Disclaimer: The views expressed in this paper/presentation are the views of the author and do

not necessarily reflect the views or policies of the Asian Development Bank (ADB), or its
Board of Governors, or the governments they represent. ADB does not guarantee the
accuracy of the data included in this paper and accepts no responsibility for any consequence
of their use. Terminology used may not necessarily be consistent with ADB official terms.

COVERING PEOPLE
ACROSS BORDERS
From Asia and the Pacific to Gulf countries

Azusa Sato
Health Specialist
South East Asia Regional Department

September 2016

Outline
Overview of
migrants

Receiving
countries
policies

Sending
countries
policies

Main issues
& moving
forward

Photo: ADB

Overview
Middle
East

1971: Male
construction
workers from Asia
to UAE (Kafala
Sponsorship
System)

1973: Large scale

migration from
Asia after oil price
rises

Mid 1980s: Less demand for

migrant labor after decline in
oil prices, Gulf war and the
completion of many
construction projects

Within
Asia
1980s: Growing labor
migration within Asia,
feminization and skilled
workers

2000s: Intra Asian

Migration, especially
SEA

Receiving

Sending

Bahrain
Kuwait
Oman
Qatar
Saudi Arabia
UAE

Bangladesh
PRC
Indonesia
Nepal
Philippines
Sri Lanka
Viet Nam

Sending&
Receiving
India
Malaysia
Pakistan
Thailand

10 mil

Migrant stock

in GCC countries
in Southeast Asia
in South Asia
Source: UN (2015)

1990
2000
2010
2015

Receiving

Taipei, China
Japan
Republic of Korea
Hong Kong, China
Singapore

20 mil

Migrants vs. Nationals in GCC

4 migrants

Migrants as % of total population

6 nationals

Top five migrant nationalities

in the UAE

Qatar: 87%

Philippines 0.4m
UAE:70%

Kuwait: 69%
Bahrain: 39%
Oman: 28%

Saudi
Arabia: 28%

Egypt
0.7m

Pakistan

India
2.8m

0.9m

Bangladesh
1.0m

Source: UN (2013)

Migrants health and employment conditions

High-risk
occupations

Temporary or
no contract

Separated
from family

Risk factors
linked to
legal status

Overtime without
pay

Long working
hours
without leave
Physical,
psychological and
verbal abuse

Domestic workers
excluded from labor
protection under
national law
Legal status of migrants determines
the level of access to health and social services

UHC
approach

Sending
countries

Worker
sponsored

policies

Photo: ADB

Philippines

UHC
approach

SSS special programs for OFW

Overseas Workers Welfare Administration
funded by OFW with benefits and orientations.
PhilHealth same insurance benefits abroad,
covering family back home.

Indonesia
Migrant Worker Insurance Program Compulsory social insurance for migrant workers.

Worker
sponsored

Sri Lanka
Labour migration legislation and regulation
Compulsory welfare insurance scheme
Protection pre-departure, in-service and upon
return

1
2

Malaysia
UHC
approach

Hospitalization and surgical scheme for foreign

workers (SPIKPA)
Mandatory, choice of 28 insurance providers
Migrant workers: premium of RM 120 (~34 USD)
per person
Annual coverage of RM 10,000 (~ 2800 USD)

Thailand
Worker
sponsored

Compulsory Migrant Health Insurance (CMHI)

Migrant workers enrolment upon conduct of preemployment health screening
Health benefits linked to the hospital where the
migrant was registered and screened

UHC
approach

Receiving
countries
policies

Employer
sponsored

Photo: Creative Commons

UAE

UHC
approach

Requires all expatriates to pay annual fees for using

government healthcare services, and additional fees for
prescription drugs and diagnostic tests such as X-rays.
Pursuant to the provisions hereof, the health insurance scheme shall
apply to non-UAE national residents and their families in the Emirate
of Abu Dhabi. Law no.23 (2005)

Qatar
Employer shall be responsible for expatriate employees
and their dependents (Law 7, Article 13)
The health insurance system shall be mandatory to ensure the
provision, in accordance with this Law and the Bylaw, of basic health
services to all Qatari citizens, GCC citizens, residents of the State
and visitors. - Qatar Law 7, Article 2

Kuwait

Employer
sponsored

Health/medical services shall be provided to aliens residing in

the State under the health insurance and medical security
systems - Kuwait Article 1 of 1999 law on alien health insurance
and the imposition of fees against medical services

Bahrain

UHC
approach

An establishment employing more than fifty workers shall

provide for the basic care of their health
Article 95, Labour Law 2008

Oman
If the worker is treated in a government or private hospital,
the employer shall incur the cost of treatment, medicine
and in-patient care at the hospital..
Article 33, Royal decree no. 35/2003 labour law

Saudi Arabia

Employer
sponsored

provide health care and organize all residents to nonSaudis in the Kingdom, and may be applied to other citizens
and the decision of the Council of Ministers. - Article 1
An employer shall provide his workers with preventive
and therapeutic health care. - Article 144

Main issues
Different laws of
reference;
national, labor law,
specific
arrangements

Overall landscape of
economy/health in GCC
changing as oil prices fall

Illegal and
undocumented
migrants
Variable levels of
implementation

Different levels of health

service coverage

Moving forward

Align national laws

& intl agreement
Policies guided by
international frameworks
Integrating health and
social welfare

Promote actions

Both sending and

receiving countries
Mandatory health
insurance in receiving
countries
Employer to subsidize

Push for UHC

approach
Migrants as part of a
broader national scheme
Go beyond health on the
basis of citizenship

Thank you