39“Double-Standard Employment”
under JPEPA: The Bilateral Agreement
and Its Implications for Filipino
Nurse Migration to Japan
Yuko O. HIRANOa
Abstract
This article scrutinizes the situation of Filipino nurses and Japanese hospital
staff under the Japan-Philippines Economic Partnership Agreement(JPEPA). As the agreement prioritizes the enhancement of free trade
between the two countries in accordance with WTO (World Trade
Organization) regulations and the principle of bilateral relations, it
compromises the professional practice of Filipino nurses who enter Japan.
Based on a construction analysis of JPEPA’s provisions on the movementof natural persons (MNP), interwoven with interviews with Filipino nurses
and Japanese hospital staff, this article points out that the MNP scheme of
JPEPA devises a “double-standard employment,” which permits Filipino
nurses to work in Japan (recognition of right to employment) but does not
permit them to practice their profession (denial of right to practice), until
they pass Japan’s National Board Examination (NBE) for nurses. As aresult, they are prevented from earning a desirable amount. Worse, even
if they pass the NBE and are allowed to work in Japan for the long term,
the program and other current pertinent laws do not allow them to raisea family in Japan. Without a clear vision of a career path or a future family
life, Filipino nurses tend to be discouraged from studying and working
enthusiastically to prepare for the NBE. Such predicament is caused by aloophole in an agreement dealing with natural persons in economic terms.
It is important that each nurse under JPEPA is treated with due respect as
an individual, not as economic goods.
Keywords: WTO regulations, Japan’s migration laws, Filipino nurses

a Professor, Graduate School of Biomedical Sciences, Nagasaki University

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Introduction
TODAY, THE MIGRATION OF NURSES across borders is one of the

major issues associated with globalization. A large number of nurses leave
their home countries to work abroad, motivated by a worldwide shortageof nurses that push many Asian countries to “produce nurses for export”(Buchan, Kingma, and Lorenzo 2005; Hosein and Clive 2007; Yeates2009). Yeates (2010) pointed out that such production is often part of awider economic development strategy that leads to the promotion of labor
export. Migrants’ remittances raise the sending country’s foreign exchange
holdings, help its government pay off debts and obtain loans, and invigorate
the economy by supporting consumption, investment, and businesses atlarge. Indeed, it is not possible to talk about nurse migration withoutsituating it in the context of trade and business today. The Filipino nurses’
migration to Japan under the Japan-Philippines Economic Partnership
Agreement (JPEPA), whose challenges I will discuss in this article, in away reflects such a trend—that is, it was crafted in accordance with therules and regulations of a bilateral trade relationship.
The JPEPA, signed between the governments of Japan and thePhilippines in 2006, is an economic partnership agreement (EPA), which
entails an enhanced negotiation of a free trade agreement under the rules ofthe World Trade Organization (WTO). It contains specific provisions on the
movement of natural persons (MNP), which allow the entry of Filipino healthprofessionals into Japan under certain conditions and requirements. This was
Japan’s first EPA that involves foreign health professionals, particularly nurses
and certified care workers. The JPEPA prescribes that Japan should accept (a)short-term business visitors; (b) intracooperative transferees; (c) investors; (d)natural persons of the other Party (in this case, the Philippines) who deliver
professional services; (e) natural persons of the other Party who engage insupplying services which require advanced levels of technology or knowledge,or specialized skills belonging to particular fields of industry on the basis of acontract with public or private organizations in the former Party (in this case
Japan); and (f) nurses and certified care workers. The Japan-Singapore
Economic Partnership Agreement signed in 2002 also contains the first five

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and its Implications for Filipino Nurse Migration to Japan35
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of these six categories of natural persons. However, the last category, “nurses
and certified care workers,” was unique to JPEPA. Therefore, it was necessarythat a new provision be added in the list in chapter 9, article 110 (Watanabe
2007, 274).1
The migration of nurses under JPEPA accorded with Mode 4 of
the General Agreement on Trade and Services (GATS),2 which covers
natural persons who are either service suppliers (such as independent
professionals) or those who work for a service supplier and are present inanother WTO member to supply such services.3 With this regard, Mode 4
can be applied to any independent professional, such as information
technology engineers, who enter Japan to work. However, the uniquenessof nurses and certified care workers is that they are health professionals
who take care of the ill or the disabled. They must obtain a work permit
and at the same time be recognized by Japan for their clinical competencies
in patient care. As Plotnikova and Bremner (2014) note, the problem ofmanaging the crossborder mobility of health workers is how to balance
economic needs and ensure coherence between professional qualificationsof foreign health workers and the national standards of the receiving
country.
Kingma (2007, 159) points out that it is reasonable for each state to
set the qualification standards for certain professions, like medicine andnursing, that require strict criteria for practice. However, this creates adisparity between a work permit (the right to employment) and a license(the right to practice) for foreign professionals. This is especially true in thecase of EPAs whose primary principle is regulated by the WTO, whichclaims that the right of each government to regulate professional standards
is one of the fundamental premises of GATS. The WTO insists that theobjective of GATS is to liberalize service trade, and not to deregulate it.
During the negotiations for JPEPA, the JNA was opposed to thepossibility of mutual recognition of nursing licenses under the agreement.
Japan requires Philippine nurses to obtain their licenses within three years4
upon entering Japan before they can work as nurses5 or as certified care workers.
The JNA’s opposition to the mutual recognition of license is understandable,

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considering the language barrier, which will be discussed later in this article.
However, this condition consigns Filipino nurses to only noninvasive work—
such as arranging the bedside environment, making the bed, and organizing
medical supplies—until they pass the National Board Examination (NBE) for
nurses (Watanabe 2007, 295). Nursing is a profession that is usually regulatedby the state. Like in many other countries, to practice nursing in Japan requires
an exclusive occupational license from the Japanese government.
Under the MNP scheme of JPEPA, Filipino nurses are permitted towork in Japan—they are considered on-the-job trainees, albeit for a limited
number of years. They cannot practice their profession (nursing) until they
pass the NBE. Such a scheme might have disappointed the Philippines,
which has been sending its nurses all over the world. The government ofJapan, on the other hand, has been insisting that JPEPA not contradict otherpertinent laws, such as passing the NBE requirement. To further minimize
even a slim gap between the existing laws of Japan and the terms of JPEPA,
the JPEPA contains a provision stating that Filipino nurses who pass theJapan’s NBE shall obtain the “special activity visa: nurse,” renewable every
three years with no limitations.6 In this regard, it appears that the governmentof the Philippines could no longer demand further compromises (i.e., for
the Filipino nurses to be able to start practicing their profession more easily
and continue doing so without limitations) because GATS, the principle
governing JPEPA, focuses on matters of trade, not on immigration policies,
labor standards, and development issues of the involved countries. Given
this situation, JPEPA, which was crafted under such a logic, could potentiallyfrustrate and disappoint the nurses of both countries.
This study focuses on the movement of Filipino nurses to Japan
under JPEPA, a trade agreement with a section on the MNP, to learn
about what has been happening since its launch, with a particular interestin the “incompatibilities” between the right to employment and the rightto practice. Has such disparity between a work permit and a license, whichis termed “double-standard employment” in this article, resulted in distrustand ill will among the people concerned with JPEPA? In order to answer
this research question, the author of this study conducted literature reviews

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and interviews of employers, employees, and organizations in both thesending and receiving countries.
Reaction of the Sending Countr
y: The Philippines
Country:
The Junk JPEPA movement, which was strongly supported by thePhilippine Nurses Association, Inc. (PNA), was popular prior to the signingof JPEPA between Gloria Macapagal-Arroyo, then president of thePhilippines, and Junichiro Koizumi, then prime minister of Japan, in
September 2006. The Junk JPEPA movement proclaimed that “JPEPA, infact, covers a wide range of trade issues which is apparently a bad deal for
the Philippines” (The PCIJ Blog, 2006). The PNA, under national president,
Dr. Leah Paquiz, issued on 19 October 2007 a position statement concerning
JPEPA; it insisted that JPEPA does not treat Filipino nurses fairly, as it does
not give them opportunity to perform nursing practices. This could downgrade
the pride of Filipino nurses, who are of export quality, the statement
comments.
Even with a bachelor’s degree earned from four years of higher educationin the Philippines, proof of competence by virtue of having passed thePhilippine Licensure Examination and three solid years of working
experience, the Filipino nurse will go to Japan not to fully practice thenursing profession but to become a trainee. Under the JPEPA, the Filipino
nurse must train under the supervision of a Japanese nurse for up to three
years. If unable to pass the nursing licensure examination in Japanese, theFilipino nurse would have to be deported. (PNA 2007)

The PNA emphasizes in this statement that they were not satisfied withthe condition that Filipino nurses in Japan will not be treated as a nurse until
they pass the NBE, which the Japanese government conducts in Japanese.
This results in the violation of the Filipino nurses’ right to practice nursing.
Having been educated in English, Filipino nurses are proud of being highly
competitive, adaptable, and in demand, especially in English-speaking
countries. As the PNA proudly stated at the beginning of the position paper,

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Y. HIRANO“Filipino nurses constitute the biggest foreign-educated nurses in the UnitedStates. There is also a growing number of nurses in Europe and in the Middle
East. They are dubbed to be the best nurses in the world” (PNA 2007).
This statement indicates that Filipino nurses are flexible and canperform the competency if no language barrier exists. However, theworking conditions of nurses in the United States, Europe, or even in the
Middle East are remarkably different from those in Japan. In the UnitedStates and Europe, most doctors and patients can speak English; in the
Middle East, doctors speak English and interpretation services are offered
for those who need it (as mentioned by a Filipino nurse referred to in thenext section of this article). This being the case, there is no language
problem in these areas. On the contrary, in Japan, only a few doctors canspeak English, let alone patients. In addition, English interpretation services
in clinical settings are uncommon. Consequently, in order for healthprofessionals to work in Japan, Japanese language proficiency is anunavoidable prerequisite. Without it, Filipino nurses will not be able toperform their profession in Japan, which they could have otherwise
exercised elsewhere in the global labor market. This does not only degrade
the Filipino nurses’ appreciation of their work in Japan but also forcesthem to reconcile with the low salary caused by the double-standard
employment: as nurse candidates who are allowed to perform the tasks ofa nurse assistant while receiving on-the-job training.
JPEPA guarantees that “candidates should receive the same wage as ora higher wage than that of Japanese staff who are engaged in the equivalentjob” (Ministry of Health, Labor and Welfare 2008) in order to alleviate thepotential gap between the salaries of Japanese and Filipinos if they performthe same job. However, the problem lies in that Filipino nurse candidates(and for that matter all EPA nurse candidates) cannot hold the same positionas Japanese nurses until they pass the NBE; as a result, they receive lower
wages. The estimated average annual income of a registered nurse in Japan is
4.78 million yen, while that of a nonlicensed assistant nurse is 2.9 million
yen (Nenshu-Labo 2016).7 It may be assumed that nurse candidates (before
passing the NBE) receive the same income as the latter. The primary reason

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why Filipino nurses migrate is to support their families in the Philippines. In
fact, in a survey conducted among nurse candidates on their reasons for goingto Japan, all of them responded, “I wish to support my family financially”(Hirano, Ogawa, and Ohno 2012). The double-standard employment is
disadvantageous to Filipino nurses on two levels: (a) they cannot performtheir nursing competency, and (b) even if they could so, they cannot earn
the same amount as Japanese nurses. This predicament seems to discourage
Filipino nurses from working and studying to pass the NBE, earn more as anurse, and stay in Japan longer if they wish.
As a consequence, such double-standard employment negatively
affects not only the Filipino nurses who send remittances to their families,
but also the government of the Philippines, which sends nurses as a bid tocompete in the global care sector. This will be explained in the following
section.
Reaction of Filipino Nurses
The double-standard employment under JPEPA does not allow
Filipino nurses to realize their professional potential until they pass the
NBE in Japanese. Generally speaking, Filipino nurses have less
opportunities to learn Nihongo because of the limited number of language
courses in the Philippine nursing curricula, which give more emphasis on
nursing practicum than on general education, including language studies(Kawaguchi 2009). One can thus assume that most of the Filipino EPA
nurses have no or little opportunities to learn Japanese in college. Thus, it
is not too difficult to imagine how hard it could be for most of the Filipino
EPA nurses to pass the NBE in a language they barely know. Intensive andextensive Japanese language training and a strong will to accomplish theirgoal are essential for them to pass the NBE.8 Nonetheless, are Filipino
nurses informed of the fact that the examination they would take isconducted in Japanese and that they would have to pass it within the first
three years after their entry to Japan?

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A Filipino nurse from the first batch of EPA nurses in Japan told theauthor how alarmed she was when she heard that the national examinationis conducted in Japanese.
I was so surprised to hear that I have to take the examination in
Japanese. I have never studied Japanese before I came [to Japan], so
how could I pass it? … I thought Japanese doctors could speak English[so there is no need for us to speak Japanese]. (Ms. A)

It was only when she started her intensive Japanese language course
in Japan that she learned that she would have to take the NBE in Nihongo.
Before she entered Japan, she was optimistic that Japanese doctors could
speak English and that English is used in clinical settings. She also mentionedthat when she was in Saudi Arabia, doctors spoke English well, and in caseshe needed to communicate with non-English-speaking patients, the hospitalprovided an English-Arabic interpreter. She expected the same with Japanesehospitals, but having an English-Japanese interpreter is very rare in Japan.
The first batch of EPA nurses received the least orientation. The authorof this noticed that the orientation given by the Philippine Overseas
Employment Administration (POEA) to the first batch focused more on
Japanese customs and culture, and very little on the working conditions inJapan and the job description of a nurse in the country (Hirano 2009).
Encouraged by the Japanese ambassador to the Philippines who saw them as“diplomats who contribute to the friendship between the Republic of thePhilippines and Japan,” the Filipino nurses must have felt proud of being
chosen to represent their country. However, it seemed that given a limited
time to prepare and dispatch the first batch of nurses to Japan, the POEA did
not have enough time to discuss details with the Japan International Corporationof Welfare Services (JICWELS), Japan’s placement agency, and to completelyorient the first batch of Filipino nurses about the preconditions for working inJapan—particularly the difference between a work permit and a license.
The weak point of the “government to government” (G-to-G) project,such as JPEPA, is that the officials in both sending and receiving countries

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are constrained by other administrative responsibilities. In other words,
they are committed foremost to the implementation of the agreement
without deviating from its provisions once it is signed. If Filipino nurses
were well informed about the requirement—to pass the NBE in a language
they know little about—they might not have applied for the program in
the first place or they could have withdrawn before departure, to theembarrassment of the Philippine government. Therefore, it is speculated
that an unpleasant side of this program was not clearly explained by thePhilippine government to the first batch of EPA nurses prior to their entry
to Japan.9
One can assume that such situation was tragic for Filipino nurses,
especially for the first few batches, who were not prepped for the “doublestandard employment.” In a separate article, the author quoted a nurse
from the second batch who was about to leave for Japan. Asked what she
would be like in the next five years, she answered that she hoped to passthe NBE and become a chief nurse in Japan (Hirano, Ogawa, and Ohno2010). Considering the low passing rate in the examination, for which she
must have prepared hard in the following years in Japan, her future vision
was clearly too optimistic.
Filipino nurses working in Japan have lesser opportunities to performtheir nursing competencies. A Filipino nurse from the first batch shared
how she felt when she was employed as a nurse candidate.10
I am a nurse in the Philippines, and I can perform an IV [intravenous
injection]. I feel dejected when I see freshly licensed Japanese nurses
giving IV to patients. I can do it better than they [the Japanese
fresh nurses].… Unfortunately, we are not treated equally due tohaving not passed the national examination for nurses in Japanese,
yet … (Ms. B)

Ms B. evoked her struggles in not being treated as an equal of theJapanese nurses, just because she had yet to obtain a nursing license inJapan. As a nurse who had worked for more than five years prior toVolume 52: 2 (2016)

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participating in JPEPA, she felt useless by not being respected for hercompetency, which is praised in her home country. Competency, which values
what a nurse can actually do in clinical settings, is stressed in recent healthprofessional education, including nursing (The Lancet 2010).
For Filipino nurses, being treated as nurse candidates brings about
not only a professional crisis but also financial one. Another Filipino nurse
from the first batch described her situation as follows:[Before we pass the examination] we are paid less [than the Japanesenurses]. I feel sorry that I can hardly send money to my family (in thePhilippines) now.… I am considering moving to a different country towork, in order to earn more money. (Ms. C)

As mentioned earlier, the primary motivation of Filipino nurses inworking abroad is usually to earn more and help support their family. If they
fail to send enough financial support, then they would feel guilty. It appears
from the narrative that some candidates who cannot manage to support theirfamily may opt to terminate their contract in Japan and move to a different
country. This will not only be disadvantageous to their career development as
a nurse; it could also even affect the sustainability of the EPA system, whichaims to train foreign nurses to work in Japan, so that they could obtain alicense and continue working long-term in the country (Ministry of Health,
Labor and Welfare 2016). In order to achieve this goal, the Japanese
government demanded a budgetary appropriation of 380 million yen for the
language education of EPA nurses and certified care workers for fiscal year
2016 (Ministry of Health, Labor and Welfare 2015). After all, the EPA programis a G-to-G project.
It is safe to suggest that the Filipino nurses’ inclination to move toanother country indicates that Japan has become a less attractive country
as a work destination for Filipino nurses. Whether or not Filipino nurses
are provided opportunities to exercise their professional knowledge andskills is a decisively important issue.

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Reaction of the Hospitals R
eceiving EP
A Candidates
Receiving
EPA
The double-standard employment under JPEPA confuses not only
Filipino nurses and their country but also Japanese hospitals and medical
institutions receiving EPA nurses. That is because the receiving hospitals
cannot count them as nurses until they pass the NBE, and satisfy the standard
nurse per patient ratio.11 In addition, receiving hospitals are required torender additional tasks to support the candidates’ learning in order for themto pass the examination. Supporting nurse candidates is not easy for thereceiving hospitals. As a Japanese preceptor to Filipino nurses said,[After taking a six-month Japanese language course,] nurses seem tounderstand what we say in simple Japanese. However, when theconversation becomes a little complicated, they start to get confused, so
we have to say the same thing in simple Japanese. … we are not Japanese
language teachers, but we have to teach them Japanese language by
spending extra hours aside from our hectic [nursing tasks]. (Ms. D)

This staff nurse confessed that it was difficult to support Filipino
nurses as this meant “additional work” from her colleagues who alreadyhad hectic schedules. Such difficulty was largely attributed to the limited
Japanese language proficiency of Filipino nurses, who were then given
only a six-month Japanese language training after entering Japan.12 Somereceiving hospitals prepared a custom-made Japanese-English dictionaryof technical terms and jargons used in clinical settings. To help thecandidates prepare for the NBE, they developed monthly curricula for theFilipino nurses13 (Hirano 2009). Some hospitals employed one or more
additional staff mostly retired nurses, to take the responsibility of training
foreign nurses. The cost per head that hospitals have shouldered was 13.6
million yen (Tsubota et al. 2015), which includes salary, staff labor, variable
expenses, and fixed costs. These hospitals need not shoulder these extra
expenses if they hire Japanese licensed nurses who could fully exercise
their professional skills upon employment. This situation with the EPA
candidates, however, caused economic and psychological burdens to thepersons concerned (Hirano and Tsubota 2016).

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There were contrasting ways in which hospitals dealt with EPA
nurses. One hospital bore the economic and psychological costs as an“investment,” so that the hospital can encourage nurse candidates toconcentrate on their study. The other hospital, especially the director, was
not pleased to accept foreign nurses and thus was less interested insupporting them.
The former case, hereafter referred to as “Hospital A,” announces
the successful cases of foreign nurses who pass the NBE every year. According
to a head nurse, the director was very proactive in providing tangible as wellas emotional support to foreign nurses. For example, he bought copies of areview book of the NBE, which includes the exams from the past five years,14
gave each of the foreign nurses a copy, and asked them to solve thirty questions
per day. He also asked for the cooperation and understanding of the headnurse and chief clerks of all the divisions in the hospital—including thepharmacy division and laboratories (Hirano 2010b). This would be later
helpful to the foreign nurses, when they needed to ask questions on special
fields, such as pharmacology or inspection sciences. Foreign nurses in
Hospital A work as assistant nurses from 8:30 a.m. to 12:30 p.m., Monday
to Friday, and were given four hours in the afternoon to study for the NBE,
including two hours of tutorial conducted by the head nurse, staff nurses, or
special instructors hired by the hospital. The time they were given to study
was not long enough, compared to other hospitals.15 At any rate, the authorof this article assumes that several factors helped the candidates pass the
NBE. First, the hospital gave every candidate sufficient emotional andtangible support, which was truly appreciated. A Filipino nurse who passed
the NBE in her second trial said that she studied very hard to reciprocate thegenerous assistance. Second, the hospital shouldered the cost of 2 million
yen per foreign nurse, including tuition for special instructors, in addition
to the scholarship program they offer to Japanese nursing students, whichcosts about 3-4 million yen per head. The hospital considers the cost an“investment,” which can be beneficial in return, if they pass the NBE.
In the latter case, hereafter referred to as “Hospital B,” nurse
candidates worked full time from 8:30 a.m. to 5:30 p.m., and an hour was

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given as a “study hour” after work. However, the director of the hospital
did not agree to employ special instructors for Japanese language training.
Through an in-depth interview with a head nurse of the hospital, amultifaceted bureaucratic construction of JPEPA in relation to therecruitment of Filipino nurses, has emerged.
Q. There is a government subsidy that hospitals can apply for by
sending an application through JICWELS as you may know. Has this
hospital applied for this subsidy?
A. No. Not yet. The director mentioned that there is no need to doso. He told us to leave them as they are, and that we do not need it.
Q. Why do you think he said such a thing?
A. I do not know. He never pays attention to the foreign nurses. It
seems that he has no interest in them.
Q. Then why did he decide to accept EPA nurses?
A. Well, he said that the MHLW asked him to accept EPA nurses. He isa member of a committee in the MHLW, and owing to this connection,
the MHLW asked him to do so.… He did not even ask our opinion
about employing EPA nurses. All he said was, “I decided to employ EPA
nurses.”… And all the tasks and responsibilities have fallen onto us[nurses]. The mass media report that EPA nurses are pitiful because
they need to pass the NBE without sufficient Japanese language support[from receiving hospitals], but actually we [nurses] are also the victims!
(Ms. E, a head nurse for Filipino nurses in Hospital B)

The interview above refers to a subsidy offered by the MHLW in orderto support hospitals in dealing with the candidates’ linguistic problems. It
could be used either to hire Japanese language tutors or to pay for Japanese
language courses. Starting in fiscal year 2010, the MHLW pays an annual
subsidy of 295,000 yen for each hospital that accepts one or more nurse
candidates, and 117,000 yen per candidate every year to cover their training
expenses (Japan Times 2010). Hospital B had a total of seven foreign nurses
at that time, including two Filipino nurses; thus, the subsidy they would receive

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may at least reduce the economic burden of supporting the nurses. The headnurse asked the director of the hospital to apply for the government subsidy,
so that they could support the foreign nurses more easily. They only had tosubmit an application form through JICWELS, with the permission of thedirector, to apply for the subsidy. However, no matter how hard the headnurse tried to persuade the hospital director, he did not pay any attention to
her advice.16 A robust hierarchal system among the hospital staff—the director
positioned at the top, and foreign nurses possibly lower than Japanese nurses—
does exist in this hospital. In the system, the director has absolute power indecision making and hospital management. Without support from the director,
Filipino nurse candidates in Hospital B, including Ms. F below, lost the
motivation to study hard for the NBE and ended up returning home withoutobtaining a license. This makes an apparent contrast to their counterpart in
Hospital A. Ms F. had compromised her profession; she would just work as anurse candidate until her contract expires. To her, as long as she could earn acertain amount as a nurse candidate, that was better than nothing.17
We were not given any enough time, enough support [to pass theNBE]. At the beginning, I tried hard to study for the NBE, but without
help from the hospital, I can hardly pass it. Finally I gave up becominga registered nurse in Japan. I will work here—since it is better thanearning nothing—until the termination of the contract, and go home tolook for another job in another country. (Ms. F, a Filipino nurse fromthe first batch in Hospital B)

However, it is noted that the indifference of the director of Hospital
B to the situation of foreign nurses, which resulted in the disappointmentof the nurse candidates like Ms. F, can be interpreted as the director’ssilent resistance against the bureaucratic procedure of the MHLW in
recruiting hospitals that accept foreign nurses for JPEPA.
In the initial stages of the implementation of the EPAs on foreign
nurses, the MHLW had a hard time recruiting “volunteer” hospitals to receive
foreign nurses. Many hospitals were hesitant to employ foreign nurses who

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lack Japanese language proficiency, especially in a double-standard
employment setting.18 Nurse candidates with little Japanese language
proficiency could not work even as trainees without the help of Japanesenurses. Therefore, supporting candidates were in some cases a psychologicalburden for receiving hospitals (Hirano and Tsubota 2016). On another level,
however, for some hospitals—especially privately owned ones such as
Hospital B—the MHLW’s inquiry must have been felt as a pressure. The
directors would have been only obliged to reply to the inquiry positively.
Here, interestingly, one can observe another layer of hierarchy above thedirectors—the relationship between the MHLW and the hospitals.
It has been observed that several hospitals that employed EPA nurse
candidates did not provide necessary training and support. In this picture,
we must notice that there are many “victims.” The first are the foreign
nurses, who received no attention from the directors. Second are the headnurses and the nursing staff, who ought to support foreign nurses but were
not given institutional assistance—exemplified by the rejection of therequests, proposals, and suggestions—by a director, who holds absolute
power in managing a hospital. Nonetheless, I argue that the hospital
directors themselves are victims. They are affected by demanding
bureaucrats who prioritize saving the face of the Japanese government
before the officials of the sending countries; the bureucrats preseted acertain (or enough) number of hospitals that employ EPA nurse
candidates at the time when many hospitals were skeptical about thefeasibility of the EPAs (Ogawa et al. 2010).19 Insisting that the EPA’s
MNP provisions, particularly those on nurses and certified care workers,
were devised from inputs of the nurse-sending countries, the MHLW
claims that it is only responsible for preparing enough number of job
offers that match the number of jobs seekers as demanded by the nursesending countries. In this logic, once a labor contract between a nurse
and a hospital is signed, the responsibilities to support the foreign nurse
are handed over to the receiving hospitals. Though some foreign nurses
are not diligent enough to pass the NBE, the MHLW insists that it is not
responsible for such matters.

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Conclusion: T
ow ar
d a Successful JPEPA
To
ard
Successful
JPEPA
The double-standard employment regulated by JPEPA guarantees
Filipino nurses the right to be employed in Japan. However, as healthprofessionals, Filipino nurses are not satisfied with mere employment by
hospitals or medical institutions because there is no guarantee that they
can “fully practice the nursing profession” (PNA 2007) until they pass the
NBE. The double standard in employment resulted in the double standard
in the nursing practice that they were allowed to do (Ms. B) or in thecompensation they obtained through the practice (Ms. C). Both situations
frustrated the Filipino nurses and their Japanese peers, for whom supporting
a nurse candidate entailed additional work, as mentioned by a Japanese
staff nurse, Ms. D. Accepting foreign nurses has depended on thephilanthropic commitment of hospital staff who work hard as “volunteers.”
Some job offerings are even merely “gestures” to please the bureaucrats,
as mentioned by Ms. E.20 One must notice that such gestures by a hospital
may not translate to support for the foreign nurse candidates; in worse cases
like Hospital B, they end up receiving no assistance at all. Such employment
is likely to disappoint foreign nurse candidates; with no hope of passing,
they are discouraged from studying the Japanese language and reviewing
for the NBE, as in the case of Ms. F.
Even after the Japanese government extended the duration of theJapanese language training program,21 the system of double-standard
employment persists because the overall framework of EPAs is governed by
WTO regulations, which prioritize the liberalization of trade in services overthe deregulation of services. In this framework, matters pertaining tomigration are out of the scope of the EPAs, despite the fact that the agreement
involves actual movement of persons. In view of such limitations, the terms
under JPEPA regulating the migration of Filipino nurses to Japan are worth
a genuine review. Otherwise, some hospitals may opt to employ foreign
nurses merely as cheap labor, and such hospitals are likely to provide
insufficient support for nurse candidates to save costs. It is safe to predict thatsuch hospitals will recruit nurses who are not well motivated to pass the

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NBE but willing to work merely as nurse assistants, and thus earn a lesser
amount. A salary of180,000 yen per month is still higher than Filipino
nurses’ earnings in the Philippines, anyway. But this is not the goal of JPEPA.
As the MHLW proclaims, the program is intended to train foreign nurses towork in Japan by obtaining a licentiate in Japan.
Unlike other sections referring to trade commodities, the MNP
section of JPEPA concerns human beings, which cannot be treated likecommodities. The provisions on the movement of health professionals
under the MNP section attracted the attention of the mass media and thegeneral public in both Japan and the Philippines. That Japan opened its
labor market was seen as epoch-making (although the MHLW has insisted
that the section has nothing to do with the opening of the labor market
but is merely a part of the trade agreement whose purpose is the promotionof free trade). The provision was even politicized, as manifested in the
PNA statement. Nurses are not commodities. They are human beings—
individuals who take pride in their profession. They wish to develop theirown career, while being conscious of the responsibility to support theirfamilies financially. For both the sending and receiving countries to benefit
from the program, it is suggested that we pay more attention to the humanaspects thereof. If it is inevitable that the movement of nurses is includedin the EPA for the enhancement of bilateral relations and trade, the programthat implements its provisions must be so crafted that each nurse is treatedas an individual citizen in terms of his/her value and socioeconomic
situation (e.g., career path, family life, etc.) and not as economic goods
A cknowledgements
cknowledgements
The author thanks Victoria Quimbo for her advice on trade matters,
particularly on the WTO.

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Notes
1

2

3

4

5

6

7

8

9

The English version of JPEPA can be accessed from the following website: http://www.mofa.go.jp/region/asia-paci/philippine/epa0609/main.pdf .
GATS contains four modes under the MNP section. Mode 1 refers to cross-border supply,
which covers a service supplied from the territory of one WTO member into the territoryof another WTO member. Mode 2 refers to consumption abroad, which involves a
service supplied in the territory of one WTO member to the service consumer of another
WTO member. Mode 3 refers to commercial presence, which involves the flow of capitalfrom one WTO member to another for the purpose of establishing a business to provide
a service.
For the details, see Japan-Philippines Economic Partnership Agreement (JPEPA 2009).
The document (PDF) is entitled, “The Agreement between Japan and the Republic of thePhilippines for an Economic Partnership” but is also known as JPEPA.
For certified care workers, they are given only one chance to take the national examination
within four years after their entry. This condition is according to the regulation of theCertified Social Worker and Certified Care Worker Law in Japan.
With 694,000 members, the JNA seems to be one of the strongest pressure groups
influencing the Ministry of Health, Labour and Welfare (MHLW). The JNA insisted on
the following four preconditions for foreign nurses: (1) to pass the NBE for nurses inJapanese language, (2) to obtain a proficient enough Japanese language ability to provide
care safely, (3) to be employed under the same conditions as Japanese nurses, and (4) not
to admit mutual recognition of license (Okaya 2005). These preconditions were all
included by the MHLW in the JPEPA negotiation.
See JPEPA (2009), chapter 6. The document (PDF) is entitled, “The Agreement between
Japan and the Republic of the Philippines for an Economic Partnership” but is also known
as JPEPA.
According to the calculation by a Japanese think tank based on the Basic Survey on Wage
Structure (Chingin kouzou kihon toukei chousa) of the MHLW.
This was proven by the higher passing rate of Vietnamese nurses in March 2016. The
passing rate of the Vietnamese was 41 percent, while that of Filipinos was 11 percent.
One of the crucial factors contributing to the passing rate, the author of this article
assumes, is the precondition for entering Japan. Under the Japan-Vietnam Economic
Partnership Agreement, obtaining an N3 level of Japanese Language Proficiency Test
(JLPT) is a precondition for entry to Japan.
The author attended predeparture orientations from the first batch to the latest (eighthbatch) in 2016 and found that the atmosphere of the orientation has changed drastically.
JICWELS officers clearly explained the precondition for working in Japan as a nurse—
namely, passing the national examination in the Japanese language. A JICWELS official
told the author that the conduct of such orientation was demanded by the receiving
hospitals. Some hospitals were disappointed with the attitude of some of the Filipino
nurses who were not motivated to work and study hard to pass the examination. This
fact is also reported in the author’s survey (Hirano et al. 2010).

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11

12

13

14

15

17
18

19

20

21

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“Nurse candidate” is the term used for nurses who enter Japan under the EPA programs
but have yet to pass the NBE.
Medical service fee regulated by the Medical Care Act will be paid in accordance to anurse per patient ratio of each hospital. The lower a nurse per patient ratio the hospital
allocates, the higher the fee that the hospital receives.
The first and second batches of Filipino nurses were given only a six-month Japanese
language training period. Upon request from the Philippines, the Japanese government
extended the length of the Japanese language training to two months (predeparture
training) for the third batch. The six-month predeparture language training started fromthe fourth batch that entered Japan in 2012, in addition to the six-month postentry
training.
This hospital also applied the same curricula for the training of a Filipino nurse who
would be accepted the following year.
The NBE for nurses composed of 240 questions. For details, see Kawaguchi’s article inthis special issue.
Some hospitals allocate almost all morning or afternoon for study hours (interviewed in
November 2010).
Interviewed October 2010.
According to the author’s previous study, a nationwide survey on the acceptance of
foreign nurses among hospitals in Japan, 61.7 percent answered that they were not or
likely not to accept foreign nurse candidates under the EPA program (Kawaguchi et al.
2009).
A study by Ogawa et al. is based on a survey of hospitals and long-term care facilities
that accepted the first batch of Indonesian nurses and certified care workers. The data
introduced to this study were comments on the EPA system that are common to theJapan-Indonesia Economic Partnership Agreement and JPEPA.
This was particularly true in the case of the hospitals that received foreign nurses at theinitial stage of the implementation of the EPAs, when there was only limited support
offered by the Japanese government. It has been eight years since Japan started receiving
foreign nurses. Today, with better, though far from sufficient, support from the Japanese
government, many hospitals are more proactively recruiting foreign nurses. Some hospitals
recruit foreign nurses as part of a management strategy—that is, preparing for the global
outreach of medical market, which the Prime Minister Abe’s cabinet is currently promoting
under the “Japan Revitalization Strategy” (Prime Minister and His Cabinet 2013)
See note 11.

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