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

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. Glin 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

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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 Sardaa, 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

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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 Dr. Lilibeth David Dr. Elizabeth Matibag DOH - Health Policy Development and Planning Bureau Ms. Juanita Valeza Mr. Jose Sandoval Ms. Geraldine Labayani DOLE - Bureau of Local Employment Ms. Milagros Oliva Dr. Marco Valeros Dr. Rhyan Gallego Ms. Vivian Tornea Atty. Bulyok Nilong DOLE - National Reintegration Center for OFWs Ms. Luisa Reyes Dr. Marissa San Jose DOLE Occupational Safety and Health Center Ms. Arlene Ruiz Mr. Benjamin Jose Bautista National Economic and Development Authority Mr. Arthur Philip Sevilla Ms. Maybelle Gorospe Mr. Jone Fung Ms. Nimfa De Guzman Mr. Carlos Canabera Mr. Pamfilo Tabu, Jr. Ms. Monica Ormillo Technical Education Skills Development Authority Philippine Overseas Employment Administration DOLE - Bureau of Working Conditions DOH-Bureau of International Health Cooperation

Mr. Alvin Cloyd Dakis Alliance of Young Nurse Leaders and Advocates Mr. Jonathan Monis International, Inc. Ms. Joycelynn Aman Philippine Association of Medical Technologists, Inc. Mr. Noel Cadete Dr. Teresita Barcelo Philippine Nurses Association, Inc.

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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 Manila Doctors Hospital Ms. Mary Eve De Leon Ms. Ivy Alcantara Ms. Katrina Ledesma Dr. Jose Dante Dator Ms. Nimia Parale Makati Medical Center 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 Dr. Kiko Tranquilino Pasig City General Hospital Pharmaceutical and Healthcare Association of the Philippines

Ms. Maria Linda Buhat Philippine Heart Center Mr. Vladimir Balbino St. Lukes Medical Center Quezon City Dr. John Jerusalem Tiongson The Medical Center Mr. Nestor Flores Abba Personnel Services, Inc Mr. Ramon Quevedo EDI-Staff Builders International Ms. Valerie Santos Health Carousel Philippines, Inc Ms. Marysol Ligod Innovative Manpower Services Ms. Catherine Peralta Jedegal International Manpower Services

Mr. Loreto Soriano LBS Recruitment Solutions Corporation Ms. Marjo Miinalainen OPTEAM Global - Regional Office Ms. Joy del Rosario PETRO - FIL Manpower Services Inc. Mr. Victor Fernandez, Jr. Mr. Hernan Guanco Philippine Association of Service Exporters, Inc Mr. Jesus Noel Litan 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 Ms. Annie Enriquez Geron Ms. Jillian Roque Philippines Government Employee Alliance Public Services-Labour Independent Confederation

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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)

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ACRONYMS
AANZFTA Association of Southeast Asian Nations-Australia-New Zealand Free Trade Agreement Association of Southeast Asian Nations ASEAN Mutual Recognition Arrangement Commission on Filipinos Overseas Commission on Higher Education Department of Foreign Affairs Department of the Interior and Local Government Department of the Interior and Local Government-Bureau of Local Government Development Department of Health DOH-Bureau of Health International Cooperation DOH -Health Human Resources Development Bureau DOH -Health Policy Development and Planning Bureau DOH-National Center for Pharmaceutical Access & Management Department of Labor and Employment DOLE-Bureau of Local Employment DOLE-Bureau of Labour Relations DOLE -Bureau of Working Conditions DOLE -Institute of Labor Studies DOLE-National Reintegration Center for Overseas Filipino Workers Department of Labor and Employment-Occupational Safety and Health Center Decent Work Across Borders Human Resources for Health International Labour Organization (Manila Office) International Labour Organization-Decent Work Across Borders Project
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ASEAN ASEAN MRAr CFO CHED DFA DILG DILG-BLGD

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

DWAB HRH ILO Manila ILO-DWAB

MASEAN MDH MRAr NEDA OWWA PEOS PDOS PHC PNA PPhA PPTA POEA PRC PRC-IAD PSLINK TESDA UP-NIH UP-NIH IHPDS

Medical Association of Southeast Asian Nations Manila Doctors Hospital Mutual Recognition Arrangement National Economic and Development Authority Overseas Workers Welfare Administration Pre-Employment Orientation Seminar Pre-Departure Orientation Seminar Philippine Heart Center Philippine Nurses Association, Inc. Philippine Pharmacists Association Philippine Physical Therapy Association, Inc. Philippine Overseas Employment Administration Professional Regulation Commission Professional Regulation Commission-International Affairs Division Public Services-Labour Independent Confederation Technical Education Skills Development Authority University of the Philippines-National Institutes of Health University of the Philippines-National Institutes of Health, Institute of Health Policy and Development Studies World Health Organization WHO Philippine Office WHO Western Pacific Regional Office

WHO WHO Philippines WHO WPRO

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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.

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 preemployment 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
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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.

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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-Generals report to the 2013 WHA to assess effectiveness and determine necessary improvements to the Codes implementation and monitoring. Responding to the call for the national monitoring of the Code, the Department of HealthHealth Human Resources for Health Bureau (DOH-HHRDB) initiated multistakeholder consultations with the Department of Labor and Employment (DOLE) and in partnership with
1

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 Codes implementation, the Philippines took a unique approach by engaging crucial partners and stakeholders in the process of clarifying the elements of the monitoring instrument, and sharing perspectives across organizations and stakeholders group to help shape the national scenario on the Code. To guide the process, the DOH operationally defined the migrant health personnel as any health worker who has last held employment in a foreign country, or whose qualification for employment was obtained in a foreign country. The Philippine approach engaged the government, employers, recruitment agencies, trade unions, professional organizations in a multistakeholder consultative process consistent with the practices of the collaborating entitiesDOH and DOLE, ILO and WHO in the Philippines. This report is a supplement to the on-line submission of the Philippine National Reporting Instrument (submitted electronically on 31 May 2012). It aims to present the wider perspectives of different stakeholders concerned with the ethical recruitment of health personnel. The report is structured to respect the flow of topics and questions as offered in the National Reporting Instrument. Further, this report also included discussions on the aspect of the Code that were not included in the National Reporting Instrument as those were deemed important by the organizers. As a result, additional questions were added tothe Philippine worksheet, which allowed the stakeholders to possibly assess the entirety of the Codes implementation. The report concludes with the highlights of the discussion. Annex A presents the Philippines stakeholders suggestions in view of a revised national reporting instrument which would take in the perspective of source countries.

THE PHILIPPINE APPROACH

Through the ILO DWAB project, and with agreement of the DOH as the lead agency for monitoring of the Code , a participatory, multistakeholder process was designed in order to bring around this important issues a wide range of stakeholders and opinions(Box 1). Box 1. The Philippine Approach: Steps in Monitoring the Implementation of the WHO Global Code of Practice on International Recruitment of Health Personnel (April to May 2012)
1. 2. 3. ILOs initiative in hosting the 29 March 2012 meeting of four partner organizations -DOH, DOLE, ILO Manila, WHO Philippines and WPRO. Development of the Philippine framework and approach (Figure 1). Development of the Philippine monitoring worksheet for multistakeholder (inclusive of the WHO National Reporting Instrument, explanatory notes on the WHO Code and WHO Users 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). Planning and organizing for the monitoring process by ILO and DOH, including logistics for orientation sessions on the Code, data collection, data processing, and multistakeholders consultative meetings. 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. Multistakeholders submission of completed worksheet. Consolidation of accomplished worksheets. 1st Multistakeholder Meeting was conducted on the basis of the consolidated data and draft country report. 2nd Multistakeholder Meeting was conducted for validation of the draft country report. Online submission of WHO National Reporting Instrument on 31 May 2012. 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. 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.

4.

5.

6. 7. 8. 9. 10. 11.

12.

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

responsible to manage international migration in the Philippine, the DOLE was also keen to take part in the process. The DOH as the national authority responsible for the monitoring of the Code dynamically took the lead in the process. The WHO Philippines and WPROs 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. 2. HHRDB is the designated focal unit of the DOH as the national responsible authority for the WHO Code monitoring. 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 1 have HRH-related mandates.

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 reaffirmed 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. 2. 3. 4. Convention No 97 Migration for Employment Convention (1949) Recommendation No 86 Migration for Employment Recommendation (1949) Convention No 143 Migrant Workers Convention (1975) 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).
1

http://dev1.doh.gov.ph/node/1069
4

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. 2. 3. To strengthen mechanisms of policy dialogue among stakeholders To strengthen employment services for healthcare professionals and skilled workers 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
5

Figure 1. Philippine Approach to Monitoring the WHO Global Code on International Recruitment of Health Personnel

Promotion of Health

Promotion of Decent Work

Sustain Health Workforce to strengthen health systems

Ethical Recruitment

Ethical Recruitment

Decent Work Across Borders for health professionals

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

With the logistical arrangements of the DOH and ILO, the Philippines convened briefing meetings for the different stakeholders to discuss the WHO Code, to orient them on the completion of the WHO National Reporting Instrument and Philippine worksheet, and obtain their commitment to participate in the monitoring process. The process continued with the collection of completed worksheets from the stakeholders and the consolidation, by the consultant, of responses per stakeholder group. The 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 Philippines implementation of the Code. The WHO National Reporting Instrument could be improved to appropriately reflect conditions in both source and destination countries of migrant health personnel. On the other hand, the data and discussions surfaced some challenges for the Philippines to better implement the provisions contained in the Code.

MULTISTAKEHOLDER PERSPECTIVES ON MONITORING THE CODE

The five groups of stakeholders (government, hospitals; professional associations; recruitment agencies; and trade unions) used a mix of methods, particularly key informant interviews, document review (policy instruments cited), and observation through their various engagements. This section presents the responses of the stakeholders and emerging general patterns with regards to the implementation of the WHO Code in the Philippines. The information is organized in such a manner that it follows the series of questions included in the WHO National Reporting instrument.

1.

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

In responding to the WHO reporting instrument, the Philippines defined the migrant health personnel as one who has last held employment in a foreign country or whose qualification for employment was obtained in a foreign country. The Philippines is considered as a source country of migrant health personnel. It is not considered yet as a destination country for migrant health personnel. Hence, the matter of equality in the legal rights and responsibilities of qualified and experienced migrant health personnel and domestically trained health workforce in terms of employment conditions of work, is not applicable to the current Philippine situation. The government agencies among the members of HRH Network Philippines clarified the Philippine situation regarding the legal rights and responsibilities of equally qualified and experienced migrant health personnel vis-a-vis Filipino health professionals in the Philippines. Though the Philippines is signatory to the ASEAN Mutual Recognition Arrangements (MRArs) on Medical Practitioners (2009), on Dental Practitioners (2009), and on Nursing Services (2006), such regional arrangements have not been implemented to allow the entry into the Philippines of foreign migrant health workers. The 1987 Philippine Constitution provides for the sustained development of a reservoir of national talents..., whose practice in the Philippines has been limited to Filipino citizens in 22 health professions and sub professions, including medicine, allied professions, medical technology, midwifery, nursing, nutrition and dietetics, optometry, pharmacy, physical and occupational therapy, radiologic and x-ray technology, and veterinary medicine (1987 Philippine Constitution Article XII Sections 10 and 14; Executive Order No. 584). The access of foreign workers to the labour market is covered by the Labor Code as amended (Article 40 referring to the employment permit ofnon-resident aliens).2 The health migrants 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

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

http://www.chanrobles.com/legal4labor1.htm 7

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 DOLE3

Article 269 of the Labor Code Prohibition against aliens;

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

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 Codes 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

9

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 governments 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
10

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 governments 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 countrys labor laws and other relevant social and economic laws and policies. When at the destination country, the DFA and the DOLEs Philippines Overseas Labor Office (POLO) are the relevant authorities for Filipino migrant workers. DOLEs 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.
11

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 DOLEs 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.

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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- andILO 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 unionss, 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 Codes 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 subnationally (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
13

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 PJEPAs 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 POEAs 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 Codes 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.

14

10.

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

Main constraints to the Codes 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 migrationrelated 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.

15

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 ILOs 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 PRCs 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.

16

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 theCodesbias 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.

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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 Codes 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 governments 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 nonconformity 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
4

http://balik-turo.cfo.gov.ph/index.php/about-us
18

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 groups 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 DOHs Doctors to the Barrios and Registered Nurses for Health Enhancement and Local Services, and DOLEs 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.
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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 DOLEs labor market study shows doctors are needed in the Philippines, which has implications on the Philippines accepting doctors from other countries.

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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 WHOs 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
21

6.

7.

8.

9.

10.

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

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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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ANNEX B: THE PHILIPPINE WORKSHEET

THE WHO GLOBAL CODE OF PRACTICE ON THE INTERNATIONAL RECRUITMENT OF HEALTH PERSONNEL
Name: Name of Organization: Date of Submission (mm/dd/yy): / / Name of person attending the MAY 17, 2012 workshop: Email: Position: Contact #s: Position:

Instructions: Please email the filled-in form to HRH.CodeofPractice@gmail.com and cc: xtinco@gmail.combefore MAY 17, 2012
(1) National Reporting Instrument Kindly accomplish the instrument in this column by ticking the boxes 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: 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 (2) Global Code of Practice on the International Recruitment of Health Personnel (3) Supplementary answers Please provide any additional answers to support (1) 1. 2. 3. (4) Additional Questions Please provide suggestions to improve questions/ comments in (1) 1. 2. 3.

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. 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.

24 | P a g e Migrant Health Personnel in this context is defined by the DOH as any health worker who last held employment in a foreign country or whose qualification for employment was obtained in a foreign country.
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(1) National Reporting Instrument Kindly accomplish the instrument in this column by ticking the boxes

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

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

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

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

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

1.

1.

25 | P a g e Migrant Health Personnel in this context is defined by the DOH as any health worker who last held employment in a foreign country or whose qualification for employment was obtained in a foreign country.
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(1) National Reporting Instrument Kindly accomplish the instrument in this column by ticking the boxes agreements or arrangements addressing the international recruitment of health personnel? Yes No (if No; please proceed to Q(6))

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

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

(4) Additional Questions Please provide suggestions to improve questions/ comments in (1) 2. 3.

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

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-

1. 2. 3.

1. 2. 3.

Countries Coverage involved 1) National 2) Subnational

Categories of Health Workforce (choose all that apply) 1) Doctors 2) Nurses 3) Midwives 4) Midwives/ nurses 5) Other .e.g. (1)

Please attach a documentat ion file if possible

Please provide a web-link if possible

lateral
3) Regional

.e.g. (1)

.e.g. (1)

26 | P a g e Migrant Health Personnel in this context is defined by the DOH as any health worker who last held employment in a foreign country or whose qualification for employment was obtained in a foreign country.
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(1) National Reporting Instrument Kindly accomplish the instrument in this column by ticking the boxes

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

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

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

Add as necessary

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

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 6.1 MS should recognize that the formulation of effective policies and plans on the health

6. Does your country have any (government and/ or non-government) programs or institutions

1.

1.

27 | P a g e Migrant Health Personnel in this context is defined by the DOH as any health worker who last held employment in a foreign country or whose qualification for employment was obtained in a foreign country.
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(1) National Reporting Instrument Kindly accomplish the instrument in this column by ticking the boxes undertaking research in health personnel migration? Yes No (if No; please proceed to Q(8))

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

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

(4) Additional Questions Please provide suggestions to improve questions/ comments in (1) 2. 3.

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.

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 7.1 7.2 Add as necessary Name of contact person Contact Details Web-link (if available)

1. 2. 3.

1. 2. 3.

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

28 | P a g e Migrant Health Personnel in this context is defined by the DOH as any health worker who last held employment in a foreign country or whose qualification for employment was obtained in a foreign country.
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(1) National Reporting Instrument Kindly accomplish the instrument in this column by ticking the boxes 8. Has your country taken any steps to implement the Code? Yes No (if No; please proceed to Q(10))

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

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

(4) Additional Questions Please provide suggestions to improve questions/ comments in (1) 1. 2. 3.

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

29 | P a g e Migrant Health Personnel in this context is defined by the DOH as any health worker who last held employment in a foreign country or whose qualification for employment was obtained in a foreign country.
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(1) National Reporting Instrument Kindly accomplish the instrument in this column by ticking the boxes

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

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

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

dependent upon the fullest cooperation of individuals and states 3.2 Addressing present and expected shortages in the health workforce is crucial to protecting global health 3.4 MS should take into account the right to the highest attainable standard of health of the populations of source countries, individual rights of health personnel to leave any country in accordance with applicable laws, in order to mitigate the negative effects and maximize the positive effects of migration on the health systems of the source countries. Nothing in the Code should be interpreted as limiting the freedom of health personnel, in accordance with applicable laws, to migrate to countries that wish to admit and employ them. 3.6 MS should strive, to the extent possible, to create a sustainable health workforce and work towards establishing effective health workforce planning, education and training and retention strategies that will reduce their need to recruit migrant health personnel 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.

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:

1. 2.

1. 2.

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

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

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

(4) Additional Questions Please provide suggestions to improve questions/ comments in (1) 3.

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 populations health needs. MS should adopt a multisectoral 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

31 | P a g e Migrant Health Personnel in this context is defined by the DOH as any health worker who last held employment in a foreign country or whose qualification for employment was obtained in a foreign country.
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(1) National Reporting Instrument Kindly accomplish the instrument in this column by ticking the boxes

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

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

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

8.3 MS are encouraged to consult, as appropriate, with all stakeholders in decision- making processes and involve them in other activities related to the international recruitment of health personnel 8.4 All stakeholders in Art. 2.2 should strive to work individually and collectively to achieve the objectives of this Code. All stakeholders should observe this Code, irrespective of the capacity of others to observe the Code. Recruiters and employers should cooperate fully in the observance of the Code and promote and guiding principles expressed by the Code, irrespective of a MS ability to implement the Code 8.5 MS should, to the extent possible and according to legal responsibilities, working with relevant stakeholders, maintain a record , updated at regular intervals of all recruiters authorized by competent authorities to operate within their jurisdiction. 8.6 MS should, to the extent possible, encourage and promote good practices among recruitment agencies by using those agencies that comply with guiding principles of the Code 10. Please list in priority order, the 3 main constraints to the implementation of the Code in your country and propose possible solutions: 1. 1.

32 | P a g e Migrant Health Personnel in this context is defined by the DOH as any health worker who last held employment in a foreign country or whose qualification for employment was obtained in a foreign country.
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(1) National Reporting Instrument Kindly accomplish the instrument in this column by ticking the boxes
Main Constraints
10.a1 10.b1 10.c1

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

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

(4) Additional Questions Please provide suggestions to improve questions/ comments in (1) 2. 3.

Possible solutions
10.a2 10.b2 10.c2

There are no constraints to the implementation of the Code 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? Yes No (if No; please proceed to Q(12)) 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 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. 3. 1. 2. 3.

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

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?

1. 2.

1. 2.

33 | P a g e Migrant Health Personnel in this context is defined by the DOH as any health worker who last held employment in a foreign country or whose qualification for employment was obtained in a foreign country.
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(1) National Reporting Instrument Kindly accomplish the instrument in this column by ticking the boxes Yes No (if No; please proceed to Q(13)) 12.1 Please provide more information or evidence of agreements as appropriate:

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

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

(4) Additional Questions Please provide suggestions to improve questions/ comments in (1) 3.

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

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

34 | P a g e Migrant Health Personnel in this context is defined by the DOH as any health worker who last held employment in a foreign country or whose qualification for employment was obtained in a foreign country.
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(1) National Reporting Instrument Kindly accomplish the instrument in this column by ticking the boxes

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

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

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

13. Does your country have any mechanism(s) or entity(ies) to maintain statistical records of health personnel whose first qualification was obtained overseas? Yes No (if No; please proceed to Q(14))

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. 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.

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

Table C Contact details of mechanism(s) or entity(ies) maintaining statistical records of health personnel whose first qualification was obtained overseas Name of mechanism or entity 13.1a 13.1b 13.1c Add as necessary Contact details Web-link available) (if

35 | P a g e Migrant Health Personnel in this context is defined by the DOH as any health worker who last held employment in a foreign country or whose qualification for employment was obtained in a foreign country.
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(1) National Reporting Instrument Kindly accomplish the instrument in this column by ticking the boxes

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

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

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

13.2 For entity named in Q(13.1) please use Table D below to specify whether the information gathered include the following:
Table D Description of the statistical information available on the internationally recruited health personnel
Entity Occupation Category (1) Doctors (2) Nurses (3) Midwives (4) Nurse/ Midwife* (5) Other 13.1a Country of Year of Age first first qualificatio recruitme (1) Yes n nt (2) No (1) Yes (2) No (1) Yes (2) No Sex (1) Yes (2) No

Add as necessary 13.1b

Add as necessary 13.1c

36 | P a g e Migrant Health Personnel in this context is defined by the DOH as any health worker who last held employment in a foreign country or whose qualification for employment was obtained in a foreign country.
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(1) National Reporting Instrument Kindly accomplish the instrument in this column by ticking the boxes

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

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

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

Add as necessary

*please use this category only if the information available has no clear separation in reported numbers between the two cadres 13.3 For the entity(ies) named in Q(13.1) which status best describes the possibility of accessing and sharing the information detailed in Q(13.2):
Entity
Information-sharing status (1) Information cannot be shared (2) Information may be shared (3) Sharing relationships not yet explored 13.3a 13.3b 13.3c

14. Does your country have any mechanism(s) or entity(ies) to regulate or grant authorization to practice to internationally recruited health personnel and maintain statistical records on them?

Yes No (if No; please proceed to Q(15))

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.

37 | P a g e Migrant Health Personnel in this context is defined by the DOH as any health worker who last held employment in a foreign country or whose qualification for employment was obtained in a foreign country.
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(1) National Reporting Instrument Kindly accomplish the instrument in this column by ticking the boxes

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

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

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

international organizations, governmental or non-governmental. 14.1 Please use Table E below to provide the contact details of each entity.

whether

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

Table E Contact details of mechanism(s) or entity(ies) regulating or granting authorization to practice to internationally recruited health personnel
Entity 14.1a 14.1b 14.1c Add as necessary Contact Details Web-Link (if available)

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

1. 2. 3.

1. 2. 3.

38 | P a g e Migrant Health Personnel in this context is defined by the DOH as any health worker who last held employment in a foreign country or whose qualification for employment was obtained in a foreign country.
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(1) National Reporting Instrument Kindly accomplish the instrument in this column by ticking the boxes
Entity Occupatio n Category (1) Doctors (2) Nurses (3) Midwives (4) Nurse/ Midwife* (5) Other 14.1a Country of Year of first first recruitment qualificatio n (1) Yes (2) No (1) Yes (2) No Age (1) Yes (2) No Sex (1) Yes (2) No

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

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

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

Add as necessary 14.1b

Add as necessary 14.1c

Add as necessary

*please use this category only if the information available has no clear separation in reported numbers between the two cadres 39 | P a g e Migrant Health Personnel in this context is defined by the DOH as any health worker who last held employment in a foreign country or whose qualification for employment was obtained in a foreign country.
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(1) National Reporting Instrument Kindly accomplish the instrument in this column by ticking the boxes

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

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

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

14.3 For the entity(ies) named in Q(14.1) which status best describes the possibility of 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.a2 14.b2 14.c2

1. 2. 3.

1. 2. 3.

14.a1 14.b1 14.c1 Pls. add as necessary

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.

40 | P a g e Migrant Health Personnel in this context is defined by the DOH as any health worker who last held employment in a foreign country or whose qualification for employment was obtained in a foreign country.
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(1) National Reporting Instrument Kindly accomplish the instrument in this column by ticking the boxes

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

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

(4) Additional Questions Please provide suggestions to improve questions/ comments in (1) 1. 2. 3.

(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

(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.

41 | P a g e Migrant Health Personnel in this context is defined by the DOH as any health worker who last held employment in a foreign country or whose qualification for employment was obtained in a foreign country.
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(1) National Reporting Instrument Kindly accomplish the instrument in this column by ticking the boxes

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

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

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

(c) What is your organizations perception of circular migration?

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. 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. 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. 3.

1. 2. 3.

Is circular migration being facilitated so that skills and knowledge can be achieved for the benefit of source and destination countries? Yes No

(d) How does the Philippines promote ethical recruitment?

1. 2. 3.

1. 2. 3.

(e) Does the Philippines have a strategy to retain, sustain and distribute health workers in the country?

1. 2.

1. 2.

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(1) National Reporting Instrument Kindly accomplish the instrument in this column by ticking the boxes Yes (If YES, please fill out the table) No

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

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

(4) Additional Questions Please provide suggestions to improve questions/ comments in (1) 3.

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. 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.

(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?

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.

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