WHO Code 2012 - Philippine Report 06.21.12

MONITORING OF THE WHO GLOBAL CODE OF PRACTICE ON THE

INTERNATIONAL RECRUITMENT OF HEALTH PERSONNEL

THE PHILIPPINE MULTISTAKEHOLDER APPROACH

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

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 BOXES........................................................................................................................... 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

ii

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

iii

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

iv

MULTISTAKEHOLDERS Mr. Frencel Tingga

Mr. Jeric Sagala Commission on Filipinos Overseas

Ms. Elsa Florendo Commission on Higher Education

Ms. Emily Villanueva – Descallar Department of Foreign Affairs

Dr. Aleli Annie Grace Sudiacal

Ms. Jeanne Bernas DOH-Bureau of International Health Cooperation

Dr. Lilibeth David

Dr. Elizabeth Matibag

Ms. Juanita Valeza

DOH - Health Policy Development and Planning Bureau

Mr. Jose Sandoval

Ms. Geraldine Labayani

Ms. Milagros Oliva

DOLE - Bureau of Local Employment

Dr. Marco Valeros

Dr. Rhyan Gallego DOLE - Bureau of Working Conditions

Ms. Vivian Tornea

Atty. Bulyok Nilong

Ms. Luisa Reyes

DOLE - National Reintegration Center for OFWs

Dr. Marissa San Jose DOLE – Occupational Safety and Health Center

Ms. Arlene Ruiz

Mr. Benjamin Jose Bautista

Mr. Arthur Philip Sevilla

National Economic and Development Authority

Ms. Maybelle Gorospe

Mr. Jone Fung

Ms. Nimfa De Guzman

Mr. Carlos Canabera

Philippine Overseas Employment Administration

Mr. Pamfilo Tabu, Jr.

Ms. Monica Ormillo Technical Education Skills Development Authority

Mr. Alvin Cloyd Dakis

Mr. Jonathan Monis

Alliance of Young Nurse Leaders and Advocates

International, Inc.

Ms. Joycelynn Aman Philippine Association of Medical Technologists, Inc.

Mr. Noel Cadete

Dr. Teresita Barcelo Philippine Nurses Association, Inc.

v

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

Manila Doctors Hospital

Ms. Ivy Alcantara

Ms. Katrina Ledesma Makati Medical Center

Dr. Jose Dante Dator

Ms. Nimia Parale National Kidney and Transplant Institute

Ms. Lizel San Pedro Ospital ng Makati – Pembo

Ms. Leonida Ventosa Ospital ng Muntinlupa

Dr. Paulo Castro

Mr. Horacio Apuyan Pasig City General Hospital

Dr. Kiko Tranquilino 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

vi

Mr. Loreto Soriano LBS Recruitment Solutions Corporation

Ms. Marjo Miinalainen OPTEAM Global - Regional Office

Ms. Joy del Rosario PETRO - FIL Manpower Services Inc.

Mr. Victor Fernandez, Jr.

Mr. Hernan Guanco

Mr. Jesus Noel Litan

Philippine Association of Service Exporters, Inc

Mr. Simon John Corocoto Signature HealthCARE

Ms. Joanna Katrina Magalong Transnational Services Inc.

Mr. Josua Mata Alliance of Progressive Labor

Ms. Suevelyn Clavite

Mr. Abdulani Lakibul Confederation of Independent Union

Mr. Julius Cainglet Federation of Filipinos Workers

Ms. Esperanza Ocampo

Ms. Josephine Pagsuyuin - Jamon Philippines Government Employee Alliance

Ms. Annie Enriquez – Geron

Ms. Jillian Roque Public Services-Labour Independent Confederation

vii

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)

viii

ACRONYMS AANZFTA Association of Southeast Asian Nations-Australia-New Zealand Free

Trade Agreement

ASEAN 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 Department of Health

DOH –BIHC DOH-Bureau of Health International Cooperation

DOH-HHRDB DOH -Health Human Resources Development Bureau

DOH – HPDPB DOH -Health Policy Development and Planning Bureau

DOH – NCPAM DOH-National Center for Pharmaceutical Access & Management

DOLE Department of Labor and Employment

DOLE - BLE DOLE-Bureau of Local Employment

DOLE –BLR DOLE-Bureau of Labour Relations

DOLE – BWC DOLE -Bureau of Working Conditions

DOLE – ILS DOLE -Institute of Labor Studies

DOLE – NRCO 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

ix

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

x

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 29th 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.

xi

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 1st 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 2nd 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

xii

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.

1

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

2

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

entities—DOH 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.

3

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 multistakeholder’s 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 29th of March 2012, which was attended by

representatives of the four partner organizations—the 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

4

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 Workers” in 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 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).

1http://dev1.doh.gov.ph/node/1069

http://dev1.doh.gov.ph/node/1069

5

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

6

Figure 1. Philippine Approach to Monitoring the WHO Global Code on


Promotion of

Decent Work

Decent Work

Across Borders

for health

professionals

Promotion of

Health

Stakeholders:

Governments, Employers, Trade Unions, Recruitment agencies, Professional Organizations

Ethical

RecruitmentEthical

Recruitment

Sustain Health

Workforce to

strengthen health

systems

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 1st 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 2nd Multistakeholders Participatory Assessment Workshop conducted on 30 May 2012

focused on the draft country report presenting the Philippine situation and the stakeholder

perspectives’ per 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.

7

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

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

http://www.chanrobles.com/legal4labor1.htm


8

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-

3Article 269 of the Labor Code – Prohibition against aliens;

exceptions.http://www.chanrobles.com/legal4labor5.htm


9

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

10

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

11

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.

12

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.

13

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’

14

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.

15

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.

http://www.dfa.gov.ph/

16

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.

17

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.

18

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

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

3. 6th 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 Philippines’ participation 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

Nurses4, 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

4http://balik-turo.cfo.gov.ph/index.php/about-us

http://balik-turo.cfo.gov.ph/index.php/about-us

19

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.

20

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.

21

CONCLUSION The present report constitutes the Philippines’ additional 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

22

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.

23

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?

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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 qualificat ion for employment was obtained in a foreign country.”

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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 [email protected] and cc: [email protected] MAY 17, 2012

(1) National Reporting Instrument

Kindly accomplish the instrument in this column by

ticking the boxes

(2) Global Code of Practice on the


(3) Supplementary answers

Please provide any

additional answers to support (1)

(4) Additional Questions

Please provide suggestions

to improve questions/ comments in (1)

1. In your country, do equally qualified and experienced migrant health personnel enjoy the same legal rights and responsibilities as the domestically trained health workforce in terms of employment and conditions of work?

Yes No (if “No”; please proceed to Q(4)) Not applicable because:

4.5 MS should ensure that, subject to applicable laws, including relevant international legal instrument to which they are party, migrant health personnel enjoy the same legal rights and responsibilities as the domestically trained health workforce in terms of employment an d conditions of work.

1.

2.

3.

1.

2.

3.

2. Which legal mechanisms are in place to ensure that migrant health personnel enjoy the same legal rights and responsibilities as the domestically trained health workforce? Please tick all options that apply from the list below:

2.a Health personnel are recruited internationally

using mechanisms that allow them to assess the benefits and risk associated with employment positions and to make timely and informed decisions regarding them

4.3 MS and other stakeholders should recognize that ethical international recruitment practices provide health personnel the opportunity toassess the benefits and risks associated with employment positions and to make timely and informed decisions. 4.4 Member States should, to the extent possible, ensure that recruiters and employers observe fair and just and contractual

1.

2.

3.

1.

2.

3.

mailto:[email protected]

mailto:[email protected]

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2.b Health personnel are hired, promoted and 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

2.c Migrant health personnel enjoy the same

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

2.d Other mechanism, please provide details if

possible:

practices in the employment of migrant health personnel and that migrant health personnel are not subject to illegal or fraudulent conduct. Migrant health 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 health workforce. Recruiters and employers should provide migrant health personnel with relevant and accurate information about all health personnel positions that they are offered. 4.6 MS and other stakeholders should take measures to ensure that migrant health personnel enjoy opportunities and incentives to strengthen their professional education, qualifications and career progression on the basis of equal treatment with domestically trained health workforce subject to applicable laws. All migrant health personnel should be offered appropriate induction and orientation programs that enable them to operate safely and effectively within the health system of the destination country.

3. Please provide evidence of legal mechanisms

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

1.

2.

3.

1.

2.

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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agreements or arrangements addressing the international recruitment of health personnel?

Yes No (if “No”; please proceed to Q(6))

heath personnel in a manner that strengthens the health systems of developing countries, countries with economies in transition and small islands. 3.5 International recruitment of health personnel should be conducted in accordance with the principles of transparency, fairness and promotion of sustainability of health 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. 5.1 In accordance with the guiding principle as stated in Article 3 of this Code, the health systems of both source an destination countries should derive benefits from the international migration of health personnel. 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. 5.2 MS should use this Code as a guide when

2.

3.

2.

3.

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 Type of Agreement

1) Bilateral 2) Multi-

lateral 3) Regional

Countries involved

Coverage 1) National 2) Sub-

national

Categories of Health Workforce (choose all that apply) 1) Doctors 2) Nurses 3) Midwives 4) Midwives/

nurses 5) Other

Please attach a documentation file if possible

Please provide a web-link if possible

….e.g. (1) .e.g. (1) ….e.g. (1)

1.

2.

3.

1.

2.

3.

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Add as necessary

*please use this category only if the information available has no clear separation in reported numbers between the two cadres

entering into bilateral, and/or regional and multilateral arrangements, to promote international cooperation and coordination on international recruitment of health 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 of effective policies and plans on the health

1. 1.

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undertaking research in health personnel migration?


workforce requires a sound evidence base. 6.3 MS are encouraged to establish or strengthen research programs in the field of health personnel migration and coordinate such research programs through partnerships at the national, subnational, regional and international levels.

2.

3.

2.

3.

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

Table B Detailed information on research programs or

institutions assessing health personnel migration

Name of Program or

Institution Name of

contact person Contact Details

Web-link (if available)

7.1

7.2

Add as necessary

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

1.

2.

3.

1.

2.

3.

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8. Has your country taken any steps to implement the Code?


1.1 Establish and promote voluntary principles and practices for ethical international recruitment of health personnel taking into account rights, obligations of source countries, destination countries and migrant health personnel 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

1.

2.

3.

1.

2.

3.

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

4.1 Health personnel, health professional organizations, professional councils and recruiters should seek to cooperate fully with regulators, national and local authorities in the interests of patients, health systems and of society in general.

1.

2.

1.

2.

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9.a Actions have been taken to communicate and 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

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.

9.d Records are maintained by all recruiters

authorized by competent authorities to operate within their jurisdiction.

9.e Good practices are encouraged and promoted

among recruitment agencies.

9.f If other steps have been taken, please give more details:

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 workforce responsive to their population’s health needs. MS should adopt a multi-sectoral approach to addressing these issues in national health and development policies. 7.1 MS are encouraged to , as appropriate and subject to national law, promote the establishment or strengthening of information exchange on international health personnel migration and health systems, nationally and internationally, through public agencies, academic and research institutions, health professional organizations and sub-regional, regional and international organizations, whether governmental or non-governmental. 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

3.

3.

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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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Main Constraints Possible solutions

10.a1 10.a2

10.b1 10.b2

10.c1 10.c2

There are no constraints to the implementation of

the Code

2.

3.

2.

3.

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?


11.1 Please provide details of the database reference or a web-link:

7.2 In order to promote and facilitate the exchange of information that is relevant to this Code, each MS should to the extent possible: a. progressively establish and maintain an updated database of laws and regulationsrelated to health personnel recruitment and migration and, as appropriate, information about their implementation b. progressively establish and maintain updated data from health personnel 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

1.

2.

3.

1.

2.

3.

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?

3.3 The specific needs and special circumstances of countries, especially those developing countries and countries with economies in transition that are particularly vulnerable to health workforce shortages and /or have limited capacity to implement the

1.

2.

1.

2.

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12.1 Please provide more information or evidence of

agreements as appropriate:

12.2 Please provide more information or evidence of financial assistance provided or received as appropriate:

recommendation of this Code, should be considered. Developed countries should, to the extent possible, provide technical and financial assistance to developingcountries and countries with economies in transition aimed at strengthening health systems, including health personnel development. 10.1 MS and other stakeholders should 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

3.

3.

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

13. Does your country have any mechanism(s) or

entity(ies) to maintain statistical records of health personnel whose first qualification was obtained overseas?


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

Contact details Web-link (if available)

13.1a

13.1b

13.1c

Add as necessary

3.7 Effective gathering of national and international data research and sharing of information on international recruitment of health personnel are needed to achieve the objectives of this Code. 6.2 Taking into account characteristics of national health systems, MS are encouraged 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. 6.4 WHO, in collaboration with relevant 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.

1.

2.

3.

1.

2.

3.

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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 Category

(1) Doctors (2) Nurses (3) Midwives (4) Nurse/

Midwife* (5) Other

Country of first qualification

(1) Yes (2) No

Year of first

recruitment

(1) Yes (2) No

Age

(1) Yes (2) No

Sex

(1) Yes (2) No

13.1a

Add as necessary

13.1b

Add as necessary

13.1c

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Add as necessary


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 and subject to national law, promote the establishment or strengthening of information exchange on international health personnel migration and health systems, nationally and internationally, through public agencies, academic and research institutions, health professional organizations and sub-regional, regional and

1.

2.

3.

1.

2.

3.

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

Table E Contact details of mechanism(s) or entity(ies)

regulating or granting authorization to practice to internationally recruited health personnel

Entity Contact Details Web-Link

(if available)

14.1a

14.1b

14.1c

Add as necessary…

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

Table F Description of information available on

authorization and regulation of practice of internationally recruited health personnel

international organizations, whether governmental or non-governmental. 7.2 In order to promote and facilitate the 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. 6.2

1.

2.

3.

1.

2.

3.

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Entity Occupation Category

(1) Doctors (2) Nurses (3) Midwives (4) Nurse/

Midwife* (5) Other

Country of first qualification

(1) Yes (2) No

Year of first recruitment (1) Yes (2) No

Age (1) Yes (2) No

Sex (1) Yes (2) No

14.1a

Add as necessary

14.1b

Add as necessary

14.1c

Add as necessary


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14.3 For the entity(ies) named in Q(14.1) which status best describes the possibility of accessing and sharing the information detailed in Q(14.2):

Entity Information-sharing status

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

explored

14.a1 14.a2

14.b1 14.b2

14.c1 14.c2

Pls. add as necessary

1.

2.

3.

1.

2.

3.

15. Please submit any other complementary

comments or material you wish to provide regarding the international recruitment and management of migration of the health workforce that would relate to implementation of the Code.

1.

2.

3.

1.

2.

3.

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(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 international discussion

Sponsored by

Year

1.4 To facilitate and promote international discussion and advance cooperation on matters related to ethical international recruitment of health personnel as part of strengthening health systems, with a particular focus on the situation of developing countries

1.

2.

3.

1.

2.

3.

(b) Are there mechanisms for internationally

recruited health workers to report non-conformity to policies on ethical recruitment and labour standards?

Ethical

recruitment Strategy or policy

Short description

Possible Constraints

Possible solutions

1.

2.

3.

1.

2.

3.

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

migration?

Is circular migration being facilitated so that skills and knowledge can be achieved for the benefit of source and destination countries?

Yes No

3.8 MS should facilitate circular migration of health personnel so that skills and knowledge can be achieved to the benefit of both source and destination countries 8.7 MS are encouraged to observe and assess the magnitude of active international recruitment of health personnel from countries facing critical shortage of health personnel, and assess the scope and impact of circular migration.

1.

2.

3.

1.

2.

3.

(d) How does the Philippines promote ethical

recruitment?

4.2 Recruiters and employers should, to the extent possible, be aware of and consider the outstanding legal responsibility of health personnel to the health system of their own 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. 4.7 Recruiters and employers should understand that the Code applies equally to those recruited to work on a temporary or permanent basis.

1.

2.

3.

1.

2.

3.

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

sustain and distribute health workers in the country?

5.4 As the health workforce is central to sustain health systems, MS should take effective measures to educate, retain and sustain a health workforce that is appropriate for the specific conditions of

1.

2.

1.

2.

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Yes (If “YES”, please fill out the table) No

Retention Strategy or policy

Short description

each country, including areas of greatest need and is built upon an evidence- based health workforce plan. All MS should strive to meet their health personnel needs with their own HRH as far as possible. 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.

3.

3.

(f) What are the measures undertaken to strengthen

educational institutions to scale up training of health personnel and developing innovative curricula to address current needs?

5.5 MS should consider strengthening educational institutions to scale up the training of health personnel and developing innovative curricula to address current health needs. MS should undertake steps to ensure that appropriate training takes place in the public and private sectors.

1.

2.

3.

1.

2.

3.

Not included in Code Column:

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 published by WHO.

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WHO Code 2012 - Philippine Report 06.21.12

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