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MONITORING OF THE WHO GLOBAL CODE OF PRACTICE ON THE INTERNATIONAL RECRUITMENT OF HEALTH PERSONNEL

THE PHILIPPINE MULTISTAKEHOLDER APPROACH

M ONITORING OF THE WHO G LOBAL C ODE OF P RACTICE ON THE I NTERNATIONAL
M ONITORING OF THE WHO G LOBAL C ODE OF P RACTICE ON THE I NTERNATIONAL

A Collaboration of the Department of Health with the Department of Labor and Employment in partnership with the
International Labour Organization (Philippines) and the World Health Organization (Philippines and Western Pacific Regional Office) and Multistakeholders

M ONITORING OF THE WHO G LOBAL C ODE OF P RACTICE ON THE I NTERNATIONAL
M ONITORING OF THE WHO G LOBAL C ODE OF P RACTICE ON THE I NTERNATIONAL

Manila, June 2012

CONTENTS

CONVENORS

 

ii

TECHNICAL and ORGANIZING COMMITTEE

ii

CONSULTANT and TECHNICAL WRITER

ii

FACILITATORS

iii

SECRETARIAT

 

iii

DOCUMENTORS

iii

MULTISTAKEHOLDERS

iii

LIST

OF

FIGURES

vii

LIST

OF

vii

ACRONYMS

 

viii

EXECUTIVE SUMMARY

x

INTRODUCTION

1

THE PHILIPPINE APPROACH

3

SUPPLEMENTAL INFORMATION

18

CONCLUSION ...........................................................................................................................

21

ANNEX A: Proposed Questions for Source Countries

23

ANNEX B: The Philippine Worksheet

24

CONVENORS

Department of Health

Dr. Kenneth Ronquillo, Director IV, Health Human Resources Development Bureau Dr. Christine Joan Co, Team Leader for Policy and Network, Planning and Standards Division

Department of Labor and Employment

Ms. Fely Romero, Director, Philippine Overseas Employment Administration

International Labour Organization (Manila)

Ms. Catherine Vaillancourt-Laflamme, Chief Technical Advisor, Decent Work Across Borders Project

Ms. Jennifer Frances dela Rosa, National Program Officer, Decent Work Across Borders Project

World Health Organization (Philippines)

Dr. Soe Nyunt-U, WHO Representative, WHO Country Office Ms. Lucille Nievera,Programme Officer, WHO Country Office

World Health Organization (Western Pacific Regional Office)

Dr. F. Gülin Gedik, Team Leader, Human Resources for Health,WHO Western Pacific Regional Office

Ms. Kathleen Fritsch, Nursing Regional Advisor, WHO Western Pacific Regional Office

TECHNICAL AND ORGANIZING COMMITTEE

Dr. Kenneth Ronquillo, Director IV, Health Human Resources Development Bureau Dr. Christine Joan Co, Team Leader for Policy and Network, Planning and Standards Division Ms. Catherine Vaillancourt-Laflamme, Chief Technical Advisor, Decent Work Across Borders Project Ms. Jennifer Frances dela Rosa, National Program Officer, Decent Work Across Borders Project

CONSULTANT AND TECHNICAL WRITER

Ms. Maria Lourdes Rebullida, DPA

FACILITATORS

Dr. Kenneth Ronquillo, Department of Health Dr. Christine Joan Co, Department of Health Ms. Catherine Vaillancourt-Laflamme, ILO Manila Ms. Jennifer Frances dela Rosa, ILO Manila Ms. Maria Concepcion Sardaña, ILO Manila Ms.Fely Marilyn Lorenzo, DrPH, University of the Philippines Manila Mr. Ricardo Casco, International Organization for Migration Ms. Maria Lourdes Rebullida, DPA, University of the Philippines Diliman

SECRETARIAT

Ms. Madelyne Mabini Ms. Desiree Joy Granil

DOCUMENTORS

Dr. Carl Antonio Ms. April Delos Santos Ms. Mary Jane Demegillo Ms. Marjorie Dungca Dr. Irene Farinas Ms. Farrah Grace Naparan Mr. Jayson Aguilar Ms. Grace Fernando Ms. Georgina Ramiro Ms. Caridad Ulanday

MULTISTAKEHOLDERS

Mr. Frencel Tingga Mr. Jeric Sagala

Commission on Filipinos Overseas

Ms. Elsa Florendo

Commission on Higher Education

Ms. Emily Villanueva Descallar Dr. Aleli Annie Grace Sudiacal Ms. Jeanne Bernas Dr. Lilibeth David Dr. Elizabeth Matibag Ms. Juanita Valeza Mr. Jose Sandoval Ms. Geraldine Labayani Ms. Milagros Oliva Dr. Marco Valeros Dr. Rhyan Gallego Ms. Vivian Tornea Atty. Bulyok Nilong Ms. Luisa Reyes Dr. Marissa San Jose Ms. Arlene Ruiz Mr. Benjamin Jose Bautista Mr. Arthur Philip Sevilla Ms. Maybelle Gorospe Mr. Jone Fung Ms. Nimfa De Guzman Mr. Carlos Canabera Mr. Pamfilo Tabu, Jr.

Ms. Monica Ormillo

Department of Foreign Affairs

DOH-Bureau of International Health Cooperation

DOH - Health Policy Development and Planning Bureau

DOLE - Bureau of Local Employment

DOLE - Bureau of Working Conditions

DOLE - National Reintegration Center for OFWs

DOLE Occupational Safety and Health Center

National Economic and Development Authority

Philippine Overseas Employment Administration

Technical Education Skills Development Authority

Mr. Alvin Cloyd Dakis

Mr. Jonathan Monis Ms. Joycelynn Aman

Alliance of Young Nurse Leaders and Advocates International, Inc.

Philippine Association of Medical Technologists, Inc.

Mr. Noel Cadete Dr. Teresita Barcelo

Philippine Nurses Association, Inc.

iv

Ms. Leonila Ocampo

Dr. Yolanda Robles

Philippine Pharmacists Association

Ms. Gayline Manalang, Jr.

Philippine Physical Therapy Association, Inc

Ms. Freyda Viesca

Employers Confederation of the Philippines

Dr. Jose Luis Danguilan

Lung Center of the Philippines

Ms. Jeanette Nora Silao Dr. Bernadette Hogar Ms. Mary Eve De Leon Ms. Ivy Alcantara Ms. Katrina Ledesma Dr. Jose Dante Dator Ms. Nimia Parale

Manila Doctors Hospital

Makati Medical Center

National Kidney and Transplant Institute

Ms. Lizel San Pedro

Ospital ng Makati Pembo

Ms. Leonida Ventosa Dr. Paulo Castro Mr. Horacio Apuyan Dr. Kiko Tranquilino

Ospital ng Muntinlupa

Pasig City General Hospital

Pharmaceutical and Healthcare Association of the Philippines

Ms. Maria Linda Buhat

Philippine Heart Center

Mr. Vladimir Balbino

St. Luke’s Medical Center – Quezon City

Dr. John Jerusalem Tiongson

The Medical Center

Mr. Nestor Flores

Abba Personnel Services, Inc

Mr. Ramon Quevedo

EDI-Staff Builders International

Ms. Valerie Santos

Health Carousel Philippines, Inc

Ms. Marysol Ligod

Innovative Manpower Services

Ms. Catherine Peralta

Jedegal International Manpower Services

Mr. Loreto Soriano

LBS Recruitment Solutions Corporation

Ms. Marjo Miinalainen

OPTEAM Global - Regional Office

Ms. Joy del Rosario Mr. Victor Fernandez, Jr. Mr. Hernan Guanco Mr. Jesus Noel Litan Mr. Simon John Corocoto

PETRO - FIL Manpower Services Inc.

Philippine Association of Service Exporters, Inc

Signature HealthCARE

Ms. Joanna Katrina Magalong

Transnational Services Inc.

Mr. Josua Mata Ms. Suevelyn Clavite

Mr. Abdulani Lakibul

Alliance of Progressive Labor

Confederation of Independent Union

Mr. Julius Cainglet

Federation of Filipinos Workers

Ms. Esperanza Ocampo Ms. Josephine Pagsuyuin - Jamon Ms. Annie Enriquez Geron Ms. Jillian Roque

Philippines Government Employee Alliance

Public Services-Labour Independent Confederation

LIST OF FIGURES

Figure1. Philippine Approach to Monitoring the WHO Global Code of Practice on the International Recruitment of Health Personnel

LIST OF BOXES

Box 1. The Philippine Approach: Steps in Monitoring the Implementation of the WHO Global Code of Practice on the International Recruitment of Health Personnel (April to May 2012)

Box 2. DOH-HHRDB as Focal Unit for Monitoring Implementation of the WHO Global Code of Practice on the International Recruitment of Health Personnel (April to May 2012)

Box 3. ILO Decent Work Across Borders Project: A Pilot Project for Migrant Health Professionals and Skilled Workers (ILO Manila with European Union funding)

ACRONYMS

AANZFTA

Association of Southeast Asian Nations-Australia-New Zealand Free

ASEAN

Trade Agreement Association of Southeast Asian Nations

ASEAN MRAr

ASEAN Mutual Recognition Arrangement

CFO

Commission on Filipinos Overseas

CHED

Commission on Higher Education

DFA

Department of Foreign Affairs

DILG

Department of the Interior and Local Government

DILG-BLGD

Department of the Interior and Local Government-Bureau of Local Government Development

DOH DOH BIHC DOH-HHRDB DOH HPDPB DOH NCPAM DOLE DOLE - BLE DOLE BLR DOLE BWC DOLE ILS DOLE NRCO

Department of Health DOH-Bureau of Health International Cooperation DOH -Health Human Resources Development Bureau DOH -Health Policy Development and Planning Bureau DOH-National Center for Pharmaceutical Access & Management Department of Labor and Employment DOLE-Bureau of Local Employment DOLE-Bureau of Labour Relations DOLE -Bureau of Working Conditions DOLE -Institute of Labor Studies DOLE-National Reintegration Center for Overseas Filipino Workers

DOLE OSHC

Department of Labor and Employment-Occupational Safety and Health Center

DWAB

Decent Work Across Borders

 

HRH

Human Resources for Health

ILO Manila

International Labour Organization (Manila Office)

 

ILO-DWAB

International

Labour

Organization-Decent

Work

Across

Borders

Project

MASEAN

Medical Association of Southeast Asian Nations

MDH

Manila Doctors Hospital

MRAr

Mutual Recognition Arrangement

NEDA

National Economic and Development Authority

OWWA

Overseas Workers Welfare Administration

PEOS

Pre-Employment Orientation Seminar

PDOS

Pre-Departure Orientation Seminar

PHC

Philippine Heart Center

PNA

Philippine Nurses Association, Inc.

PPhA

Philippine Pharmacists Association

PPTA

Philippine Physical Therapy Association, Inc.

POEA

Philippine Overseas Employment Administration

PRC

Professional Regulation Commission

PRC-IAD

Professional Regulation Commission-International Affairs Division

PSLINK

Public Services-Labour Independent Confederation

TESDA

Technical Education Skills Development Authority

UP-NIH

University of the Philippines-National Institutes of Health

UP-NIH IHPDS

University of the Philippines-National Institutes of Health, Institute of Health Policy and Development Studies

WHO

World Health Organization

WHO Philippines

WHO Philippine Office

WHO WPRO

WHO Western Pacific Regional Office

ix

EXECUTIVE SUMMARY

The Philippines initiated a participatory multistakeholder process for the monitoring of implementation of the WHO Global Code of Practice on the International Recruitment of Health Personnel (The Code). The Department of Health (DOH) took the lead as the WHO designated national authority, with the Department of Labor and Employment (DOLE), and in partnership with the International Labour Organization (ILO Manila) and the World Health Organization (WHO Philippines and Western Regional Pacific Office), and local stakeholders from the government, trade unions, employers, recruitment agencies, and professional associations.

The process benefited the fact that the ILO, with the financial support of the European Union, is implementing a project called Decent Work Across Borders: A Pilot project for Migrant Health Professionals and Skilled Workers (DWAB).The project is implemented through a partnership with DOLE, trade union and employers organizations and other relevant partners. It provided the opportunity to work with the DOH on their common concern for ethical recruitment of human resources for health (HRH).

The ILO DWAB hosted an initial meeting on the 29 th of March 2012, which was attended by representatives of the four organizing committee members the DOH, DOLE, ILO and WHO Philippines and WPRO. In this meeting, organizers discussed the WHO Global Code of Practice on the International Recruitment of Health Personnel, also known as the Code, and its National Reporting Instrument. This meeting mapped the terms of their collaborative engagement to assist the DOH in monitoring the Code using a participatory approach, tapping on the ILO experience to work through social partners.

The organizers ventured into the preparation of a Philippine Monitoring Worksheet for multistakeholders to provide supplementary data and clarificatory statements. This worksheet, which stakeholders were asked to complete, included the WHO National Reporting Instrument questions and linked those to the statements from the Code. The worksheet also included a column for stakeholders to add supplementary information and clarification on their responses. The worksheet also provided the opportunity for stakeholders to propose improvements to the wording of the questions included in the national reporting instrument.

With the logistical support of the DOH and ILO, the Philippines convened introductory briefings in April 2012, for the stakeholders (governments, trade unions, hospitals, professional organizations and recruitment agencies) to present and discuss the provisions of the WHO Code, to orient them on the completion of the WHO National Reporting Instrument and Philippine worksheet, and obtain their commitment to participate in the monitoring process. The stakeholders were encouraged to consult their constituents in completing the worksheet.

Stakeholders were asked to send their completed worksheet electronically before the organizers convened a first multi stakeholder meeting as to allow the collection of information and consolidation of responses per stakeholder group.

The 1 st Multistakeholder Participatory Assessment Workshop was convened on 17 May 2012. Each group of stakeholder gathered to discuss and clarify the consolidated data in separate sessions. The plenary session that followed allowed clarification of responses across stakeholder groups. The meeting lasted one full day.

The 2 nd Multistakeholders Participatory Assessment Workshop on 30 May 2012 focused on the consolidated draft country report that presented the Philippine situation and the stakeholders’ perspectives.

The different stakeholders described the Philippines as a source country, that is, a sending country of migrant health personnel rather than as a destination country, that is a receiving country. It is from this perspective that they responded to the items in the WHO National Reporting Instrument. In this light, it was suggested that the WHO develop an additional instrument that would better capture the perspective existing in source and destination countries with regards to health personnel migration.

The perspectives of the five stakeholders groups indicated the nuances of the Philippine experiences as a source or sending country for health personnel with respect to bilateral and multilateral agreements that have been forged between the Philippines and other countries. Philippine policies and programs are geared at the promotion and protection of the rights and welfare of Filipino migrant health personnel, including raising awareness through pre- employment and pre-departure orientation seminars for migrants and through continuous orientation for and performance evaluation of recruitment agencies. The Philippines also established a re-integration center for returning Filipino migrants.

While the Philippine is signatory to the ASEAN Mutual Recognition Arrangements (MRArs) for the health professions of Dentistry, Medicine, and Nursing, these have not been made operational as of yet. There are restrictions arising from the 1987 Philippine Constitution (which does not allow foreign workers to work in the country) and contradictions in the provisions of other laws and policies on receiving foreign health professionals. For these reasons, the Philippine is not yet a destination for foreign health professionals. Foreign health professionals found in the Philippines are trainees such as medical residents or under an exchange visitors program and under limited practice of profession for the conduct of medical missions for delivery of health services in crisis or emergency situations, researchers and teachers.

The responses and discussions around the WHO National Reporting Instrument and the Philippine Monitoring Worksheet surfaced many challenges for the Philippines as a source country. The supplementary worksheet and the multistakeholder process were pursued to document the gaps in the WHO instrument using a source country perspective.

The Philippines endeavored to contribute its experience with regard to the participatory monitoring of the Code as a good practice in the global efforts to raise awareness of and

address ethical recruitment of health personnel. Much more than the contribution of a full

and very detailed country report to the WHO, the process led by the DOH and DOLE, with the ILO and WHO proved to be a very efficient channel to raise the awareness of the importance of ethical recruitment of health personnel across a wide range of stakeholders. It created momentum to pursue activities on this matter and seek to continuously improve systems regarding the migration of health personnel. The process the country underwent in

the past months will be captured into a “good practice sheet” which the Philippines is keen

to share with the WHO and the ILO, member countries and other organizations that seek to promote ethical recruitment of health personnel.

MONITORING OF THE WHO GLOBAL CODE OF PRACTICE ON THE INTERNATIONAL RECRUITMENT OF HEALTH PERSONNEL

THE PHILIPPINE MULTISTAKEHOLDER APPROACH

INTRODUCTION

Reaching a landmark decision on 21 May 2010 at the Sixty-third World Health Assembly (WHA), the 193 Member States of the World Health Organization (WHO) adopted the WHO Global Code of Practice on the International Recruitment of Health Personnel(The Code).This marks a historic milestone in the global efforts since 2004 to develop a code of practice that addresses health workforce migration, given the observed critical shortage in health personnel and weakened health systems experienced by some 57 source countries identified by WHO. The Code promotes voluntary principles and practices for ethical recruitment of health personnel, considering the rights, obligations and expectations of source countries, destination countries and migrant health personnel. It intends to serve as a reference for Member States in establishing or improving the legal and institutional framework required for international recruitment of health personnel and in the formulation of bilateral agreements and other international legal instruments. The WHA recommends that the Code be a core component of bilateral agreements, and national, regional and global responses to health personnel migration and health systems strengthening, particularly in developing countries, and countries with economies in transition. The Code is expected to facilitate and promote international discussion as it poses as a guide for Member States to work with various stakeholders (such as health personnel, recruiters, employers, health professional organizations, and other organizations).

Among the guiding principles, the Code asserts that the “health of all is fundamental to the attainment of peace and security,” for which individuals and states should render fullest

cooperation. Member states, recruiters, employers, and stakeholders are enjoined to observe the voluntary international principles on ethical recruitment of health personnel to mitigate negative effects and maximize positive effects on health systems worldwide, for both source and destination countries, and upon the health personnel themselves.

The

Code

provides

for

the

designation

of

a

national

authority

responsible

for

implementation (Article 7.3). Furthermore, the Code enjoins the participation of

international development organizations in rendering assistance to member countries.

It was planned that the implementation of the Code would be monitored for the first time in 2012 and thereafter every three years. The first round of national and global data will be used for the WHO Director-General’s report to the 2013 WHA to assess effectiveness and determine necessary improvements to the Code’s implementation and monitoring.

Responding to the call for the national monitoring of the Code, the Department of Health- Health Human Resources for Health Bureau (DOH-HHRDB) initiated multistakeholder consultations with the Department of Labor and Employment (DOLE) and in partnership with

the International Labour Organization (ILO Manila) and the World Health Organization (Philippines) and the Western Pacific Regional Office (WPRO), and participation of local stakeholder organizations.

The ILO is the UN specialized agency which seeks the promotion of social justice and internationally recognized human and labour rights. It operates through social dialogue between governments, trade union and employers’ organizations. The ILO is the only United Nations agency with a constitutional mandate to protect migrant workers. In 2011, the ILO received funding from the European Union to implement an initiative called Decent Work Across Borders (DWAB): A Pilot project for Migrant Health Professionals and Skilled Workers. The 3-year project seeks to better understand schemes in line with circular migration of skilled and health professionals in three member countries, namely: India, Philippines and Vietnam. Considering the relevance of their endeavors to international health workforce migration, the ILO, and its government partner DOLE were instrumental in bringing their tripartite constituents to collaborate with the DOH in monitoring the WHO Global Code of Practice.

As an initial step to monitoring the Code’s implementation, the Philippines took a unique approach by engaging crucial partners and stakeholders in the process of clarifying the elements of the monitoring instrument, and sharing perspectives across organizations and

stakeholders group to help shape the national scenario on the Code. To guide the process,

the DOH operationally defined the migrant health personnel as “any health worker who has

last held employment in a foreign country, or whose qualification for employment was obtained in a foreign country.” The Philippine approach engaged the government, employers, recruitment agencies, trade unions, professional organizations in a multistakeholder consultative process consistent with the practices of the collaborating entitiesDOH and DOLE, ILO and WHO in the Philippines.

This report is a supplement to the on-line submission of the Philippine National Reporting Instrument (submitted electronically on 31 May 2012). It aims to present the wider perspectives of different stakeholders concerned with the ethical recruitment of health personnel.

The report is structured to respect the flow of topics and questions as offered in the National Reporting Instrument. Further, this report also included discussions on the aspect of the Code that were not included in the National Reporting Instrument as those were deemed important by the organizers. As a result, additional questions were added tothe Philippine worksheet, which allowed the stakeholders to possibly assess the entirety of the Code’s implementation. The report concludes with the highlights of the discussion. Annex A presents the Philippines’ stakeholders’ suggestions in view of a revised national reporting instrument which would take in the perspective of source countries.

THE PHILIPPINE APPROACH

Through the ILO DWAB project, and with agreement of the DOH as the lead agency for monitoring of the Code , a participatory, multistakeholder process was designed in order to bring around this important issues a wide range of stakeholders and opinions(Box 1).

Box 1. The Philippine Approach: Steps in Monitoring the Implementation of the WHO Global Code of Practice on International Recruitment of Health Personnel (April to May 2012)

  • 1. ILO’s initiative in hosting the 29 March 2012 meeting of four partner organizations -DOH, DOLE, ILO Manila, WHO Philippines and WPRO.

  • 2. Development of the Philippine framework and approach (Figure 1).

  • 3. Development of the Philippine monitoring worksheet for multistakeholder (inclusive of the WHO National Reporting Instrument, explanatory notes on the WHO Code and WHO User’s Guide on the Code, and worksheet sections for supplementary data and clarification from stakeholder respondents (Annex B); and stipulation of the operational definition of migrant health personnel (DOH definition).

  • 4. Planning and organizing for the monitoring process by ILO and DOH, including logistics for orientation sessions on the Code, data collection, data processing, and multistakeholders consultative meetings.

  • 5. Multiple meetings for stakeholders’ orientation on the WHO Code National Reporting Instrument and the Philippine worksheet; and, for stakeholders’ commitment to participate in the data collection and consultations.

  • 6. Multistakeholders’ submission of completed worksheet.

  • 7. Consolidation of accomplished worksheets.

  • 8. 1st Multistakeholder Meeting was conducted on the basis of the consolidated data and draft country report.

  • 9. 2nd Multistakeholder Meeting was conducted for validation of the draft country report.

    • 10. Online submission of WHO National Reporting Instrument on 31 May 2012.

    • 11. Submission of full report on the Monitoring of the WHO Global Code of Practice on the International Recruitment of Health Personnel: The Philippine Multistakeholder Approach in June 2012.

    • 12. Preparation of a good practice sheet documenting the entire participatory process in line with the monitoring of the Code and submission to the WHO and ILO in July 2012.

The ILO DWAB hosted the initial meeting on the 29 th of March 2012, which was attended by representatives of the four partner organizationsthe DOH, DOLE, ILO and WHO Philippines and WPRO. In this meeting, partners discussed the Code and its National Reporting Instrument, and mapped the terms of their collaborative engagement to assist the DOH in monitoring the Code. It was agreed then that much value would be added to the report by inviting a wide range of stakeholders to the table. It was also agreed that, such an open and participative process would raise awareness and interest of the issue of ethical recruitment and the Code itself. The ILO offered its experience in dealing with social partners to the benefit of the monitoring of the Code. As the ILO main governmental partner and agency

responsible to manage international migration in the Philippine, the DOLE was also keen to take part in the process.

The DOH as the national authority responsible for the monitoring of the Code dynamically took the lead in the process. The WHO Philippines and WPRO’s support was instrumental in linking the Philippines efforts to the WHO in Geneva. (Box 2).

Box 2.

DOH-HHRDB as Focal Unit for WHO Global Code of Practice on the International Recruitment of Health Personnel

  • 1. HHRDB is the designated focal unit of the DOH as the national responsible authority for the WHO Code monitoring.

  • 2. HHRDB is the Secretariat of the Human Resources for Health (HRH) Network Philippines, a multi-sectoral organization of government agencies and non-government organizations that have HRH-related mandates. 1

The ILO is implementing the “DWAB project: A Pilot project for Migrant Health Professionals and Skilled Workersin the Philippines, as well as in India and Vietnam, for which the WHO Global Code of Practice is relevant. (Box 3).

Box 3. ILO DWAB: A Pilot Project for Migrant Health Professionals and Skilled Workers(ILO Manila) The
Box 3.
ILO
DWAB:
A
Pilot
Project
for
Migrant
Health
Professionals
and
Skilled
Workers(ILO Manila)
The
International
Labour
Organization
(ILO)
is
the
United
Nations’
international
organization
responsible for drawing up and overseeing international labour standards. It is the only
'tripartite' United Nations agency that brings together representatives of governments,
employers and workers to jointly shape policies and programs promoting Decent Work for
All.
The ILO has a constitutional mandate to protect migrant workers, and this mandate has been re-
affirmed by the 1944 Declaration of Philadelphia and the 1998 ILO Declaration on Fundamental
Principles and Rights at Work. It has been dealing with labour migration issues since its inception in
1919. It has pioneered international Conventions to guide migration policy and protection of migrant
workers. All major sectors of the ILO - standards, employment, social protection and social dialogue -
are relevant to labour migration within its overarching framework of Decent Work for All. ILO adopts
a rights-based approach to labour migration and promotes tripartite participation in migration policy.
In 2006, the ILO adopted its Multilateral Framework on International Migration. Further, the ILO has
adopted 2 conventions (and associated recommendations) focusing specifically on migration issues.
1.
Convention No 97 – Migration for Employment Convention (1949)
2.
Recommendation No 86 – Migration for Employment Recommendation (1949)
3.
Convention No 143 – Migrant Workers Convention (1975)
4.
Recommendation No 151 – Migrant Workers Recommendation (1975)
The Philippines joined the ILO in 1948. As of January 2012, the Philippines had ratified 33
conventions, including the 8 fundamental conventions on freedom of association and
collective bargaining (C87, C98), forced labour (C29, C105), discrimination (C100, C111) and
child labour (C138, C182) Further, the Philippines has ratified the 2 migrant specific
conventions (C97, C143).

The ILO Decent Work Across Borders (DWAB) project: A Pilot project for Migrant Health Professionals and Skilled Workers, a European Union funded project, seeks to better understand schemes in line with circular migration of health professionals. This will be done by engaging governments, trade unions, and employers organizations around the 3 main objectives:

  • 1. To strengthen mechanisms of policy dialogue among stakeholders

  • 2. To strengthen employment services for healthcare professionals and skilled workers

  • 3. To enhance labour market information system with regards to the migration of healthcare professionals and skilled workers

Through this project, the ILO seeks to foster an approach to migration that benefits the migrant workers, the source and destination countries within a rights-based framework for labour migration management. The project focuses its activities on three Asian countries with significant outflows of health professionals and skilled workers for foreign employment, namely: the Philippines, India, and Viet Nam.

Under the DWAB project, the ILO is looking at ethical recruitment practices of private recruitment agencies to include and incorporate the guidelines on the ethical recruitment of health care professionals and skilled workers adopted by the World Health Organization and provision of the ILO Convention 181 on Private Employment Agencies as well as the ILO Multilateral Framework on labour migration.

The four partners developed the Philippine framework that underlies the unique Philippine approach to the monitoring process. The Philippine approach (Figure 1) expresses the dynamics of institutional collaboration on ethical international recruitment to sustain the local health workforce, to strengthen local health systems, and to ensure decent work across borders among health professionals. The DOH and the DOLE are at the forefront as the responsible government agencies with the World Health Organization and the International Labour Organization as members of the United Nations system in charge of international agreements relevant to health personnel migration. Though these organizations have different core orientations-- health and labour, their collaboration is anchored on the common goal of ensuring ethical recruitment of health personnel.

Considering the WHO National Reporting Instrument, and issues of its relevance and appropriateness to the unique national situation--that of an exclusively source country--the partners ventured into the preparation of a specific Philippine monitoring worksheet for various stakeholders to provide supplementary data and clarificatory statements. This Philippine monitoring worksheet for stakeholders to complete includes the WHO National Reporting Instrument, linked to the specific articles of the Code, and 2 additional columns for stakeholders to add supplementary information, and clarify their responses.

The term 'multistakeholders' refers to the participating organizations that were grouped into five stakeholder groups, namely:

  • government institutions with migration related functions

  • hospitals as employers of health personnel

  • health professional associations

  • trade unions

  • recruitment agencies

Figure 1. Philippine Approach to Monitoring the WHO Global Code on International Recruitment of Health Personnel
Figure 1. Philippine Approach to Monitoring the WHO Global Code on
International Recruitment of Health Personnel
Promotion of
Promotion of
Decent Work
Health
Decent Work
Sustain Health
Ethical
Ethical
Across Borders
Workforce to
Recruitment
for health
Recruitment
strengthen health
professionals
systems
Stakeholders:
Governments, Employers, Trade Unions, Recruitment agencies, Professional Organizations
With the logistical arrangements of the DOH and ILO, the Philippines convened briefing
meetings for the different stakeholders to discuss the WHO Code, to orient them on the
completion of the WHO National Reporting Instrument and Philippine worksheet, and obtain
their commitment to participate in the monitoring process.

The process continued with the collection of completed worksheets from the stakeholders and the consolidation, by the consultant, of responses per stakeholder group.

The 1 st Multistakeholders Participatory Assessment Workshop was convened on 17 May 2012. Each group of stakeholder gathered to discuss and clarify the consolidated data in separate and parallel sessions. The plenary session that followed allowed cross-sectoral clarification of responses.

A 2 nd Multistakeholders Participatory Assessment Workshop conducted on 30 May 2012 focused on the draft country report presenting the Philippine situation and the stakeholder perspectivesper item in the Code.

The monitoring experience proved to be worthwhile in eliciting the issues and concerns of the Philippines with respect to the status of implementation of the Code in the country. The Philippine approach optimized the use of the WHO instrument as stimulus for cross-sectoral and multi-sectoral discussion on issues relevant to the Philippine’s implementation of the Code.

The WHO National Reporting Instrument could be improved to appropriately reflect conditions in both source and destination countries of migrant health personnel. On the other hand, the data and discussions surfaced some challenges for the Philippines to better implement the provisions contained in the Code.

MULTISTAKEHOLDER PERSPECTIVES ON MONITORING THE CODE

The five groups of stakeholders (government, hospitals; professional associations; recruitment agencies; and trade unions) used a mix of methods, particularly key informant interviews, document review (policy instruments cited), and observation through their various engagements.

This section presents the responses of the stakeholders and emerging general patterns with regards to the implementation of the WHO Code in the Philippines. The information is organized in such a manner that it follows the series of questions included in the WHO National Reporting instrument.

  • 1. Legal rights and responsibilities of equally qualified and experienced migrant health personnel and domestically trained health workforce in terms of employment and conditions of work.

In responding to the WHO reporting instrument, the Philippines defined the migrant health personnel as one who has last held employment in a foreign country or whose qualification for employment was obtained in a foreign country. The Philippines is considered as a source country of migrant health personnel. It is not considered yet as a destination country for migrant health personnel. Hence, the matter of “equality in the legal rights and responsibilities of qualified and experienced migrant health personnel and domestically trained health workforce in terms of employment conditions of work”, is not applicable to the current Philippine situation.

The government agencies among the members of HRH Network Philippines clarified the Philippine situation regarding the legal rights and responsibilities of equally qualified and experienced migrant health personnel vis-a-vis Filipino health professionals in the Philippines. Though the Philippines is signatory to the ASEAN Mutual Recognition Arrangements (MRArs) on Medical Practitioners (2009), on Dental Practitioners (2009), and on Nursing Services (2006), such regional arrangements have not been implemented to allow the entry into the Philippines of foreign migrant health workers.

The 1987 Philippine Constitution provides for the “sustained development of a reservoir of

national talents

...

”,

whose practice in the Philippines has been limited to Filipino citizens in

22 health professions and sub professions, including medicine, allied professions, medical technology, midwifery, nursing, nutrition and dietetics, optometry, pharmacy, physical and occupational therapy, radiologic and x-ray technology, and veterinary medicine (1987 Philippine Constitution Article XII Sections 10 and 14; Executive Order No. 584).

The access of foreign workers to the labour market is covered by the Labor Code as amended (Article 40 referring to the employment permit ofnon-resident aliens). 2 The health migrant’s right to be a member of labor organizations varies among countries; some allow membership as in the case of the United States as a receiving country, in some cases

2 Article 40 of the Labor Code Employment permit of non-resident aliens.

membership is restricted such as in the Philippines (RA 6715 Labor Code as Amended Article 269). 3

There are observable contradictions in Philippine laws and policies pertinent to allowing foreign health professionals to practice in the country. Given the DOH definition of a health worker, there are yet no foreign health professionals practicing in the country. Currently, the Philippines is not a destination for foreign health professionals, though it is a source country for health professionals.

The participating hospitals noted the involvement of foreign health workers as residents/trainees in hospitals;however, such medical residency does not make them health workers, in the context of the DOH definition of a health worker.

The health professional associations observed the presence of foreign health professionals in the Philippines, but only in the context of taking up medical residency,engaging in medical missions, and generally for training, research, and academic engagement, for a temporary duration, compliant with national policy restrictions. However, there are provisions in the Professional Regulation Commission (PRC) Modernization Act, and other specific laws on the professions that need review and implementation given the WHO Code implementation. For intance, by virtue of Registration by Reciprocity, “foreign educated physical therapists allowed to practice in the country are covered by the same law as locally educated professionals given that requirements for reciprocity are complied with (RA 5680 Section 21 Registration by Reciprocity). In the Nursing Act of 2002, foreigners can work in the Philippines given an agreement of reciprocity with the sending state.Currently, there are no foreign health professionals in the Philippines, given the DOH definition of a migrant health personnel.

In the perspective of recruitment agencies, this particular question in the WHO reporting instrument does not apply to the Philippines as it is considered to be a sending country. Based on their experience, destination/receiving countries vary in policies and practices; but in the case of the United States of America, Filipinos and other foreign migrants may find protection in US labor laws.

The trade unions’ group cited the Philippine legislation, Republic Act(RA) 8042 amended by RA 10022 (Migrant Workers Act)Section 2 (a) (b), for the Philippineto protect the dignity of Filipino migrant workers, afford full protection to labor, local and overseas. With regard toforeign health professionals present in the Philippines under the status of trainees, there are observations that somereceive even better treatment than their Filipino counterparts.

  • 2. Legal mechanisms to ensure that migrant health personnel enjoy the same legal rights and responsibilities as the domestically trained health workforce

From the perspective of the HRH Network Philippines, certain Philippine government agencies, such as the Philippine Overseas Employment Administration (POEA), the DOLE-

3 Article 269 of the Labor Code Prohibition against aliens;

Philippine Overseas Labor Offices (POLOs), the Overseas Workers Welfare Administration (OWWA), and the PRC, respectively oversee procedures for Filipino migrant health workers and hiring/recruitment agencies, such as in securing appropriate employment permit, visa, and special permit to practice profession. Other mechanismsare bilateral agreements with specific stipulations with regard to migrant health professionals, such as the Philippine-Japan Economic PartnershipAgreement (PJEPA), ASEAN-Australia-New Zealand Free Trade Agreement (AANZFTA), and the Recruitment Agreement between the Government of the Philippines-United Kingdom of Great Britain and Northern Ireland. However, despite government agreements on initial requirements necessary to practice in a given country, there have been instances when Filipino migrant health professionals have had to comply with additional requirements that are not necessarily initially stipulated in their contracts.

In Philippine hospitals, there are foreign health professionals that come to the Philippines to be residents, trainees, administrators, or researchers, teachers or practioners in the context of medical missions.These foreign health professionals are compliant with the rules of the PRC, the Civil Service Commission (CSC), and the Bureau of Immigration (BI).

Other legal mechanism mentioned by the health professional associations emphasized the provisions ofvarious Memorandum of Agreement (MoA) and the regulations of the DOH and PRC that serve asguides for the conduct of medical missions in the country by foreign health professionals. In their view, since the Code’s provisions have yet to befully implemented in the Philippines,mechanisms needed to be in place cannot still be appreciated.

Considering the Philippines as a sending country of health professionals, this WHO monitoring item is not applicable according to recruitment agencies. However, considering varying national situations, recruiters referred to labor laws in receiving countries as legal mechanisms that promote the protection of Filipino migrants, such as in the United States of America. The POEA provides legal mechanisms and attempt to adopt prevailing wage rates in receiving countries to ensure protection of Filipino migrant workers.

Trade unions represented in the workshop cited RA 8042 as amended by RA 10022(Section 4), “whereby the State shall deploy OFWs (Overseas Filipino Workers) only in countries where the rights of Filipno migrant workers are protected.Most Filipino health personnel migrate due to limited options for local employment. Their local education and training are not directly accredited in receiving countries in order to qualify for work abroad. Filipino migrant health workers are reportedly discriminated because they do not receive the same remuneration (as nationals of other countries) and encounter difficulty in getting promoted in the receiving country. For instance, Filipino pharmacists need to have a post-graduate degree to be hired as pharmacists in the Middle East; otherwise, they are hired as pharmacy assistants. Trade unions raised the need to strengthen the monitoring of Pre-Departure Orientation Seminars (PDOS) by the OWWA, and Pre-Employment Orientation Seminars (PEOS) by the POEA, aimed at helping workers understand their rights and privileges in receiving countries.

  • 3. Evidence of legal mechanisms

Identified by the government agencies in the HRH Network Philippines, the legal mechanisms on employment and conditions for local health workers that are relevant to foreign migrant health workers are the following: (1) PRC regulations; (2) Labor Code - Book 3 (Conditions of Employment in the Philippines);(3) DOLE Department Order No. 97-09 (Revised Rules for the Issuance of Employment Permits to Foreign Nationals; the implementing guideline for Article 40 of the Labor Code on the issuance of employment permits;and, (4) DOLE Department Order No. 120-12 (Amending Certain Provisions of Department Order No. 97-09 Entitled Revised Rules for the Issuance of Employment Permits to Foreign Nationals).

As legal mechanisms, the hospitals are guided by the Civil Services Commission (CSC), the practice laws specific to the health professions, the PRC regulations, and the Bureau of Immigation (BI) requirements.

Referring to Philippine legal mechanisms, the recruitment agencies cited the Migrant Workers Act (RA 8042 as amended by RA10022) implemented by POEA. And taking the view of the USA as the receiving country of Filipino migrant health workers, the recruitment agencies noted the following national laws: USA Immigration and Nationality Act of 1952 (Sections 101(a)(15)(H)(i)(b) and (b1); 212(n) and (t), and 214(g), as amended (8 USC §1101(a)(15)(H)(i)(b) and (b1), 1182(n) and (t), 1184(g); 20 CFR Part 655 Subparts H and I); also, the William Wilberforces Trafficking Victims Protection.

According to the trade unions, legal mechanisms are embodied in the Migrant Workers Act (RA 8042 as amended by RA 10022), in the PJEPA bilateral agreement and ASEAN MRArs and other similar government’s agreements. Despite legal mechanisms, procedures have not always been properly followed as shown in certain cases. The trade unions group emphasized the need for the WHO National ReportingInstrument to differentiate the question on legal mechanisms for sending and receiving countries.

  • 4. Bilateral, regional, multilateral agreements or arrangements regarding the international recruitment of health personnel

Philippine bilateral, regional, and multilateral agreements and arrangements relevant to the international recruitment of health personnel, identified by the government agencies in the HRH Network Philippines, include the following: (1) ASEAN MRArs respectively for Dentistry, Medicine, and Nursing services;(2) Recruitment Agreement between the Government of the Philippines-United Kingdom of Great Britain and Northern Ireland; (3) PJEPA; (4) AANZFTA;and, (4) Medical Association of Southeast Asian Nations (MASEAN). Compliance by countries cannot determined due to the lack of a monitoring system.

In hospitals, there are few twinning arrangements and exchange of trainees between the Philippines and a foreign institution, usually in the form of Memoranda of Agreement.

Professional associations mentioned the ASEAN MRArs and the PJEPA as evidence of existing legal mechanisms in the country

For recruitment agencies, the POEA and the Department of Foreign Affairs (DFA)were seen as the appropriate agencies that can provide the detailed information on the bilateral

agreements. On their part, they stand to support the government and to ensure proper implementation of existing laws as these apply to migrant workers. Recruitment agencies

see the government’s role in initiating and properly implementing bilateral agreements.

Aside from the PJEPA and the ASEAN MRAs, trade unions identified other Philippine bilateral (national or subnationals) arrangements with, for example,British Columbia (in Canada), United Arab Emirate, Bahrain; Iraq, Japan, Marianas Island, Indonesia, and Trinidad and Tobago.

In destination countries where there are no specific bilateral or multilateral mechanisms for

protection of migrant health workers, the Philippines may look at the country’s labor laws

and other relevant social and economic laws and policies. When at the destination country, the DFA and the DOLE’s Philippines Overseas Labor Office (POLO) are the relevant authorities for Filipino migrant workers. DOLE’s POLO are mandated to check if Filipino workers abroad are protected. The POEA and DOLE are mandated to take charge ofmigrant

workers’ protection in collaboration with the DFA.

5.

Descriptions

of

bilateral,

regional

or

multilateral

agreements

or

arrangements

The HRH Network Philippines identified the POEA and DFA as the appropriate agencies to provide supplementary answers to this monitoring item. In the case of PJEPA, the MOU sets the procedures for recruitment and deployment of Filipino nurses and careworkers to Japan. Under the agreement, Japan health facilities hire Filipino registered nurses with three (3) years work experience to undergo language training. For careworkers, entry requirement is a four-year course and Caregiving NC-II or the nursing course for certified caregivers. After passing the licensure exam, they can work as nurses and careworkers in Japan. Candidates who do not pass the Japan licensure exams can be employed in Japanese retirement villages in the Philippines to be able to use their exposure to the Japanese language and culture. With respect to Australia and New Zealand, these countries have committed to hire Filipino registered nurses that have undertaken the two-month bridging program. Given the experiences with these bilateral agreements, the government agencies stakeholder group emphasized the need to set standards and include ethical recruitment in future agreements.Aside from the PJEPA and the ASEAN MRArs, the professional associations identified the Philippine agreements with Canadaas regards to the hiring of nurses.

Trade unions described PJEPA as national in scope pertinent to Filipino nurses and noted that this was signed in light of RA 8042, as amended by RA 10022, for protection of Filipino migrant workers. The trade unions raised their concern for the application of the General Agreement on Trade and Services Mode 4 provisions in bilateral and multilateral agreements and for laws in destination countries relevant to migrant workers, not merely an agreement. They suggested that the WHO monitoring instrument include, in the future, other elements to track implementation of the bilateral and multilateral agreements/arrangements such as the following: training, working conditions, grievance mechanism, skill recognition, and responsibilities of recruitment agencies. They raised the importance of the agreement/arrangement being written in the language that workers can understand and that can be monitored.

Websites are available as sources of information on the Philippine bilateral and multilateral agreements and arrangements.

  • 6. Research in health personnel migration

In general, research on the subject of health personnel migration has been conducted by various Philippine organizations.

Government agencies referred to the conduct of research in the following organizations:

HRH Network Philippines and member organizations, particularly the DOH, the National Institutes of Health (NIH), the DOLE-Institute Labor Studies (ILS), and the Public Services Labor Independent Confederation (PSLINK).

The hospitals mentioned the DOH and DOLE, ILO and WHO as the institutions with research on health personnel related to migration. On their part, they collect data, receive reports from alumni networks, and conduct interviews that may have some relevance to health

professionals’ migration.

The professional associations’ group cited the National Institutes of Health-Institute of Health Policy and Development Studies (NIH-IHPDS). The Philippine Association of Medical Technologists (PAMET) expressed its intention to prepare a research proposal on health migration.

Recruitment agencies referred to researches done in the Philippines by the DOH, DOLE, POEA and PSLINK and in receiving countries, by the US Department of Labor and US professional organizations.They have observed that, research has been limited to the academe (for example Asian Institute of Management), while others, such as recruiters, have not been invited to participate in research endeavors.

Citing RA 8042, as amended by RA 10022(Sec. 10 and Section 17), trade unions acknowledged DOLE’s creation of a re-placement and monitoring center for returning Filipino migrant workers, named the National Reintegration Center for Overseas Filipino Workers (NRCO). This office implements mechanisms for re-integration of returning Filipino migrants into Philippine society, serving as promotion house for local employment. For research on health professionals’ migration, they identified the following organizations:

PSLINK, UP Manila, DOH-ILS, POEA,and the HRH Network Philippines.

  • 7. Contact details of research programs or institutions

The DOH is identified as the appropriate agency for information on research programs and institutions, specificially the DOH-HHRDB and the HRH Network Philippines of which the DOH-HHRDB is the Secretariat. Contact information are available for the NIH, Asian Institute of Management (AIM), other entities, even individuals that do research on health personnel migration.

8.

Action to implement the Code

The DOH is the identified national authority to respond to how the Codehas been implemented in the Philippines. Relevant to implementation are the Philippine international legal instruments, namely: the ASEAN MRAs, PJEPA and MASEAN.In the view of government agencies in the HRH Network Philippines, Philippine laws and policies tend to be conflictingwith the provisions of the WHO Code.

Hospitals considered some of their practices as aligned with the provisions of theCode. Private hospitals follow and harmonize the DOH and DOLE requirements in the operation of hospitals, while public hospitals follow those of the CSC.

Professional associations attributed their awareness of the Code to this current DOH- and- ILO initiativeto monitor theCode through multistakeholders consultations.Prior to this, they had limited awareness of the Code.

The implementation of POEA regulations and the Migrant Workers Act are relevant to the implementation of theCode, according to the recruitment agencies group. They considered theDOH-and-ILO initiated multistakeholder process as a step to monitor the Philippine implementation of theCode.

Among the trade unions’s, there is very limited awareness of the of the Code. They have not observed the Code being discussed in universities, in technical vocational schools, neither is the Code referred to in the PDOS and PEOS, undertaken respectively by the OWWA and POEA.

  • 9. Steps taken to implement the Code

In general, the stakeholders observed the WHO Code’s implementation in the Philippines in terms of the steps below listed in the WHO monitoring instrument:

  • (9.a) Actions have been taken to communicate and share information across stakeholders on health worker recruitment and migration issues, as well as the Code, among relevant ministries, departments and agencies, nationally and sub- nationally

  • (9.b) Measures have been taken to involve all stakeholders in any decision making processes involving health personnel migration and international recruitment.

  • (9.c) Actions are being considered to introduce changes to laws or policies on the international recruitment of health personnel.

Not all bilateral agreements containprovisions on HRH. Among HRH Network Philippines members, the DOH is deemed the appropriate agency to respond to how the Code has been implemented, while other government agencies have authority with regard tothe international recruitment of health personnel.

Hospitals have practices relevant to the implementation of the Code covering items 9a to 9c in the monitoring instrument, which are compliant with the PRC and CSC requirements. In the case of the Philippine Heart Center (PHC), a specialty government hospital, has interacted with recruitment agencies to develop exchange arrangements for their nurses’

training abroad.The PHC also has nursing alumni all over the world and informal networking through online communication, and visits of foreign health professionals that can be harnessed for the purposes of the Code, such as information dissemination and data collection.

Among professional associations, the Philippine Nurses Association, Inc. (PNA) is engaged in collaboration with the POEA in the conduct of the PEOS, and has monitored the PJEPA’s implementation. Such actions are relevant to the implementation of theCode.

For the recruitment agencies’ group, the implementation of the Codemay be considered in terms of: (1) the implementation of the Migrant Workers Act (RA 8042 as amended by RA 10022); (2) the processing for pre-screening and job offer; and, (3) the conduct of the PEOS and PDOS. Further, one agency shared its “no-placement fee policy.” They also referred to POEA’s role as a step toward the implementation of the Code because it regulates recruitment agencies, ensures compliance with Philippine labor laws, and ensures protection of Filipino overseas workers through fair working conditions in employment contracts. Recruitment agencies also averred that they do not have a forum to make recruiters understand the Code. On the other hand, the POEA called attention to their Continuing Agency Education Program to advocate ethical recruitment to licensed recruitment agencies, as well as, the PEOS conducted by POEA and PDOS conducted by OWWA, as potential platforms for knowledge dissemination on the Code. The recruitment agencies suggested that they, the POEA, and DOLE, be engaged in collaboration and discussion on the Code’s implementation in the following years. Establishment of an on-line feedback mechanism to track how Filipino migrant health professionals are treated in destination countries was strongly recommended.

The trade unions confirmed the observations that items 9a to 9c in the WHO National ReportingInstrument are operational in the Philippines.

In addition, recruitment agencies are engaged in records keeping and promotion of good practices, which are items 9d and 9e in the monitoring instrument, respectively. The recruiters group suggested the following interventions: (1) awareness raising among migrant health workers, recruitment agencies, academe, professional organizations, through multi media, the You Tube, comics, with the use of local language and in the perspective of the migrant workers; (2) a global meeting among the biggest sending countries (Philippines, India, China); (3) Commission on Higher Education (CHED)to include theCode into the curriculum of the health professions, and the PRC to include the same into the licensure examinations; and, (4) CSC to incorporate the Code provisions into the system of performance appraisal of public sector health professionals. Awareness of the Code has not cascaded from DOH and the HRH Network Philippines to other government agencies and stakeholders.

10.

Main constraints to the implementation of the Code in the country and proposed possible solutions

Main constraints to the Code’s implementation, in the view of the HRH Network Philippines, derive from the limitations posed by provisions of the 1987 Philippine Constitution and other laws.

For hospitals, constraints emanate from the devolution of authority in the delivery of health services from DOH to the local government units, the hospital budget and the lack of agreements among institutions regarding HRH.

The professional associations listed the lack of information on the Code as a constraint. The monitoring instrument itself poses a constraint in that many questions in the National Reporting Instrument do not apply to the situation in source countries, like the Philippines.

Promotion of ethical recruitment was seen to be a challenge. To promote ethical recruitment among recruitment agencies, an incentive scheme such as an award system was recommended. Instead of sanctions, recruitment agencies suggested the institution of an award system for good practice on the Code , differentiating it from the current award system that recognizes the number rather than the quality of processed transactions for foreign recruitment.The proposed alternative award should focus on quality rather than quantity in the recruitment agencies’ performance.

Main contraints cited by the trade unions are: (1) unemployment forcing local health personnel to migrate, indicating the need for industry policies and programs; (2) lack of awareness on the Code, among the migrant health workers, trade unions, and recruiters,which may be appropriately addressed by communication and information drives; (3) lack of dialogue on the WHO Code between receiving countries and migrant health personnel; (4) policy gaps on the part of government; and, (5) sanctions that can penalize the recruiter and employer.

  • 11. Database of laws and regulations related to international health personnel recruitment and migration and information related to their implementation

According to HRH Network Philippines’ member-government agencies, the POEA and the DFA maintain a data base of laws and regulations related to international health personnel recruitment and migration (www.poea.gov.ph-Labor Agreements Section; www.dfa.gov.ph). Other stakeholders are not informed of the existence of any such data bases on migration- related laws. The recruiters’ and trade unions’ groups suggested that planning be done to include the setting up of databases.

  • 12. Technical cooperation agreement and financial assistance related to international health personnel recruitment or the management of and migration

In the case of the PJEPA, there are government agencies in charge of giving technical assistance, such as the DOH, DOLE, and PRC.

In hospitals, there are no technical and financial assistance on matters of international health personnel recruitment and migration mangement.

Recruitment Agencies cannot respond to this monitoring item.

Trade unions questionned the meaning of “financial assistance and technical cooperation”. It is not clear whether this monitoring item refers to government-to-government relations, or to government with international fund organizations like ILO’s DWAB and the Asian Development Bank.

  • 13. Statistical records of health personnel whose first qualification was obtained overseas

Among government agencies, the POEA maintains a database of board passers for the purposes of the PJEPA, while the PRC maintains a list of foreign health professionals that requested permission for limited local practice. Maintaining statistical records is tedious and difficult,though an important task for government agencies.

Hospitals were not aware as to where such statistical records could be obtained and they do not also operate such mechanisms. They do not track migrant health professionals who obtained their license from other countries, though in certain cases of visiting foreign health professionals, they conduct exit interviews.

Recruitment agencies cannot respond to this monitoring item and trade unions stated that they do not have any such database.

  • 14. Mechanism(s) or entity(ies) that regulate or grant authorization for practice of internationally recruited health personnel and that maintain statistical records

Among government agencies, the PRC’s International Affairs Division and POEAhave mechanisms that regulate and grant authority for internationally recruited health personnel to practice or work in the Philippines. However, the government agencies in the HRH Network Philippines are not aware of entities that maintain statistical data in the countryon health professionals who first obtained their license to practice overseas.

The hospitals in this stakeholder group are not aware of such mechanisms. Professional organizations, recruitment agencies, and trade unions identified the PRC as possibly the government agency with data on the registration of foreign health professionals.

The stakeholders identified the POEA and the BI, but are unclear on these agencies’ roles

with respect to alien records data base.

Over all, stakeholders agreed that this monitoring item no. 14 wasnot applicable to the Philippines, which is considered a source rather than a destination country for internationally recruited health personnel.

15.

Complementary comments or materials on the international recruitment and management of migration of the health workforce related to the implementation of the Code.

The HRH Network Philippines emphasized theCode’sbias toward destination countries indicating the importance to develop the instrument pertinent to source countries. Stakeholders responses point to the need for strengtheing the monitoring of the Code, to link policy and practice, and to build the information database system.

For hospitals, the references for international recruitment and migration management of the health workforce are the Migrant Workers Act (RA 8042 as amended by RA 10022), the Magna Carta of Public Health Workers (RA 7305), the Labor Code of the Philippines, and the Code of Ethics of each Health Profession.

Recruitment Agencies commented that theCodehas the right intentions and meaning, but is lacking in relevance and islimited by the “voluntary” adoption and implementation of member countries. As suggested, the Codeshould be disseminated not only to government institutions, but to all stakeholders, including recruitment companies and migrant health

workers

in

all

countries.

The

feedback

mechanism

should

be

made

available

(even

throughweb) for all stakeholders to determine who are practicing the Code andwho are in

need

of

information.

SUPPLEMENTAL INFORMATION

At the on-set of this process, the technical and organizing comimitee mapped the questions in the National Reporting Instruments side by side with the provisions of theCode and concluded that some important provisions of theCode were not included in the National Reporting Instrument.As a result, additional questions were addedto the Philippine worksheet by the committee, which allowedthe stakeholders to possibly assess the entirety of the Code’s implementation. So as to not confuse those additional questions with those in the National Reporting Instrument, letters were used by the organizing committee to address these new items.

  • a) Philippine participation in international discussions and advanced cooperation on matters related to ethical international recruitment

Some HRH Network members reported the Philippine government’s participation in the recent international discussions on ethical international recruitment, among other such fora included:

  • 1. 6 th Asia-Pacific Action Alliance on HRH in 2011

  • 2. 10 th ASEAN Joint Coordinating Committee on Nursing (AJCCN) in 2011

  • 3. 6 th ASEAN Joint Coordinating Committee on Medical Practitioners (AJCCM) in 2011

This DOH-and-ILO multistakeholder initiative, with their partners,constitutesthe first time for the hospital to participate in such discussion on WHO Code and on ethical recruitment of health personnel.

Some of the professional associations have participated in international discussions concerning theASEAN MRArs and the PJEPA.

Some trade unions are aware of Philippinesparticipation in international fora, while some have themselves participated in international discussions on ethical international recruitment, migration and development.

  • b) Mechanisms for internationally recruited health workers to report non- conformity to policies on ethical recruitment and labour standards?

The Philippines is not a destination country for internationally recruited health workers. For Filipino migrants abroad, the Philippines has embassies and labor offices in destination countries to receive reports on non-conformity to policies, ethical recruitment, and labour standards.

  • c) Perception of circular migration

Professional associations mentioned the Balik Turo (return teaching)project for Filipino Nurses 4 , for those who have been abroad to share their knowledge to local nurses. Circular migration is done by way of scholarships for training and education from the receiving country to the sending country. There are migrant health professionals who opt to stay in

their adoptive country, while others move from one country to another using one foreign employment as “jump-off” to another target country. The professional associations acknowledged their limited knowledge about circular migration.

From the hospital group’s perspective, circular migration is the transfer of technology of a migrant health worker from the destination country to the source country. The PHC experience provides an example of Filipino nurses sharing their learning from abroad upon return to the Philippine hospital.

Recruitment agencies suggested that circular migration be facilitated and encouraged for the benefit of stakeholders, in both source and destination countries, and to highlight the importance of reintegration to sending countries. Circular migration addresses brain drain and promotes transfer of technology from receiving to sending countries. For society to benefit from circular migration, remittances need to be plowed back to investments in health in the Philippines to provide re-integration options and to facilitate technology and knowledge transfers. In this context, circular migration becomes an economic and a political issue. Currently, they are not aware of re-integration policies for health personnel. This is also a personal concern because individuals can opt to become citizens of destination countries rather than be a worker with a contract or working visa.

For trade unions, there existno single and agreed upon definition of circular migration. In general, circular migration is similar to temporary migration, which undermines workers’ rights in so many ways and negatively impact on the delivery of health services.

  • d) Philippines’ promotion of ethical recruitment

To promote ethical recruitment, the HRH Network Philippines and recruitment agencies suggested the inclusion of provision on ethical recruitment in bilateral and multilateral agreements. Hospitals use the Contract of Service as a stop-gap measure pending available permanent positions;government hospitals follow CSC guidelines and private hospitals follow the Labor Code provisions. The PNA conducts information dissemination through websites and chapters throughout the country. Recruitment agencies and trade unions cited the amended Migrant Workers Act as a means for promotingethical recruitment.

Compliance with ethical recruitment should be national in scope, with a national policy to regulate recruiters and foreign employers.

  • e) Strategy to retain, sustain and distribute health workers in the country

The HRH Network Philippines reported several programs such as the DOH’s Doctors to the Barrios and Registered Nurses for Health Enhancement and Local Services, and DOLE’s former program, Project: Nurse Assigned in Rural Service. There are DOH Community Health Teams in the country. The Philippines has a six-year plan up to 2016 to carry out the Migrant Workers Act (RA 8042 as amended by RA10022).

Some hospitals have residency programs in remote areas, after which the health professionals return to their hometowns. There are retention schemes in hospitals for the health professionals.

Trade unions emphasized the need for more jobs for Filipinos in the Philippine,with fair compensation, better working conditions, and implemenetation of the Migrant Workers Act (RA 8042 as amended by RA10022).

f) Measures undertaken to strengthen educational institutions to scale up training of health personnel and developing innovative curricula to address current needs

Stakeholders generally observed the WHO Codeto be biased in favour ofreceiving countries, while the Philippines is currently a source countryof health professionals. The stakeholders have taken the perspective of the Philippines as a source country in responding to the monitoring of measures for strengthening educational institutions for the health professions.

  • CHED has policies on moratorium for nursing programs, for schools to become Centers of Excellence, and financial assistance programs.

  • Technical Education and Skills Development Authority (TESDA) offers caregiver courses.

  • The University of the Philippines Manila, a state funded university, has initiated the return service of graduates in the health professions, for them to initially serve the country.

  • The Commission on Filipinos Overseas (CFO), in cooperation with the DOH Bureau of International Health Development (DOH-BIHC), runs an exchange visitors program for foreign health professionals to come to the Philippines and for Filipino medical doctors (under J1 Visa) to enhance their skills overseas.

Hospitals have their own specialization programs and certification of competencies. However, there is no mechanism for national certification to recognize competencies.

The professional associations suggested the review of the curriculum for K-12.K-12 is the newly implmented program of the Department of Education where basic education is extended by two years to enhance the basic education curriculum. Such program was designed to ascertain that Filipino graduates of teriatry educationwill be more capable of competing with their global counterparts as they will now have received the same internationally-accepted number of years of basic education.

Recruitment agencies cited the limitations of the Code, the need for dissemination and feedback. Since the US is a prefered destination of health professional graduates, the CHED, PRC, TESDA, and universitites should take appropriate measures.

Trade unions observed the requirement forpassing average in board examinations. If the schoolsare unable toproduce successful examinees for five consecutive years, they will no longer be allowed to offer such course. The trade unions also pointed out the need to strengthen research, and to link the labor market with the academe

DOLE’s labor market study shows doctors are needed in the Philippines, which has

implications on the Philippines accepting doctors from other countries.

CONCLUSION

The present report constitutes the Philippinesadditional contribution to the monitoring of the WHO Global Code of Practice on the International Recruitment of Health Personnel. The Department of Health (DOH) of the Philippines, being the designated national authority to oversee the implementation of the Code, accepted in March 2012 the proposal of the International Labour Organization to set up a participatory assessment process to collect data, instead of having DOH single-handedly collecting data, to include in the WHO National Reporting Instrument. Under the organizing leadership of the DOH, DOLE, the ILO and WHO fed a process which through various preliminary meetings and two multistakeholder assessment meetings yielded the information that became the basis for the on-line Philippines National Reporting Instrument (submitted on 31 May 2012) and this supplementary, more thorough report.

Five stakeholders group were identified as relevant to the exercise: government, trade union

and employers’ organizations, recruitment agencies and professional organizations.

As a way to conclude this report, below are some of the main points that were extracted from the meetings with stakeholders and that the organizing committee would like to

submit to the WHO’s attention.

  • 1. The monitoring instrument should be differentiated for sending and receiving countries, respectively. The questions need to be applicable to respondents from sending and receiving countries.

  • 2. The WHO monitoring instrument can include other elements to track implementation of the bilateral and multilateral agreements/arrangements such as the following: training, working conditions, grievance mechanism, skill recognition, and responsibilities of recruitment agencies. They raised the importance of the agreement/arrangement beingwritten in the language that workers can understand and that can be monitored.There is still a need to set up a database of Philippine laws and policies relevant to the WHO Code

  • 3. Ensuring the circulation of information about the Code should be a priority. The Code should be disseminated not only to government institutions but to by all stakeholders, including recruitment agencies and migrant health workers in all countries through multi media, the You Tube, comics, with the use of local language and in the perspective of the migrant workers.

  • 4. A feedback mechanism should be made available (even by web) for all stakeholders to determine who are practicing the Code andwho are in need of information. A formal feedback mechanism is also suggested to obtain information from the health professionals who undergo the recruitment process. For CHED to include the Code into the curriculum of the health professions and the PRC to include this into the licensure examinations

  • 5. In terms of collaboration for effective monitoring, there should be a stronger tandem between countries’ departments of health and labor to ensure the implementation of The Code. An example of collaboration may be done through information dissemination using DOH, DOLE and other relevant government

websites and the inclusion of information about the Code in the seminars for Filipino migrant workers and recruitment agencies.

  • 6. Stakeholder/sector planning relevant to the WHO Code can help in taking action and ensuring progress of stakeholders or sectors in the next round of monitoring. An advisory or oversight group may be created and a sector-specific plan of action be prepared relevant to the implementation of the Code.

  • 7. Translation of the Code as an international framework to policies and programs at the national levelis necessary to ensure that ethical recruitment is adhered to by recruiters and to institutionalize effective mechanisms for negotiations with foreign employers.

  • 8. For the Philippines as a source country, the involvement of foreign health workers in hospitals is mainly as trainees (e.g., residency/fellowship) and not as workers. There are experiences on twinning arrangements between Philippine hospitals and foreign hospitals for training/exchange of trainees.

  • 9. Hospitals have no data to track migration of health personnel. Data primarily comes

from alumni reports, exit interviews, and data on the percentages of those who resigned or went on-leave. Hospitals are still bound by national laws and by regulations of the PRC, CSC, POEA, and BI, which are found to be consistent with the provisions of the Codeon the International Recruitment of Health Personnel. 10. Given that health professionals have common concerns including migration, an omnibus law is recommended to cover the principles underlying the practice of the different professions, without encroaching on the respective practice of the

professions.

The participatory assessment process set in motion by the organizers (DOH, DOLE, ILO and WHO) proved not only to be an efficient way to collect data for the National Reporting Instrument and additional report, but it is also a tool to raise awareness of the Code and the importance of ethical recruitment of health personnel. Through the various meetings organized between March and May 2012, a momentum was generated among stakeholders, which Philippine government agencies and the ILO Decent Work Across Borders project, tapping into the dynamism of the DOH and DOLE will now strive to sustain in the view of continuously improving the systems ensuring that the rights to movement of migrants, the rights to health and the right to decent work for all.

The success of the process undertaken by the Philippines will be documented and turned in an easy to use guide (good practice sheet) that the authorities would be glad to present and share to the WHO and ILO and their member countries.

ANNEX A: PROPOSED QUESTIONS FOR SOURCE COUNTRIES

The Philippine worksheet developed by the DOH, DOLE, ILO and WHO, which was completed by the many stakeholders allowed them to contribute amendment and improvement to the WHO National Reporting Instruments. The following are some of the questions formulated by DOH that WHO may take into consideration when developing an updated reporting instrument that would better reflect the perspective of source countries:

  • 1. Do health personnel that migrate from your country to work in destination countries enjoy the same legal rights and responsibilities as domestically trained health workforce in terms of employment and conditions of work?

  • 2. What legal mechanisms are in place to ensure that health personnel that migrate to destination countries enjoy the same legal rights and responsibilities as the domestically trained health workforce?

  • 3. As a source country, are there mechanisms, processes and structures in place to engage in bilateral, regional or multilateral agreements addressing the international recruitment of health personnel?

  • 4. To describe those steps to implement the Code (add to the list)

    • a. Development of a long- or medium-term plan that includes health personnel migration and international recruitment

  • 5. Has your country participated in international discussions and advanced cooperation on matters related to ethical recruitment?

  • 6. How does your country promote ethical recruitment?

  • 7. Does your country have a strategy to retain, sustain and distribute health workers in the country?

  • 8. Has your country implemented measures or strategies to scale up training of health personnel and develop innovative curricula to address current needs?

  • 9. Measures undertaken to strengthen educational institutions to scale up training of health personnel

    • 10. Are there mechanisms by which migrant health personnel/agencies are able to report non-conformity to labor contracts/policy?

    • 11. Are there provisions of the Code that have not been recognized/implemented through international legal instruments?

    • 12. In your country, have health systems been strengthened or health workforce been sustained as a result of the implementation of the Code?

ANNEX B: THE PHILIPPINE WORKSHEET

THE WHO GLOBAL CODE OF PRACTICE ON THE INTERNATIONAL RECRUITMENT OF HEALTH PERSONNEL

Name:

Position:

Name of Organization:

Email:

Contact #s:

Date of Submission (mm/dd/yy):

/

/

Name of person attending the MAY 17, 2012 workshop:

 

Position:

Instructions: Please email the filled-in form to HRH.CodeofPractice@gmail.com and cc: xtinco@gmail.combefore MAY 17, 2012

 

(1)

 

(2)

(3)

(4)

National Reporting Instrument

 

Global Code of Practice on the International Recruitment of Health

Supplementary answers

Additional Questions

Kindly accomplish the instrument in this column by ticking the boxes

Personnel

Please provide any additional answers to support (1)

Please provide suggestions to improve questions/ comments in (1)

  • 1. In your country, do equally qualified and experienced

4.5

MS

should

ensure

that,

subject to

  • 1. 1.

 

migrant health personnel enjoy the same legal rights and responsibilities as the domestically trained health workforce in terms of employment and conditions of

applicable laws, including relevant international legal instrument to which they are party, migrant health personnel enjoy the

  • 2. 2.

work?

same legal rights and responsibilities as

  • 3. 3.

 
Yes the domestically trained health workforce

Yes

the domestically trained health workforce

No (if “No”; please proceed to Q(4))

in terms of employment an d conditions of

Not applicable because:

work.

 
  • 2. Which legal mechanisms are in place to ensure that

4.3

MS

and

other stakeholders should

  • 1. 1.

 

migrant health personnel enjoy the same legal rights

recognize that

ethical

international

and responsibilities as the domestically trained health

recruitment practices provide health

  • 2. 2.

workforce? Please tick all options that apply from the

personnel the

opportunity

toassess

the

list below:

benefits and risks associated with

  • 3. 3.

employment positions and to make timely

2.a Health personnel are recruited internationally and informed decisions.

2.a Health personnel are recruited internationally

and informed decisions.

     

using mechanisms that allow them to assess the benefits and risk associated with employment

4.4

Member States should, to the extent

positions and to make timely and informed decisions regarding them

possible, ensure that recruiters and employers observe fair and just and contractual

 

(1)

(2)

 

(3)

(4)

National Reporting Instrument

Global Code of Practice on the International Recruitment of Health

Supplementary answers

Additional Questions

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Personnel

Please provide any additional answers to support (1)

Please provide suggestions to improve questions/ comments in (1)

 

practices in the employment of migrant health personnel and that migrant health personnel are not subject to illegal or

   
  • 2.b Health personnel are hired, promoted and

fraudulent conduct. Migrant health

 

remunerated based on objective criteria such as levels of qualification, years of experience and degrees of professional responsibility on the same basis as the domestically trained health workforce

personnel should be hired, promoted and remunerated based on objective criteria such as levels of qualification, years of experience and degrees of professional responsibility on the basis of equality of treatment with the domestically trained

  • 2.c

Migrant health personnel enjoy the same

health workforce. Recruiters and employers

 

opportunities as the domestically trained health workforce to strengthen their professional education, qualifications and career progression

should provide migrant health personnel with relevant and accurate information about all health personnel positions that they are

  • 2.d Other mechanism, please provide details if

offered.

 

possible:

4.6 MS and other stakeholders should take measures to ensure that migrant health personnel enjoy opportunities and

incentives to strengthen their professional

appropriate induction and orientation

  • 3. Please provide evidence of legal mechanisms

education, qualifications and career progression on the basis of equal

1.

1.

identified in Q(2) either as attachments or links to online files.

treatment with domestically trained health workforce subject to applicable laws. All

2.

2.

migrant health personnel should be offered

programs that enable them to operate safely and effectively within the health system of the destination country.

3.

3.

  • 4. Has your country or its sub-national governments entered into bilateral, regional or multilateral

2.3 The code provides ethical principles applicable to the international recruitment of

1.

1.

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National Reporting Instrument

(1)

agreements or arrangements addressing the international recruitment of health personnel?

No (if “No”; please proceed to Q(6))

Yes

agreements or arrangements addressing the international recruitment of health personnel? No (if “No”; please proceed to
lateral national (choose all ion file if possible 2) Multi- that apply) possible 1) Bilateral 3)
lateral
national
(choose
all
ion
file
if
possible
2) Multi-
that apply)
possible
1) Bilateral
3) Regional
1) Doctors
2) Nurses
3) Midwives
4) Midwives/
nurses
5) Other
….e.g. (1)
.e.g. (1)
….e.g. (1)
Health
of
Countries
Coverage
Categories
Please
Please
Agreement
involved
1) National
of
Type
attach
a
provide
a
2) Sub-
Workforce
documentat
web-link
if
  • 5. Please use Table A below to describe these bilateral, regional or multilateral agreements or arrangements:

Table A Description of bilateral, multilateral, regional agreements or arrangements

Global Code of Practice on the International Recruitment of Health Personnel

(2)

heath personnel in a manner that strengthens the health systems of developing countries,

countries with economies in transition and

3.5 International recruitment of health

small islands.

personnel should be conducted in accordance with the principles of transparency, fairness and promotion of sustainability of health

Destination countries are encouraged to collaborate with source countries to sustain and promote health human resource development and training as appropriate. MS should discourage active recruitment of health personnel from developing countries facing critical shortages of health workers.

systems in developing countries. MS in conformity with national legislation and applicable international legal instruments to which they are part, should promote and respect fair labour practices for al health personnel. All aspects of the employment and treatment of migrant health personnel should be without unlawful distinction of any kind.

systems of both source an destination countries should derive benefits from the international migration of health personnel.

  • 5.1 In accordance with the guiding principle

  • 5.2 MS should use this Code as a guide when

as stated in Article 3 of this Code, the health

Supplementary answers

Please provide any additional answers to support (1)

(3)

2. 3.
2.
3.
2. 3. 1.
2.
3.
1.

Please provide suggestions to improve questions/ comments in (1)

Additional Questions

(4)

2. 3.
2.
3.
2. 3. 1.
2.
3.
1.

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(1) (2) (3) (4) National Reporting Instrument Kindly accomplish the instrument in this column by ticking
(1)
(2)
(3)
(4)
National Reporting Instrument
Kindly accomplish the instrument in this column by
ticking the boxes
Global Code of Practice on the
International Recruitment of Health
Personnel
Supplementary answers
Additional Questions
Please provide any
additional answers to
support (1)
Please provide suggestions
to improve questions/
comments in (1)
Add
as
necessary
entering into bilateral, and/or regional and
multilateral arrangements, to promote
international cooperation and coordination
on international recruitment of health
*please use this category only if the information
available has no clear separation in reported numbers
between the two cadres
personnel. Such arrangements should take
into account the needs of developing
countries and countries with economies in
transition through the adoption of appropriate
measures. Such measures may include the
provision of effective and appropriate technical
assistance, support for health personnel
retention, social and professional
recognition of health personnel, support for
training in source countries that is appropriate
for disease profile of such countries, twinning
of health facilities, support for capacity
building in the development of appropriate
regulatory frameworks, access to specialized
training, technology and skills transfers, and
the support of return migration whether
temporary or permanent
5.3 MS should recognize the value both to
their systems and to health personnel
themselves of professional exchanges
between countries and of opportunities to
work and train abroad. MS in both source
and destination countries should encourage
and support health personnel to utilize work
experience gained abroad for the benefit of
their home country
6.
Does your country have any (government and/ or
non-government) programs or institutions
6.1 MS should recognize that the formulation
1.
1.
of effective policies and plans on the health

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National Reporting Instrument

(1)

undertaking research in health personnel migration?

No (if “No”; please proceed to Q(8))

Yes

undertaking research in health personnel migration? No (if “No”; please proceed to Q(8)) Yes

Name of Program or

Name of

Contact

Web-link (if

Institution

contact person

Details

available)

7.1

     

7.2

     

Add as necessary

     
       
       
       
  • 7. Please use Table B below to provide the contact details for these research programs or institutions

Please include Research programs or institutions involved in assessing working conditions of Filipinos recruited abroad*

Table B Detailed information on research programs or institutions assessing health personnel migration

Global Code of Practice on the International Recruitment of Health Personnel

(2)

strengthen research programs in the field of

such research programs through partnerships at the national, subnational, regional and international levels.

health personnel migration and coordinate

workforce requires a sound evidence base.

6.3 MS are encouraged to establish

or

Global Code of Practice on the International Recruitment of Health Personnel (2) strengthen research programs in

Supplementary answers

Please provide any additional answers to support (1)

(3)

2. 3.
2.
3.
2. 3. 1.
2.
3.
1.

Please provide suggestions to improve questions/ comments in (1)

Additional Questions

(4)

2. 3.
2.
3.
2. 3. 1.
2.
3.
1.
 

(1)

 

(2)

 

(3)

(4)

National Reporting Instrument

 

Global Code of Practice on the International Recruitment of Health

 

Supplementary answers

Additional Questions

Kindly accomplish the instrument in this column by ticking the boxes

Personnel

Please provide any additional answers to support (1)

Please provide suggestions to improve questions/ comments in (1)

8.

Has your country taken any steps to implement the

1.1

Establish and promote voluntary

   

Code?

principles and practices for ethical

1.

1.

international recruitment of health personnel

 
Yes taking into account rights, obligations of 2. 2.

Yes

taking into account rights, obligations of

2.

2.

No (if “No”; please proceed to Q(10))

source countries, destination countries and

 

migrant health personnel

 

3.

3.

1.2

To

serve

as

reference

for

MS

in

establishing or improving the legal and

institutional framework required for the international recruitment of health personnel

1.3

Provide guidance that may be used where

appropriate in the formulation and implementation of bilateral agreements and other international legal instruments

2.1

The

Code is

voluntary. MS and other

stakeholders

are

encouraged

to

use

the

Code

 

2.2

The Code is global in scope and is

intended as a guide for MS working together with stakeholders such as health personnel, recruiters, employers, health professional organizations, relevant sub-regional, regional and global organizations, whether public or private including NGO and all persons concerned with international recruitment of health personnel

3.1

The health of all people is fundamental to

the attainment of peace and security and is

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(1)

(2)

 

(3)

(4)

National Reporting Instrument

Global Code of Practice on the International Recruitment of Health

Supplementary answers

Additional Questions

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Personnel

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Please provide suggestions to improve questions/ comments in (1)

 

dependent upon the fullest cooperation of

   

individuals and states…

3.2 Addressing present and expected shortages in the health workforce is crucial to

protecting global health… 3.4 MS should take into account the right to the highest attainable standard of health of the populations of source countries, individual rights of health personnel to leave any country in accordance with applicable laws, in order to mitigate the negative effects and maximize the positive effects of migration on the health systems of the source countries.

Nothing in the Code should be interpreted as limiting the freedom of health

personnel, in accordance with applicable laws, to migrate to countries that wish to admit and employ them.

3.6 MS should strive, to the extent possible, to create a sustainable health workforce and work towards establishing effective health workforce planning, education and training and retention strategies that will reduce their need to recruit migrant health

personnel…

9.

To describe those steps taken to implement the Code, please tick all items that apply from the list

4.1 Health personnel, health professional organizations, professional councils and recruiters should seek to cooperate fully

1.

1.

below the box can be ticked even if only some of the elements per step have been applied:

with regulators, national and local authorities in the interests of patients, health systems and of society in general.

2.

2.

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(1)

(2)

(3)

(4)

 

National Reporting Instrument

 

Global Code of Practice on the International Recruitment of Health

Supplementary answers

Additional Questions

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Personnel

Please provide any additional answers to support (1)

Please provide suggestions to improve questions/ comments in (1)

   

9.a Actions have been taken to communicate and

 

3.

3.

 

share information across sectors on health worker recruitment and migration issues, as well as the Code, among relevant ministries, departments and agencies, nationally and sub- nationally

5.6 MS should consider adopting and implementing effective measures aiming at strengthening health systems, continuous monitoring of the health labor market and coordination among all stakeholders in order to develop and retain a sustainable health

 
  • 9.b

 

Measures

have

been

taken to

involve

all

workforce responsive to their population’s

 

stakeholders in any decision making processes

health needs. MS should adopt a multi-

involving health personnel migration and international recruitment.

sectoral approach to addressing these issues in national health and development

 
  • 9.c Actions are being considered to introduce

policies.

 

changes to laws or policies on the international recruitment of health personnel.

7.1 MS are encouraged to , as appropriate and subject to national law, promote the establishment or strengthening of

 
  • 9.d

 

Records are maintained by all recruiters

information exchange on international

research institutions, health professional

 

authorized by competent authorities to operate within their jurisdiction.

health personnel migration and health systems, nationally and internationally,

 
  • 9.e Good practices are encouraged and promoted

through public agencies, academic and

 

among recruitment agencies.

 

organizations and sub-regional, regional and international organizations, whether

 
  • 9.f

If

other steps have been taken, please give

governmental or non-governmental.

 

more details:

 
 

8.1 MS are encouraged to publicize and implement the Code in collaboration with all stakeholders in accordance with national and sub national responsibilities.

8.2 MS are encouraged to incorporate the Code into applicable laws and policies

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(1)

 

(2)

(3)

(4)

National Reporting Instrument

 

Global Code of Practice on the International Recruitment of Health

 

Supplementary answers

Additional Questions

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Personnel

Please provide any additional answers to support (1)

Please provide suggestions to improve questions/ comments in (1)

 

8.3

MS

are

encouraged to consult, as

   

appropriate, with

all

stakeholders

in

decision- making processes and involve

them

in

other

activities

related

to

the

international recruitment of health personnel

8.4 All stakeholders in Art. 2.2 should strive to work individually and collectively to achieve the objectives of this Code. All stakeholders should observe this Code, irrespective of the capacity of others to observe the Code. Recruiters and employers should cooperate fully in the observance of the Code and promote and

guiding principles expressed by the Code, irrespective of a MS’ ability to implement the

Code

  • 8.5 MS should, to the extent possible and

according to legal responsibilities, working with relevant stakeholders, maintain a record , updated at regular intervals of all recruiters authorized by competent authorities to operate within their jurisdiction.

  • 8.6 MS should, to the extent possible,

encourage and promote good practices among recruitment agencies by using those agencies that comply with guiding principles of the Code

10. Please list in priority order, the 3 main constraints to the implementation of the Code in your country and propose possible solutions:

 

1.

1.

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(1) (2) (3) (4) National Reporting Instrument Kindly accomplish the instrument in this column by ticking
(1)
(2)
(3)
(4)
National Reporting Instrument
Kindly accomplish the instrument in this column by
ticking the boxes
Global Code of Practice on the
International Recruitment of Health
Personnel
Supplementary answers
Additional Questions
Please provide any
additional answers to
support (1)
Please provide suggestions
to improve questions/
comments in (1)
Main Constraints
Possible solutions
2.
2.
10.a1
10.a2
10.b1
10.b2
3.
3.
10.c1
10.c2
There are no constraints to the implementation of
the Code
7.2
In
order
to
promote and facilitate the
11.
Has your country established a database of laws and
regulations related to international health personnel
recruitment and migration and, as appropriate,
information related to their implementation?
exchange of information that is relevant to
this Code, each MS should to the extent
possible:
1.
1.
2.
2.
a. progressively establish and maintain
3.
3.
Yes
an updated database
of
laws
and
No (if “No”; please proceed to Q(12))
regulationsrelated
to
health
personnel
recruitment and migration and, as
appropriate, information about their
implementation
b. progressively establish and maintain
updated
data
from
health personnel
11.1 Please provide details of the database reference
or a web-link:
information systems in accordance with Art.
6.2
c. provide data collected pursuant to
subparagraphs (a) and (b) above to the WHO
Secretariat every 3 years, beginning with an
initial data report
3.3 The specific
needs and special
12.
Does your country have any technical cooperation
agreement, provides or receives financial assistance
related to international health personnel recruitment
or the management of and migration?
circumstances of countries, especially those
1.
1.
developing countries and countries
with
economies in transition that are particularly
vulnerable to health workforce shortages and
2.
2.
/or have
limited capacity to implement the

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(1)

 

(2)

(3)

(4)

National Reporting Instrument

 

Global Code of Practice on the International Recruitment of Health

 

Supplementary answers

Additional Questions

Kindly accomplish the instrument in this column by ticking the boxes

Personnel

Please provide any additional answers to support (1)

Please provide suggestions to improve questions/ comments in (1)

   

Yes

recommendation of

this

Code,

should

be

3.

3.

 

No (if “No”; please proceed to Q(13))

considered. Developed countries should, to

 

the extent possible, provide technical and

  • 12.1 Please provide more information or evidence of

financial

assistance

to

agreements as appropriate:

developingcountries and countries with economies in transition aimed at strengthening health systems, including health personnel development.

  • 12.2 Please provide more information or evidence of

10.1 MS and other stakeholders should

financial assistance provided or received as appropriate:

collaborate directly or through competent international bodies to strengthen their capacity to implement the objectives of the

Code.

10.2 International organizations, international donor agencies, financial and development institutions and other relevant organizations are encouraged to provide their technical and financial support to assist the implementation of this Code and support health system strengthening in developing countries and

countries with economies in transition that are experiencing critical health workforce shortages and /or have limited capacity to

implement the objectives of this Code…

 

10.3

MS either on

their

own

or

via

their

engagement

with

national

and

regional

organizations,

donor

organizations

and

other

relevant

bodies

should

be

encouraged

to

provide

technical

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  • Kindly accomplish the instrument in this column by ticking the boxes

National Reporting Instrument

(1)

Kindly accomplish the instrument in this column by ticking the boxes National Reporting Instrument (1)
Kindly accomplish the instrument in this column by ticking the boxes National Reporting Instrument (1)
 

13.1 Please use Table C below to provide the contact details of each entity.

Table C Contact details of mechanism(s) or entity(ies) maintaining statistical records of health personnel whose first qualification was obtained overseas

 

Name of mechanism or entity

   
 

13.1a

   
 

13.1b

   
 

13.1c

   
 

Add as necessary

   
   

13. Does your country have any mechanism(s) or entity(ies) to maintain statistical records of health personnel whose first qualification was obtained overseas?

Global Code of Practice on the International Recruitment of Health Personnel

(2)

those countries. strengthening development developing assistance economies countries personnel transition, financial countries including capacity, support systems
those countries.
strengthening
development
developing
assistance
economies
countries
personnel
transition,
financial
countries
including
capacity,
support
systems
aiming
health
health
with
and
to
or
at
in
in

information on international recruitment of health personnel are needed to achieve the objectives of this Code.

to establish or strengthen and maintain, as appropriate, health personnel information systems, including health personnel migration and its impact on health systems. MS are encouraged to collect, analyze and translate data into effective health workforce policies and planning.

international organizations and MS, is encouraged to ensure, as much as possible, that comparable and reliable data are generated and collected pursuant to 6.2 and 6.3 for ongoing monitoring, analysis and policy formulation.

  • 6.2 Taking into account characteristics of

international data research and sharing of

  • 3.7 Effective gathering of national and

national health systems, MS are encouraged

with relevant

collaboration

  • 6.4 WHO,

in

Supplementary answers

Please provide any additional answers to support (1)

(3)

Supplementary answers Please provide any additional answers to support (1) (3) 2. 3. 1.
2. 3. 1.
2.
3.
1.

Please provide suggestions to improve questions/ comments in (1)

Additional Questions

(4)

Kindly accomplish the instrument in this column by ticking the boxes National Reporting Instrument (1)
2. 3. 1.
2.
3.
1.

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(1) (2) (3) (4) National Reporting Instrument Kindly accomplish the instrument in this column by ticking
(1)
(2)
(3)
(4)
National Reporting Instrument
Kindly accomplish the instrument in this column by
ticking the boxes
Global Code of Practice on the
International Recruitment of Health
Personnel
Supplementary answers
Additional Questions
Please provide any
additional answers to
support (1)
Please provide suggestions
to improve questions/
comments in (1)
13.2 For entity named in Q(13.1) please use Table D
below to specify whether the information
gathered include the following:
Table D Description of the statistical information available
on the internationally recruited health personnel
Entity
Occupation
Country of
Year of
Age
Sex
Category
first
first
qualificatio
recruitme
(1) Yes
(1) Yes
(1) Doctors
n
nt
(2) No
(2) No
(2) Nurses
(3) Midwives
(1) Yes
(1) Yes
(4) Nurse/
(2) No
(2) No
Midwife*
(5) Other
13.1a
Add
as
necessary
13.1b
Add
as
necessary
13.1c

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Migrant Health Personnel in this context is defined by the DOH as “any health worker who last held employment in a foreign country or whose qualification for employment was obtained in a foreign country.”

DOH_DWAB_4.27.2012

(1) (2) (3) (4) National Reporting Instrument Supplementary answers Additional Questions Kindly accomplish the instrument in
(1)
(2)
(3)
(4)
National Reporting Instrument
Supplementary answers
Additional Questions
Kindly accomplish the instrument in this column by
ticking the boxes
Global Code of Practice on the
International Recruitment of Health
Personnel
Please provide any
additional answers to
support (1)
Please provide suggestions
to improve questions/
comments in (1)
Add
as
necessary
*please use this category only if the information available
has no clear separation in reported numbers between the
two cadres
13.3 For
the entity(ies)
named in Q(13.1)
which
status
best
describes
the
possibility of
accessing and sharing the information detailed
in Q(13.2):
Entity
Information-sharing status
(1) Information cannot be shared
(2) Information may be shared
(3) Sharing relationships not yet
explored
13.3a
13.3b
13.3c
14. Does your country have any mechanism(s) or
entity(ies) to regulate or grant authorization to
practice to internationally recruited health personnel
and maintain statistical records on them?
7.1
MS are encouraged to , as appropriate
1.
1.
and subject to national law, promote the
establishment or strengthening of
information exchange on international
health personnel migration and health
2.
2.
3.
3.
Yes
No (if “No”; please proceed to Q(15))
systems, nationally and internationally,
through public agencies, academic and
research institutions, health professional
organizations and sub-regional, regional and

37 | P a g e

Migrant Health Personnel in this context is defined by the DOH as “any health worker who last held employment in a foreign country or whose qualification for employment was obtained in a foreign country.”

DOH_DWAB_4.27.2012

Kindly accomplish the instrument in this column by ticking the boxes

National Reporting Instrument

(1)

  • 14.1 Please use Table E below to provide the contact details of each entity.

  • 14.2 For the entity named in Q(14.1) please Table F below to indicate whether the information gathered include the following details:

Entity

Contact Details

Web-Link

(if available)

14.1a

   

14.1b

   

14.1c

   

Add as necessary…

   
     

Table F Description of information available on authorization and regulation of practice of internationally recruited health personnel

Table E Contact details of mechanism(s) or entity(ies) regulating or granting authorization to practice to internationally recruited health personnel

Global Code of Practice on the International Recruitment of Health Personnel

(2)

international organizations, whether governmental or non-governmental.

exchange of information that is relevant to this Code, each MS should to the extent possible:

b. progressively establish and maintain updated data from health personnel information systems in accordance with Art.

and facilitate the

order to promote

7.2

6.2

In

Supplementary answers

Please provide any additional answers to support (1)

(3)

2. 3. 1.
2.
3.
1.

Please provide suggestions to improve questions/ comments in (1)

Additional Questions

(4)

2. 3. 1.
2.
3.
1.

38 | P a g e

Migrant Health Personnel in this context is defined by the DOH as “any health worker who last held employment in a foreign country or whose qualification for employment was obtained in a foreign country.”

DOH_DWAB_4.27.2012

(1) (2) (3) (4) National Reporting Instrument Kindly accomplish the instrument in this column by ticking
(1)
(2)
(3)
(4)
National Reporting Instrument
Kindly accomplish the instrument in this column by
ticking the boxes
Global Code of Practice on the
International Recruitment of Health
Personnel
Supplementary answers
Additional Questions
Please provide any
additional answers to
support (1)
Please provide suggestions
to improve questions/
comments in (1)
Entity
Occupatio
Country
of
Age
Sex
n
first
Year of first
recruitment
Category
qualificatio
(1) Yes
(1) Yes
n
(1) Yes
(2) No
(2) No
(1) Doctors
(2) No
(2) Nurses
(1) Yes
(3) Midwives
(2) No
(4) Nurse/
Midwife*
(5) Other
14.1a
Add
as
necessary
14.1b
Add
as
necessary
14.1c
Add
as
necessary
*please use this category only if the information available
has no clear separation in reported numbers between the
two cadres

39 | P a g e

Migrant Health Personnel in this context is defined by the DOH as “any health worker who last held employment in a foreign country or whose qualification for employment was obtained in a foreign country.”

DOH_DWAB_4.27.2012

 

(1)

(2)

 

(3)

(4)

 

National Reporting Instrument

 

Global Code of Practice on the International Recruitment of Health

Supplementary answers

Additional Questions

Kindly accomplish the instrument in this column by ticking the boxes

 

Personnel

Please provide any additional answers to support (1)

Please provide suggestions to improve questions/ comments in (1)

 

14.3

For the entity(ies)

named in Q(14.1)

which

     
 

status

best

describes

the

possibility of

1.

1.

accessing and sharing the information detailed

in Q(14.2):

2.

2.

   

Entity

Information-sharing status

 

3.

 

(1) Information cannot be shared (2) Information may be shared (3) Sharing relationships not yet explored

3.

14.a1

14.a2

14.b1

14.b2

14.c1

14.c2

Pls. add as necessary

 
   

15. Please submit any other complementary comments or material you wish to provide regarding the international recruitment and

   

1.

1.

 

management of migration of the health workforce that would relate to implementation of the Code.

 

2.

2.

 

3.

3.

Kindly accomplish the instrument in this column by ticking the boxes

National Reporting Instrument

(1)

Title/ theme of

Sponsored

Year

international discussion

by

     
     
     
  • (a) Has the Philippines participated in international discussions and advanced cooperation on matters related to ethical international recruitment?

Yes, please provide the details in the table below

No

Title/ theme of Sponsored Year international discussion by (a) Has the Philippines participated in international discussions

Ethical

Short

Possible

Possible

recruitment Strategy or policy

description

Constraints

solutions

       
       
       
       
  • (b) Are there mechanisms for internationally recruited health workers to report non-conformity to policies on ethical recruitment and labour standards?

Global Code of Practice on the International Recruitment of Health Personnel

(2)

recruitment of health personnel as part of strengthening health systems, with a particular focus on the situation of developing countries

1.4 To facilitate and promote international discussion and advance cooperation on matters related to ethical international

Global Code of Practice on the International Recruitment of Health Personnel (2) recruitment of health personnel

Supplementary answers

Please provide any additional answers to support (1)

(3)

2. 3. 1.
2.
3.
1.
2. 3. 1.
2.
3.
1.

Please provide suggestions to improve questions/ comments in (1)

Additional Questions

(4)

2. 3. 1.
2.
3.
1.
2. 3. 1.
2.
3.
1.
 

(1)

 

(2)

 

(3)

(4)

National Reporting Instrument

 

Global Code of Practice on the International Recruitment of Health

 

Supplementary answers

Additional Questions

Kindly accomplish the instrument in this column by ticking the boxes

Personnel

Please provide any additional answers to support (1)

Please provide suggestions to improve questions/ comments in (1)

       
  • (c) What is your organization’s perception of circular

3.8

MS should facilitate circular migration of

   
 

migration?

health personnel so that skills and knowledge

1.

1.

 

Is circular migration being facilitated so that skills

can be achieved to the benefit of both source and destination countries

2.

2.

and knowledge can be achieved for the benefit of

8.7

MS

are

encouraged

to

observe

and

3.

 

3.

 

source and destination countries?

assess the magnitude of active

 

international

recruitment

of

health

   
 
Yes personnel from countries facing critical

Yes

personnel from countries facing

critical

No

shortage of health personnel, and assess the

 

scope and impact of circular migration.

 
 

4.2

Recruiters and employers should, to the

   
  • (d) How does the Philippines promote ethical

extent possible, be aware of and consider the

1.

1.

recruitment?

outstanding legal responsibility of health personnel to the health system of their own

2.

2.

country such as fair and reasonable contract of service and not seek to recruit

them. Health personnel should be open and transparent about any contractual obligations they may have.

3.

3.

4.7

Recruiters and employers should

understand that the Code applies equally to those recruited to work on a temporary or permanent basis.

 

5.4

As

the

health

workforce

is

central to

   
  • (e) Does the Philippines have a strategy to retain,

sustain health systems,

MS

should

take

1.

1.

sustain and distribute health workers in the country?

effective measures to educate, retain and sustain a health workforce that is

2.

2.

appropriate for the specific conditions of

42 | P a g e

Migrant Health Personnel in this context is defined by the DOH as “any health worker who last held employment in a foreign country or whose qualification for employment was obtained in a foreign country.”

DOH_DWAB_4.27.2012

 

(1)

(2)

(3)

(4)

 

National Reporting Instrument

 

Global Code of Practice on the International Recruitment of Health

Supplementary answers

Additional Questions

Kindly accomplish the instrument in this column by ticking the boxes

Personnel

Please provide any additional answers to support (1)

Please provide suggestions to improve questions/ comments in (1)

   

Yes (If “YES”, please fill out the table)

 

each country, including areas of greatest

   
 

No

need and is built upon an evidence- based

  • 3. 3.

 

health workforce plan. All MS should strive to meet their health personnel needs with their

 

Retention Strategy

Short description

 

own HRH as far as possible.

 

or policy

   

5.7 MS should consider adopting measures

   

to address the geographical

   

maldistribution of health workers and to

 

support their retention in underserved areas, as through the application of education measures, financial incentives, and regulatory measures, social and professional support.

 

(f)

What are the measures undertaken to strengthen educational institutions to scale up training of

5.5 MS should consider strengthening educational institutions to scale up the training of health personnel and

  • 1. 1.

 
   

developing innovative curricula to address

  • 2. 2.

 

health personnel and developing innovative curricula to address current needs?

current health needs. MS should undertake steps to ensure that appropriate training takes place in the public and private sectors.

  • 3. 3.

Not included in Code Column:

Article 9 (Monitoring and institutional arrangements) articles

Article 9 (Monitoring and institutional arrangements) articles

  • 7.3 For purposes of international communication, each MS, as appropriate, designate a national authority responsible for exchange of information regarding health

 

personnel migration and implementation of the Code. MS so designating such and authority should inform WHO. Designated national authority should be authorized to communicate directly or provided by national law or regulations, with designated national authorities of other MS and with the WHO secretariat and other regional and international organizations concerned, and to submit reports and other information to the WHO secretariat pursuant to 7.2 (c) and Art. 9.1.

7.4 A register of designated national authorities pursuant to paragraph above shall be established, maintained and
  • 7.4 A register of designated national authorities pursuant to paragraph above shall be established, maintained and published by WHO.