of access to information are important

reasons why we are having an oversupply of nurses. We do not know when the UK

or US will open or close its market. We do not know if what we have as information

is correct. The inaccurate and/or inadequate information may cause fl aws, gaps and

lags in the decision-making process of the individual and the household. This decision

starts from whether to take up nursing in college or not. In the case of nursing

students it takes 4 to 5 years before they graduate. If the sending society feels the

strong international demand for nurses and caregivers today and reacts immediately,

the actual increase in supply will come only after 4 years. That explains the lag that

may result in the oversupply of nurses.

1. Where do Filipino students of nursing and caregiver schools want to work abroad and why?

My first key question is about the perceptions of Filipino students of nursing

and caregiver schools on where they want to go. The main issue here that made me

curious was that, will Filipino nurses really go to Japan? Japan may be thinking

about accepting Filipino nurses and caregivers, but even if it starts accepting Filipino

－ 33－

Trends in the Choice of Overseas Destination of Filipino Nurses and Caregivers

nurses and caregivers, they might not be willing to go. Well, for some, Japan can be

the last choice.

In answering this question, let me introduce to you the results of some of my

research projects. First, let us look at the results of a survey that I conducted in

Cebu and Manila with two of my collaborators, Prof. Nakai and Prof. Goto, both are

here with us today. We implemented the survey to students in 1 public and 2 private

universities in Cebu City and 3 private universities in Metro Manila. In total, we had

630 respondents, 511 of them were students of nursing and the rest were students in

caregiving. The results may not be surprising to us, because we all know that the fi rst

choice is still the US for 60 percent or more than half of the nursing students.

Table 1. Where do Filipino nursing students want to go?

n=511 First Choice Second Choice Third Choice

Rank Country ％ Country ％ Country ％

1 US 60.08 UK 28.38 Japan 21.33

2 UK 14.68 US 18.79 Australia 18.00

3 Canada 7.44 Canada 13.89 Canada 11.94

4 Australia 4.31 Australia 7.83 UK 11.55

5 Japan 1.76 Japan 6.65 US 9.20

Maybe this is an uninformed decision because we all know that currently, the US

is not accepting nurses and we do not know when it will resume accepting our nurses

again. Also, the UK stopped employing nurses from the Philippines, but then it is still

one of the favorite destinations of our nursing students.

If we do not look at the ranking of choices (in terms of their first or second or

third choice) of the nursing students, we can see from our results that almost 100

percent of our respondents want to go to the US, that is, 506 out of 511 students. On

the other hand, Japan ranks 4th as a destination. Well, I think this is still fairly high,

maybe this is partly because we are from Japan, so probably they wanted to please us.

The top 3 reasons given as to the choice of destination are high salary, having

－ 34－


a family in the destination (social network) and high level of care technology. The

fi rst reason is explained by the push-pull theory, and the second one, by the NELM.

It seems that for these Filipino respondents, the fi rst reason is economic, the second

might be social, and the third one has something to do with the career “orientedness” of Filipinos – we just do not want to go abroad for the salary, 40 percent of those

surveyed would want some sort of career mobility/development in the destination

country.

And how different are the salaries? I got this data on the average salaries of

nurses and doctors on PPP basis from the WHO database. For the Philippines the

estimated average salary of a nurse is 380 dollars and for the destination countries

chosen by the respondents (the US, UK, Canada and Australia), it is considerably

much higher.

In the case of the UK, it is around 6 times more. This wage difference apparently

sends a signal to our students of nursing schools to work in these countries.

I also looked at the reasons for choosing a specifi c destination country. I limited

it to the first choice because I feel this is really where these nursing students will

Figure 1: Purchase Parity Pay (PPP) ComparisonsSource: WHO database on health care wages. Quoted in: Vujicic et al. (2004).

－ 35－


want to go – the US, then UK, Canada, Australia and lastly Japan. Except for Japan,

expected high salary becomes a very good motivation for our nursing students to

choose any of the other destinations. Then the second strongest motivation is “family

and relatives living there” so again networking is a very important factor/motivation

for those who want to go to Australia and the US. These are obviously similar to the

general trends.

Let us look more closely at the motivations to go to the US. Let me share with you

the preliminary results of my interview survey of Filipino nurses in the US. This will

also give us some ideas as to why Filipinos will really want to work in that country.

My respondents are 35 nurses whom I interviewed in Florida and whose age ranges

from 35 to 45 years old. I found out that the lowest salary they were getting was

$25/hour in a nursing home. This is still low by American standards, maybe because

the nurse who gave me this fi gure is an unauthorized migrant. One nurse receives

as much as 74 dollars per hour for home visits of terminally ill and AIDS patients.

The salaries really depend on the type of work and work setting. Also, of these 35

nurses that I interviewed, most of them are already US citizens with families in

the US. Some were invited by their families who were already residents in the US,

some brought their families to the US 1 to 2 years after they themselves came to

this country. We can see therefore that for us Filipinos, the family or social support is

really an important factor in migration decisions.

It also seems that our nurses in the US are happy with their work, although I

must admit that having only 35 respondents is not enough to suffi ciently prove this.

For job satisfaction, I asked my respondents to rate their job satisfaction from 1 to 5,

with 5 points meaning “very satisfi ed,” under 6 criteria – career development, salary/

wage, job content and relationships with patients, supervisor and co-workers. In the

case of these 35 nurses, they seem to be happy with what they have in the US as their

average rates are rather high at more than 4 points. In the afternoon, I am going to

present the case of Japan and we will notice the difference with this one.

From my studies, it also seems that Filipino nurses in the US do not suffer from

wage discrimination, which can be defi ned as being given a smaller wage while doing

the same job; or getting the same wage while having different skills, qualifi cations or

ability. I used data from the US government of about 15,000 respondents, and what I

did was to decompose the wage difference using a formula commonly used in gender-

based wage discrimination. Here, we can isolate the wage gap that is explainable by

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the worker’s attributes and that which cannot be explained. In the survey, there was

no question that specifi cally asked the respondent on whether he/she was educated in

the Philippines, so as dummy for Filipino nurses, I used 2 proxies; 1. Asian-educated

or not, and 2. Philippine-born or not. This is justifi able because most of the foreign

nurses in the US from Asia are Philippine-born.

I found out that on the average, Philippine-born or Asian-educated nurses earn

15 percent more than the US educated nurses. We found out that Filipino nurses

get more. I tried to decompose this wage gap, and found out that part of the wage

difference can indeed be explained by lower average years of tenure and ability to

use languages other than English, that means that compared to the Filipino nurses,

the US educated nurses have less number of working years in the US and can only

speak fewer kinds of language (perhaps only English). However, there is still part

of this wage gap that cannot be explained. Other than that which can be caused by

measurement problems, the part of the wage gap that is “unexplainable” is caused by

Philippine educated nurses getting lower returns for years of experience compared to

those US educated. This means that the experience in the Philippines is not counted/

considered in the wage decision. However, despite the presence of this wage gap,

Filipinos are still attracted to work in the US as its wages are still much higher than

that in the Philippines.

How about the motivations in choosing Japan? Japan has a relatively different

combination of the motivations cited by the nursing students. As to the first

motivation, our students chose high level of care technology, skills and standards. This

implies that by working in Japan, they think that they will be able to learn about

the country’s high level of care technology – something that is related to the desire

for career development. The second strongest motivation is interest in the country’s

culture, which is not an economic one. It is more of knowing Japan, its culture and

technology that motivates students to choose this country as a destination. This

motivation does not appear as one of the three main motivations for Filipino nursing

students to work in the other 4 countries.

At present, we can say that Japan is not a popular choice for Filipino nursing

students. Then we can ask, why not? The top 3 reasons cited were (1) cannot speak

the Japanese language; (2) hard to understand its culture and practices; and (3)

people cannot understand English. Again, the main reasons are not economic factors.

We can see here how Filipino nursing students value good communication at the

－ 37－


workplace - the language, culture and practices.

How about the case of students in caregiver schools? Now we get a different

picture. Of the 119 respondents, 40 percent answered that their fi rst choice is Japan;

and 76.47% of all students included Japan in their top three choices. This may be

partly because of hopes of being able to work in Japan under the JPEPA.

Table 2. Where do Filipino caregiving students want to go? (Top three choices, multiple answers)

Country No. of Students (%) to total

Canada 102 85.71

Japan 91 76.47

US 56 47.06

UK 45 37.82

Australia 13 10.92

Japan is the second favorite destination, and the top reason given was high

salary. This is understandable as the salary that caregivers generally get in other

Asian countries like Singapore and Taiwan is relatively lower compared to Japan. It

must also be noted that the countries that accept foreign careworkers are still few.

On the other hand, the reasons cited for not choosing Japan are (1) cannot speak

Japanese (2) cannot become permanent resident or Japanese citizen and (3) hard to

understand culture and practices. In JPEPA and under the current immigration law,

it will be really hard even to become permanent residents unless a Japanese license is

obtained (under the JPEPA requirements) and working years in Japan is more than

10 years.

2. What are the implications of the current perceptions of Filipino nursing and caregiving students about migration on JPEPA?

Japan at present is strong in its position to accept foreign careworkers only under

JPEPA. There is no other way, no private initiatives, no other arrangements but only

under JPEPA. However, given the strict provisions of JPEPA, will Filipinos be willing

to go to Japan? On a bigger scale, we can ask the question, will this agreement work?

－ 38－


I know these are questions that are hard to answer, and I can only make projections

based on the research fi ndings that I presented in the fi rst part of this presentation.

2.1. Filipino nurses and caregivers may not go to Japan to work.

Our survey shows that Japan is not a top choice, especially of nursing students,

as a destination. I think more caregivers than nurses will want to go to Japan to

work, especially if they are given an equal opportunity to work in other countries.

However, some nurses and caregivers may still want to go to Japan under JPEPA

if the migration cost is low (as Japan will shoulder most of it) and the recruitment

procedure is quick and simple. Especially for the caregivers, the stiff entry

requirements remain to be a big challenge that will eventually limit their entry to

Japan.

2.2. Filipinos expect to work in a high tech environment in Japan.

Can Filipinos be trained in a high-tech environment under JPEPA? This all

depends on the types of work that the Filipino nursing and caregiving “candidates” or

trainees will get in their host institution. Especially for nurse trainees, their job may

be limited to non-medical tasks or, for caregivers, to some specifi c elderly care tasks

like assistance in bathing.

2.3 Salary is the strongest motivation for Filipinos in their choice of destination.

Is Japan’s salary attractive enough? I showed you the salary of the US, UK,

Australia, and we found out the salary is not really high in Japan, although JPEPA

requires that the Filipino candidates or trainees get the same amount of wages as

their Japanese counterpart.

2.4. Filipinos value good communication in the workplace, as expressed in

their concern about language and cultural profi ciencies.

Language and culture are important elements that motivate or discourage

Filipino students in choosing Japan as a destination, but are these properly addressed

under JPEPA? There is a 6-month language and skills training course before the

candidates/trainees are sent to their host institutions but I do not think 6 months will

be enough. I studied Japanese for 1 year but I still found it hard to participate in my

undergraduate classes.

2.5 The decision on the choice of destination depends on the availability and

accuracy of information.

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In making a rational decision, information about the host country is crucial.

At present, our information on JPEPA is rather limited and deciding based on such

limited amount of information can cause disappointment both from the Filipino

worker and the Japanese host employer, which can in turn affect the success of

migration under JPEPA. What we need now is to inform all stakeholders about

what is happening. This is rather difficult considering the wary attitude of both

governments regarding JPEPA.

As I have run out of time, let me just reiterate my fi ndings in conclusion to this

presentation. Most Filipino nursing and caregiving students desire to work abroad,

particularly in the US, UK, Canada and Australia. The main reasons for choosing

the destination are the salary, social/familial support and high-tech care technology

in these destination countries. Also, Japan did not appear to be a popular choice of

destination among nurses, but it is, relatively, among caregivers.

In projecting the success of careworkers’ migration under JPEPA, I believe it

is important to (1) know the perceptions (motivations and de-motivations) of the

potential workers and (2) give the stakeholders suffi cient and accurate information

that will make them make rational decisions. These two points can aid us in

addressing the feasibility and sustainability issues of Filipino health workers’

migration to Japan under JPEPA. Thank you very much.

－ 41－

Let me congratulate the first three presentors for their very excellent papers

which have really given us a lot of insights. For my short reactions to these three

papers, I would like to make a few points, all within the context of migration towards

Japan under the JPEPA agreement.

First, history really shows how health worker migration has been the shortcut to

meet the needs of destination countries, and I think history will bear that in all areas

of the globe. And even in many of our international discussions very recently, it has

been pointed out that the problem of migration can only be solved if the destination

countries take care of its retention problems. When we look at the plight of health

workers, doctors, nurses, midwives and the whole gamut, why do they move from third

world countries to fi rst world countries? It is because of better pay and better working

conditions. Why do the doctors, nurses and other health workers in those destination

countries not stay, or why is there not very much motivation for the young people to

go into health work? Comparatively, the work conditions and pay of health workers,

even in those first world destination countries, are not also competitive to those in

other professions. So you can see that the solution in all countries whether it is third

world or fi rst world is to improve retention management and to probably value health

work a little bit better and take care of them in all their societies. I think that point

has been made and shown aptly in the papers. That is the role of government policy

in managing migration. And we do believe that migration needs to be managed. We

cannot leave migration to the whims of the market.

Lack of government leadership has already been shown in the Philippines for

so many decades now. Instead of managing the exchange and making sure that

Reaction

Dr. Fely Marilyn LorenzoProfessor, College of Public Health

University of the Philippine Manila

－ 41－

－ 42－

Dr. Fely Marilyn Lorenzo

our country and health system benefits from this exchange, we have merely been

observers to the bleeding and what one of our colleagues called the haemorrhage of

our health workers to other countries. Lack of government leadership has led to really

professional individual response. Here in this country, the nursing sector has tried

to cope and grapple with this problem, and the nurses have been in the forefront in

looking for solutions, mostly because it has affected our profession. The Philippine

situation is somewhat different from many countries because we have a very large

private sector here. In many countries, the government holds sway both in pre-service

training and deployment of health workers. Policies can be put in place meaningfully

and they can be implemented well. But here in the Philippines, we know we do not

lack government policies but they are hardly implemented. The implementation

is also difficult because of a large private sector that largely ignores government

regulations.

I agree with the finding that asymmetric information has a large effect on the

choices and decisions of migrants. However there are other factors that need to be

considered alongside asymmetric information. A very important factor is the lack of

harmonized policies here in the Philippines to sustain employment and deployment in

hard-to-reach areas and also lack of long-term strategic plans that are implemented.

That is why I am happy to be part of the Department of Health-Human Resources for

Health Strategic Planning that tries to come up with a solution for the next 25 years.

And, as mentioned by Dr. Carlos, it does not take only a year or two to carve solutions

and to implement them because of the length of training of all our health workers.

So a 25-year plan to some may seem long, but if you look at the rationality of a long-

term strategic plan, it makes sense. Right now we are happy to report that the WHO

is looking at the Philippine model of strategic planning. The Master Plan is one of the

best practices in the world. In May 2009, we are training seven countries from Asia

and the Pacifi c, here in the Philippines, to also do their own strategic plan. We feel

this is a solution and that all countries should do this whether third world or first

world.

As regards reasons for going abroad and its relationship to JPEPA, our studies

and fi ndings also corroborate with the fi ndings of Dr. Carlos’ and Dr. Sato’s studies

that the economic and social reasons really hold weight for motivating people to want

to leave the country. These social factors are also the retention factors. They do not

want to leave the Philippines because they do not want to leave their aged parents or

their families. And so, these are the factors that we should manage very well, either to

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Reaction

regulate nurses abroad or to improve retention here at home. Aside from that, JPEPA

is seen by the nursing sector, and by a large number of our people, as disadvantageous

because of the low salaries and the very diffi cult working conditions. We work very

closely with our Japanese nurse counterparts and they tell us very frankly, “we do not

want Filipino nurses here in Japan.” So how can we justify sending our own people

to a country that may not even accept us? We see this in a lot of manifestations in

policy. If the Japanese really wanted Filipino nurses, why are they not willing to

translate their licensure exam to English? Why do they require language lessons to

be done within Japan for three years and get them to work as caregivers for the fi rst

three years? We really feel frankly that this is an exploitative situation. If you are a

registered nurse in the Philippines, and can work anywhere else in the world, why

will you go to Japan as a caregiver for the first three years? It just does not make

sense. If the Japanese really want Filipino nurses to go to Japan, they can make

the work conditions a little bit better so that the Filipinos will feel welcome and be

confi dent that they will be taken care of and be of value in that society.

With wage discrimination, what was pointed out was a very excellent point,

and we have seen this also in our studies. We feel that this is part of a global

discrimination that is ongoing. Unfortunately, even if fi rst world countries need third

world health workers to help them with their health care system, the reciprocity and

the conditions of work across the countries do not seem to really compute. We see this

in the US and the UK, and we have seen this in Japan and many other countries. We

have to look at this and policies like the mutual recognition agreements, and other

policies that might be able to solve these problems. But we should really rethink

our tendency to ignore and accept wage discrimination. Again this does not make

sense. If you can earn a better livelihood and enjoy the comfort of home and family,

why go abroad if you will be treated differently and not be given your higher value?

Even when I was in Berkeley I saw this. If you are working as a health worker or

professional in any other country, looking at the current conditions, it seems like labor

discrimination still is prevalent in all the countries.

Finally, on migration management, for caregivers, Japan is preferred, because

the market for caregivers is smaller and there is not much choice for caregivers.

The caregivng market used to be large in Canada, but that has since closed and so

the other caregiver market that is still up is Japan, and that is the reason for the

acceptance. For the migration management point, we think migration management

should not be left to be driven by the market. Migration management should be a

－ 44－

Dr. Fely Marilyn Lorenzo

combination of market incentives, but it should also use social factors to manage

migration as well as professional factors. If we all look at the push and pull factors, as

well as the economic and the geographic access factors, then there is a lot we can see

in terms of factors to manage. I always say this, but I will say it again. In any scarce

commodity like oil, the countries producing these scarce resources always benefit

from that exchange. The Philippine’s very valuable asset is its people. But how come

when we send our workers abroad, we do not get the benefi t? It is still the destination

countries that benefi t from this exchange. I feel that there is really something terribly

wrong with this type of exchange. It is my hope that academic exercises like this and

also government efforts will be able to look for a more mutually benefi cial agreement

across countries and around the world.

－ 45－

This presentation is in consultation with my boss (Dr. Ronquillo), but there are

some questions which come from me personally as Division Chief of the Planning and

Standards Division.

For all the papers that were presented, they were very informative and most

of the information that were shared are reflective of and validate issues and

concerns that have been repeatedly discussed in several forums and meetings in the

health sector. They have just documented what has been over and over told to the

Department of Health (DOH) that we should consider. This conference also refl ects

the necessity of updated and accurate data for policy and decision-making.

For the fi rst paper, I prefer to take it up in relation with what DOH has. It has

been said that the DOH has crafted the Human Resources for Health Master Plan.

That is true but it is really quite diffi cult to determine what are the members or the

professions we refer to as the Human Resources for Health. So in the presentation

there were 21 categories that were considered as human resources for health.

However, in our Master Plan, we have defi ned 23 categories.

I saw the date of the data on the distribution of health workers, which is way

back in 1998. Sad to say, we also do not have updated data to really determine the

distribution of health workers. However, because we focused on the first five years’ strategies of the Human Resources for Health (HRH) Master Plan, we are doing

the HRH stock survey. We have completed the survey only in regions 2 and 11. We

are using the machinery of the DOH in collecting data that is why it has taken us

quite a number of months already. We hope to complete the survey for the other

Reaction

Dr. Kenneth RonquilloDirector, Health Human Resource Development Bureau, Department of Health

Dr. Dorie Lynn BalanobaHealth Human Resource Development Bureau, Department of Health

－ 45－

－ 46－

Dr. Kenneth Ronquillo and Dr. Dorie Lynn Balanoba

regions by the second quarter of 2008. Then, only then, can we see the distribution

of health workers across the regions. We will also see if there would be problems or

inadequacies in different regions, as well as oversupply in other regions for health

workers. We are also doing validation of workforce projections. In the Master Plan, a

workforce projection was done to predict defi cits and oversupply of health workers,

so we may be guided whether to produce more or less of a certain profession. This

workforce projection was based on assumptions. Now that we have data from regions

2 and 11, the assumptions that were done then were already converted into actual

data gathered through the stock survey producing better projections. So we will also

be doing the same for all the other regions once we have the complete data from the

HRH stock survey.

For the consensus of oversupply/inadequacies of health workers, in 1993, it

was mentioned that there was adequate supply for doctors. But right now, although

there was no formal consensus that was established, we believe that the number of

doctors is inadequate based on enrolment and residency trends. Even in government

hospitals, you will fi nd decreasing numbers of doctors going into specialty training.

As a result, there are specific skills that are affected like pathology, radiology and

psychiatry. The only specialty that is not affected is dermatology. We are also looking

at the new prescribed method of determining the requirements for our health

facilities - that is the Workload Indicator in Staffi ng Needs (WISN). And because of

this, we have not yet fully determined the requirements of the Philippines for health

workers. That is why we cannot declare whether we are over- or undersupply or

adequate in terms of specifi c health human resources.

Also the paper mentioned about coping with migration and indicated several

measures. DOH as a lead in health recognizes the realities of migration. We, together

with other government agencies, believe that we cannot prevent our nurses from

going out of the Philippines and rendering service outside the country. As stated

in the Master Plan, we need to manage migration, but it has to be done by several

agencies because in the Philippines, there are several agencies who decide on HRH. It

is not only DOH. That is why we formed the HRH network where existing policies are

being reviewed. We also want to harmonize the policies we have so that we will have

one stand as a country on what we really want for our HRH.

Among the policies that we want to go into are policies that will support

competency-based education and licensing, policies that will improve salaries,

－ 47－

Reaction

working conditions, and career development. Further, we want to have a stand on

bilateral/multilateral agreements. Return migration is also one of those we want to

address. Mutual recognition agreements are also opportunities we want to participate

in, because if our experiences and our competencies are recognized among countries

then we can demand the appropriate wage/salaries for our health workers. We are

looking at declaring mission-critical professions, just like the pilots, but because of

lack of data we cannot do it yet.

In the second paper, we would like to emphasize that export of nurses was never

a policy/program of the government. It is just a reaction to the demand of nurses from

other countries.

There are my personal inquiries for further elaboration by the authors. For the

South Africa model, can you elaborate on the allowances that were mentioned in

terms of its percentage on basic salary, the source of funding and the qualification

criteria? Kindly elaborate what you meant by saying that the impact of international

migration in South Africa is still limited. Also, considering that the Philippines

produces more than what are needed in the county, is there a signifi cance of the ratio

of domestic versus overseas employment on the health care delivery system in the

Philippines? Can the author recommend the application of the South Africa model in

the Philippines at this time?

For the third paper, we agree with the conclusions and recommendations, and

suggest that this paper be made available to the implementing agencies. Can the

author comment on the possibility of nurse graduates who are non-board passers

going to Japan as caregivers?

(Presented by Dr. Balanoba)

－ 49－

Responses from the Presentors

Ruth Carlos (presentor): I will start with the suggestion that this paper be

made available. Actually, what I presented today is just part of the result of the survey

we conducted in the Philippines last summer. We had around 25 questions including

up to how much they want to remit, how much income they are expecting, whether

they are planning to come back to the Philippines and so forth. Since Professor Nakai

and Professor Goto who did the survey together with me are here today, I will consult

with them about your suggestion. At the moment we are thinking of producing a fi nal

report, collating all our fi ndings, hopefully within this year.

As regards the possibility of nurse graduates who are not board passers going

to Japan as caregivers, I think, it is not a requirement for caregivers to be a board

passer. I do not think that there is a clause in the JPEPA that one has to be a board

passer to work as a caregiver. I just have the JPEPA scheme here. There are two

requirements for certifi ed care workers: either a TESDA caregiver course certifi cate or

a nursing college degree. So even if one is not a board passer, it is possible for him/her

to work in Japan as a caregiver, as far as this written JPEPA scheme is concerned.

But I do not know if there are talks of restricting the non-board passers.

Edmunda Rillon: As already mentioned by Dr. Lorenzo, they are silent about

passing the board. The reality is, they make you go over there and take the course

in Japan, in addition to you being a graduate. I see this as very frustrating and even

insulting to our education.

Responses from the Presentors and Open Discussion

－ 49－

－ 50－

Chizuko Sato (presentor): Before answering the specific questions raised by

reactors, I also want to emphasize the point made by Dr. Lorenzo. Even the countries

receiving foreign nurses need to come up with retention policies for their own nurses,

which should include policies that seek to improve the working conditions of nurses.

The UK nurses are also going out of the country. South Africa is also a receiving

country, for doctors mainly, in order to compensate for the shortage of skills in South

Africa. This is another aspect of international migration of health workers in South

Africa. It is not just a sending county, but also a receiving country.

One of the questions raised by Dr. Balanoba is about allowances – how many

percentages of basic salary is given as scarce skills and rural allowances. I do not

have the numbers here, but I can e-mail you about this later. With regard to the

source of funding for these allowances, the budget is from the government. South

Africa spends a quite significant amount of budget on the social sectors, including

the health sector and the Department of Social Welfare. It is because South African

government considers social security expenditure as a poverty alleviation strategy.

The government sort of hands out money to poor people in order to reduce the

disparity between rich and poor. So it is from the government source.

Another thing peculiar to South Africa is this occupational specifi c dispensation

by which the government is increasing the salary for nurses in public sector. The

problem is, they are increasing the salary of nurses, but at the same time the South

African government is saying that certain nursing posts cannot be fi lled due to lack

of funding. This means that even if they increase the salaries of nurses who are

currently employed in public hospitals, their heavy workload may not be reduced as

hospitals cannot employ more nurses. We think this contradiction has to be addressed.

What do I mean by that the impact of migration is still limited on South African

market? It is because shortage has always been there, regardless of increase of

international migration. Compared with the Philippines where we saw the impact of

out-migration of nurses on various aspects of society, it is still quite limited in South

Africa. We have media reports of brain drain and nurses going abroad, but in the

actual situation, the percentage of South African nurses who are working abroad is

still quite limited.

Dr. Balanoba said that the Philippine government has never encouraged or

adapted the policy of nurse to go abroad. Yes, that may be true. But what I understand

－ 51－


is that one of the major roles of the POEA is to market Filipino human resources

overseas. So if there is demand overseas for nurses, why not market them abroad? It

is not a policy in strict terms but in a broad sense there is a sort of encouragement

from the government side for the Filipino nurses to go abroad.

The last question is whether the recommendations from South Africa can be

implemented in the Philippines or not. Because of the differences in the historical

patterns of migration and in the government emphasis on migration, I think probably

it won’t work. Still many countries are devising retention policies for their nurses and,

as Dr. Lorenzo mentioned, it is not only sending countries that should come up with

retention policies, but the receiving countries should also work to improve working

conditions of its nurses. This is something all countries should work on. There are

some lessons we can probably learn from the South African experience. But really

again, it will be the question of budget, which means the question of political will. For

instance, where will the budget come from in order to increase the salaries of nurses?

Ruth Carlos (presentor): Just one minute on this subject. I would like to

comment that the big difference between South African and Philippine nurses is that,

when we went to South Africa, we learned that the South Africans would want to

come back after working in the UK for 2-3 years, but for the Filipinos it is more on a

long-term plan, that we want to go to the US to get the citizenship. And people have

been asking me why, I said I do not know. Another thing is about the policy and the

application of this policy to the Philippines. I think the most important thing there is

the feeling of sense of crisis. Because we have not felt the crisis that South Africa is

experiencing now. I think we do not need these policies yet. Maybe when we become

aware of the crisis or when the crisis comes to us, then we will fi nd some solutions

from the South African experience.

Open Discussion

Jorge Tigno: My name is Jorge Tigno, I am with UP and I teach Political Science.

I have questions that have to do with the presentations. I do have some questions that

pertain to motivations of why young people enter the health professions in the fi rst

place. In the powerpoint presentations that you gave us, there are some discussions

there why health professionals choose to leave the Philippines. I do not know if there

are any surveys that had been done that relate to this issue of why people choose the

－ 52－

health profession, given the low salaries and poor working conditions involved. Why

do people choose to become nurses, caregivers and health workers?

The second question I have relates to the premise of the fi rst two presentations,

and that is the issue of oversupply of health care workers in the Philippines. Is there

really an oversupply or is it simply a condition of causality between migration and

the labor market itself? There is still a shortage of health workers in the rural areas

in the Philippines, so this relates also to the commentary of Dr. Lorenzo that there is

a lack of management in terms of the policy aspect.

The third question that I have, I think this has not been presented, has

something to do with demographic realities taking place in the destination areas. The

aging/greying population of Japan has certainly created imperatives for the hiring

of health care workers. I wonder to what extent is the receiving side considered. I

understand that the study will have to do more on the sending side, but I guess it is

also a question on the demand side, what are the possible reasons for hiring and not

hiring foreign caregivers and nurses, on the part of Japan, the US, Canada and the

UK?

And this leads to my fi nal issue, and again this has not been brought up in the

discussion, concerning this medical migration, the migration of natural persons to

areas where medical care is available. So you have people coming from Japan to the

Philippines or Thailand, to seek medical or health care, or when they become ill or

some other cause. I think this will fall under Mode 4 in the movement of natural

persons. In the general sense, not only in the sense of JPEPA, well it is no longer

a major point for me because I will be making my own discussion in the afternoon,

but I think what should be considered is the kind of noodle bowl effect that might

create a problem. Many are not familiar with the noodle bowl phenomenon, wherein

it emphasizes bilateralism rather than multilateralism, which in my view is a more

strategic way of addressing the management of migration.

Ruben Caragay (presentor): I would like to comment on the question of the

motivations why they go into the health professions. There are many reasons. I think

those in the education institutions can share, because they usually ask students

why they want to become a nurse or a doctor. Aside from the prestige or the belief

that they can earn, their movitations include that their parents are doctors also,

or that they consider the profession as a stepping stone to go abroad. So these are

－ 53－


some of the reasons. The second one is about the distribution. I mentioned there is

maldistribution in the Philippines – many of the professionals are in the urban rather

than in the rural areas where they are needed.

Ruth Carlos (presentor): Another question is about Japan’s demographic

reason for the increasing demand for care workers. In the case of Japan we will have

a more detailed overview of what is happening in Japan regarding aging and the

shortage of care workers in the afternoon session. As for the other one about medical

tourism, we have not looked at this matter yet.

A participant from the Department of Health: On the matter about surplus,

we have a production surplus right now for most health workers’ categories here, but

the deployment is the problem that we have, that is why we still have shortage. We

are in a very diffi cult/ironic situation where we produce too much but we do not have

enough positions in government or the private sector. Our health workers cannot

go where they are needed. A case in point is what we have been showing in the past

studies. There is increased contractual positions in the health sectors. Never before

have we found doctors in contractual positions, and nurses in contractual positions

outnumber those with permanent positions. As far as these people are concerned, they

do not have real jobs when they go to these contractual positions. If you are talking

about numbers we are in oversupply. In terms of real demand in the country, the

demand is not there.

Ruth Carlos (presentor): Maybe you can look at our paper which we included

in today’s conference kit. This is the result of our interview survey last year in Cebu.

We found out that there is still a shortage of skills of nurses, but not in terms of their

number of nurses.

AF

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When we were organizing this conference I already thought I would not have

any role to play here except to put our Federation (PHILFEJA) to be part of the

organizers. But then a perspective of Philippines-Japan bilateral relations was needed

to put today’s topic into context. I will not talk about caregivers or nursing, nor

policies per se, but of the generalities on the prospects or the possibilities, especially

when the Japan-Philippines Economic Partnership (JPEPA) is in place. This is not

focused on nurses and caregivers, but will involve the so-called movement of natural

persons across boundaries. I will share my perspective as a student of international

relations, but I hope that the caregiver and nursing aspect will also be given some

general enlightenment.

First, we have to look at the relations between the Philippines and Japan,

especially the contemporary relationship. In 2006, we celebrated the 50 years of

normalization of diplomatic relations between Japan and the Philippines. In that 50

years or half a century that spanned, the bilateral relations, even the multilateral

relations, have undergone certain transitions. As I see it, Philippines-Japan relations

have transformed. In the immediate post-war years, we have what you call the

phase of reconciliation – that was when we had the treaties of amity and that made

us normally interacting as Asian neighbours. The second phase was of strategic or

ideological alliances which I think is not fading but it was being expanded. Both

the Philippines and Japan were members of the SEATO (Southeast Asian Treaty

Organization). Well, Japan was the member, but under the American umbrella of

the alliance, we (the Philippines) were a part of it. And then there was the national

reconstruction phase. The 1970s saw the phase of integration in the region, and

Japan was one of the first dialogue partners of the ASEAN with the Philippines –

Philippines-Japan Emergent Partnership: Prospects

Dr. Sylvano D. MahiwoProfessor, Asian Center, University of the Philippines Diliman

－ 57－

－ 58－

Dr. Sylvano D. Mahiwo

that strengthened the relationship between the two countries. Now our relationship

is being infl uenced by globalization.

We are seeing now an emergent new form of partnership between our two

countries. When we say partnership, theoretically, it should be on equal footing. I said

theoretically because one may be ahead than the other in other aspects. Philippines

and Japan are said to be complementary partners. First, in the economic sphere,

we are not competitors. Politically, I think, we are not competitors either. Even in

security, I don’t think we are competitors.

But relevant to the discussion of migration of nurses and caregivers, I think that

the human resources aspect is one of the most complementary in that character of

Philippines-Japan relations. Here we see Japan as so-called aging society. When you

go to Japan you will see the seats in the buses and trains where it says “special seats

for the aged.” These seats are becoming longer, and even priority seats for the elderly

in the buses are increasing. Those who are 65 years old and over should be given

priority in obtaining those seats in the buses. On the other hand, in the Philippines

the mean age is perhaps 17 – this shows a great complementation in terms of

demography. And that would include not only the prospect of nurses, but older Japan

in population and younger Philippines in population are complementary, and this is

another development in the bilateral relations.

Of course, we do not decrease our trade. There is trade between our two countries,

meaning, the flow of goods, money, finance, information. But we see that human-

oriented fl ow is increasing. So these characterize our present/emergent partnership.

To preserve both nations, Japan has to reengineer its “social facilities/services” in

order that other nations, like the Philippines, can fi nd employment for its unemployed

population. So this is part of nation-building for Japan.

I would like to share how we can view the caregivers/nurses/flow of natural

persons in what I call the meta-nation state structure of relationships. This was a

small coinage I made when I was writing my thesis when I was in Japan. A meta-

nation state simply is the state that is the core. It is beyond a state that causes

the fl ow of goods and people. If you look at this as a highway (either Japan’s or the

Philippines’ highway), highway A is the nation state. Within it is highway B, which

I call the intra-highway, the highway that is within Japan or within the Philippines.

But you can call it a sub-national state highway or flow. A is the flow, but various

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Philippines-Japan Emergent Partnership: Prospects

fl ows are also being developed in B. And beyond the nation we have the C which is

the extra nation state interaction. I think, in the case of nurses, IT engineers, even

our seamen, they can flow in these three phases or channels. It could be initiated

internally, meaning by an agency, or by a sub-state or a province, promoting the fl ow

of people. It can also be beyond, a group of nations that will initiate the fl ow, i.e., in

the C. This C is also a channel. A is the nation state, and B the sub-nation state and

C is the extra-nation state. This is not limited to the Philippines and Japan but holds

true also between any interacting two nations.

Just to give an example, Singapore is a small nation state. And it may be too

much for Singapore to really deal with Japan so it only concentrated on northern

Kyushu, so there is intensive trade between the two. So that is between a nation state

A and sub-nation state B. Similarly, maybe a province or a city in the Philippines

that has a great number of nurses can promote interaction with a city or prefecture

in Japan. By the way, I was in Kobe, Professor Endo here was my host, and I was in a

conference which was sponsored by the Hyogo Prefecture. Though it may not involve

Japan as a whole, it wanted to look at how the Hyogo Prefecture could interact with

other nations. So they invited Chinese, Korean, Filipino and persons from other

nations. This is what I call now a meta-nation state interaction. It is not exclusively

nation state that will initiate but it can be both within and outside. For example, the

Philippines Nurses Association can be a player. It is not the Philippines, but it is a

subpart of the Philippines.

Now, we have the so-called EPA (economic partnership agreement) with Japan.

The agreement is a 900-page document. Its characteristic is that it is not dealing

－ 60－

Dr. Sylvano D. Mahiwo

with mere fl ow of goods/money/fi nance, but chapter eight of the agreement deals with

the fl ow of natural persons. This is what is crucial about this emergent relationship.

They are not talking about cars but people. It depends on the outcome of policies in

implementation but this is one of it. FTA (free trade agreement) is distinguished

from EPA. FTA is just free trade but EPA includes human resources. The movement

of people in Japan is called Hito no Idou. It is now part of our bilateral relationship.

But Japan and Singapore did not have this. So it is just between our two countries

because of the complementation explained just a while ago. We look at human

resource development not as an object to exploit but as part of our nation-building.

And depending on how we implement our policy, and how we deal with our partners

like Japan, we may achieve our goals of nation-building.

If issues are incurred in the mere fl ow of goods – like the fl ow of bananas or cars –

how much more issues will be incurred with the fl ow of people? It will be very complex

in terms of issues and policies. Now there are legal issues – labor, employment – but

there are also non-legal issues. What I would like to emphasize here is that if and

when the Philippines or Japan, after successfully implementing a policy of accepting

our nurses and caregivers, if they go to Japan, then there is the process of education

and training, which I call human communication and management. This includes the

issues of how you interact with the Japanese who are the receivers of our nurses and

who deal with the Filipinos, and how we train and manage also the Filipinos who will

be dealing with the Japanese. This might become a good potential for more research

and study – the so-called cross cultural interactions and relations. This meta-nation

state relation is what we call in Filipino “Bagong Pakikisama.” No more are the

days like when we dealt with Japan in the 1950s, 60s and 70s. We have to change,

and Japan should also do the same. It must be mutual. Japan should not be dealing

with the Philippines just as it did during the days of the entertainers. So, Bagong

Pakikisama or Atarashii Tsukiaikata. The meta-nation state relations will bring us

into a different level of interaction, not necessarily a higher level of interaction. It

should be open, liberal, and for mutual benefi t. And that touches on the philosophical

and the cultural values of both nations. But I can see that in this emergent

Philippines-Japan relation, we have to deal with these various issues/prospects as the

partnership goes to a different stage.

－ 61－

This afternoon, I am going to present about what is happening in Japan with

regards to the employment of care workers in its nursing homes. I will begin by

introducing the labor market for elderly care – i.e. the demand and supply of care

workers and the factors affecting them. Then I will introduce the case of one nursing

home in Osaka and finally, I will describe and comment on the situation of the

resident Filipinos in Japan who are currently working as caregivers. This study is

part of my bigger research project on tapping Filipino residents in Japan as care

workers. As we may already know, there are many Filipinos living in Japan, about

200,000 in 2006. Quite a number of them are former entertainers who got married

to Japanese. Among them, some have already divorced and been living on child

support. I think that training them to work as caregivers can help in their social and

economic integration in the Japanese society. Working as caregivers may be a good

alternative for them as a stable source of income. Many of them do not want to come

back to the Philippines since they want to raise their children in Japan but do not

have the means unless they rely on the husband. I started doing research on this

topic in 2003, and since then, I have been going around Japan to look at this issue.

I would like to introduce my two co-presentors who are professors of Social Welfare

in Osaka, Professor Hisako Nakai of Osaka University of Human Science and Prof.

Yumiko Goto of Hagoromo International University. I think the social welfare aspect

of the issue is one perspective that is crucial and yet neglected in the literature. Many

of us are social scientists - sociologists, economists, and political scientists. I am now

collaborating with them with one research project which is about designing a training

curriculum for foreigners who want to become caregivers or homehelpers. Maybe later,

they can share with us some of their insights and other research fi ndings regarding

our topic.

The Employment of Healthcare Workers in Japanese Nursing Homes: Implications on Filipino Caregivers

Prof. Hisako NakaiProfessor, Osaka University of Human Science, Japan

Prof. Yumiko GotoAssociate Professor, Hagoromo International University, Japan

Dr. Ma. Reinaruth D. CarlosAssociate Professor, Department of Intercultural Communications, Ryukoku University

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－ 62－

Prof. Hisako Nakai, Prof. Yumiko Goto and Dr. Ma. Reinaruth D. Carlos

1. The Labor Market for Caregivers in JapanThere was a question this morning by Professor Tigno abut Japan’s aging society.

Many of us here are already quite familiar about the rapid aging population of the

country as the major cause of the increasing demand for workers to take care of these

elderly people. The ratio of the elderly to total population is projected to increase from

20.1% in 2005 to 23.1 in 2015 and 31.8 in 2030. This means that currently, 1 out of 5

Japanese is an elderly aged 65 years old and above, and by 2030, the ratio will be 1

out of 3.

The demographic reasons usually given about the high ratio of elderly are their

long life expectancy and low birth rate. In 2005, the average life expectancy of a male

is 78.56, and of females is much higher by 7 years at 85.52. A Japanese woman who

retires at the age of 65 still has to live 20 years more, and of those 20 years, how many

years can she live independently? Who will take care of her? Also, the birth rate of

Japan is very low, reaching only 1.32 in 2006 and it ranks second only to Italy (1.19)

in terms of low birth rate among OECD countries.

The elderly people needing care in Japan are classifi ed into three categories, 1.

those who are physically weak; 2. those suffering from dementia and need long term

care except for the bedridden, and 3. the bedridden elderly including the bedridden

elderly having dementia. The number of elderly in each category is increasing, and

by 2025, it is expected that of the 5.3 million elderly needing care, 2.6 million will be

physically weak and 2.3 million will be bedridden (including those bedridden with

dementia).

The increasing number of elderly has taken its toll on the cost of their care.

Currently, 90% of the cost of elderly care is subsidized by the Long Term Care

Insurance and 10% is paid by the elderly himself (out-of-pocket). In Singapore, the

co-payment by the elderly depends on the income of the family. In Japan, the burden

of the family increases as the amount of services the elderly requires increases,

regardless of whether the family is poor or not. The 90% of the total cost that is

funded by the government is shared by the national government (25%), the local

government, city/municipality (25%), insurance premium paid by those members who

are 65 years old and above (19%) and insurance premium paid by those aged 40 to 64

years old (31%).

In order to avail of the services offered under the Long Term Care Insurance

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system, the elderly needs to apply at the town offi ce for certifi cation. He will then be

assessed and recommended by the local government staff for a physical examination

and evaluation by a physician. After the endorsement by the physician and further

assessment by a team of local government staff, he will be certifi ed according to the

level of his elderly care needs. The maximum care need level 5 will be granted to those

who are bedridden with dementia, and level 1 will be for those who are evaluated to

need 5-6 hours of care every week. A care plan will be designed for the elderly, which

will be the basis for availing of the care services.

There are several kinds of providers of elderly care services: the welfare facilities

(like nursing homes and sanitarium-type medical care facilities); in-home or home-

based service providers (for example, daycare, home-visits and group homes) and

preventive long term care providers (giving physical training and nutrition advice).

The sanitarium type of medical care is similar to the geriatric ward of hospitals. In

day care centers, the elderly people are sent by the family in the morning and brought

back to their home in the afternoon, while in group homes there are about 9 elderly

living together with 2 care workers watching over them. The government has also

introduced preventive long-term care among the elderly citizens because it realizes

the need to prevent them from having dementia and to provide for physical exercise

and rehabilitation.

Care workers in Japan are classified into two categories. One is certified care

workers (kaigofukushi-shi) and the other is licensed home-helpers levels 1-3. The

latter is different from certified care workers in terms of the contents and period

of training. The former is issued by the national government, while the latter is

regulated by local governments (city or prefecture). There is a movement towards

phasing out the home-helper system, or rather, incorporating this to the certified

care worker certifi cation system. Currently, even non-holders of home-helper or care

worker license are allowed to work in care facilities. As of May 2006, it is estimated

that there are 545,000 workers who are certifi ed care workers. In 2004, only about

38.7% of those working in elderly facilities were license holders (of either of above

categories).

Realizing the considerable increase in the demand for elderly care, as pointed

also out by Prof. Tigno this morning, will lead us to worry about who will do the work.

I doubt if there will be enough source of this kind of workers domestically. One

－ 64－


reason is the high rate of exit of workers in this labor market. There is an annual rate

of exit of 20.3% for all care workers, which is considerably higher than in the case of

workers in all sectors (16.2%)1. The reason is because elderly carework is perceived

as a tough job in Japan. There is also a considerable gap between the number of

available jobs (job offer) and those who are looking for a job (job seeker) in the care

sector, or what we technically call the job offer to job seeker ratio. If this ratio is 1, this

means that for every 1 job seeker, there is 1 job available for him, or 1:1. For elderly

care work, this ratio has gone up to 2.5 in 2006, implying a shortage of workers. One

care worker seeking full-time or part-time regular job, there are 2.5 jobs available to

him. This is in stark contrast to the case of jobseekers in all sectors, which is just 1 in

2006.

There are many reasons for the shortage of care workers. The first of these

reasons is the low salary of a care worker compared to those of other types of workers.

Another factor that affects the popularity of elderly care is the level of job satisfaction

obtained from it. Surveys by the Carework Foundation (Kaigo Roudou Antei Center)

in 2004 and 2005 show a relatively low percentage of care workers satisfied with

their wages and salary, working hours, rest days, type of employment, job content,

relationship with co-workers and relationship with patients. Over-all, only 18% of

all care workers in elderly care facilities surveyed expressed satisfaction in their job;

while those who are home-based have a slightly higher level of 21.0%.2 The data also

shows that compared to those working in facilities, home-based care workers are

particularly happier with their wages and salary, job content, and relationships with

co-workers and patients. All these tell us the story of Japan having an increasing

number of those who need elderly care but lessening capacity of the domestic labor

market to supply the necessary number of care workers.

2．An Elderly Care Facility in Osaka: The Case of HakujuenTo give us some idea about how an elderly care facility is operated in Japan, I

would like to introduce Hakujuen, a nursing home run by Hakujukai, a social welfare

organization in Nishinari Ward in Osaka City. It has a special elderly home unit

(capacity: 144 persons), and a low-cost elderly home unit (capacity: 40 persons). It also

accommodates elderly on a short-stay program (16 persons) and provides day service,

1 Data source: For care workers, Care Work Foundation (Kaigo Roudou Antei Center) and for all workers, Ministry of Health, Labor and Welfare (2007).

2 Data source: Survey by Care Work Foundation (Kaigo Roudou Antei Center) (2002 and 2004).

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home care and nursing visits. It also has an offi ce that assists the elderly and their

families in designing the elderly’s care plan.

The residents in this facility have a regular schedule/routine as follows:

Table 1 : Daily Schedule of a Resident in an Elderly Care Facility (Hakujuen)

If a Filipino care worker comes to Japan, he is expected to attend to all these

activities of the residents, because in Japan, works are not clearly divided among the

nurses, nursing aides and health attendants. Unlike the systems in other countries

like the US, there is no well-defi ned hierarchy as to who will perform the care tasks.

The Japan Nursing Association takes the stand that a nurse should do everything.

The same is the case for care workers who have to do almost everything except

medical activities such as injection.

With regards to the staffing, the Japanese government requires a specific

proportion of workers of different classifi cations depending on the number of residents

and the degree of care needs. For this facility of about 190 residents, the required and

actual proportions of the staff are as follows:

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Table 2 : Staff Composition in an Elderly Care Facility (Hakujuen)

The fi gures for the minimum required number of staff are indicated in Table 2,

columns A, B and C while those for the actual employed staff are found in columns D,

E and F. Since non-regular employees are counted not equally with the regular full-

time staff, and employees are allowed to hold concurrent positions, some of the fi gures

are in decimal forms. In the case of this nursing home, we can see that it employs

more workers than what is required under government guidelines, and there are less

non-regular or part-time workers than regular ones.

I believe that these kinds of information are helpful for our nurses and caregivers

planning to go to Japan under EPA – to give them an idea about nursing facilities in

this country.

3. Filipino Long-term Residents as Caregivers in JapanActually, we already have some Filipinos working in Japan as caregivers. Many

of them are married to Japanese and have been living in Japan for quite a long time.

Many of them have studied and obtained a home-helper’s license level 2. Therefore,

compared to those who will be coming under EPA, they are relatively knowledgeable

of the Japanese language and culture and have some training in the Japanese way

of elderly care. I would like to introduce 5 of these Filipino caregivers whom we

interviewed to find out their labor conditions and difficulties in the workplace. We

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have also talked with their supervisors to ask about their impression and evaluation

about them.

Table 3: Profi le of Interviewed Filipino Residents Working as Caregivers in Japan

What were the difficulties that they experienced in the workplace? The first

problem is that with regards to their relationship with their Japanese co-workers,

whom they say do not openly express their views and opinions (unlike the Filipinos who

are quite frank). As their ability to write Chinese characters is still generally weak, they

fi nd it hard to understand technical terms and take down records and documentation

in Japanese. Finally, there are some differences in the Japanese-way and Filipino-

way of housekeeping methods such as bed-making. Filipinos seem to deviate from the

Japanese-way of doing things and make their own modifications or improvements.

These issues have caused some kind of confl icts or tension in the workplace.

The Japanese supervisors that we interviewed pointed out the positive attitudes

of the Filipino caregivers, such as cheerfulness, skills in dealing with the elderly

(particularly those with dementia) and in performing care tasks, and eagerness to learn.

However, the Japanese supervisors seem to have a hard time dealing with some of the

negative attitudes that they see in the Filipino caregivers. These include their diffi culty

in team working, as we have our own way of doing stuff while the Japanese will prefer

collectivism – doing what everyone does. They are also criticized for their frequent

absence at work, especially the single mothers, who have to attend to the needs of their

－ 68－


children. The nursing homes need to keep a regular number of its staff at any time

and it is not easy to get a replacement in case these Filipino caregivers suddenly fail to

come to work. Also, although they have been living in Japan for quite some time, many

of these Filipino caregivers cannot read and write fl uently, that is why it is so diffi cult

to share information with the Japanese co-workers. The Filipino’s loose concept of “time” and “excessive” expressed closeness towards the elderly can also become a source of

friction between the Filipino and Japanese caregivers. Filipinos would like to render

extra care or go beyond what is supposed to be done. As a result, the Filipino caregivers

is well-liked by the residents, causing jealousy by the Japanese staff.

Despite these problems, the Japanese supervisors whom we interviewed said that

they still want to employ Filipinos because they think that given proper education,

training and support, they can do very well in this kind of work. Unfortunately, this

seems not to be the general trend as what was found in a survey that Profs. Nakai

and Goto did in 2006 to 114 elderly care facilities, of which only 43% are either

already employing (3%) or considering hiring foreigners (41%). In this survey, it

also appeared that the major requirement in employing foreign workers is their

proficiency in the Japanese language. Age does not seem to matter but Japanese

elderly care facilities prefer female care workers with care knowledge and skills, and

good personality. Moreover, about 87% of those surveyed would want or expect the

foreigners to perform all kinds of tasks, not just specializing in some specifi c simple

ones. This is good news for us who are worried about job discrimination against the

Filipinos going to Japan under EPA.

As time is running up, I would like to end this presentation by repeating the

important points that I would like to emphasize here: First, there is indeed an

increasing demand for elderly care, and therefore careworkers, due to demographic,

social and institutional transformations happening in Japan. We know that the

domestic labor market has limited capacity to meet those demands, thus opening a

window of opportunity for Filipino careworkers to work specially in nursing homes

like Hakujuen in Osaka. It must be remembered however, that at present, and

learning from the experiences of the long-term Filipino residents who have been

working as caregivers in Japan, there are big challenges facing foreign careworkers –

specifi cally the issues with the supervisors and co-workers - arising from the lack of

Japanese language profi ciency and intercultural differences.

(Presented by Dr. Carlos)

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The content of your presentation encouraged me to speak about my preparation

in accepting Filipino nurses to my city. Two years ago, the local government called me

for advice on how universities/academicians can contribute to this trend of inviting

Filipino nurses. Since I have stayed in the Philippines for 15 years, I was chosen to

talk with local government offi cials.

First of all, today I really learned much about the nature of the economic

partnership agreement and its impact on the society. When I listened to the

presentations, I thought maybe Japanese government is inviting the Filipino nurses.

I also thought of a case of the global economy care market and migrant workers

cases. But I also thought there was something strange happening here, because

my fellow workers are working to prepare to accept Filipino nurses under better

working conditions, better training and better education so that they can understand

the Japanese society, culture, and health systems better. We have never considered

Filipino nurses as a commodity in the international market.

As long as my city/community needs Filipino nurses, especially highly qualifi ed

nurses, to work in our hospitals, we will consider a Filipino nurse as a human being

not a commodity or human resource. We are considering the Filipino nurse as our

fellow, a very kind fellow who is helping us. This is a common feeling in small cities

in Japan, especially in Hyogo Prefecture and in Kobe City. All the presentations you

gave us today were all about the foreign affairs and what the Japanese Ministry of

Health, Labor and Welfare was thinking. But please consider that, if your senators

approve the JPEPA and implement the JPEPA, and the fi rst Filipino comes to Tokyo,

Osaka or Kobe, my city can make a promise that we have no intention to treat you

Reaction

Dr. Masaki EndoPresident, Kobe International University

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Dr. Masaki Endo

like cheap labor.

We want highly qualified nurses from the Philippines. They are our fellow

citizens. So at the local government level, we consider all these negative aspects

of the JPEPA. If it is not all the local governments, I at least talked with the local

governments in Tokyo and Hyogo Prefecture. Things went like this. Local government

asked our national government: “why not expand the training to one year and not

just six months, why not make it longer?” The government answered: “because this

is the rule.” The national government did not accept our request. I am not a local

government official, I am just a consultant to them. Within the JPEPA framework,

however, we can realize better with longer training period and better labor conditions.

And then we can also treat nurses as our fellows. That is our common stance in the

local, small cities. So please do not neglect us. We, local governments, are the one that

is responsible to workers in the cities, not the central government nor the Ministry of

Health, Labor and Welfare.

Now, my second point is what we are doing now in preparation. There are 2-3

universities asked by the government to prepare courses for 10-months language

training and some cross-cultural Japanese studies, so-called Japanology, for nurses

before they go to the hospitals. And after that, we provide education in hospitals. We

are planning to send Japanese teachers to hospitals. This year, I invited a faculty

of a nursing college in the Philippines to come to my college in full scholarship to

study Japanese. I am training faculty members of the nursing college, because I

think the best way is for Filipino nursing educators to teach Japanese to Filipino

nursing students so that they can handle the course well. And secondly, including the

complaints and criticisms, nurses can share their experiences in Japanese hospitals

with their fellow nurses. Many Filipino nurses are applying for a job in the United

States as they do not need to learn Japanese language. In addition to offering this

course, we can also invite Filipino Japanologists/Anthropologists. Our small city Kobe

is trying our best so I hope you won’t say that we insult Filipino nurses. We respect

Filipino nurses, so please do not hesitate to come to Japan.

－ 71－

I am not going to talk about Japan right away. I am going to another continent.

During the 1960s and 1970s, Germany had a strong demand for foreign workers

which they eventually got from Turkey. However, by the late 1970s and early 1980s,

a lot of Germans were complaining and their lament was “we asked for workers

and what we got instead are human beings.” What this basically illustrates is the

intricate/complicated dimensions involved when it comes to the migration of human

beings for trade in labor. Human migrations can lead to unintended consequences.

Human labor, as it moves, carries with it a social dimension which is clearly evident

in the present migration of Filipino careworkers in Japan, as of course is evident

in Dr. Carlos’ presentation. I will be focusing my comment on two areas: fi rst is on

Japan-Philippines relations and the second area will be related more to the policy

dimension of those kinds of relationship.

First consideration, when we speak of relations between the Philippines and

Japan, or between any two countries, would be the considerations with other

stakeholders. What we see at the surface would be the relations between nation

states or between state actors, but it is important to consider that there are also other

sub-national actors. We have local government, academics, people from NGOs, and

even trade unions. And as far as receiving countries are concerned, as what Dr. Endo

made evident in his discussion, local governments certainly have a different attitude

towards foreigners than the national government. Local governments tend to be more

receptive because they really see the problem of the shortage as it is. However, if we

go back to the JPEPA question, this interesting national-local dynamic/tension is

somehow glossed over or swept under the rug.

Reaction

Dr Jorge TignoAssociate Professor, Department of Political Science,

University of the Philippines Diliman

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－ 72－

Dr Jorge Tigno

My second comment with respect to the first issue is that we need to consider

also the different social and cultural factors that come in when one speaks of relations

between two societies/countries. Dr. Carlos also rendered this kind of discussion.

But if we look at the surveys done on the impressions of Filipinos of Japan and the

Japanese, these impressions are really the main things that color our relations with

the country and these people. A lot of Filipinos look at Japan as the land of electronic

gadgets, anime, geishas, and of course their yen, but not exactly in that particular order.

And, the Filipinos also perceive the Japanese as hardworking, disciplined, rather

inexpressive but strict. Again, nothing in that particular order. But again, these

considerations have to be taken into account when we speak of substantive relations

between the two countries.

As far as policy relations are concerned, with respect to JPEPA, there is this

over-emphasis by national policy makers on bilateralism, as I have mentioned in

this morning’s open forum. And this sense of bilateralism is actually the focus of the

concurrence of bilateral arrangements/agreement and what this leads to is a condition

called a noodle bowl effect. If you were to have a map of the whole of Asia, and you

would have to draw lines between countries that have bilateral arrangements with

one another, it would look like a noodle bowl. What this could produce is a condition

that could actually muddle rather than facilitate trade and also human mobility. That

is one issue. Bilateral arrangements could also be sometimes problematic when the

arrangement is done between two unequal partners. For any kind of partnership to

succeed, the contracting parties must not compete with each other, and this is what

is evident in Dr. Mahiwo’s presentation, and this is true between the Philippines and

Japan. However, the issue between the Philippines and Japan, where one is more

powerful/capacitated than the other economically, can prescribe the mutual benefi ts

principle or the benefi ts that both parties can achieve in partnership with each other.

So you have an unequal partnership basically.

Third point, rather than looking at the phenomenon from a purely outflow

standpoint of Filipinos going to Japan, it is more important for us to consider the

latter aspect of migration in terms of continuous mobility of Filipinos going to the US,

Japan or Australia. Now they think it is even better for them to move to either the

UK or Canada or somewhere else, even France. This is becoming more evident now

– the continuous mobility of people with skills which they can bargain in the global

market. This is the last point when one speaks of relations and policies that frame

these kinds of relations between states.

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Reaction

I think we should also consider the importance attached to residentialism, which,

at the national level, imbues in the state the power to determine who gets to live,

to enter, to work and to stay within its jurisdiction. The thing here is that we need

to overcome this idea that it is only the state that determine who gets to enter the

country. Dr. Endo has indicated in his commentary that local governments are very

willing to accommodate these kinds of arrangements that national governments

are hesitant to enter into, and this, I think, is where local government can take the

lead in setting examples for national governments to follow. But more than that,

national government needs to bear in mind the importance of having a multilateral

perspective. This is what I call the three M strategy – Multilaterally Managed

Mobility. You come up with standards and codes of conduct that many countries,

not just two countries in a bilateral arrangement, can follow and adhere to. This is

certainly the best solution, but unfortunately is also the most diffi cult to attain. So

instead of having these three M, you have bilateral arrangements that are entered

into. What you are getting is actually not the best solution but the second or third

best solution.

OP

EN

FO

RU

M

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1. Ms. Jennifer Frances de la Rosa, Institute of Health Policy and Development

Studies, National Institutes of Health, University of the Philippines Manila

The policy I studied about is an operational agreement between the UK and the

Philippines to be able to ethically recruit nurses. The UK is very keen on being ethical

about this. In fact, they came up with a list of countries where they can recruit nurses

from. From that list they discarded most of the African countries and just considered

a few countries like the Philippines, as they see the Philippines as their ethical

source, together with South Africa and India. This bilateral agreement with the

Philippines was forged in 2002, and in the same period they also forged agreements

with India and South Africa. Recruitment of Filipino nurses in the UK began in 1997-

98 and peaked in 2001.

The reason why the bilateral agreement between the UK and the Philippines

was forged was because, from the Philippines side, they saw that there were private

recruiters who were very opportunistic. They charged so much placement fees and

that affected nurses. That is a consequence which we learned from the private

recruitment side, if we do not go through a bilateral agreement, then we will have

these kinds of opportunistic behaviour. From the UK side, I think, what pushed for

this bilateral agreement, based on information obtained from the Department of

Health and the Philippine Embassy in the UK, were the working conditions that the

Philippine nurses in the UK were subjected to. Again, it was because of protecting

nurses from poor working conditions and high placement fees.

The results of my study yielded both strengths and weaknesses of the bilateral

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Guest Comments

－ 78－

agreement. I used the systems framework in evaluating the bilateral agreement.

When I decided to evaluate it, the bilateral agreement has already been terminated

– it was terminated in 2006 – and the UK already declared a non-shortage. Did the

Philippines know about this? No, they were surprised. There was some information

asymmetry there. My study therefore found out that we have to be wary about

producing so many nurses, because we do not know how the countries on the receiving

end will react. They (the receiving countries) can just say that “we are stopping it”, as

we (the sending countries) will be left with so many nurses.

One of the strengths of the policy was in the government to government

process that both the Philippines and the UK went through – the coordination,

the negotiations and the agreements that they forged. It was actually a consensus

between the two countries. However, there were also weaknesses. Amongst the

weaknesses was the lack of content in terms of the provisions of bilateral agreement.

Why lack of content? Because things like working conditions and mutually benefi cial

strategies were not really present in the document.

In 2004, there was a follow-up memorandum of agreement, and they came up

with health care cooperation between the UK and the Philippines and it was to have

bilateral exchanges on training and education. But this did not fly until the policy

was terminated in 2006. There was this initial plan but it did not fl y. For the outcome,

I asked the question. Was the policy effective? The perceived effectiveness that I got

was that it was effective in such a way that it pushed for ethical recruitment. Nurses

went to the UK without paying a placement fee. So nurses were relieved of that

burden (placement fee). Thus, the policy was effective. However, did it really attain its

target? Unfortunately the designed target or the planned target was 1,000 nurses to

be recruited for the UK, but eventually, in 2006, we only had 225. So was it effective

or not?

Of course there were contextual problems surrounding the termination of the

policy, among which was, first, there were too few positions available for foreign

nurses in general, because the UK was already generating its own nurses. The UK

thought that this migration thing was just a band-aid solution and a more long-term

plan was to generate its own nurses. They were already in the UK and they were

already occupying these basic positions. There was a general decline in the number

of nurses coming from the Philippines, which is the same for South Africa and India.

There are some contextual problems that affected the implementation of the bilateral

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Guest Comments

agreement.

In the end what should be noted, I think, is that we need to look at the contextual

problems when we develop a policy. If, as you can imagine, the peak was in 2001

and the bilateral agreement came in 2002 when there was already a decline in the

number of nurses being recruited to the UK. Then the agreement might become

useless. Secondly, the government needs to advocate for mutually-benefi cial strategies

and policies within the bilateral agreement. They need to come up with development-

friendly strategies and policies. In this case, it was just to recruit nurses to the UK.

Initially there was a memorandum of agreement for health care cooperation, but

nothing happened to it. So in the end nothing happened to us as well. And then the

government needs to be able to put forth win-win situations/policies. It is very diffi cult

to negotiate such policy, but as what Dr. Lorenzo said, if we were like oil, at least we

should be able to say this is what we are putting forth, this is our stand, and hope to

get more out of this bilateral agreement.

This is the fi rst time that I am putting forth something about this study. I am still

in the process of expanding it, because in the university you are just allowed to write

limited number of words. Hopefully, I will be able to share it with the people who

have helped me come up with this study. Among the stakeholders I have interviewed

was Consul de Leon from Department of Foreign Affairs. Thank you very much sir.

The study involved people from here and the UK and I had somewhat a balance of

perceptions.

2. Consul Mario L. de Leon, Jr., Senior Special Assistant, Undersecretary for

Administration, Department of Foreign Affairs

I served as the Consul-General of the Philippine Embassy in London from 2000 to

2006. That was the time when there was a peak in nursing recruitment. Of course, we

also had our Labor Attaché there whose work was more on capital recruitment. There

are two things I want to share with you. I know most of you are from the academe.

One is on what Dr. Lorenzo said earlier about the retention policy, particularly

of the destination countries. In the UK, although there were about 50,000 Filipino

nurses, that was our estimate, about one-third of them came from other countries,

the Middle East primarily, some from Singapore and Malaysia. In other words, the

figure that was captured by the POEA was merely those that came directly from

－ 80－

the Philippines. How come one-third transferred from other countries going to the

UK? That means that skilled labor usually try to find a more comfortable, a more

hospitable environment. I think that goes for all nationalities. That is the reason why

Africans are going to the UK. Also, ten percent of Filipino nurses in the UK went to

the U.S. So that speaks about comparative advantages of all destination countries. I

think that is where we really have to put more of our energies on. This is a study of

the Filipino diaspora. If we are talking about management relations, we should look

at about 8-9 million Filipinos who are all out of the Philippines.

Secondly, I would like to go to the part on mutual recognition. I would like

to share our experience in the UK on that. When I just arrived there, they only

recognized four universities in the Philippines – of course UP is one of them, UST,

Ateneo and De La Salle. If you are a graduate of a university other than these

four, your four-year degree would only be considered two years. Now you ask me,

how come the nursing degree was accepted? The reason is, a nursing qualification

in the UK is only equivalent to a three-year college here. If you have a four-year

college degree here, that is superior. That is the reason they accepted our nurses.

They accepted academic qualification, yet one thing they did not accept was the

professional qualifi cation. That is the reason why even some of our nurses who have

ten years work experience had to start at the lowest rank of the profession when

they entered the UK. That is why when we were there we felt that there is really a

need to strengthen mutual recognition agreements, not only in academic, but also in

professional qualifi cations.

It is not as simple as just the embassy doing the work. This requires public-

private partnership of all stakeholders. When you talk about nursing, for instance,

you do not only need the Professional Regulatory Commission or the Nursing Board

for that matter, but of course, the nursing associations to work on that. In fact, we

worked with CHED (Commission on Higher Education) primarily to win in that

issue. Secondly, when it comes to academics, those are the things we have to work

on now. The third thing that I want to say about mutual recognition is that one of

our problems is we seem to have substandard nursing schools. Trying to put forward

mutual recognition of our health curriculum is one way of setting standards for our

nursing schools. In other words, this is one area we really felt we need to focus on.

When it comes to managing migration, it will be a definitely mutually beneficial

thing. It is not only our workers being able to work there, but at the same time they

will achieve certain standards while studying here. And that really helps the country.

－ 81－

Guest Comments

Those are some of the insights I have in working six years with Filipino nurses.

I just want to put in context the 2004 Memorandum of Agreement between the

UK and the Philippines, which was more substantive than the recruitment agreement.

One reason why it did not fly was in 2004 there were ten accession countries in

the EU. The UK government had a big problem at that time because under the EU

framework, there is mutual recognition. So if you have all of those Poles, those Czechs

going into the UK, they just cannot refuse them. One of the things that the UK did

was to make it mandatory for them to learn the English language. But as regards the

academic qualification, the UK did not have any choice. It was a political decision,

not a technical decision. That was one of the reasons why I would say the demand for

nurses other than those from the EU countries started going down. Unfortunately,

we were affected. The same thing happened with South Africa and India. I just like

to mention that was one of the reasons why the number of foreign nurses in the UK

registry decreased, and it was more of political rather than based on market forces or

anything else.

3. Mr. Masahiro Nakamura, President, Inter-Asia Company, Fukuoka, Japan

Thank you very much for inviting me to this conference and also for giving me

the opportunity to give some comments about the issues we are talking about in this

conference. I am from Kyushu, the Southern Island in Japan, from the prefecture of

Fukuoka. I have been doing programs to support Filipinos to be independent in my

area Fukuoka.

Maybe in Japan, being a foreigner is not a bed of roses. Many of the foreigners,

Filipinos and especially those coming from Southeast Asia, are really having a hard

time in Japan. In Japan, in order to get a stable job, one really needs language

proficiency and some skills. And we felt this is important to some foreigners. So I

thought of giving them this kind of support.

My child opted to work as a bridge between Japan and Southeast Asia. He was

working to bring in careworkers from the Philippines and Indonesia, but he passed

away four years ago. In order to take up what my son was doing before, I started

the Inter-Asia Company, in order to offer support for the foreign residents in Japan,

especially those who came from Southeast Asia. So after preparing for one year, I

started to offer the Japanese language course and home helper course to Filipinos in

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Fukuoka.

The Japanese language course is offered free at two places in Fukuoka

Prefecture. Within the past one and half years, 75 Filipinos came to study Japanese

language course. With regard to the home helper course, it started in March 2006. Up

to now, we had it four times and 63 students graduated. Out of the 63, 55 are Filipinos

who now have home helper license level two. For those Filipinos who cannot afford

to pay the tuition fees of the home helper course, Inter-Asia offered the course free.

If one has the home helper license level two, then s/he can work anywhere in Japan.

The license is valid for life. When we hand over the certificates at the graduation

ceremony, a lot of the Filipino students are very happy and some even burst into tears

because of their sense of achievement.

Through the Japanese language course and the home helper course, I was able

to realize how great the Filipinos are. We think Filipinos are very cheerful and

warm. They respect their parents, siblings and elderly people, and this is something

which the Japanese are now rather forgetting about. Also, Filipinos have maintained

some connection/ties with their families and humanity which the Japanese are

losing. Japan has become affluent but I think that the heart of the Japanese has

unfortunately become poor. That is why I think that if the Filipinos come to work in

nursing homes in Japan in order to provide care for the elderly, we think the Japanese

elderly will also be very happy.

I have been really looking for work for those graduates of the home helper

course level two. Out of the 55 graduates that I have, only 6 were able to fi nd jobs.

The reason is not mainly on the side of the Filipino residents but on the side of the

Japanese. The main reason is low wages for home helpers in Japan. The salary/wage

of a Japanese care worker is only about half of what all workers receive or even less

than half. With this low salary of care workers/givers, even the Japanese cannot

maintain a good livelihood. That is why recently, a lot of Japanese are leaving their

jobs in the nursing homes. This is a very serious problem in Japan, still up to now

the Japanese government has not really done anything about it. And it has not really

shown the direction of its policies regarding these low salaries.

Despite of the problems of low salaries, the 6 graduates of the Inter-Asia

company who studied the home helper course are working very hard in Japanese

nursing homes. They are really popular among the Japanese elderly and these elderly

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Guest Comments

are really grateful and appreciate their hard work. We have been getting positive

evaluations from the owners of the nursing homes as well.

However, this is not the general case in Japan. There is still resistance from

nursing homes about employing foreign caregivers. Therefore, the graduates of Inter-

Asia can be a pioneer in order to overcome the resistance of Japanese society against

employing foreign care workers. The governments of Japan and the Philippines

have agreed on this EPA (Economic Partnership Agreement) in September 2006 and

there is a plan to accept 1,000 Filipino nurses and care workers to Japan. Regarding

the EPA, I think Filipino nurse and caregiver candidates have to overcome so many

difficult hurdles. And I really think it would be very difficult for nursing homes to

accept these foreign care workers. It is not feasible. I can understand why even in

the Philippines, this is not yet even ratifi ed in the Senate. I do not expect anything

from this EPA. Even if 1,000 care workers come from the Philippines, it will not help

solving the shortage of care workers in Japanese nursing homes.

Shortage of human resources in Japanese nursing homes is not limited to nurses

and caregivers who have the national qualifi cations, but also the helpers who change

nappies or those who help in feeding the elderly, in bathing and so forth. The shortage

of these kinds of helpers for these kinds of works is really serious. I think that with

the rapidly aging society of Japan, the only way to solve this problem is to ask the

foreigners to do the care work for us.

The mission of Inter-Asia is to assist the foreigners including Filipinos who can

come and work in Japanese nursing homes to become a good partner to Japanese care

workers. That is the mission of Inter-Asia. I would like to exert more efforts in making

my dream come true. That is my goal.

(Delivered in Japanese, interpreted by Dr. Carlos and Dr. Sato)

4. Mr. Ron Vilog, Graduate Student, Ateneo de Manila University and Faculty

member, Global City Technical College

My study is about the institutional response of nursing and caregiver schools to

the opening of Japan’s health care market. This is very relevant to the presentation of

Dr. Carlos this morning. She interviewed students, while I conducted interviews and

focus group discussions with the nursing professors and deans. And these are their

－ 84－

reactions.

I will start with the perceptions of nursing professors and deans. First and

foremost, they have positive views about Japan. They think that Japan is a generous

country with polite people, etc.

But as for their negative views, they think that Japan is a birthplace of

Japayukis, entertainers and geishas. Also, their negative reaction is more on the

JPEPA. The result of Dr. Carlos’ study is that the students think that non-economic

reason is the main factor that discourages them from going to Japan. In my study, it

is the treatment of the nurses. They (my informants) think that the Filipino nurses

will be treated as second class nurses or second class assistants. However, Japan is

claiming that it will not treat our nurses as trainees or second class nurses, so this

issue should be clarifi ed. And then, they have concerns about the Nihongo training

under the JPEPA.

They also want the OJT (on the job training) and the licensure exam to be

scrapped. They also think that in Japan, nurses are assistants of doctors, while in the

Philippines and even in the Western market, nurses are professionals assigned in the

management of patients. They have a different job from the doctors and they are not

assistants to doctors. They are also concerned about compensation, as was mentioned

a while ago, and of course the hiring procedure and the work scheme.

Next, I will talk about the perceptions of the caregiver schools. Let me share with

you a story of my visit to a school in Davao City. This caregiver school offers a 4-year

degree program for caregivers. It is specifi cally training caregiver students for Japan

and is offering a curriculum consisting of Japanese culture, Japanese society and so

on. Students there obtain a BS degree in Social Services Major in Care for the Elderly,

in other words, a BS caregiver degree course for the Japanese market. I inquired why

they train the students for the Japanese market. The nursing schools are not willing

to train the students for this market, but the caregiver schools are very enthusiastic

to train students for the Japanese market. Why? They said that it was because of the

demand of students. There are many students who want to go to Japan. They have

cited many organizations and institutions which are already coordinating with them

including recruitment agencies. These organizations are already proposing to have

this kind of partnership so that they will be hiring students in the future.

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Guest Comments

But despite the willingness of the caregiver school administrators to train

students for Japan, they also want the JPEPA to be renegotiated because of the

provisions on the language profi ciency exam, the language degree requirement, and

the local licensure exam.

So, the main point of my thesis is, first and foremost, the employment of

caregivers is more feasible than that of the nurses because of the support of various

schools and the willingness of administrators to train the students. Both sectors,

nursing and caregiver administrators, demand renegotiation of JPEPA. They want

the labor requirements to be renegotiated. And lastly, I also pointed out in my paper

that, despite anti-JPEPA movements, Japan is still perceived as a promising market.

They have very good views about Japan. They just want the labor policies to be

renegotiated.

－ 87－

Carolina Hernandez (Institute for Strategic and Development Studies): I

happen to be also part of the Kobe MAFIA, as I taught at Kobe Daigaku (University).

I have been in Japan quite often, and I was a visiting professor at the universities

in Shizuoka and Kobe. I have mixed feelings about Japan – it is many things, it is

old and new in many ways. My Japanese friends always tell me to please bear with

us when we are not able to adjust quickly to the changing environment because we

happen to be a kimono culture – you cannot walk very fast in a kimono. I think this

is the kind of approach that we need to adapt when we are dealing with our Japanese

colleagues.

The first comment that I want to make has to do with this issue that we are

talking about on migration of health workers from the Philippines to Japan and

this complementary kind of relationship. I want to look at it as a strategic issue in

Japan’s bid for a regional role in a new changed circumstance. I think Japan’s issue

of opening up its doors to skilled workers from other parts of the world, in particular

health workers from the Philippines, should be seen as a strategic vehicle for Japan

in its bid for this kind of regional role. I think it is an advantage that Japan has over

China. However, Japan, I think, is not playing this role very well. I think this is a test

on what Japan will do on its side; whether or not Japan is prepared to really take the

lead from being terribly old to being new and embracing globalization and all that.

And I say this because I think that research studies like what you are undertaking

are not being done in order to advance knowledge basically, but it has a policy

component, and the policy component must speak not only to those that are involved

in migration issues but it must also speak to Gaimusho (Ministry of Foreign Affairs),

among other things.

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Open Forum

－ 88－

The second point is related to the 3M (Multilaterally Managed Mobility) strategy

that Jorge proposed. We need to look at this multilaterally. However, why are we

looking at it bilaterally? I think the short answer is that the partners that Japan has

right now, or the partners that China has for that matter, are a group of countries

that are so different from each other. We are talking ASEAN here, especially with

the FTAs (Free Trade Agreements) of Japan with Southeast Asian countries, and

CAFTA (China ASEAN Free Trade Agreement). We (Southeast Asian countries) are so

different from each other, and you can see that we cannot even agree on many points.

When we go down to the level of the basics, ASEAN cannot agree. We have friends

from the Department of Foreign Affairs here, I have a brief with ASEAN in terms of

the ASEAN Charter, the generation of which raised so much hope especially for those

of us who have devoted time in this. I have devoted 30 years of my life advancing and

arguing very hard with people who do not have faith in ASEAN, contributing my time

and my energies to efforts such as these, because I was part of the group of so called

experts convened by Japan and ASEAN to look at the joint cooperation in people-

to-people exchange in human resource development. This pre-dated JPEPA, and I

pushed very hard for Japan to consider opening its doors to health workers, so I have

an interest in this particular issue. I am not happy with the kind of document that

came out, but I did not negotiate the document. I did, however, negotiate the report

of the experts group with my co-chair Mr. Dano from Japan. This is the problem

with ASEAN – it cannot get its act together. This Charter that other countries that

are members of ASEAN are already ratifying, in my view, should not be ratifi ed by

our country, because it will not lead to the building of an ASEAN community by

ASEAN. It is not easy. It will not also help ASEAN to remain at the core of East Asia

community building because this has to do with your thing, right?

Third, I like non-state actors because I have been one. The most substantive part

of my life has been to partner with non-state actors, but we have limitations, as you

very well know. I appreciate Endo-san’s point about looking at Filipino nurses as

fellow citizens. We want to give them the same privileges, look at it from the Hyogo

Prefecture’s point of view, not from the Japan’s point of view. But at the end of the

day, national policies are made by governments at the national level. I think no

matter what we can do in our own individual capacities and down at the grassroots

level where real people work or live, that will not amount to much until we are able to

make government change its policies and urge Japan to reconsider its policies. Japan

has bureaucratic rules and regulations that had been crafted in the 19th century

－ 89－

Open Forum

and continue to be upheld until today. When I was a professor at Kobe Daigaku

(University), I was doing research on ASEAN integration, but I could not leave Kobe.

The things that I need were outside Kobe, but it took a lot of persuasion on the part of

my dean to convince the University Administration. Education needs to readjust its

lenses – this is one of the most diffi cult things in dealing with Japan. Non-state actors

are fi ne, but we have limitations and we need to work in order to petition government

to change. That is an enormous challenge I am not even sure I am going to be able

to see in my lifetime. And mind you, those policies that are made by Ministry of

Foreign Affairs are the most conservative, they are the bastion of protecting national

sovereignty more than those of the Ministry of National Defense. I know this because

I have worked with them for thirty years.

And then finally, I have a question. I got interested in the presentation this

morning that Ruth made with Dr. Sato, and that is, that they are working on human

security implications of migration. So, I want to understand how you define human

security because it is a very important element. It speaks to the issues that were

raised by Endo-san earlier, and, of course, it is one of the major flags of Japanese

foreign policy. But it is something that needs to be explicated in more detailed ways.

We are also interested in human security and we have proposed the project to JICA

(Japan International Cooperation Agency) on mainstreaming human security in

ASEAN integration. There is an agreement in principle, needing just a bit more detail.

I want to know how you defi ne human security, and the issues that you are looking at.

Moderator: Thank you for pointing out the strategic perspective of our discussions

and the question on human security. Dr Hernandez gave us the wisdom of her works

through the years about ASEAN and Japan, and this should add to the enlightenment

we want to achieve in this conference. Ruth and Chizuko can reply to that question.

Chizuko Sato (Ritsumeikan University): The most basic defi nition I usually use

for human security is the one employed by Amartya Sen, which is “freedom from want

and freedom from fear.” That means peace and development. I do research in South

Africa where the crime rate is very high. People there usually confuse human security

with personal safety, but that is very narrow meaning of security. By human security,

we mean that people have to have a decent livelihood – this means being free from

poverty, freedom from want. Also, people cannot live a happy life if your country is

under civil war. There are many African countries which had a civil war in the 1990s.

That is why human security also means freedom from fear, meaning peace. Maybe

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it is still a bit broad and a lot of people use the word human security with different

interpretations. But I think the most basic elements of human security are these two

essences, this combination of development and peace. Both matters should be catered

for the security of people who live all over the world.

Ruth Carlos (Ryukoku University): Can you tell us about the JSPS research project

we are working on? There is one group among us doing the theoretical aspect of human

security, and we are doing something about the Philippines in terms of shortage of

nurses.

Chizuko Sato (Ritsumeikan University): About the research project, I start

by saying that human security is not only about the people’s lives in developing

countries. It also affects people living in developed countries. International migration

is something that links people living in the north and south. When we are trying to

look at international migration from the perspective of human security, especially

focusing on health workers/professionals, what we see is that through the migration

of health workers from developing countries to developed countries, the care/welfare

system of the developed/receiving countries will be improved. It contributes to

enhancing the human security of people living in receiving countries. But what will

happen to the health care system of the sending countries? That is what we are trying

to address in our paper and part of which I presented this morning. We call this the

dilemma of human security. The welfare system of receiving country will be improved

through international migration of health workers, but that of the sending country

might deteriorate. We want to fi nd a way to solve the problem of both sides.

This is a three-year project and we have just started, this is the end of the fi rst

year. We are trying to compare Asia and Africa. In Asia, we are looking at migration

from the Philippines to Japan – because Japan might open up and accept foreign

health workers. And in South Africa, where there is migration taking place, we want

to see if there are similar issues encountered by these two regions, and whether we

can come up with policy implications. It should not be just a study. It should have

some kind of policy implications, as human security should be rooted in enhancing

people’s livelihoods at the grassroots level.

Rey Conferido (Department of Labor and Employment): I am Rey Conferido,

I was the Labor Attaché of the Philippines to Japan from 2004 to 2007. Now, I am

Acting Assistant Secretary for Employment Promotion and Manpower Development

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of the Department of Labor and Employment (DOLE). I just have some comments to

make regarding the discussion this morning.

I agree with Professor Hernandez, who was my chairman in the Department of

Political Science at UP when I was there, that Japan is a complex society. It is also a

society in transition, I would say. And in many ways, there are contradictions within

that country. I also look at the relationship between Japan and the Philippines as

something that is governed by a lot of things – from the Second World War to the

Entertainers’ Era. But there are certain spots in the relationship that can encourage

the relationship between the Philippines and Japan. I used to tell my counterparts

in Japan that I myself had a complex relationship with the country. My father was

a guerrilla fighting the Japanese during the Second World War, and yet I married

somebody who is half-Japanese – my wife is a Nikkeijin –, and my children practically

grew up in Japan.

So when we were negotiating – I was not part of the negotiating panel but I was

advising our negotiator – I was telling our counterparts from the Ministry of Health,

Labor and Welfare of Japan that they should probably recast their perspective

because they were openly saying that they were not going to negotiate anything

that was not to their advantage. That may be a too frank statement coming from the

Japanese but that is understandable from a country perspective. From the words

of Bishop Frank Moore, who wrote the book “Immoral Man, Moral Society,” what is

immoral to an individual is moral to a group or to a nation because what is selfi shness

to an individual is nationalism at that level. So, I can understand the contradiction

and complexity of perspective.

But I was telling my Japanese friends that they should start to look at things

from a mutually benefi cial standpoint. I remember in 1996 when I fi rst got involved

in APEC, we were already telling them about labor market complementation because

how else can we complete globalization when we only talk about trade investment

liberalization without complementation of human resources? The last dimension

probably that would complete globalization is human resource complementation.

How else can the world survive? Technology has not solved the problem of aging.

Japan has been grappling with it and I doubt it will go away. We also think about the

multiplicity of role of women. Japan is now trying to raise retirement age, they are

now adjusting retirement age from 60 to 65, and they said they will adjust this one

year every three years hereafter. And when they have reached 70 as retirement age,

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then they will completely remove retirement age. I was joking with my friends, I was

saying, “Do you think that it is sane to just live for work and nothing else?”

But you will notice that from then on, Japan, together with Korea, – I was Labor

Attaché to Korea before Japan – Korea was another country which wouldn’t touch the

subject of labor market complementation with a 10 foot pole. But during my term, I

was the one who negotiated the foreign workers employment system when Korea fi rst

recognized that they really need workers and not trainees. In fact I was playing with

some risk when I kept on kidding the Ministry of Foreign Affairs of Japan when I

said, “why not learn from the Koreans.” And the Japanese would say, “No, no, no.” The

IOM Director General himself was saying, why look at Germany as your example,

when you can look at the neighbor who has fi nally recognized the reality that they

need workers instead of trainees. But Japan, as Professor Hernandez said, is a

kimono culture, it will take time.

The good thing about JPEPA is that they (Japan) have offi cially recognized the

need for workers. You look at the Local Government Units, NGOs and corporations.

The representative of Keidanren (representatives of business sector), Mr. Tosho

Suzuki, is my personal friend, and together with his former boss, Mr. Okuda, the new

chairman of Keidanren, they have long been advocating for Japan to recognize that

they really need workers. But again, Japan is taking a little time. I suppose we have

to give a little recognition to the effort of the Japanese also to open up their market.

Maybe at this time Japan is regretting a little bit because they have ratifi ed JPEPA

quite early and now it is very important for the Japanese to save face.

In my three years of dealing with the Japanese, I have learned to trust their

engineering sense. What the Japanese do not like is rejecting something that has not

even been tried. That is something that will set back our relationship with Japan

to a very significant extent I am afraid. But they recognize the complexity of our

characters. Once something that has been there does not work, I think, the pressure

of the private sector and the NGOs will get the Japanese government to yield and

allow more significant reforms. So I have been suggesting to the private sector of

Japan to talk to our legislators and policymakers as well.

One thing that we should probably look at is the experience of the Filipinos

with the shipping industry. I remember in the 1980s, many of the ships manned

by Filipinos were being interdicted because, at that time, the Japanese were not

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observing many labor rights. They were paying the Filipinos very poorly. Since then,

after a series of negotiations and many efforts, the Japan Seamen’s Union is now

a misnomer because this union has now only less than 2,000 Japanese members.

And guess how many Filipinos they have as members? About 27,000. If the Filipino

seafarers in Japan decide to sleep for about a week, Japan will probably be paralyzed

for a week, because all their raw materials are shipped into Japan by Filipinos and

all of their exports are shipped out of Japan by Filipinos. How are the Japanese

treating our seafarers now? You will envy the way they are being treated now – the

offi cers get 5,000 to 7,000 dollars a month. Also the offi cership is now being opened to

the Filipinos. Maybe, in fi ve years time, the domestic shipping industry will also be

open to the Filipinos. How are they treating our schools? They are now sending the

best simulators and the best professors. They are now also granting scholarships to

the Filipinos and cadetships in Japan. That is a model that we can look at. We should

not only look at the problems or all the negatives, but we should also appreciate how

Japan is changing and facilitating those changes. Thank you.

Leny Velasco (Philippine Nurses Association): I am Leny Velasco and I represent

the Philippines Nurses Association (PNA). As everybody knows probably, we are

admittedly against the JPEPA. Not for the reason that we are against the Japanese

people or we do not appreciate the culture that the Japanese offers, but more because

of the policy that is against the Filipino nurses in general.

Firstly, when this was formulated, we were not properly consulted. It would

appear the Philippine government does not know the conditions and the issues

that confront the Filipino nurses. I would think that there is a gross misimpression

of what the destination country needs and what the Filipino nurses can provide.

The destination country needs caregivers, whereas the labor that the Philippine

government is offering to them is composed of highly skilled and trained professional

nurses whose qualifi cations go beyond what the destination country needs. We feel it

is a mismatch. What will be the implication? Since we already have an oversupply of

nurses, the unemployed nurses would very much want to go to Japan on the wrong

premise. It is not simply the issue of employment for them, although it is a basic need

for them. When they go there and they find out that their skills are beyond what

they are doing, it will be a cultural problem, a tragedy. It is beyond economics. We are

against the policy because we think it is a solution that the Philippine government

did not think about. They are going to send skilled workers just so they can attend/

address the unemployment issue. They did not even consult us. Instead of coming

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out with quality nurses and improving the quality of education so there is a rational

number of graduates for available jobs, what they will be doing is they are going to

send these nurses to a country which will provide culture shock for them. And they

are not prepared for it. That is the concern of the PNA.

We think, as Dr. Hernandez enunciated, it is a policy that is not really

developmental and is not pro-people. And like what the political scientist said, when

you talk of human security, it has to be a combination of both development and peace.

For us nurses, we think it is not a solution or a rational way of addressing the issues

like unemployment, poor quality education, and lack of health services for the poor

Filipino people. We do not have an oversupply of nurses and health workers, but they

(the Philippine government) are not opening up positions for our nurses to be able

to be absorbed by the hospitals and the grassroots. They are in fact cutting down on

the health budget. They are not opening up plantillas. They are sending them abroad

because they will earn dollars, just to prop up this government. It is a band-aid

solution that eventually bombs in its face again. And the Filipino people and Filipino

nurses and health workers are the ones who will suffer from it.

Edmunda Rillon (UP Manila): I am Professor Rillon, a retired professor of the

College of Public Health, Department of Health Policy and Administration, and at the

same time a military nurse retired from the Armed Forces of the Philippines. Firstly,

I would like to thank the organizers of this conference for having invited me today to

have a broader understanding of the problem on migration of Philippine health care

workers, particularly, the nurses and the caregivers. This afternoon, I really saw that

the demand for Philippine nurses by the Japanese government is really pushed by

the fast rate of aging in their country. But in the presentations given, I think what

they need is more of caregivers who can attend to the needs of the growing elderly

population.

For the better understanding of the participants today, the curriculum of

Philippine nursing is a little bit broader than what is desired or demanded by the

Japanese government. As a matter of fact, the care of the elderly is just a subspecialty

in the nursing profession. It is a specialty particularly on those having mental

deficiencies, which is highly paid. You have heard of Alzheimer’s disease, etc. They

rate the same way as those having infectious diseases such as AIDS. People who are

caring them are paid very highly.

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The offer the Japanese government is giving us, which the Philippine government

also accepted, shows that the health care workers are not paid as much as the general

workers. I do hope that as a nation and as an organization, the Japanese people will

come to open up/renegotiate. If our Filipino workers will go to their country, and

they are having social problems already, fi rst, they will be faced with the risk of the

unknown – what is awaiting them in a foreign land. And the other problem, which

is now demonstrated with the migration of some workers in the Middle East, is the

disruption of family relationships. With this I hope the Japanese people will come to

see the great sacrifi ce the Filipino worker is making to meet their needs.

We do understand that there is a need to take care of the elderly in that country

(Japan) now. As Dr. Endo and Mr. Nakamura expounded, there is really that need.

But they have also expressed their own limitations and these have to be reconsidered.

We are not totally against nurses migrating. We are now global in nature, we are one

family in this world, and we have got to understand one another. But defi nitely the

receiving country should also understand our own situation.

Maria Teresa Dioko (Department of Health): I am Maria Teresa Dioko from the

Department of Health (DOH). I am very new to this particular topic. I attended this

session as a help for myself since we are going into policy work at the DOH. Human

resources have a lot of implications with all the other policies that the DOH is

developing.

My question is, how open/easy is it for prefectures or universities to actually

negotiate with private citizens of the Philippines? As we see here, Kobe is saying

they are open and inviting people. And we saw in the presentation that there is a

Mindanao university teaching Japanese. I would imagine that there are already

negotiations, slips and gaps of people, already going into Japan. My concern is that

while I agree that a bilateral agreement that is mutually acceptable and a win-win

situation for both is the best solution, I wonder what type of provisions are we making

or how are we preparing ourselves, in terms of giving social support/security for those

people actually coming in (to Japan). I am afraid, after fi ve or ten years, we will have

this session again and then we will have another speaker saying, “Oh, that particular

migration was totally unmanaged.” What provisions do we actually have? Can we

learn from the seamen? What kind of social securities were given to those people who

were coming in during the time before this particular acceptance was initiated.

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Moderator: I think that is clearly a question on policy. How this undesirable thing

can be prevented? I think this conference did not deal with policy. No specifi c policy

was discussed here but that is a very important concern. Our reactor Endo-sensei

said Kobe welcomes workers. Maybe Kobe has some policies, not Japan as a state,

but maybe in the Local Government Units or the sub nation state levels.

Masaki Endo (Kobe International University): The local government gives us the

scholarship funds to invite someone, a faculty of a nursing college in the Philippines,

to learn the Japanese language and Japan studies as a student and not as a trainee.

It is a 10-month scholarship but we increased that to one year. They do not work

in the hospitals, but if they want, they can visit the hospital. I am looking at the

provision for nurses, not the caregivers. Hyogo Prefecture has no policy on caregiver.

What I said was that I invited nursing faculty members for scholarships, not health

workers. The agreement has not yet been ratified. Without an agreement with the

Philippines, we will not invite any workers. But please be careful as I think some

workers are working in Japan already.

Moderator: With regard to policy and what was mentioned about Korea, I would

like to share with you my own insight. Last February, there was a conference on this

topic and a Korean Professor, my counterpart, said that they have now abolished

the trainees in Korea, though people still come to Korea in the guise of trainees. It

is a clear policy. And the reaction of the Japanese audience, a Professor from Kobe

University, was that Japan is behind, because Korea already abolished that kind of

trainee status. That is a policy but unfortunately we cannot discuss specific policy

because there is really no policy in Japan yet. Perhaps if JPEPA will be finally

approved, then the policies can come in. Any comment on this?

Rey Conferido (Department of Labor and Employment): When we were

negotiating the foreign employment permit system in Korea, there was a question

whether or not to abolish the trainee system in Korea immediately. There were many

Filipino trainees at that time. A lot of people will be hurt if you immediately abolish

the system. The stand that I took with the Korean government, in fact I spoke at the

Philippine Parliament, was to let them co-exist for a while, and let the people realize

which system is better than the other. The better system will survive, while the other

will die a natural death.

In fact, I have already proposed this informally even to JITCO (Japan

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International Training Corporation Organization). In the discourses we had in Japan,

I was trying to lead our counterparts to look at the model of the shipping industry.

The Japanese will not want to do anything in a grand and immediate way. If you do it

that way, you are turning them off. They would want to discover things for themselves.

As a country that is probably still the second largest economy in the world, they

would not want to be taught. They would rather discover things for themselves. So,

you have to do things rather strategically for them to realize that it is not only in

your interest but it is also in their best interest. That was what we tried to do. It is

sometimes very diffi cult to be in government because everything will be colored with

politics. You would probably not realize how difficult it was for us to even get the

Japanese government to recognize that they needed foreign workers.

The cultural mindset of the Japanese, for centuries, is that they can live on their

own. They are an archipelago, they are away from the mainland, they have weathered

volcanoes, earthquakes, and two atomic bombs. And they can live by themselves.

Changing that mindset was quite difficult. It was easier for the Koreans than for

the Japanese to do it. But you have to let them realize that it was through their own

experience that they have done certain things, and that to be dependent to a certain

extent to foreigners is not exactly bad. That is why I kept repeating to them, “Look at

your shipping sector, were you happy with your shipping sector or not?” But you have

to gradually build confi dence with the Japanese.

Now, are we going to decide for our nurses and caregivers by ourselves? Are we

going to say, “No, we do not want the opportunity,” or do we let them (Filipino nurses

and caregivers) decide for themselves? I was in Japan for three years verifying all

the contracts of the Filipinos working there, including the engineers who are highly

paid, but I have never seen a more detailed contract offer than for the nurses and

caregivers. The terms and conditions will be defi ned – hours of work, wages, even the

kinds of patients they will deal with, the prefecture where they will work – everything

will be transparent to the candidates, and it will be up to the candidates to decide

whether they like it or not. I have worked with government since 1983 and I have

never seen a more perfectly negotiated agreement. I have also dealt with the private

sector – I was a conciliator-mediator for fi ve years dealing with collective bargaining

agreements – I have never seen a more perfect agreement. What is important is to

keep on building on these agreements, rather than completely rejecting them.

At the end of the day, I keep on hearing “Will the government send these people

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to Saudi Arabia or to the US?” Is this really the case? Is it really the government

sending them? Or is it really the people deciding whether the offers are acceptable

to them or not? I think, at the end of the day, what the government ought to do is to

make things more transparent, allow for information to be available to people, and let

those people decide rationally whether it is for them or not.

I have talked to PNA a number of times and I keep on using this allegory. I can

understand the pride of the Filipino nurses, and the emphasis they give for quality.

I hope this is not seen in a derogatory manner. I would probably liken them to the

manufacturers of Mercedes Benz, BMW and Volvo. There is pride in producing such

quality, but sometimes people do not need a Mercedes or a Volvo. Sometimes people

are happy with a Toyota. Japan is facing a lot of problems. The aging population is

the biggest in the world. And it is still moving so fast. The ability to support that

population with their resources is also dwindling.

That is why I have been opening up the idea to the Japanese associations. I was

telling them, why not let your older people take a longer vacation in the Philippines?

There is movement in Japan right now. Among the aged, there is this movement

promoting a discovery of second life. A lot of Japanese are so frustrated. It was

estimated that about seven million baby boomers are soon going to become 65. Out

of that number, the most conservative estimate is that 1.16 million of them are going

to retire – many of them supervisors in companies. The sad part is they could not

fi nd a young Japanese person to whom they could transfer the technology that they

know because the young people are no longer interested in the industries. They are no

longer interested in hard work. Instead, they just want to be “freeters” and enjoy life.

They said, “Why should we repeat the experience of our elderly?” Thus, I said, why

don’t you send them (Japanese elderly) on vacation to the Philippines? We will also

teach them English and Tagalog, and then they can teach our people agriculture. They

can teach us technology for small enterprises. Then perhaps, the relationship will be a

lot more complementary.

Edmunda Rillon (UP Manila): This is just an addendum to what our Labor Attaché

(Conferido) is saying. There is now one Japanese community in the Philippines

wherein all these retirees are huddled in one place. It is a one-stop community, all

their needs are met. This is part of the medical tourism proposed in this country. It is

already existing. They are also hiring our Filipino nurses and caregivers. I think it is

in Cavite or Laguna. It is in Sta. Rosa, Laguna.

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Ron Vilog (Ateneo de Manila University): This is in line with the argument of

the PNA. The Japanese Nursing Association, JNA, is also claiming that there is no

shortage of nurses. I would like to ask the opinion of our speakers on this issue. This

was also asked during our conference in Ateneo. No one could answer the question.

The Ministry of Health also released data that there is a very low shortage of nurses.

JNA is saying that there is no shortage of nurses. But there are thinktanks, like for

example a study conducted at Nihon Fukushi (Welfare) University says that there is

a chronic shortage of nurses. And there are several studies that claim that there is a

shortage.

Leny Velasco (Philippines Nurses Association): We came up with an official

position in the issue of JPEPA, and part of this says, “we are giving utmost

consideration to the offi cial position of the JNA, that reforms and improvement in the

conditions of the working conditions, salaries and benefi ts of local Japanese nurses

should fi rst be instituted before the entry of Filipino nurses.” They should institute to

improve the working conditions of local Japanese nurses fi rst before they can ensure

that Filipino nurses will have favorable working conditions in Japan. That is the

information that came from the JNA.

Moderator: But with regards to the shortage, you have data there Ruth?

Ruth Carlos (Ryukoku University): I do not have the data right now. But we can

fi nd in the newspapers that there is a shortage of nurses. According to the JNA, there

is no shortage of potential nurses. This means there are registered nurses who are

not working. The thinking of the JNA is to tap fi rst this domestic supply of potential

nurses. The problem now is it is very hard to tap these nurses because of the poor

working conditions of nurses in Japan.

Masaki Endo (Kobe International University): The Japan Nursing Association

branch in Kobe also insists that there is no shortage of nurses. Their fundamental

data is graduates of nursing colleges. However, most nursing college graduates of

Japan will not work as nurses. I think the best estimate is 40 percent of nursing

graduates who would work as a nurse, as work as a nurse is very diffi cult and the

social status of nurse is not high. Someone mentioned that Japanese nurses are

treated as assistants of medical doctors. That is true in local cities. But in Tokyo, we

can find professional and committed nurses as shown in the St. Luke’s College of

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Nursing’s research results. However, most of the nursing school graduates at the local

level want to work only for 2-3 years, possibly to marry physicians. I am not insulting

the nurses. Forty percent of nursing college graduates join the hospitals, but in six

months many of them quit their job due to heavy workloads. It is very diffi cult to get

especially qualifi ed nurses. The government of Hyogo Prefecture also admitted there

is an adequate number of nurses existing in the Prefecture.

Rey Conferido (Department of Labor and Employment): To complement what

was just said, Ambassador Siazon used to joke with Foreign Minister Machimura,

because Ambassador Siazon’s wife is also Japanese and he has lived in Japan for

so long. He said that it is only in Japan where ghost doctors and nurses can cure. If

you go to many of the hospitals, you would see the names of doctors and nurses just

to retain their accreditation as a hospital. But if you look for them you will not fi nd

them. There are islands in Japan where you cannot be born because there is no doctor

or obstetrician. There are recent statistics showing that more than 1,000 have died

because they have been rejected and have been passed on from hospital to hospital

and could not be accommodated. I have a colleague, a graduate student who was

playing basketball in Japan, who got fractured. He went to the emergency room but

was not accepted because he had no reservation. That speaks of the situation in Japan

– there is a real need. More than 100,000 Japanese health practitioners are retiring

within two years upon entry into the profession.

The situation of the Japanese health workers in Japan is not as good as the

situation of the Filipino nurses in the Philippines. We have to realize that. But

there are efforts to improve this. I can understand the stand of the JNA. As I said,

it is expected that they should advance the interest of their members, in the same

way that I expect the PNA to advance the interest of its members. But at the end

of the day, government, societies, people must decide on how to make a workable

compromise so that we can improve the situation of the nurses in the Philippines. We

should also advance the interest of the nurses in Japan.

In fact I have told those who are interested like the ones in the shipping industry

in Japan, the highest cost item for anyone that would live here (Japan) would be

housing. But you have many buildings that have no residents and you continue to

build more residences. Transportation is no problem. It is a standard practice in

Japan that transportation cost is shouldered by the employer. Food is another cost

item. If you are going to be interested in hiring Filipinos, you are not supposed to just

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provide them with salaries. You would have to look at the support mechanisms they

would need. But if we do not come up with a good framework, I am afraid that there

will be a huge crack that can be exploited by anyone interested to bring in workers. It

would be more dangerous.

For example, scholarships in Japan – the moment you enter as a student, you

are allowed by the Japanese immigration law to apply for part-time work permission,

and you can work for 28 hours a week. I am afraid that this will be exploited. People

who have not even graduated or qualifi ed will be there. But given the right support,

I think the Filipino nurses can do it and make it well in Japan. In fact, I forgot to

say that in Hyogo Prefecture, in the early 1990s at least 2 Filipinas graduated from

Hyogo University and passed the Japanese nursing licensure exam given the right

support. I hope the Japanese private sector and the Japanese government will not

stop at the six months language support – maybe it will become longer. But they will

need a lot more support than what is being currently offered.

Connie Gundayao (Alliance of Health Workers): Good afternoon I am Connie

Gundayao from the Alliance of Health Workers (AHW). I am a community nurse by

profession. This is my fi rst time to attend a conference about Japan and learn about

Japanese culture. As a community nurse, I have been to many rural provinces. Most

of them are far-fl ung, in the Visayas and Mindanao. Since we are also discussing the

shortage of nurses in Japan, and in the morning session we also discussed about the

supposed oversupply of nurses in the Philippines, I would like to share my experience

when I was working in the Mindanao and the Visayas.

I have seen for myself and experienced the actual shortage of nurses in the rural

areas where most of the Filipino people actually live. We have experienced dying

Filipino patients before they are ever brought to the nearest health facility – district

hospitals and health centers – which are undermanned especially now with nurses

and doctors going out as nurses. In connection to what Dr. Sato said a while ago about

human security, being “freedom from want and freedom from fear”, and we have to

consider also the impact of this migration to the sending country as well as its effect

on the receiving country, we have to recognize the negative effects of this migration on

the sending country, in particular on our country. We have data showing that at least

200 hospitals have closed down due to lack of personnel – medical and nurses. Some

are already partially closed due to lack of personnel, and the remaining staff nurses

in the hospitals, especially government hospitals, are overworked because they have

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to service all the patients and they lack nurses in these hospitals.

I would like to reiterate the point made by Dr. Marilyn Lorenzo in the morning

during her commentary about the retention and management of health care workers.

This would be a longer lasting solution to the problem of shortage in Japan as well

as to the problem of health resources in the Philippines. Although we are saying that

we have oversupply in the Philippines, I think there must be some efforts to solve the

problem of health workers and nurses who are staying in the Philippines, primarily

the problem of salaries, about the working conditions and the benefi ts. If the Japanese

nurses are also having problems about the working conditions and salaries, that

should be one of the priorities of the governments of the Philippines and Japan. If we

try to address this, maybe some of the nurses and other health workers may decide

to stay, and somehow help alleviate the problem of shortages, both in receiving and

sending countries. Thinking about this from the point of view of a community nurse,

we have experienced for ourselves the diffi culty of having no nurses and doctors in

rural communities where nurses and doctors are needed most.

Chizuko Sato (Ritsumeikan University): I am trying to respond to the comments

made about the slow change in the Japanese society. I have no interest in defending the

Japanese government. But I want to add a social/cultural aspect of our aging society.

Numbers cannot tell everything. We saw the statistics in Dr. Carlos’ presentation –

20 or 30 percent of the population will soon be over 65. That is a huge percentage. We

are also talking about the retirement of the baby boomers generation, and that is my

father’s generation. I belong to the generation of the second baby boomers who are not

producing kids or delaying the marriage – that is causing the problem of aging society.

Maybe because I come from rural society and from an extended family, my parents

looked after my grandparents at home. Putting them in a nursing home was simply not

an option. We had to look after our grandparents at home.

Now, it is my generation. None of my sisters are living with our parents, all

moved out of our parents’ house. In time, my parents will age, and what are we going

to do, if say, one of my parents dies? We cannot leave them alone, but we do not have a

culture of employing domestic helpers to look after family members. In this situation,

with time, more and more families will make a decision to send their family members

to elderly homes. What I want to emphasize is, we are in a transitional stage and we

have mixed feelings about putting our parents into the care of somebody else. That

is why the Japanese are quite particular about the qualifi cations of people who will

－ 103－

Open Forum

look after our parents/grandparents. Nationality does not matter, but we still feel

that the people who will look after our parents/grandparents should be nice people. I

just wanted to emphasize this transitional situation in Japan, which is very different

from the UK and US where historically there was no culture of living together with

grandparents.

Ruth Carlos (Ryukoku University): Just to share with you the dangers of leaving

this to unscrupulous recruiters, we came across this issue in Tokyo where there were

around seven Filipinos who were recruited as caregivers from the Philippines. They

were each charged one million yen for recruitment fee. And this was done by an

NGO which claimed that this was for the training of the next generation of Filipino

nurses. One of my colleagues went to where they were housed, and it was completely

the same as how they treated entertainers before. They were housed with cameras,

no passport, they were given cellphones but all were checked who you called to. You

wonder what visa they used to come to Japan, since as of now there is no visa yet for

careworkers. They were there as trainees or, I think, students of Japanese language.

Their daily schedule goes like this. They wake up at five in the morning then

study Japanese until around lunchtime. From lunchtime, they go to the nursing

home for “training” until nine in the evening. Because of this one million yen which

they were told to pay, they were sad and discouraged. They could not come back to

the Philippines because they have to pay for that one million yen. So we have to be

very careful of these recruiters, especially without the JPEPA, as there are already

recruiters doing these activities because there is real need for caregivers.

However, at the same time, there are local governments that are really preparing

for the acceptance of foreign workers. I have seen four prefectures. But then, no one

can move because the visa is the problem – they do not have a visa for foreign nurses.

I think, under JPEPA, they will be given a visa for designated activities.

Another thing is regarding the reply of the JNA to my question. I was telling them,

why not just divide the licensure exam into two, one is the skills evaluation and the

other is the language evaluation, because I am sure in terms of skills we are at par with

them, but then, with the language problem, we cannot pass this exam. My impression

is that it is not something that will check the skill of the nurse, but it is something that

will check the language profi ciency of the Filipinos if the foreigners will come. It would

be very hard for our nurses to pass that exam because of the language problem.

表紙デザイン：　山中大輔・内田晴子研究シリーズ 8Research Series 8

龍谷大学アフラシア平和開発研究センター　研究シリーズ 8

日本－フィリピン間の人の移動に関する会議報告書フィリピン人看護師・介護士の国際移動

－日本への送出しの可能性－2008 年 3 月 25 日


Japan as a Potential Host Country for Nurses and Caregivers


March 25, 2008

Afrasian Centre for Peace and Development Studies, Ryukoku University

Research Series 8


　

発行日／ 2009 年３月 12 日発　行／龍谷大学アフラシア平和開発研究センター　　　　http://www.afrasia.ryukoku.ac.jp/

　　　　〒 520-2194 滋賀県大津市瀬田大江町横谷１－５　　TEL / FAX 077-544-7173印　刷／株式会社　田中プリント

PUBLISHED BY AFRASIAN CENTRE FOR PEACE AND DEVELOPMENT STUDIES,

RYUKOKU UNIVERSITY

　1-5 Yokotani, Oe-cho, Seta, Otsu City, Shiga 520-2194　TEL / FAX + (81) 77-544-7173　http://www.afrasia.ryukoku.ac.jp/

PRINTED BY TANAKA PRINT CO., LTD.

ISBN 978 - 4 - 903625 - 80 - 5





2008年3月25日





研究シリーズ　

８　　　　　　日本

－

フィリピン間の人の移動に関する会議報告書　

フィリピン人看護師・介護士の国際移動

－

日本への送出しの可能性

－

龍谷大学アフラシア平和開発研究センター

ISBN 978 - 4 - 903625 - 80 - 5

　豊臣秀吉の時代以来、日本とフィリピンの間ではさまざまな形での人の移動が行われてきた。戦前には、日本の南方政策のもとでダバオのプランテーションやバギオのベンゲット道建設に従事するために多くの日本人労働者がフィリピンに移住したが、今では彼らの子孫が日系人として祖先の生まれ故郷に戻ってきている。戦後は、研究者や留学生の行き来が増加した一方で、1960年代にはフィリピン人ボクサーや音楽隊の来日が盛んになった。1980年代以降は、エンターテイナーや IT技術者のような一時的な出稼ぎを目的とする労働者の移動がフィリピンから日本への国際移動の中心を占めるようになった。さらに、日本人の配偶者として移住するフィリピン人も増え、今日、日本に住むフィリピン人はおよそ 20 万人に達する。他方、1万 4000 人を超える日本人（2007 年 10 月 1 日現在）が、NGOのボランティアやフィリピン人の配偶者、学生、ビジネスマンとしてフィリピンに暮らしている。近年では、老後の生活をフィリピンに求める日本人も増えている。　21 世紀に入り、フィリピン─日本関係は新たな段階を迎えている。2006 年 9 月、グローバル化の進展によって拡大する人的資源、モノ、サービス、投資の国境を越えた交換を包含する二国間の経済連携協定（日比経済連携協定＝ JPEPA）が、フィリピンのアロヨ大統領と日本の小泉首相によってフィンランドで調印された。2007年に日本の国会で批准され、2008年にフィリピンの上院で批准された JPEPAには、フィリピン人看護師と介護士の日本への送出しについての規定が盛り込まれていた。フィリピン人看護師や介護士に対する国際的な需要は、先進国における少子高齢化や労働者不足によってのみならず、先進国で介護労働が商品化されたことによっても増大しているが、日本もまた例外ではない。だが、この規定は、JPEPAのなかでもっとも多くの議論を呼ぶことになった。フィリピン人看護師・介護士の日本への送出しをめぐっては、情報不足あるいは事実誤認に基づくものと思われる多くの問題が日本とフィリピンそれぞれの関係者の間で未だ解決されずに残っている。　それゆえ、この会議はフィリピンからの看護師、介護士の国際移動の現状とフィリピン─日本間の看護・介護分野での人的交流についての情報を共有し、意見交換を行うことを主たる目的として開催された。両国の医療・介護部門への JPEPAの影響や日本の医療・介護施設での外国人労働者の雇用の見通しについても議論が行われた。この会議のもう一つの目的は、医療・介護問題や国際移動について研究を行っているフィリピン人研究者と日本人研究者の間での協力関係を強化し、研究成果を共有することにあった。そしてもっとも重要だったのは、会議を通じて、日本とフィリピンの両国において、政府・非政府を問わず、この問題に関係するさまざまなステークホルダーの間での議論と対話を深めることだった。われわれは、この問題についての両国間での対話がこれからも継続してゆくことを願っている。

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フィリピン人看護師・介護士の国際移動 · PDF filefrequented Northern Luzon during the pre-Spanish period, the first recorded ... instrument of both countries. Against