ＮＯＴ FOR CITATION OR QUOTATION WITHOUT PRIOR PERMISSION OF
AUTHORS.

FOR WHOSE CARE?
Filipino Nurses and Caregivers In Japan: Bilateral Issues and Concerns1
Maria Rosario Piquero-Ballescas
withOrlando Ballescas, Kayoko Teshigawara,Benjamin San Jose, Hiroaki Watanabe
Introduction
This paper discusses certain bilateral issues and concerns related to the
movement of Filipino nurses and caregivers to Japan as provided in the
proposed Free Trade Agreement (FTA) between Japan and the Philippines also
known as the Japan-Philippines Economic Partnership Agreement ( JPEPA).
Like other industrialized countries, Japan has proposed opening her immigration
doors to Filipino nurses and caregivers for their elderly. Already high, thepopulation of Japan’s elderly is expected to rise to 26% in 2015 and to 35.7% in
2050.
Aside from this alarming demographic profile, economic and social aspects haveaggravated the need to meet the needs of the elderly. Costs for the care of theelderly have risen while health and caregivers to take care of them havedwindled. Figures 1-5 show the geographical distribution of the elderly, numberof shisetsu and careworkers as well as the available nurse/careworkers andfacilities throughout Japan.
The decrease in the number of Japanese care and health providers has been
traced to economic ( such as low wages, unattractive work conditions for what is
considered as a 3-K job, kitsui, kiken, kitanai) as well as social factors ( such as1This is a revised version of the research supported by the Japan Institute for Labor
Policy and Training and the Japanese Society for the Promotion of Sciences. We would
like to sincerely thank all our informants and contacts for the research data, andespecially, Mr. Hiroaki Watanabe, Prof. Motoko Shuto, Ms. Kayoko Teshigawara, Mr.
Benjamin San Jose for their generous time, assistance and support throughout the courseof this research. And most of all, to Orly for his continuing, supportive partnership andto Aiko and Karlo for their love and understanding.

preference for non-3K jobs, women shifting to non-care professions and jobs,
delayed marriage age, nuclearization of Japanese family, among others).
Concern for meeting an aging, aged or ultra -aged society , not only for its
demographic but economic and social aspects as well, has prompted Japan topropose the import of health and care providers on a trial basis from thePhilippines.
The Philippines has long been known as a migrant-sending country. Filipino
nurses and caregivers have been among the estimated 8 million Filipino
migrants found throughout the world. Industrial societies, with similar problem
and concern for their elderly and dependents, have allowed the entry and insome cases, even the residence and settlement of significant numbers ofFilipino nurses and caregivers and their families.
The Philippine Government has sustained its active Nurse Migration policy,
ensuring the continuing availability of supply of Filipino nurses ready anddesiring to work abroad. Figs 6-8 show Filipino Nurse Supply and Nurse
Migration by type of visa and by country of destination.
Through a Free Trade Agreement (FTA) proposed in 2002, the Japan-Philippine
Economic Partnership Agreement (JPEPA) contains the specific provision
concerning the Movement of Natural Persons ( MNP) which allows for the entryof the Filipino health and care personnel into Japan, given certain conditions andrequirements.
Awaiting final approval by the Philippine Senate, to date, no nurses andcaregivers have been sent to Japan from the Philippines through this formal,
official bilateral route.
However, since the inception of the FTA proposal in 2002, Japanese as well as
Philippine media have reported about caregivers and nurses having entered
Japan from the Philippines. Our own field research observed and confirmed
these reports about Filipino women caregivers already, at present, recruitedeither from the Philippines or within Japan and either being trained or alreadyworking as caregivers in Japan.

2Encouraged by the proposed FTA, various stakeholders have initiatedcaregiving-related activities both in the Philippines and/or in Japan, making theencounter of Filipino caregivers and nurses with Japanese elderly clients already,an existing reality and practice, despite the delay in and absence of the official
approval of the FTA.
This initial report will present data of a study conducted within February andMarch, 2007 about bilateral issues and concerns related to the pre-FTA ongoingpractice and initiatives as well as to the proposed FTA policy of having Filipino
nurses and caregivers in Japan.
The data results may provide reflection points for the following importantquestions:1) Should the FTA proposal push through, what mechanisms and proceduresfor selection, recruitment, entry, dispatch, work and for the mutual protectionof migrant workers and the elderly need to be implemented?
2) Is the FTA-MNP proposal to hire Filipino health and care providers aneffective response to the need of the multi-faceted issue and needs of theJapanese elderly as well as to the problems of employment and better
conditions for Philippine nurses and caregivers?
This initial qualitative presentation of pre-FTA caregiving-related initiatives canserve as a mirror for future initiatives involving Filipino nurses and caregivers
who will be sent from the Philippines to Japan through the JPEPA ( FTA).
These present initiatives gathered by this research can also highlight importantlessons as well as concerns and issues
i)that can inform and guide the decision as well as the future
implementation of the policy regarding the future movement ofFilipino nurses and caregivers to Japan should the FTA be
approved, and/or

3

ii)

that can provide protection and proper care for all stakeholders,
especially the Japanese elderly and the Filipino health andcare providers, with or without the FTA approval.

Research Methodology
Using multiple methodologies, data for this research have been taken throughliterature review, statistical documentation , focused group discussions ( FGD),
interviews and site/agency visitations.
The literature and statistical documentation for this research started in thePhilippines in May, 2006 followed by various interviews with key informants invarious parts of Japan on the general situation of Filipino migrants in Japan from
October 2006 till January. 2007. The specific interviews with key persons in
caregiving training centers, agencies, and organizations as well as with Filipino
caregivers, including an observation session of Filipino caregiving trainees wereconducted within February and March 2007.
Focused group discussions were conducted with about 26 Filipino caregivers invarious places in Japan ( Tokyo, Maizuru and Nagoya) while more than100
questionnaires for caregivers and caregiving trainees have been distributed tovarious training centers and through personal networks. Interviews were also
conducted with about 10 key Japanese informants ( belonging to welfare ,non-profit and business organizations) related to the training and dispatch ofFilipino caregivers and nurses in Japan. About 8 Church and NGO members andvolunteers, were also interviewed about their assessment of the situation ofFilipino migrants and their views about Filipino caregivers and nurses in Japan.
Later interviews were conducted as well in Ehime and Fukuoka.
Despite reports about Filipino nurses now working in Japan, this research was
unable to trace and directly interview these Filipino nurses. The brief
discussion about issues and concerns about Filipino nurses in Japan have beenobtained from data a) provided by one Japanese agency involved in the training
and dispatch of Vietnamese nurses in Japan, b)from emailed questions
answered by about 3 Japanese nurses, and c) from literature and statisticalreview.
4

This report will present mainly qualitative field work data to emphasize thecontext of selection, entry, recruitment, dispatch and work which statistical data
often cannot capture and which are as important, even perhaps, more important
than reports about stock and flow of migrant health and care providers.
While qualitative data may present wider range and depth of the context ofhealth and care provision of migrants, it is highly suggested that, given moretime, future quantitative research be conducted to emphasize the wider
representation and validity of these initial qualitative findings to ensure betterand more comprehensive guidance and direction for the proposed FTA policy aswell as for more effective implementation of foreign health and care provision
beneficial to as many stakeholders as possible, especially the main stakeholders,the Japanese elderly and the Filipino nurses and caregivers in Japan.

Initial Research Highlights
This presentation will have 2 main sections: Part One : The Close Encounter ofFilipino Caregivers and Japanese Elderly, and, Part Two: Bilateral Issues andConcerns Related to Filipino caregivers and nurses at present already in or
expected , in the future, to enter Japan.
Heavily qualitative, Part I will present initial data about the profile of present
Filipino caregivers in Japan as well as information about their selection andrecruitment, training, dispatch and finally, their direct encounter with theJapanese elderly in their homes, in day service centers, and even in hospitals
either through direct hire or generally facilitated by various Japanesestakeholders belonging to NPOs, welfare or business organizations. Discussion
will also focus on their caregiving work, the world of caregivers and nurses inJapan, as well as their relations with their co-workers and their elderly clients.
Part 2 will present an analysis of bilateral issues and concerns mostly derived
from the experiences of the Filipino caregivers already in Japan as well as thepractices of other care-giving related stakeholders. This will be made andsuggested for policy, practice, and theory.

5Part One: The Close Encounter of Filipino caregivers and Japanese Elderly
I. The Stakeholders
A. Profile of Filipino Caregivers Now in Japan
There are now 2 types of Filipino caregivers in Japan: the rainichi Filipinos ( thenewcomers brought in recently from the Philippines , to date, by JapaneseNPOs) and the zainichi2 Filipinos ( the long-time residents in Japan).
Although fewer in number, the profile of newcomers ( n=7) can serve as a
mirror of future caregivers and nurses to be sent from the Philippines if FTA isapproved. The following data compare the rainichi or newcomer and zainichior long-term Filipino caregivers (n=74 ):i.

age- the newcomers are younger , 30 years old or less while the zainichi
Filipinos are older, above 30 years old)ii.

civil status- the newcomers are mostly single, while the zainichi Filipinos areeither married , divorced , separated or widowed;

iii.

birthplace- the newcomers are all from Luzon ( which can be expected as
deployment of newcomers may start in Manila (at the beginning of
the FTA approval) while the zainichi come from various places ofLuzon, Visayas, and Mindanao;

For the first time in our research experience about Filipino migrants inJapan since the early 1990s, Japanese informants for this 2006-2007
research used the term zainichi Filipinos, a label that was only applied
previously only to the most numerous migrants in Japan, the resident
Korean and Chinese in Japan. While on the one hand, it is a positive signthat the Filipinos are now accepted as residents of Japan, the term also
contains negative connotations of remaining foreigners or different from theJapanese, despite long-term residence and settlement.
2

6

iv.

educational attainment- the newcomers are college graduates while among the zainichi arethose who completed high school, those with some years of college,or those who completed college;v.

previous jobs
- very few had previous jobs in the Philippines for both types of Filipino
caregivers especially the newcomers who are fresh graduates fromthe Philippines. The zainichi were mostly previous entertainers who
have married Japanese. Some have continued as entertainers andare training to be caregivers, or a number are entertainers by night,
caregivers by day.

vi.

visa status- newcomers are on temporary shugakusei ( pre-college students) or
tourist3 visas while zainichis are naturalized citizens, spouses, orpermanent residents

vii.

date of entry in Japan- newcomers have just arrived last October 2006 ( or earlier4) while
zainichis have been here since the 1980s.

viii.

Present Job in Japan- zainchi are spouses, caregivers, or combined entertainer/caregivers
while the newcomers are students doing part-time job/training ( ortourists working5 ) as caregivers.

ix

Japanese Language Skills and Cultural Knowledge and Exposure- zainichi can speak and understand Japanese and their culture due tolonger stay but need to study formal reading and writing of Japanese
while newcomers are just starting to learn and be exposed to bothformal Japanese ( speaking, reading, and writing ) and Japanese

A recent news item reported 100 Filipinos on tourist visas dispatched as
caregivers to a nursing home in Japan, see The Yomiuri Shinbun, “Nursing
home used Filipinas to skirt employment rules,” April 28, 2007.
4 Ibid.
5 Ibid.
3

7

culture.
x.

Remittance – Regardless of length of stay, both types remit money for
their households back in the Philippines.

B. The Caregiving-Related Organizations and Companies
This portion will show the profile of varying key players involved in theselection, recruitment, training, and dispatch of present Filipino caregivers andnurses in Japan. These key players are from a welfare agency, from the civilsociety ( NPOs) and from business organizations , with the NPOS and businesscompanies engaged in activities aside from caregiving.
Some observed similarities/dissimilarities of these stakeholders are:
i.
ii.
iii.
iv.
v.

vi.

Start of Caregiving Activities: After FTA proposed in 2002
Three of the founders/officials of present caregiving business are
married to or divorced from Filipino wives
Two companies are involved with foreign clients while 2 companies
have links with welfare and/or medical organizations in Japan.
All have training and dispatch components for the Filipino caregivers
with varying fees and commissions for such activities.
Except for the welfare agency, all other companies have active
networks with Philippine stakeholders (among the finance, medical,
local and national governments and agencies)
Except for the welfare agency, other stakeholders started from
non-caregiving backgrounds and businesses

2. Selection and Recruitment
I.

For Caregiving

There were several observed patterns of selection and recruitment ofpotential caregivers to be sent to Japan or to be allowed to train in Japan.
These include: a) two types of NPO patterns, 2) a welfare agency experience,
and, 3) two types of business company practice.
a. NPO Model
8Type 1a: Selection and Recruitment in the Philippines,
Organized in 2004, the NPO official informed us that he had to take thefollowing steps before being able to bring Filipino caregivers to Japan.
These steps included:ii)

Social networking both in the Philippines and in Japan

In the Philippines, the NPO official established networks with various
key individuals, organizations and institutions connected to business,real estate, and politics in the Philippines. Having had previous
experience in computerization of medical receipts in Japan, the NPO
representative was also able to establish ties with Japanese andFilipino medical/health practitioners and organizations. In Japan, theNPO also established links with sponsors, schools, and has plans tolink with the Welfare Program of the local governments and otheragencies, including eliciting police support in the future.
Both his Philippine and Japanese contacts and networks allow his
NPO to establish links with Philippine local caregiving schools, thatare provided scholarships by this NPO’s Japanese sponsors. Part oftheir future plan is to establish a retirement village for Japanese backin the Philippines and hence, the selection and recruitment of future
Filipino caregivers is aimed both for the Japanese elderly who will
retire in the Philippines ( Long Stay Program) or who will remain in
Japan. This NPO also plans, in the future, to be a hakken kaisha , anoutsourcing company.
Public consultations about the proposed sending of Filipino caregivers
and nurses were also done by the NPO official in various area of thePhilippines ( like in Dagupan in Luzon, Cebu in the Visayas and Davao,in Mindanao ) often in close coordination with local government officials.
iii)

Government accreditation and registration both in Japan andin the Philippines

9

The mother company of the present NPO was established in 2002,
earlier by 2 years than the NPO as stated earlier. In order to be allowed
to bring Filipino caregivers to Japan, on a shugakusei visa ( to study
Japanese Language in Japan), the NPO had to hurdle very strict
Japanese immigration requirements such as proof of the company’s
good status, profits, sponsors, proof of no violation and staff credentials.
The visa application took from 4-8 months to complete.
iii) Selection Process
Seven of the eight young Filipinos selected for the second batch sent toJapan in October 2006 were chosen from the top graduates of theirrespective colleges or universities. Six of them finished caregiving
courses in the NPO-affiliated caregiving schools in various parts ofLuzon. They also had to sign a contract with the NPO , signed by amember of their own or extended family, who had collateral ( land orproperty) in exchange for their scholarship ( which is really a study now,
pay later plan) to Japan. Total scholarship per year per student is Y1.5
million yen which they are expected to pay back from their salary ( either
from their work in Japan or back in the Philippines , in a caregiving
agency with links to this NPO).
Type 1b: Selection and Recruitment from Retirement Village in thePhilippines
Shown on TV, a Japanese NPO established a retirement village forJapanese in one Luzon province. The documentary did not explain therequirements for selection and recruitment but it showed Filipino nurses
who trained in the Philippine retirement village as caregivers and who
learned Japanese language as having been sent to one place in Japan.
Type 2: NPO Linked with Japanese Company: Recruitment andSelection in JapanAn advertisement leaflet taken from a church showed volunteers of anNPO, in collaboration with a Japanese business company, calling theattention of those interested to become Home helpers ( with Level 2
10

License ) to enlist and enroll in a caregiving course exclusive for Filipinosor to call a hotline for additional questions about the course.
b. Welfare Agency Selection and Recruitment
This welfare office started to train and later hire/dispatch Filipino homehelpers after being informed about the case of Filipino women who approachedand requested help to find jobs from a Catholic nun in 2003. Unable to work asentertainers because of their age and because of problems that resulted fromtheir divorce, the religious nun told the Japanese home helper about the need tosupport these Filipino women to allow them to live by themselves. The Filipino
women were accepted as part of the welfare responsibility of this agency. The
religious nun requested that the welfare agency accept 2 Filipinos per year. For
the next year, 3 were trained while 2 were trained in 2006. For this year, thewelfare agency accepted 4 Filipinos for training. So far, only 1 Filipino student
did not complete the training.
c. Business Company Model 1
Belonging to a larger company started in 1991 and with Y10,000,000 statedcapitalization, the company started with 1) international placement service, 2)
telecommunication products – international phone cards, 90% of their clients are
Filipinos-, 3) broadcasting ( cable tv and media publishing), 4) Consumer goods
and services, 5) personal training and temporary staffing ( with IT andengineering sections), and, with 6) caregiving training in Tokyo, Chiba,
Kanagawa, Saitama and more proposed places in the future.
Its caregiving arm started a training course for the first batch of more than 20
applicants in 2005. The decision to focus on Filipinos as caregivers were basedon several factors: 1) their mother company continues to have a large Filipino
clientele base, 2) their founder was formerly married to a Filipina, and, 3) theirobservation that the Filipino women were acceptable to Japanese as evidenced
by their having been the favorite among foreign entertainers.
Recruitment for their training courses have been done through personal
introductions, through their call centers and their media outlets. Through theirwidely-circulated newspaper targeted at their large Filipino clientele base,11

( especially the zainichi Filipinos, the entertainers and spouses ), they
announced their caregiving training course, luring them to enroll so they could
pursue their dreams of having a brighter future, stable job in Japan, with good
pay and benefits. Their ads also inform the readers that they can work part-timeat rojin ( elderly) homes while enrolled at the caregiving academy.
The response from all over Japan to their initial announcement, mostly byphone , was overwhelming and the course remain popular among zainichi
Filipinos. The fact that this training center belongs to a mother company with ahistory of human resource outsourcing has made it even more attractive to thosedesiring to be employed while or after the training.
This caregiving training academy requests applicants to show their passport,
visa, Alien Certificate of Registration ( ACR ) as they have a policy not to allow
overstayers to enroll for the training.
d. Business Company Model 2
Starting as an outsourcing company ( hakken kaisha) for Brazilian Nikkeijin, thislarge company has spread from Japan throughout the world with branches in
Brazil, Indonesia, Philippines, among others. The company engages in
production through contracts, hardware/software development, introduction anddispatch of human resources and employs over 2400 workers ( 780 Brazil
Nikkeijin and more than 300 Filipinos).
As a response to the FTA proposal, the company initiated their first caregiving( home helper) training in 2003 with Latin Americans as their main targets but as
this did not pick up, they shifted and targeted Filipinos instead. Through word of
mouth, applicants for their training course came in large numbers. The company
is now offering their 8th course this month. The youngest trainee , so far, was 20
years old while most of the trainees are about 40 years old and over. They
welcome zainichi FIlipinos and require a copy of the ACR and passport fromtheir applicants. The training course, however, is open to tourists. There havebeen 3 tourist trainees so far.
II. NPO Model for Nurse Recruitment

12

Established in 1990, this NPO has a Technical Intern Training Program linked
with various countries, including the Philippines. There are 80 Filipino trainees
now in Japan through this program. It also serves as a union for medium andsmall companies.
This NPO also operates the Foreign Nurse Level Training Support Program.
This NPO started this program due to the shortage of nurses in Japan and tohave foreign caregivers and nurses in the company’s retirement villages in thethird world countries. It received permission to do so in 1993 from the Japanese
Ministry of Health and Welfare.
Students who were high school graduates were recommended by the
Department of Health in Vietnam to this NPO which in turn, matched them with
14 Japanese hospitals. In1994, Japanese Language Education was offered in
Vietnam for 17 months ( together with lessons in math, English and Chemistry)for 31 Vietnamese students who, after acquiring intermediate level proficiency,
came to Japan in 1996 to take the exams for nursing schools. Unfortunately,
they all failed and had to be sent home.
Subsequently 32 students were again trained in Vietnam and sent to Japan for
the exams for nursing school and this time 4 passed. From 1994 till 2002, 174
students were trained in Hanoi, with 109 of these ( 63% of trained) sent to Japanand 61 of these ( about 56%) passed the exams. Drop-out rate was only 3%( about 5 students).
Related to the FTA (JPEPA), this NPO reported that in 2004 , it expected the
FTA approval. Some 12 hospitals applied to be allowed to hire foreign caregivers
and nurses but this petition was rejected by the Japanese Government. The
hospital application was said to have been planned by the NPO together with theJapanese Ministry of Economy and Industry.
Anticipating the eventual approval of FTA, this NPO has started to recruit nurses
since 2004 through their Philippine stock company which will also be in-chargeof sending the selected Fiiipinos to Japan. The Philippine stock company is abranch office of a Japanese advertising company that takes care of thedevelopment of a special club for Japanese retirees in the Philippines and, inturn, the Japanese NPO takes charge of selling the Club while at the same time13

being a major investor of the Japanese advertising company. The Philippine
stock company has a line-up of top Philippine government and business figures
as their board of directors.
They initially chose 7 Filipino nurses out of about 50 applicants but now only 5
remain as one quit due to health problems and another decided to go to Englandwith her husband.
The applicants had to undergo several interviews, the first conducted by afemale Filipino company employee for character evaluation, the second andthird, with 4 interviewers including Japanese. Selection is done on the basis ofcharacter ( hospitality, smiling, independent personalities), whether they areyoung enough to master Japanese and serious enough to go to Japan, among
other criteria.
After their selection, the chosen Filipino nurses will be sent to a Japanese
language school for 7 months and caregiver course for 3 months in thePhilippines.
This NPO and the hospitals accepting the students paid for their study expenses.
If they are able to go to Japan through the FTA and pass the requirement and be
employed, they do not have to repay these study expenses. However, if not,they have to repay these expenses back to the NPO. They are required to passthrough POEA and they expect to come to Japan as home helpers or nurse
trainee and will be dispatched to the NPO-affiliated or member Japanesehospitals although the Japanese and Philippine governments have yet to decide
the mechanisms for fielding Filipinos to Japanese institutions within FTA.
Even if they understand that they will work as home helpers ( although perhaps
the definition and meaning of home helpers differ among Filipinos and Japanese
as will be explained in a later section), many Filipinos have applied but only few
have so far been selected as already discussed.
Those who are sent to Japan as Home Helper Trainee will take the Care
Worker’s board exam. Those who come to Japan on Nurse Trainee will prepare
for Nurse board exam in Japan. According to this NPO, when the FTA isapproved, the Kokusai Kousei Jigyoudan (Japan International Corporation of14

Welfare Services (JICWELS) will be in charge of Filipino care workers andnurses.
3.

3.
Training and Dispatch Information ( Please refer to Fig. 9 -11 forsummary data on training and dispatch)Present practice related to caregiving training and dispatch of caregivers now inJapan again are varied or comparable, in terms of training place, key players,
period, fees, and content. We present the following summary data:
On Training
a. Location of Training Centers
The newcomer caregivers trained in the caregiving training schools in
the Philippines which had links with the NPO that recruited and sent them toJapan later. Then in Japan, they were made to do actual training at a Japanese
shisetsu ( one type of center for the elderly), again with links to the same NPO.
On the other hand, the zainichi Filipino caregivers trained in various parts ofJapan, at centers either owned by the business companies or in cooperation
with the local government as in the case of the welfare agency trainees.

b. Training Period, Fees, and Payment Schemes
The newcomers paid from P16,000-P20,000 for their 6-months caregiving
training in Luzon-based training centers which had links with the JapaneseNPO. In Japan, their Japanese language training costs Y750,000 for a half-day
course for a year in a Tokyo Language School. Including their air ticket andother expenses while in Japan, the newcomers are expected to later pay backtheir scholarship expenses totaling to about Y1.5 million yen per year to the
NPO through salary deduction ( as earlier noted, either from their salary inJapan when they start to work formally or from their salary in the Philippines atthe proposed retirement village with links to their NPO host ). They are now
hired as trainees in a Japanese shisetsu in the morning while they are students
of Japanese language in the afternoon.
15

The zainichi Filipino caregivers, on the other hand, paid varied rates ( either incash or installment) depending on where they had their training. The welfare
agency trainees paid a low Y50,000 total fee for 130 hours of training throughthe welfare agency in collaboration with the local government. Those who went
through the training centers of the business companies in Tokyo and Nagoya
paid from Y90-000 to Y100,000 for the same training period. One other groupof trainees of a business company that refused to be interviewed paid
Y110,000 for their training
The following graph summarizes the various existing training models derived
from the research’s various informants:

Trainingzz Managed
Managed andand owned
owned byby Private
Privatepartnerpartner schools,
schools,zmanagedzmanaged byby welfare
welfare agency
agency and
and
local
local government
governmentzz managed
managed andand owned
owned byby caregivingcaregivingrelated
businesscompanies
related business companies

Philippines
Philippines
Japan
Japan

PeriodFEES

1. 6 months( NPO Type 1A Model)

PhP 16,000-20,000 (about ¥40,000-¥50,000)in thePhilippines + ¥1.5 million (¥750,000 for air ticket, school
tuition fees, other costs in Japan)

2. 3 months( Welfare Agency Model)¥50,000 (¥30,000 financial assistance by the local
government

3. Business Company Models¥90,000--¥110,000 (with textbooks, practical training fees,
taxes)

A.100 hours lecture/ 20 Hours
House Helper 2 License

OJT for¥90,000¥98,000 (including tax, textbooks, practical training fee)

B.25 days

Fig. 9. Training Center Types, Duration, and Fees
The Filipino nurses being recruited in the Philippines by an NPO are on
scholarship which need to be paid back later. Hence, their scholarship issimilar to a study now, pay later plan.

16

Tr a in in g Fee Pa y m en t Sch em e:

1 . Stu d y n o w , p a y l a te r p l a n
2. Cash3 . I n sta llm en t

Training Content

4. Scholarship (Free or To be Repaid
Fully, Through Return Work or
Installment Plan)
1 ) b a sic ca reg iv in g kn ow led g e2 ) b a sic ca reg iv in g tech n iq u es3 ) OJT ( Pra ctica l tra in in g ) a t n u rsin gh om e, d a y serv ice cen ter, h om ev isit)4 ) Ja p a n ese la n g u a g e ( a t cen ter orh om ew ork) , a n d , Ja p a n ese Cu ltu re.

Fig. 10. Training Payment Schemes and Content
Training content generally includes four major areas: basic caregiving
information, basic caregiving techniques, practical training ( on-the-job training),
and Japanese language and culture.
The Fukuoka model ( involving a volunteer business company linked with theYMCA) introduced an elderly-sensitive approach to language and culture
training different from the standard book-based language and culture training ofother centers.
Dispatch
Several models have been observed related to dispatch, as follows:
1. Newcomer caregivers from the Philippines are dispatched to day service
centers or nursing homes by the Japanese NPOs through their Partner Care
Companies or through dispatch companies. The Japanese NPO may receive
fees for introduction and dispatch.
2. Zainichi Filipino caregivers, after training , may be recommended by thewelfare agency to their partner care companies who dispatch them for home17visitations or to day service centers. The welfare agency does not receive
any introduction or shokai fee.
3. Zainichi Filipino caregivers who graduate from training centers managed bybusiness companies either apply directly to their employers ( direct hire) ormore generally, they are recommended by their training centers who are paid
shokai and dispatch fees by receiving care-related organizations.
Shokai fees vary ( for example, a business company or NPO may receive
about 20% of the total yearly income of one careworker. Dispatch fees also
vary ( for example, ranging from 30-40% or more of the per hour wage of one
careworker.
4. Filipino newcomer nurses being recruited at present in the Philippines will bedispatched from the Philippines by a Japanese NPO to their partner hospitals
in Japan.
See the Dispatch Graph below for the summary of present dispatch models
involving Filipino caregivers now in Japan.
Dispatch Model 1
From thePhilippines:
JapaneseNPO

Trainees
Tourists

Japanese
Partner Care
Companies
JapaneseJapanese
Dispatch
DispatchCompanies
Companies

1.
1. DayDay Service
Service Center
Center2.
2. Nursing
Nursing Home
Home
3.
Hospitals
3. Hospitals

Dispatch Model 2
WelfareWelfare Care
Care
OfficeOfficeGraduates

Own CarePartnerCompanies

1.Day
1.Day Service
Service Centers
Centers
2.Home2.Home Visits
Visits

Dispatch Model 3
Care Training andDispatch Companies

Graduates1.
1. DayDay Service
Service Center
Center2.
2. Nursing
Nursing HomeHome
3.
3. Hospitals
Hospitals

Dispatch Fees – Varied-(ex. 30-40% per hour wage per careworker)
Shokai Fees- Varied ( ex. 20% of yearly income/careworker)

Fig. 11 Various Dispatch Models

18

4. The World of Caregiving and Nursing in Japan6
Caregivers’ World in Japan
There are 3 types of care workers or caregivers in Japan with the following
requirements:
1. Care Workers (Kaigohukushishi) have to pass the board exam
after 2 to 4 years experiences (required experience depend on
institution they were working for) or they have to graduate fromwelfare system university7.
2. Care Managers have to pass the care manager’s practice course
exam and after passing, have to practice for 32 hours. They will be
registered in each prefecture as Care Managers. The requirements
for the exam for the practice course include license of Medical
Doctor, Pharmacist, Nurse, Care Worker and so on. Also, they musthave more than10 years experience.8
3. Home Helpers ( Level 1-3 ) Only total number of training hours( lectures and practice) are required for this type of caregivers.
a. Home Helper Level 1---They have to take 230 hours lectures inhome helper course authorized by local government9.
b. Home Helper Level 2--- They have to take 180 (60 hours
lecture, 42 hours practice, 30 hours practice in institution) hours
lectures in home helper course authorized by local government10.

We would like to thank Ms. Kayoko Teshigawara for the data in thissection.
7 Care qualification.com
http://www.kaigonosikaku.com/license/kaihuku.html access 2007/03/28
8 Care license navi http://www.kaigo-shikaku.com/caremanager/4way.html
access 2007/03/28
9 Ibid.
10 Ibid.
619

c. Home Helper Level 3--- They have to take 50 hours lectures inhome helper course authorized by local government. Nursing careinsurance system in Japan has been changed since 2006. And theinstitution will not be able to charge to nursing care insurance
system on any care by Home Helper grade 3 from 2008 April so Home
Helper grade 3 will not be able to work in institutions11.
Some Activities of Filipino Caregivers in Japan
1. NPO Caregiving Trainees at Shisetsu and Rented Apartment: Wage Per
Hour: Y800
The following show the weekly schedule of the newcomers or rainichi Filipino caregivers
brought to Japan last October 2006 by a Japanese NGO:WEEKDAYS
430am-530- wake up, prepare for work, make bento ( packed lunch)

530-730- leave apartment, commute for work730-1130- arubaito ( paid part time work – also considered as practical training

time required of trainees) at a shisetsu ( given instructions about what to do )12
1130-1pm- lunch and commute to Nihongo school

1-5pm- Study Nihongo

5pm-onwards - go home, have dinner, do house chores, homework
SATURDAYS and SUNDAY
Study, House Chores, Church ( Except for Sunday which is Church day, they said theycannot leave home without permission from the NPO head)

2. Direct Hire, Working in Hospital13 ( As caregiver or nurse aide?) Wageper Hour:Y1200/hour

AllAbout http://allabout.co.jp/career/careerwelfare/closeup/CU20010919/
access 2007/03/28
12 Please check details of activities described for hospital careworker’sschedule. The activities are reported to be similar for both caregivers andnurse aides.
13 We would like to thank Ms. Penafrancia Oishi for this information.
11

20

There are 4 shifts: 1) Hayade ( early or first shift), 2) Nikkin ( Day Shift), 3) Osode( late, second shift), and 4) Yakin ( night shift) with the following detailed tasks:
Hayade ( First Shift) Schedule :7am-3pm

Get Body Temperature, Bed Up, Prepare for Breakfast
Mouth Cleaning, Dishwashing

Nikkin ( Day Shift) Schedule
9am-5pm
Changing diapers, recreation, rehabilitation, bedding,washing hands, Bed up for lunch, making tea
Osode ( Late/Second Shift) Schedule
11:30am-7:30pm Morning bath, afternoon bath, ( PM) recreation, change
diapers, serve snacks, cleaning, ( PM) mouth cleaning,change diapers etc
11:30-11:50
Write Record About Patient ( in Nihongo )12:45-1:30
LUNCH BREAK
3:30-3:50
Write Record About Patient
4-4:15
BREAK TIME
Yakin ( Night Shift) Schedule
5pm-9am
Bed up for dinner, Make rounds every hour
Staff dinner
Change diapers, write records, round every hour
Staff on Rotation , 2-hour sleep
Change diapers etc, clean face and hands with hot towel
Bed up for breakfast, dishwashing
Morning Assembly
4. Home Helper ( Parttime Helper, Parttime Entertainer ) Wage per
Hour:Y850
Evening till about Midnight or Past Midnight:
Entertainer
Morning till about 9-10am:: Housewife/ Household Chores
10am-4-5pm: AM: Drive to Work as Home Helper atElderly’s Private Home ( cooking
21

Japanese meals for elderly,
dishwashing, giving bath in Japanesetub ( ofuru), change diapers, cleaningetc)
PM : Drive back to Welfare office towrite report about Elderly Client

The World of Nurses in Japan
Types of Nurses
Within a Japanese hospital are the following types of nurses and theirdescriptions:
1. Nurse -They have to pass the nursing board exam after graduatingfrom a Japanese nursing course. There are different kinds of nursing
courses in Japan: University, Technical College and Junior college.
All graduates from these schools can take the board exam and after
passing, they can get same licenses. They work in hospitals, clinics,
and welfare institutions. They take care of patients ( including familyon treatment and living) in institutions. In Japan, nurses have to do
everything for patients so that the patient can live quality of life.
2. Public Nurse ( hokenhu) and 3. Midwife - They have to pass thenursing board exam and the Public Nursing or midwife board exam,
respectively, after graduating from a Japanese public nursing course.
If nursing students study about nursing in University, they can takenursing and public nursing or midwife course at the same time.
University nursing course students can choose public or midwife
course except for nursing. After graduating they can take 2 board
exams. Others in technical college and junior college have to enroll in
the public or midwife course again after graduating nursing course.
Public nurses work in health centers established by local governmentor school.
22Midwives work in hospitals or clinics. They are allowed to establish
their birth home connected to obstetricians. They especially takecharge of pregnant women and nursing mothers.
4. Sub Nurse (Zyunkangoshi) - They have to pass the exam conductedby prefectures after graduating from a Japanese Sub nursing course.
Graduates from junior high school can enroll in the Sub nursing
course. Actually, all students are graduates from high school
nowadays. Sub nurses can enroll in nursing course again if they have
graduated from high school.
Present within the world of nurses and in hospitals are the Nurse
Aides. They don’t need to pass any exam. Anyone can work as Nurse
Aide in the hospital that admits them. They work in hospitals,
clinics or welfare institutions. They have to do anything with nurse
or midwife or public nurse.
Nurse Aides support nurses and midwives. For example, they bring patientsto rehabilitation room, x-ray room or other places in hospitals if the patientsare fine. Or they carry patients and place them on the beds or to someexamination room with nurses if the patients have serious illnesses. Or they
can do bed-bath or support bath for patients with nurses. Also they can let
the patients eat and let the patients move to wheelchair and so on.
It is very important to inform Filipino nurses before they are sent to Japan
about the differences and similarities of their world with that of theJapanese nurses.
For example, a Filipino nurse license includes midwife skills while inJapan, only a Japanese midwife is allowed to assist in delivery. Hence,
Filipino nurses who are allowed to assist in child delivery in the Philippines
cannot be allowed to do it in Japan because Filipino are not graduates ofJapanese midwife courses.
Also , in the Philippines, there are many Filipinos who are graduates of
midwife courses but due to fund shortage, are underemployed and work as
nurse aides instead.
23

NURSES’ WAGE DATA
Wages for nurses in Japan depends on each school type and experience.
Generally, the highest wage goes to University graduates, second to juniorcollege, and last to technical college graduates.
Wages also depends on hospitals and area. Commonly, wages at public
hospitals are better than private. Wages in urban hospitals are better thanrural. As an example, one Japanese nurse who has been working for around10 years in a public hospital gets more than 300,000 yen per month, after cut
off tax, medical insurance and pension reserve and gets bonus 2 times in a
year.
The salary of a midwife is the same as a nurse in a hospital. Hence, the wage
does not always depend on the type of nurse license. One nurse said she gets
4,000 per hour nowadays as a part timer. This high salary may be related tothe shortage of midwife in Japan. Wages also depend on the employee. If thehospital sees some special skills among their nurses, they may increase theirsalary.

On the average, a Japanese nurse aide gets about Y1000 per hour.

CLOSE ENCOUNTER OF JAPANESE ELDERLY AND FILIPINOCAREWORKERS
At the start, negative responses from Japanese elderly, caregiving-related
institutions and agencies are elicited about the hiring of Filipino caregivers.
One Filipino caregiver reported crying after she was shouted at and sent outof the room by a Japanese elderly during her first day at a shisetsu.
However, after the initial encounter, positive reactions replace the earlier
negative ones. “Cheerful, smiling, respectful and caring for elders, hospitable,

almost treated like “idols” by their elderly clients,” Filipino caregivers,
despite their language and cultural challenges, are breaking barriers anddemonstrating the universal practice of care.

24Asked what they like about caregiving, some responses include: “loves tocare for elderly, learn caring skills that will apply to own family ( especiallyfor those married to Japanese nationals), can speak Nihongo, security
brought by license, for higher social standing, for earnings to help family
back in Philippines.”
While the present Filipino caregivers and caregiving trainees also thinkcaregiving is difficult, dirty, and dangerous, and they have to face language
and cultural problems as well as low wages, more and more zainichi
Filipinos, however, are interested or are training for caregiving in Japan.
There have been , so far, 15 caregiving trainees, 8 of whom are now onsimultaneous OJT and language training in Japan through an NPO network.
Of 400 trainees in a Tokyo training and dispatch company, 350 have
graduated while about 120 have worked as caregivers ( about 20-30%). In
another training and dispatch company in Nagoya, 110 have graduated with
30 working, 17 of whom were dispatched while 13 hired directly.
While most graduates want to work and while those who have worked wantto continue to do so, problems of employment, and sustainability are affectedby matching considerations of time and specific demand requirements ofpossible workplaces as well as personal/household factors ( for example, anumber of zainichi caregivers have been asked to stop by Japanese husbands,or they find work schedules incompatible with home schedules and chores, orthey find wages low and work as difficult, dirty and dangerous). These
problems encountered by zainichi Filipino caregivers are the same ones thathave been articulated as important factors for the increasing shortage ofJapanese care and health providers.
Still , in all, the number of Japanese elders needing assistance and attention
remains unabated. The increase in the number of Filipinos who want to train
as caregivers, both in Japan and in the Philippines, guarantees a steadysource of care providers not only for Japan but for the whole world.
Once won over, many clients have reported to have asked to be taken caredof by Filipino caregivers, who often enough see and consider the Japanese25elderly not just as patients but as their own family members as evidenced by
the following statements:“ We were so shocked and deeply saddened to see so many old people
staying away from their families at one center,” remarked many
Filipino caregivers.
“ Our clients cry and we do as well, when we have to part,”
said one home helper. “We love them like our own grandparents.
We can feel they love us too,” more than one remarked happily.

Part 2: Filipino Caregivers and Nurses in Japan: Bilateral Concerns
and Issues
The Movement of Natural Persons (MNP) proposed within the FTA between
Japan and the Philippines is expected to respond to problems affecting bothcountries. Hence, the movement of Filipino caregivers and nurses to Japan is
expected to address the shortage of care and health providers for an
ultra-aged society on the part of Japan, and at the same time, address laborand employment opportunities for a large labor pool in these sectors on thepart of the Philippines.
The proposed FTA carries a particular framework that posits bilateral
cooperation and agreement to bilateral, related yet distinct social problems.
Can migration solve the need for more health and care providers for the hugeand still expanding population of Japanese elderly and at the same time
address the problem of unemployment in the care and health sectors in thePhilippines?
The research data presented earlier about ongoing pre-FTA activities invarious parts of Japan show evidence that even without migration andwithout the MNP or the FTA approval, there are already ongoing efforts toresolve the issue of shortage of care and health providers within Japan,
particularly by utilizing the large pool of zainchi Filipinos now in Japan,
mostly spouses of Japanese nationals.
26

While these pre-FTA initiatives raise the further issue of whether there still
is a need for the proposed MNP of the FTA or not, the research data also
bring to attention significant issues and concerns related to the entry,
recruitment, training , dispatch, sustainability, labor and human protection
and welfare of Filipino care and health providers.
Mostly women, the gender issue and concern must also be properly
addressed.
Counterposed against this framework that views foreign labor replacement
to resolve labor shortage within the host country are 2 perspectives that 1)
view such labor migration as ineffective for solving social problems thatwarrant internal , national efforts and resolutions , and, 2) view resolution ofsocial problems of countries as requiring global analysis, response, andaction.
We now move on to address the more significant issues and concerns forpolicy, practice, and theory.

1. Pre-FTA initiatives as Precursor or Replacement for FTA?
While there may be initial problems caused by the first personal encounterand meeting of Japanese caregiving agencies and elderly with Filipino
caregivers, so far, the general assessment has been positive. The Filipino
caregivers are good for the Japanese elderly and vice-versa.
While the direct encounter is favorable and highly recommended, the path
towards the direct encounter of the principal stakeholders, the elderly andthe Filipino caregivers, is long and winding and needs to be smoothened inorder to assure genuine and positive outcomes for all parties concerned.
Our research data as well as literature point to the issues that need to beresolved: regular and effective regulation related to the manner andprocesses of selection, entry, recruitment, training, dispatch and actual work
situation and conditions.

27More importantly, before the FTA is approved, the following questions haveto be resolved. What visa status, what specific work terms and conditions,and what protective measures will be accorded to Filipino nurses andcaregivers in Japan?
Will future newcomer Filipinos be adequately and correctly informed about
their visa status, their specific work and conditions within the Japanese
world of caregiving and nursing and about protective mechanisms for themfrom the start of their recruitment, to their training and dispatch andemployment and stay in Japan?
Will Filipino Nurses work as nurses or as nurse aides( as described above) inJapan? Since Filipino nurses have yet to pass Japanese nursing board exams,
will they most likely serve first as Nurse aides in Japan, a position for which
Japanese do not require any license at all?
Once they have the Japanese license, they can work as nurses. To get thatlicense, however, will mean they will have to master the Japanese language
and pass the exams which even Japanese nurses themselves cannot easily
pass.
Hence, training becomes a very vital step involved in the implementation of
the MNP provision of the FTA. What type of training is adequate enough toequip our Filipino nurses and caregivers with not only the skills andlanguage proficiency needed for their jobs but also one that will equip themwith the proper attitude and behavior towards the Japanese elderly?
While the pre-FTA initiatives documented here present challenges to be
hurdled , the same pre-FTA initiatives also show several recommendable
highlights:

a. HOME HELPERS AND NURSE AIDES SUFFICIENT TO URGENTLY
MEET NEEDS OF JAPANESE ELDERLY AT PRESENT AND IN THE
FUTUREThe report of Filipino caregivers as well as interviews of Japanese nurses
and caregiving companies show that more than licensed careworkers and28

nurses, home helpers ( level 2) and nurse aides are more urgently needed,
now and in the near future, by the Japanese elders with families
unavailable to provide them with care and attention.
This result has implications for the stringent requirements of high levelof education as well as language requirements and caregiving experience
required of Filipino caregiving newcomers if the FTA is approved.
The positions of nurse aides and home helpers do not require licensing
exams but hours of skills and language/culture training as describedearlier. Hence, language training can move away from too muchemphasis on the extremely difficult language proficiency requirement to
one towards a working language knowledge enough to establish effective
communication between the Filipino care and health providers and theJapanese elderly.
b. CARE /WELFARE AND BUSINESS GO TOGETHER.
There are, at present, many available participants interested in either orboth the welfare and business dimensions of care and health provision for
the Japanese elderly.
Extreme care and regulation, however, must be made so that care andwelfare are not unduly commercialized or are superseded and controlled
merely or mostly by business concerns. Even governments can reap thefinancial benefits of a thriving migration industry through documentary
requirements ( passport and visa fees, among others).
Earlier data has shown how much training fees are paid by Filipino trainees,both in Japan and in the Philippines with no guarantee of employment after
the training ( only about 20-30% of the trainees in Japan were employed
after their training). Strict monitoring and regulation of deserving training
centers should be done to avoid the possible mushrooming of fly-by-night or
diploma-mill training centers both in the Philippines and in Japan.
The same strict monitoring system should be applied as well to selection andrecruitment of newcomers and/or zainichi Filipinos for nursing and29caregiving work in Japan. Otherwise, the issue of human trafficking ( veryclear in the case of the Filipino entertainers sent to Japan) will once again
show its ugly face, especially with the FTA approval, this time involving
another set of Filipino migrants, the nurses and caregivers. Already, even
without the formal approval, attempts to smuggle caregivers and nurses into
Japan may already have been initiated as evidenced by the newspaper reportof Filipino tourists brought in for employment in nursing homes in Japan.
Abusive dispatch and employment brokers, who may charge excessive
introduction ( shokai) , dispatch ( hakken) and other fees should also bemonitored and duly apprehended so as to protect not only the Filipino
migrants but also the Japanese elderly who also pay high costs for being
cared for.
A win-win situation for business and welfare sectors must be reached so thatcare is truly rendered to the Japanese elderly needing the service as well as
the Filipino migrants needing the employment.
c.

TAPPING LARGE POOL OF ZAINICHI FILIPINOS IN JAPAN

There is a large pool of Filipino women long-term residents or permanent
citizens now in Japan interested and available for training and dispatch forcaregiving provision. ( see Table 1 and 2 for Statistics of Registered Filipinos
in Japan, total and by status).
Able to understand Japanese language and culture due to their long stay,zainichi Filipinos are already integrated in Japanese society and homes.
Their long stay and understanding of Japan and the Japanese are theirstrongest assets that can be posed versus the newcomers who need time andtraining to enter even just the gate of Japanese society and homes.
Perhaps even overstaying women , who have demonstrated their staying
capacity, hiding from Japanese authorities for years, braving risks for thesake of their families, can be considered for amnesty and be integrated aspart of this latent pool of zainichi Filipinos to work as caregivers and nurse
aides for Japanese elderly?

30

Tapping the zainichi Filipino labor pool in Japan will raise the issue of
whether there is still the need to select and recruit newcomers from thePhilippines, in the short and long run.
If Filipino newcomer recruitment is allowed, the issues and problems related
to entry , training, recruitment, dispatch, and work procedures as well as ofvisas and fees still have to be sorted out and regulated more tightly.
Otherwise, charges of cheap labor exploitation, human rights violation ,illegal entry or human trafficking, especially of females, may once again
emerge just as these did in the case of the entry to Japan of thousands ofFilipino entertainers , trainees and others in the past.
Having and employing Zainichi Filipinos will also help erase the critiquethat Japan may be contributing not only to brain drain but also to care drain
if newcomers are brought in from the Philippines.
It will also avoid the gap that may be created by the entry of newcomers who
may have higher educational levels and professional practice than their local
Japanese counterparts and will avoid allegations of cheap labor,
underemployment, and possible cases of discrimination of Filipino migrant
health providers and caregivers.
The experience of the Zainichi Filipinos as caregivers also raises several
fundamental questions about what are really important in the training andpractice of caregiving for Japanese elderly.
1. Is knowledge ( of caregiving skills, Japanese language, culture )more important than the heart ( attitudes, actual genuine care
and affection )?
2. Is spoken and written language the only form of humancommunication?
3. Or more importantly, can care actually be taught in training
centers and schools?
Employing zainichi Filipinos also provide social redemptive , reintegrative
mechanisms for those socially stigmatized because of their past entertainer
status. This will be futher discussed in the next section.
31

d. WELFARE AND LOCAL GOVERNMENT MODEL SOCIALLY REDEMPTIVE
and REINTEGRATIVE
The agencies that have originally been welfare-based show the best modelfor training, cooperation with local governments, providing redemptive,socially, reintegrating mechanisms for both needy Filipino women ( many
former and continuing entertainers) as well as for the Japanese elderly.
Being locally-based, these genuine welfare institutions , together with thelocal government units, know the location of the needy ( please refer toearlier maps of Japanese elderly population), the location of the Filipino
community they can tap to be caregivers and nurse aides ( see Fig. 12 forlocation of Filipinos throughout Japan) as well as the social problems
needing attention within their vicinity.
The combined resources of various local stakeholders ( local government withwelfare, NPOs, business companies, foreign residents and other key players)
can be tapped to promote genuine care and welfare for both the Japaneseelderly and Filipino migrants in their communities.
Having been long in the field of care and welfare, caregiving and nursing
initiatives should involve more of these welfare-based people and agencies( as well as the Japanese nurses and caregivers and their associations
together with the medical labor groups, among others) in every local
government, in meeting the needs of Japan’s elderly, especially through thetraining and dispatch of foreign and Japanese care and health providers.
A strict and regular monitoring system of employed foreigners in all
caregiving and nursing facilities within the local prefectures can be drawn
up to ensure the protection of all possible stakeholders, especially the
supposed beneficiaries of the MNP, the Japanese elderly and theunemployed Filipino migrants.
The initial challenge of acceptability of zainichi Filipinos by the Japanese,
however, will have to be hurdled. Research data, however, confirm that thischallenge, once overcome over some brief period of time, show how successful
and happy the encounter is between the Japanese elderly and the Filipino
32

care providers. Sustainability of employment , not only for Filipino but forJapanese care providers as well, can also be ensured through the provision of
better working incentives and terms.
e.

MNP NOW, LATER, OR NEVER?

Given these initial issues and concerns, perhaps it will be wise for both
Japan and the Philippines to be guided by local caregiving initiatives inJapan first and allow some period of serious monitoring and evaluation ofthese existing pre-FTA initiatives to direct future policy and practice. In themeantime, it may be wiser to postpone or altogether scrap the MNP
provision of the proposed FTA.
At the very least, the postponement will allow for the implementation
mechanisms and procedures to be smoothed out in the course of local,
pre-FTA caregiving endeavors being undertaken at present in Japan.
It may also be worthwhile for both governments to seriously consider the
separation of the MNP from the rest of the FTA. Why lump the movement ofcaregivers and nurses ( even IT professionals) together with the movement ofcommodities and even the so-called toxic wastes that are incorporated in the
proposed FTA? Are both the Japanese and Philippine governments soinsensitive as to consider human beings as commodities to be traded andmarketed?

2. Labor Migration as Solution to Bilateral Social Problems?
The proposed MNP of the FTA assumes that movement of natural persons
across countries will contribute to the solutions of social problems of thebilateral parties involved.
Linda Aiken and her colleagues, however, have countered that rather thanbring solutions, migration of foreign labor aggravates instead care andnursing shortages in the host countries while creating brain drain in the33

countries of origin.14

Instead, they propose that “ sustained
underinvestment in nursing education” is a theme that industrialized
nations must address and that the “countries that use the most nurses
should make the biggest investments in nursing education in both their own
and the developing countries from which they recruit nurses.”
They further suggest that “1) the developed countries have not done all they
can to create a sustainable professional nurse workforce that meets theirneeds, 2) the work environment of work nurses in developed countries ,
especially in the hospitals, which are deficient, need to be corrected, 3)
Ethical recruitment guidelines must provide strategy for responsibly
managing international nurse ( and caregiving) recruitment, and , 4) for a
2-prong approach to be adopted where developed countries will be diligent in
exploring actions to stabilize and increase their supply of health ( and care)providers and moderate demand through strategic investments and fordeveloping countries to respond to the health needs of their own citizens.”
Japan and the Philippines can best study more seriously first, and thenapply the important lessons that can be learned from the previous
experiences of other industrialized countries regarding the migration ofhealth and care providers for the care of the elderly.

3. Migration as Global Householding
The proposed MNP of the FTA assumes that the social problems to be met bythis provision are either locally or bilaterally linked in solution, if not in its
causes.
Prof. Mike Douglass, however, criticizes the conventional view oftransnational migration as labor migration, a movement affected bypush-pull factors operating within receiving and sending countries andinvolving individual decision makers only. Instead, he posits that

Linda Aiken et al, Trends in International Nurse Migration, Health
Affairs, Vol. 23, Number 3, May, June 2004.

14

34

transnational migration is really global householding15, “the processes of
forming and sustaining households on a global scale.”
He proposes that “ global householding is only partially motivated andmanifested in work and in income opportunities. Marriage, bearing, raisingand education children, and caring for the elderly are among the household
motives for transnational movements and linkages among people. From asocietal point of view, global householding is also a response to collapsing
population growth below replacement, severe labor shortages, risingdependency ratios, welfare systems going broke, and rapidly aging societies”
which characterize present Japanese and Philippine migration.
This perspective calls attention to the need to consider the global roots of thesocietal problems now experienced by households in crisis throughout theworld. For the particular question to ask of Japan and the Philippines iswhat are the roots of their multi-faceted problems of the shortage of care andmedical providers for the Japanese elderly and of chronic unemployment andoutward migration of the same sector in the Philippines?
When the roots are traced, the global nature and linkages of these social
problems in Japan and the Philippines to global economy will be clearer.
Hence, given this perspective, when the question is asked whether the MNPof the FTA can be an effective solution to address the social problems of boththe Philippines and Japan, the answer can only be a No. The social problems
affecting both Japan and the Philippines have roots located within thepresent global system that prioritizes the development of the economy andmarkets, rather than of communities and people.
Does the MNP provision within the proposed FTA move in the direction of
the construction of a better global world for all and better communities forboth the peoples of the Philippines and Japan?

Mike Douglas, Global Householding- The Missing Dimension ofTransnational Migration Research and Policy in Pacific Asia,” November
2006.

15

35

For whose care is the MNP within the FTA being proposed? For those in themarket and the state or for those who genuinely care and for those who
genuinely need urgent care among the Japanese elderly and the Filipinos?

36