7Chronic First Aid: The Scheme for
the Movement of Filipino Nurses
under the Japan-Philippines Economic
Partnership Agreement (JPEPA),
2009–2016
Shun OHNOa
Michiyo YONENO-REYESb
Yuko O. HIRANOc
Abstract
This article surveys the trajectory of the problematic implementationof, and later amendments to, the Japan-Philippines Economic Partnership
Agreement (JPEPA)’s Movement of Natural Persons provisions between
2009 and 2016, with reference to the Japan-Indonesia Economic
Partnership Agreement (JIEPA) and the Japan-Vietnam Economic
Partnership Agreement (JVEPA). It draws on official documents of the
Ministry of Foreign Affairs of Japan (MOFA), the Ministry of Health,Labour and Welfare of Japan (MHLW), Japan International Corporationof Welfare Services (JICWELS), and the Philippine Overseas
Employment Administration (POEA), among others, as well as astructured survey conducted among the Japanese employers who
accepted the first batch of Filipino EPA nurse candidates in 2011, a year
after the deployment of Filipino nurses. The study is based on formal
and informal interviews since the early 200s with the government
officers of the pertaining countries, EPA nurse candidates, and Japanese
language education experts. In addition, the paper refers to the recently
introduced English proficiency standard for foreign nurse applicants inAustralia to reflect on Japanese language requirements in the EPA-MNPabc

Chair and Professor, Department of Global Citizenship Studies, Seisen University, Tokyo
Visiting Fellow, University of Tokyo
Professor, Graduate School of Biomedical Sciences, Nagasaki University

1 2 (2016)
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scheme. This study identified the learning of the Japanese language —and the difficulties thereof—as a key element of the scheme, and showsthat a series of merely short-term amendments have been made toaddress the issues. The article concludes by suggesting a more systematicmanagement of the EPA-MNP scheme, especially in matters concerning
Japanese language training.
Keywords: JPEPA, Filipino nurse migration, migration policy of Japan,
movement of natural persons, Japanese language for foreign workers

Introduction
By the end of 2016, Japan will have established fifteen economic
partnership agreements (EPAs) and one free trade agreement (FTA).
Generally speaking, EPAs promote free trade and other areas of economic
cooperation, such as investment and the protection of intellectual property
rights. Japan has signed ten EPAs with Asian countries. These include thePhilippines (Japan-Philippines Economic Partnership Agreement, or
JPEPA, 2006), Indonesia (Japan-Indonesia Economic Partnership
Agreement, or JIEPA, 2007) and Vietnam (Japan-Vietnam Economic
Partnership Agreement, or JVEPA, 2008). All these EPAs are consideredhistorically remarkable for the provisions on the “movement of natural
persons” (MNP). Through the MNP scheme, qualified nurses andcareworkers from counterpart countries can work in Japan under designatedconditions.1 In the early 2000s, mere news of the possible opening ofJapan’s labor market in health and care service under EPA was received
with excitement by the sending countries. In diplomatic negotiations for
the EPA, both Philippine and Indonesian governments expected that the
EPA would provide their health-related workers an opportunity to workin Japan, one of the most graying countries in the world.2 Indeed, boththe Philippines and Indonesia strongly demanded that the EPA include
provisions that would facilitate the mobility of their health care workers toJapan.3 With these EPAs, Japan de facto opened its labor market in nursing
and caregiving to foreigners, while meticulously controlling the scheme

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and consistently claiming that the program promotes international goodwill,
and that it is not a solution to a labor shortage. In doing so, Japan retains
the closed-door policy to foreign workers in principle (Vogt 2007, 2013;
Chiavacci 2012).
The Japanese Nursing Association (JNA) was reluctant to receive
foreign colleagues.4 The JNA insisted that introducing foreign nurses under
the MNP provisions of the EPA must not push unless until the job securityof Japanese nurses was protected. According to Okaya (2005), then amember of the Board of Directors of JNA, the association proclaimed thefollowing six preconditions in receiving foreign nurses in Japan: 1) foreign
nurses must pass the National Board Examination for nurses (hereafterNBE) in Japan to become a registered nurse; 2) foreign nurses must acquiresufficient Japanese language proficiency as they provide care; 3) foreign
nurses must sign the contract which stipulates that they work under thesame working conditions as Japanese nurses; 4) Japan must not agree tothe mutual recognition of nursing licenses from sending countries; 5) theJapanese government must monitor the working conditions of foreign nurses
in order to prevent medical accidents; and 6) the Japanese government
must supervise an agency which protects both foreign nurses and receiving
hospitals from possible exploitation.
Obviously, the JNA was not against the MNP provisions per se, but
insisted on the protection of the human rights, particularly the working
conditions, of foreign nurses and the safety of their patients. The JNA
feared that the entry of foreign nurses to Japan’s labor market might evenexacerbate the already adverse working conditions of Japanese nurses.
They were also afraid that the influx of foreigners might affect the highquality of services that Japanese nurses prided themselves on. At the endof the day, those proposed preconditions were largely incorporated in theimplementation scheme of the EPA-MNP provisions.
Similarly, the Japan Medical Association (JMA) opposed the MNP
provisions of the EPAs. They particularly (1) did not want to have the amutual recognition of nursing licenses; and 2) would only admit foreign

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nurses who pass the NBE in the Japanese language. The JMA also opposed
the relaxation of regulations in the medical and health industries, whichmight affect the safety of patients. The JMA further insisted that it is thestate’s responsibility to train nurses (i.e., regulating nursing education) andthat Japan must prioritize strengthening nursing education in the country
before receiving foreign nurses (Nihon Ishi Kai [Japan Medical Association]2012).
In contrast, the Japan Business Federation (Nihon Keizai Dantai
Rengokai [Keidanren]) supported the MNP provision of the EPA. As earlyas 2004, Kiyoaki Shimagami, then Chairperson of Taskforce for
Promotion of EPA of the Federation, said, “Facilitating the cross-border
movement of natural persons is important for many reasons. Foreign
workers would contribute to the generation of dynamic, multicultural anddiversified environment necessary for the revitalization of the Japanese
economy.” The Federation also suggested that Japan relax regulations inorder to help foreign nurses take the NBE and become a registered nurse
in the country (Nihon Keizai Dantai Rengokai [Keidanren] 2004).
In summary, professional associations are more concerned about
avoiding medical accidents that could cause serious injuries or even deaths,
while the business community, represented by Keidanren, stresses the aspectof the government’s deregulation of the labor market to allow foreigners.
Despite their different positions over the employment of foreign nurses,
all three aforementioned organizations recognized the importance of one
factor: that foreign nurses acquire proficiency in the Japanese language.
Indifference to, and/or because of, the objections from the nursing
and medical associations, the Japanese government proposed to receive
only a limited number of foreign nurses (and careworkers) from Indonesia
and the Philippines. During diplomatic negotiations for EPAs, the Japanese
government took advantage of the strong demand of its Southeast Asianpartners to open the labor market, so as to be able to demand in exchange,enhanced free trade, and to limited quotas to protect the domestic labormarket for nurses (Asato 2007, 39).5

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The Japanese government pushed through with the diplomaticnegotiations in the 2000s, ignoring the strong opposition of major
professional associations in medicine and nursing. It is safe to suggest theJapanese government prioritized free trade with each partner country
through EPAs over the protection of the working conditions of nurses (ofboth foreign and Japanese) and the benefits of the hospitals that accept
foreign nurses.6 This is alarming because of the possible adverse effects inclinical settings. In connection to that, opposition groups in the Philippines
like the Junk JPEPA Movement raised concerns about the inequality ofthe treaty and called attention to the working conditions (possible
exploitation, deskilling, maltreatment) of Filipino nurses/careworkers inJapan.7 The fundamental issue here is that this government-to-government,
de facto labor migration program is crafted under bilateral economic
agreements for the promotion of free trade. At least, the official records ofthe bilateral negotiations between the Philippines and Japan show thatboth governments paid little attention to the nature of the profession.8,9
Nurses are professionals who deal with peoples’ health and lives. Thus,
language skills, in addition to professional competencies, are crucial. The
movement of nurses should not have been treated merely as a matter of
exchange under free trade, or as an issue of manpower quantity; it shouldhave also been considered in terms of qualifications and the quality ofservices. Furthermore, apart from working conditions and professional
qualifications, candidates will have to live and cope with an entirely different
society and way of life in Japan. At least, minimum comfort needs to beguaranteed.
Despite the importance of language, Japanese language education
experts were hardly involved in the decision-making process. Thus, thescheme, for which Japanese linguistic competency is vital, was formulated
without logical basis (Nunoo 2016).10 It is regrettable that no sufficientfeasibility studies on the implementation of the MNP provisions—e.g.,
crafting a decent scheme of implementation from matching system toJapanese language training—were conducted. No time was spared forVolume 52: 2 (2016)

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S. OHNO, M. YONENO-REYES & Y. HIRANO

preparations (e.g., by granting a grace period for deployment), and aJapanese government official admitted that it would have been better if
there were enough preparations.11
In early 2008, the JIEPA took effect. Subsequently, the applicationof Indonesian nurse and careworker candidates was called, and they
were deployed to Japan in August 2008 after computerized matching.
Similarly, as soon as JPEPA was ratified by the Philippines in late 2008,
the deployment of the first batch of Filipino candidates began in May
2009. 12
Unsurprisingly, as deployment began without enough preparations,
all parties involved—candidates, hospital managers and staff, Japanese
language teachers, government officers, and even volunteer supporters—
faced serious challenges, which invited criticisms from politicians, mass
media, and the general public. To respond to complaints and requests
from candidates and their employers, the Japanese government has mademinor amendments to the scheme several times (e.g., special considerationsin the NBE) in the past nine years (early 2008–late 2016). In addition, theJapan International Corporation of Welfare Services (JICWELS)—asemigovernmental organization under the Ministry of Health, Labour andWelfare, and responsible for the implementation of the provisions on nurses
and careworkers of EPA-MNP—has also crafted some measures to facilitate
the training of nurse candidates (e.g., consultations, seminars for nurse
candidates, a manual for hospitals); they extend support for both hospitals
and candidates. But each of these measures has been done only on an
immediate, ad-hoc basis, without systematic (e.g., short-, mid- and longterm) planning and direction.
This article sheds light on such a disturbing situation. It asks how
the MNP scheme under JPEPA has been managed since 2009 and describes
the fundamental problem in the implementation of the scheme. In doingso, it surveys the trajectory of the implementation of, and amendments to,
JPEPA’s MNP scheme between 2009 and 2016, with reference also to
JIEPA and JVEPA. Official documents of the Ministry of Foreign Affairs

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of Japan (MOFA), the Ministry of Health, Labour and Welfare of Japan(MHLW), Japan International Corporation of Welfare Services (JICWELS),
and the Philippine Overseas Employment Administration (POEA), among
others, were consulted.
Also consulted was the result of a structured survey conducted among
the Japanese employers who accepted the first batch of Filipino EPA nurse
candidates in 2011, a year after the deployment of Filipino nurses.13 For
this survey, the anonymous questionnaire assessed the Filipino nurses andsought to determine changes in the workplace after the hospitals received
Filipino nurses. The questionnaire was distributed to 45 hospitals, and 30
hospitals responded (Return rate: 66.6 percent). In addition, the authors
used the results of a survey, conducted between 2009 and 2016, of thenurse candidates. The survey was conducted at the POEA just before theirdeparture each year; the total number of respondents is 475.14
The authors also obtained data from formal and informal interviews
with the government officers of the pertaining countries, EPA nurse
candidates, Japanese language education experts since the early 2000s. In
addition, to reflect on Japanese language requirements in the EPA-MNP
scheme, the authors referenced the recently introduced English proficiency
standard for foreign nurse applications in Australia, as well official
documents and key interviews conducted in 2011 in that country. In thefollowing sections, the paper presents statistics on, and the historicalbackground of, the prominence of Filipino nurses outside the Philippines,
including Japan. It then follows the trajectory of the implementation of
the EPA-MNP scheme in its early years (e.g., 2009–2011); the assessmentby the hospitals of the first batch Filipino nurses who entered Japan in2009 (conducted in 2011); the expansion of Japanese language training
since 2011; and the entry of Vietnamese EPA nurses in 2014 and theirhigh passing rate. The article concludes by suggesting a more systematicmanagement of the EPA-MNP scheme for nurses, especially in mattersconcerning Japanese language training.

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S. OHNO, M. YONENO-REYES & Y. HIRANOInternational Migration of Filipino Nurses
Among scholars of migration studies, there is more or less a
consensus that the Philippines is a “sending country” that has a diversityof migrants (from skilled to nonskilled occupations) in various destinations(about 190 countries) (e.g., Castles and Miller 2013). As of 2016, overten million Filipinos are working or living outside the country (Asis 2017).
Although the destinations of Filipino nurses have diversified in recent
years, many of them still prefer to work in English-speaking countries,
such as the United States, the United Kingdom, Canada, and Singapore(Figure 1). In the Philippines, nursing education has been conducted in
English since the early twentieth century under American colonial rule.15
In 2016, 19,551 Filipino nurses were deployed overseas (POEA n.d.).
Having received nursing training primarily in English and familiar withfellow nurses in English-speaking countries, it is easy to imagine howchallenging it must be for Filipino nurses to have to master the Japanese
language and work in Japan. At the same time, it was likewise difficult forJapanese employers to accept foreign nurses who had been trained undera non-Japanese nursing curriculum and had little knowledge of Nihongo.
Figure 1 shows the number of Filipino nurses deployed to major
destination countries from 2000 to 2010, according to the Philippine
Overseas Employment Administration (POEA).16 It is noted that it excludes
nurses deployed outside official channels and that there probably exists a
discrepancy between the official figure and the actual number of those
deployed.17 Despite these limitations, this graph is informative. It tells usthat popular destinations of Filipino nurses are English-speaking countries,
including Saudi Arabia. The numbers who were deployed there rose evenmore than 6,000 after 2007. It also implies that the number of Filipino
nurses deployed to different countries changes each year according tocountry, depending, presumably, on labor market conditions in the hostcountries and in the Philippines. For instance, the figures reflect that theUnited Kingdom, which once actively hired Filipino nurses in 2001
through formal channels, did not do so in the following years. This is

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presumably because the United Kingdom began to prioritize migrantnurses from the other countries of the European Union (EU). Indeed, thenumber of Filipino nurses entering the UK through formal channels sharply
dropped from 6,949 in 2001 to 3,633 in 2002. Also, the United States
tightened the border security measures after the 11 September terrorist
attacks in 2001. In addition, due to an economic recession, the UnitedStates prioritized American nurses and restricted the entry of migrant nurses,
especially after 2006, when the key source countries of internationallyeducated nurses, namely the Philippines, India, and China, were clearing
the backlog for the Employment-based slots (Masselink and Jones 2014).
FIGURE 1
Transition of the number of Filipino nurses deployed abroad through official
channels by country, 2000–2010 (Source: POEA 2001–2011)

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The movement of Filipino nurses to Japan goes against historicalnorms: a) it is a movement of medical professionals, not unskilled workers;
and b) it is a flow from an English-speaking country to a non-English
speaking country.18 Expecting adult professionals to acquire a high levelof language proficiency in a minority language (in this case, Japanese)
within a limited time is unprecedented. The latest statistics by POEA indicatethat the number of Filipino nurses deployed abroad in 2016 was 19,551;
only 0.3 percent (60) were deployed to Japan, which ranked twelfth among
the countries that received Filipino nurses in the same year. Saudi Arabia
remains a predominant host country, employing 13,817, which isequivalent to more than 70 percent of all Filipino nurses deployed abroadin 2016 through formal channels. It is worth pointing out that West Asian
countries, where professional medical services are rendered in English,
have become popular destinations (POEA n.d.) (Table 1).
ovisions
A-MNP PrThe Scheme of the JPEPPro
JPEPA-MNP(Early Stage)
Table 1: Filipino nurses deployed abroad through official channels
by country, 2016 (Source: POEA n.d.)

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17

The JPEPA (2006) was the first scheme for Japan to officially allow
foreign (in this case Filipino) nurses to work long-term in the country, but it
was not implemented until 2009 because it was only ratified in late 2008.
Meanwhile, Indonesia was the first nation to implement such a scheme
through JIEPA (2007). The JVEPA was signed in 2008, but negotiations forthe additional scheme of the EPA-MNP began in 2010, and the first batchof Vietnamese nurses was deployed to Japan only in 2014.
In implementing the JPEPA-MNP provisions on nurses andcareworkers, all arrangements for the employment and placement of thecandidates are executed under the supervision of both governments. The
Philippine Overseas Employment Administration (POEA) manages theinitial screening, the computerized data-matching system, and theinterviews of Filipino applicants. The Japan International Corporation of
Welfare Services (JICWELS) coordinates with Japanese employers.19 After
FIGURE 2
Flow chart of receiving EPA nurse candidates in Japan by country(Source: MHLW 2017)
Indonesia

Entry
to
Japan

Same as Indonesia

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S. OHNO, M. YONENO-REYES & Y. HIRANO

both the applicant and employer agree to terms and conditions of training
and work, they sign the contract (Figure 2). The employer pays acommission fee (131,400 yen per candidate); a management fee (20,000
yen per candidate per annum; 10,000 yen per RN per annum) to
JICWELS; and 450 US dollars to POEA. In addition, the employer isobliged to pay a Japanese-language training institution around 360,000
yen per candidate (Kokusai Kosei Jigyodan [JICWELS] 2016a).
The first two batches of Filipino nurse and certified-careworker
candidates (those who entered Japan in 2009 and 2010) had limited
knowledge of Japan and the Japanese language and studied Nihongo forsix months at designated training institutions only after arrival. They received
stipends for accommodation and daily allowance during the training. The
Their employers, as well as the Japanese government shouldered theexpenses for the language lessons (ibid.).
After the six-month training in Japan, each candidate is dispatched
to a designated hospital. Until they pass the Japanese national board
examination for nurses (NBE), they are considered a “nurse candidate;”in that capacity, they are expected to work as an apprentice as they continue
studying the Japanese language and nursing practices, and reviewing for
the NBE. They also receive a salary equivalent to that of a Japanesecounterpart—in strict compliance with the Labor Standards Act andMinimum Wage Law. However, the scheme for the JPEPA-MNP
provisions is silent about what/who that counterpart is. Also, they do notprovide a unified standard of work conditions for candidates (e.g., housing,work, and study hours). 20 This has caused confusion and a sense of
unfairness among nurse candidates (see Añonuevo’s article in this volume).
Nurse candidates have a chance to take the NBE once a year for three
years. Candidates who passed the national examination will be recognized
as registered nurses (RN), and qualified to work in Japan with a “designatedactivity visa.” Once they become registered nurses, they have to receive
the same salary as that of Japanese. This is the uncompromising rule of
JPEPA (Kokusai Kosei Jigyodan [JICWELS] 2016b).

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19

In early 2010, when the first batch of Filipino nurse candidates
took the NBE for the first time, only one passed. The passing rate wasextremely low (1.7 percent). Also, none of the first batch of Indonesiannurse candidates passed the NBE on the first try (2009) and among them
only two made it in 2010 on the second attempt. The poor results elicited
harsh criticisms from Japanese politicians and mass media, whichunanimously pointed out the candidates’ limited Japanese language
proficiency.21 Indeed, the six-month language training is not enough forforeign nurses to master Japanese and work in clinical settings. It is eveninsufficient for foreign candidates just to understand the questions in the
NBE. Katsuichiro Nunoo (2016) aptly points out the lack of—therefore
the need to conduct—feasibility studies, and proposes the standardizationand development of research-based teaching materials in Japanese language
training for EPA candidates.
A Nurseatch of Filipino EP
Assessment of the First B
EPA
Batch
Candidates bbyy R
eceiving Hospitals
ReceivingThis section presents the result of the follow-up survey for hospitals(n=30) that employed the first batch of Filipino nurse candidates who
were not given predeparture Japanese language training. It was conducted
in 2011, a year after the candidates’ deployment to each hospital. The
result of the baseline survey conducted in 2009 among the same hospitals(n=21) before deployment (Hirano, Ogawa, and Ohno 2010) supplements
the discussion.
The baseline survey informs us that many hospitals that employed
the first batch of Filipino nurses were motivated to do so in order to prepare
for the “internationalization” of the hospital, rather than to mitigate theshortage of manpower in nursing (ibid., 131). Thus, the hospitals seemed
to have been reluctant to assign Filipino nurse candidates in sectors which
do suffer from manpower deficiency; instead, the hospitals took theopportunity to carefully observe the ability of Filipino nurses as part of
future recruitment plans (i.e., possibility of hiring foreigners).

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According to the follow-up survey, 60 percent of the respondents(n=30) answered that they were satisfied/somewhat satisfied with Filipino
nurses.22 The hospitals highly observed Filipino nurses for their personalities
such as cheerfulness (86.7 percent) and their working attitudes, such as
respecting elders and patients (both 83.3 percent). On the other hand,according to the data of the follow-up survey, the hospitals were less satisfied
with the (poor) mastery of Japanese language, especially in making nursing
records (23.3 percent) (Figure 3). Filipino nurses’ deficiency in the Japanese
language was negatively correlated to the degree of satisfaction of Japanesehospitals with the Filipino nurse candidates. On the other hand, the degreeof satisfaction of Filipino nurses was negatively correlated with suchstatements such as “They can communicate with Japanese staff ” (r=-.643,
p<0.001); “They can communicate with patients in Japanese” (r=-.563,
p=0.002); “They master necessary Japanese to make nursing record” (r=FIGURE 3
Assessment of the first batch of Filipino nurses by hospitalby percentage (multiple answers)(Source: Ogawa, Hirano, Kawaguchi, Ohno, 2010, with modifications)

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21

FIGURE 4
Changes in the workplace after receiving the first batch of filipino nurses
by percentage(Source: Ogawa, Hirano, Kawaguchi, Ohno, 2010, with modifications).507, p=0.006). The result does not contradict with that of the correlation
coefficient between the degree of satisfaction and the changes in hospitals
after receiving the first batch of Filipino nurses (Figure 4). The more theyexperienced that “The cases of intervention to the troubles between Filipino
nurse candidates and Japanese staff have become necessary” and that “Thecases of intervention to the troubles between candidates and patients havebecome necessary,” the more they got disappointed with themselves forreceiving Filipino nurses (r=-.665, p<0.001 and r=-.553, p=0.002).
From the result of the survey, it is safe to assume that language
deficiency of the Filipino EPA nurses is one of the major reasons for the
dissatisfaction of Japanese employers, which discourages them to employ
Filipino nurses.

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Expansion of Japanese Language T
Trraining:
Re visions of the Scheme
It was only after the first batch of EPA candidates came to Japanthat receiving hospitals realized that a six-month Japanese training course
was not enough for Filipino nurse candidates to acquire enough proficiency
and fully exercise their competency. It is logical to associate the deficiencyof Japanese language proficiency of Filipino nurse candidates with the
low passing rate in the NBE. In the first place, they need such proficiency
just to conduct their daily lives in Japan. Therefore, it was considerednecessary that EPA candidates receive language training before entering
Japan. Since 2011, the Japanese government has provided predeparture
Japanese language training for EPA nurses from the Philippines (in addition
to the six-month postarrival training). Tokyo also provided measures tohelp Japanese employers train their foreign employees and improve thepassing rate.
a. Predeparture Japanese-language training program,mainly funded by the Japanese government, has beenoffered since 2011; two months for batch 2011; threemonths for batch 2012; and six months starting frombatch 2013 to the present.
b. JICWELS staff and Japanese-language education
experts visit hospitals hiring EPA candidates to conduct
guidance seminars.
c. Questions of the National Board Examination (NBE)
are made more comprehensible for foreign examinees;e.g., 1) English has been used for persons’ names andfor the Japanese names of diseases since 2011; 2) Kana(phonetic guide to Chinese characters) has been given
for the kanji (Chinese characters used in Japanese) since2011 (partial) and 2013 (all); 3) Simpler andstandardized sentence structure is applied; and 4)
Augmentation of the examination hours (for nurses)
from 2 hours and 40 minutes each in the morning and

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17

in the afternoon to 3 hours and 30 minutes for bothsessions (30 percent increase) since the 2013 NBE.
(Kokusai Kosei Jigyodan [JICWELS] 2013a).
d. Seminars by JICWELS
e. Financial assistance by JICWELS to hospitals forJapanese language training.
The above-mentioned measures are ostensibly designed to makeforeign examinees feel more comfortable in taking the national
examination. According to the result of the JICWELS’s questionnaire
survey among the 205 nurse candidates (Filipinos and Indonesians) who
took the NBE in 2013 and chose the exam paper with a phonetic guide to
all kanji, 75 percent responded that the kana was helpful in answering thequestions (Kokusai Kosei Jigyodan [JICWELS] 2013b). Regarding theexamination hours, 65.3 percent of 164 Filipino and Indonesian nursing
examinees said that the extended examination time was sufficient to answer
all the questions (ibid.).
The idea of adding a phonetic guide to every kanji in the NBE
questions was initiated by a note made by Katsuya Okada, the then Ministerof Foreign Affairs. He said, “It should not take place that foreign nurses
who are competent in their country fail to pass the NBE even after a threeyear training in Japan and return to their home country” (Asahi Shimbun2009). This fact implies that to some extent, political power was behindsuch implementation, presumably motivated by the smooth promotionof free trade.23
Entr
A
Entryy of Vietnamese Nurses under JVEP
JVEPAVietnamese nurses began to enter Japan under the Japan-Vietnam
Economic Partnership Agreement (JVEPA) in 2014. Under JVEPA,
Vietnamese nurses receive twelve-month predeparture Japanese language
training in Vietnam, and only those who have gained an N3 level ofJapanese Language Proficiency Test (JLPT) are eligible to sign the contract

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with a Japanese employer. An N3 level competence entails the “ability tounderstand Japanese used in everyday situations to a certain degree.” That
is to say,Reading: One is able to read and understand written materials withspecific contents concerning everyday topics. One is also able to grasp
summary information such as newspaper headlines. In addition, one
is also able to read slightly difficult writings encountered in everyday
situations and understand the main points of the content if somealternative phrases are available to aid one’s understanding.
Listening: One is able to listen and comprehend coherent conversations
in everyday situations, spoken at near-natural speed, and is generallyable to follow their contents as well as grasp the relationships among
the people involved. (Japanese Educational Exchanges and Services[JEES] n.d.)

Since 2015, Vietnamese nurse candidates have had high passing
rates in the NBE (55 percent among those who took the NBE for thesecond time, and 44.4 percent among those for the third time) (Figure 5).
It is reasonable to attribute this result to the screening system, wherein
only N3-level speakers can work in Japan.
The Vietnamese nurses’ high passing rate obviously impressed boththe Philippine and Indonesian governments. They recognized that Vietnam
is a worthy rival for Japan’s labor market. The major difference between
Vietnam and other two countries in the scheme for nurse candidates is theduration of Japanese language program (twelve months before departureand two months after entry in Japan) and the screening for JLPT N3.
Therefore, it is safe to suggest that language proficiency is a key for ahigher passing rate in the NBE.
Today, Filipino and Indonesian nurse candidates must have acquired
the Japanese language skills equivalent only to the N5 level of Japanese
Language Proficiency Test (JLPT) in order to be deployed to Japan. The N5
level is defined as “having the ability to understand some basic Japanese,”

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25

FIGURE 5
Passing rate of batch 2014 nurse candidates in the NBE
by the number of examinations taken and by country of origin(Source: MHLW 2017)
0.0 (no passers for 1st trial)that is “to read and understand typical expressions and sentences written in
hiragana, katakana, and basic kanji;” and the ability “to listen andcomprehend conversations about topics regularly encountered in daily lifeand classroom situations, and is able to pick up necessary information fromshort conversations spoken slowly” (Japanese Educational Exchanges andServices [JEES] n.d.). Foreign applicants of the NBE are required to have aJapanese language proficiency at least equivalent to the JLPT N2 level; thismeans that one has to be able to “understand Japanese used in everyday
situations, and in a variety of circumstances to a certain degree” (ibid.).
Reading: One is able to read materials written clearly on a variety of
topics, such as articles and commentaries in newspapers andmagazines as well as simple critiques, and comprehend their contents.
One is also able to read written materials on general topics andfollow their narratives as well as understand the intent of the writers.

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Listening: One is able to comprehend orally presented materials
such as coherent conversations and news reports, spoken at nearlynatural speed in everyday situations as well as in a variety of settings,
and is able to follow their ideas and comprehend their contents. One
is also able to understand the relationships among the people involved
and the essential points of the presented materials.” (Japanese
Educational Exchanges and Services [JEES n.d.]

The expansion of Japanese language training (from six months after
arrival to the total of twelve months covering both predeparture andpostarrival) and the precondition of JLPT-N5 equivalent for deployment
have somewhat improved the Japanese language proficiency of Filipino
nurse candidates. Figure 6 compares the results of surveys on language
FIGURE 6
Comparison between the second and eighth batches of Filipino Nurses
in language acquisition and cultural affinity

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acquisition and cultural affinity between the second and the eighth batchesof Filipino nurse candidates (batches 2009 and 2016, respectively). Amongthe second batch of Filipino nurses who did not have predeparture Japanese
language training, only 34.8 percent had studied Japanese at the time of
deployment (average duration of Japanese language training then was 3.1
months); this is significantly lower (p<0.001) than the eighth batch (100percent) (average duration of Japanese language training at the time ofdeparture was 6.7 months). Only 6.5 percent of the second batch held
JLPT certificates of any level, while 20.7 percent of the eighth batch(p=0.036) did so. Correspondingly, the degree of knowledge about NBE(range; 1–4) (p=0.006) and about Japanese society and culture (range: 1–4)
(p<0.001) were higher in the eighth batch (Figure 6). This implies thesignificance of language proficiency in familiarizing oneself with Japanesesociety, culture, and the NBE. It is expected that such familiarity translates toa high passing rate and to even long-term residence in Japan after passing
the NBE.
Cost ffor
or Language T
Trraining
The previous sections presented the vital significance of mastery ofJapanese language in working as a nurse in Japan. At the same time, theburden of receiving hospitals, aside from that of the Japanese government,
in providing training for nurse candidates has been highlighted. This section
now looks at Australia to reflect on the training scheme under the EPAMNP provisions, with emphasis on how the Australian government controls
the English proficiency of nurse applicants from abroad. The system ofAustralia does not differ significantly from that of other countries thatstrategically accept foreign nurses (MHLW 2012, see below). That is tosay, generally speaking, a high language standard is set and the cost of
training for such requirements and professional skill development isshouldered by an applicant.
Australia has been actively employing professional nurses fromabroad. There were 335,315 nurses and midwives as of 2015. Registered

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Nurses (RNs) comprised 76.36 percent (256,034), while enrolled nurses
stood at 8.41 percent (28,211). Just over 20 percent (20.4 percent) of the
midwives and nurses obtained their license outside Australia (AustralianInstitute of Health and Welfare 2016). All requirements for overseas RNs
and midwives are determined by the Australian government’s Nursing
and Midwifery Board. However, the skills of foreign nurses and midwives
are evaluated by a private organization, the Australian Nursing andMidwifery Accreditation Council (ANMAC). This limited company,
composed of board members who are nursing professionals, was establishedin Canberra in 2010. Its mission includes evaluating the skills of foreign
nurses and midwives who apply to Australia’s Skill Migration Program. It
has carefully studied nursing and educational standards and practices ofsending countries such as the Philippines, India, and Singapore.
The ANMAC prescribes that overseas nurse applicants have abachelor’s degree in nursing and experience working as an RN for a certain
period. Besides educational attainment and work history, it also requires
all applicants get an IELTS (International English Language Testing
System)24 score of 7.0 or higher in the four areas (listening, reading, writing
and speech), or achieve OET (Occupational English Test)25 Level “A” or“B” in the four areas.26 It is worth noting that the IELTS score of 7.0 is thesame as what the United Kingdom (U.K.) requires from foreign nurse
applicants. It is even higher than college admission requirements.
This strict language policy was introduced in all Australian states in2010. Before 2010, each state had its own language standard for incoming
RNs from abroad. However, this inconsistency became an issue after the
insufficient English proficiency of some migrant nurses caused
miscommunication and misunderstandings between nurses and theirpatients, and between nurses and their coworkers. Consequently, the
ANMAC decided to standardize the language requirements.
The IELTS score of 7.0 also became a minimum requirement forforeign students’ entry into nursing schools in Australia, such as The
Canberra Institute of Technology (CIT, a government vocational school).
The CIT also requires different English scores for foreign freshmen

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depending on a course; for enrolled nurses, it’s IELTS 6.5 or higher; andfor aged care, it’s IELTS 5.5 or higher.27 The differences imply thatstakeholders recognize varying language skills for different contexts.
Private institutions in Australia offer various “bridging courses” foroverseas-born nurses, too. These courses are provided for professional
nurses coming from abroad who are required to take shorter educationand training in Australia than native nursing students.
Table 2 summarizes the admission requirements for a bridging course
at three different Australian institutions (as of 2011). Each institution
requires an IELTS score of 7.0 in accordance with the standard of the
ANMAC, along with relevant work experience as a nurse. The tuition isremarkably high for nurses from developing countries. This explains why
only a few Filipino nurses have departed for Australia in the past few years(i.e., in 2016, see Table 1). A small-scale research by Japan’s Ministry of
Table 2: Requirements for foreign nurse applicants in bridging courses
at nursing schools in Australia

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Health, Labor and Welfare (MHLW 2012) collected basic information onrequirements for foreigners who want to become a nurse in seven developed
countries (the United States, Canada, Germany, South Korea, China, theUnited Kingdom, and Sweden). The results show that in each country,
language standards are usually uncompromising in granting foreigners
nursing licenses. Also, the cost of the acquisition of qualification/license
should be shouldered by each applicant.
The practices of other developed countries, represented by Australia
here, paradoxically highlight the idiosyncratic nature of the EPA-MNP
scheme. First, essentially, no reasonable and feasible system has been
established in Japanese language training, which is decisively crucial andought to be conducted most efficiently. Second, the cost of language training
is largely shouldered by the Japanese government. This ultimately comesto a matter of the quality and cost of training, and whether the cost benefits
the society in any way. On this, both the Japanese and the Philippine
governments need to face sincere criticisms. Katsuichiro Nunoo points
out that “improvements” that the Japanese government and JICWELS
have rendered—for instance, by amending the initial scheme in the past
eight years—are often merely stopgap measures. As a result, consistency
in Japanese language training has been grossly sacrificed (2016).
Tamiko Noborizato et al. (2010) describe the task of teaching
Japanese to adult professionals for a limited time “a magnificent
experiment” (44). For Naoki Okuda (2011), it is “a touchstone for accepting
foreigners” (129). It is indeed a magnificent experiment for Japanese
language educators who face tremendous pedagogical demands, but for
Gabriele Vogt (2013, 18), who argues that JPEPA is “a system deliberately
designed to fail” because it is not attractive to both nurses and hospitals,
the JPEPA-MNP scheme is “at best, a small-scale testing field for new
migration policies” (35). The low passing rate, which is attributable to thelanguage barrier, has elicited criticisms of the scheme. However, if thescheme is meant to be an experiment, it shall bear fruit—be it a magnificent
one or a small-scale initiative—if the Japanese government uses the scheme
even just for systematic data gathering. Unfortunately, however, that is not

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the case (Nunoo 2016). It is suggested that the Japanese government,
together with the Philippine government, systematically collect informationfrom each candidate (linguistic background, acquisition of Japanese
language skills at different stages; passing/ failure and percentage of correct
answer in the NBE; length of work in Japan, and so on), and utilize it for
future improvement of the scheme and beyond.
Conclusion
This article reviewed the trajectory of implementation of the JPEPAMNP provisions. The scheme for implementation of JPEPA-MNP
provisions on nurses has been revised several times in accordance with thedemands of EPA nurses/ nurse candidates, Japanese employers, andnonclinical stakeholders, such as policymakers. The revisions were madeto improve the NBE passing rate, the common primary concern. It is safe
to suggest that each amendment has elements pertaining to Japanese
language proficiency. A high passing rate in the NBE by Vietnamese
candidates, who can enter Japan only after acquiring the JLPT N3 level ofproficiency, highlighted the problem of the JPEPA’s scheme, which wasestablished without feasibility studies and without the involvement ofexperts of second-language acquisition. The implementing scheme of
JPEPA-MNP has turned out to be a system without a system whose
operational cost has been enormous, particularly for Japan. The flaws havebeen mended with a series of first-aid band aids, but what is needed is afundamental overhaul.
In a few years, the scheme will celebrate its tenth anniversary. The
Japanese government should not be continuing first-aid measures forever.
It is suggested that fair and comprehensive evaluation of the JPEPA-MNP
scheme be conducted and remodeled to collect meaningful data on foreign
health professionals’ acquisition of Japanese language proficiency; on theiradjustment to working and living in Japan; cost performance; and economic
aspects vis-à-vis the promotion of free trade and flow of investments. The
Philippine government shall likewise conduct a comprehensive yet focused
assessment on the movement of Filipino nurses to and from Japan.

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A cknowledgements
cknowledgements
The author wishes to thank Kyushu University, the Japan Society for
the Promotion of Science and the Directorate General of Higher Education(DGHE), Ministry of National Education, Indonesia for their support to thefollowing research studies: 1) “International sociological research regarding
the opening of Japan’s labor market: Focusing on the fields of care and nursing”(Representative: Shun Ohno, fiscal years 2007–09); 2) “An international study
on care services, lives and mental health of Indonesian certified-care-workers
coming to Japan” (Representatives: Shun Ohno/Reiko Ogawa and Bachtiar
Alam, fiscal years 2009–11); 3) “A comparative study on receiving foreign
workers in the fields of nursing and caregiving” (Representative: Shun Ohno,
KAKENHI No. 23530664, fiscal years 2011–14); 4) “Beyond friction, quest
for co-existence: A study of foreign nurses entering Japan under the bilateral
economic agreement” (Representative: Yuko O. Hirano, KAKEHNHI No.
26293113, fiscal years 2014–2019). Furthermore, the editors had to defer
the publication of this issue because of our meticulous treatment of data;
they had to return to the field and clarify some inconsistent information presented
in earlier versions of the manuscript, which could not be adequately resolved
during the editing process in 2016.
Notes
1

2

3

Similar schemes were explored in the process of the preparations of the EPAs between
Japan and India, and between Japan and Thailand, but both efforts were shelved. The
JVEPA had been signed in 2008 but the diplomatic negotiations for the scheme of MNP for
nurses and careworkers began only in 2011 and the supplemental resolution was signed in2012. The four-year interval between the EPA proper and the supplemental resolution madeit possible for stakeholders to observe the implementation of the JIEPA-MNP and JPEPAMNP schemes. That resulted in the twelve-month, predeparture Japanese language training,
and the precondition of passing the JLPT N3 for signing of work contract.
For the Philippines, see Yagi, Mackey, Liang and Gerlt, 2014. For Indonesia, see Amariand
Hayashi 2008; and Asia Economic Institute 2008.
See Asato 2007. Also, Ms. Fifi Arianti Panchaweda, Director of the Center of Manpower
and Transmigration, Indonesia mentioned this in the symposium, “Globalizing Nursing
and Care: Discussions over Foreign Workers’ Entry into Japan’s Labor Market,” held inMarch 2008. See Suzuki 2007 for details of the concerns on the provisions on the MNPduring the bilateral negotiations for these EPAs.

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5

6
7

8

9

10

11
12
13

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Similarly, the Japan Association of Certified Care Workers (JACCW) was reluctant to receive
foreign careworkers. Today, both JNA and JACCW are more open to accepting EPA nurses
and careworkers. In fact, they did not express opposition to JVEPA in the early 2010s. At
present, in the advent of opening for careworkers under the technical trainee program, they
believe that continuing and strengthening of the EPA programs must be prioritized.
See also Vogt 2007 and 2013 for the inconsistency of EPA-MNP scheme between thepremise of trade and de facto labor migration. Also, see Yamazaki 2006 (11) for theJapanese cabinet’s decision to accept nurses and careworkers for the purpose of advancing
negotiations on economic partnership with Asian countries.
See Hirano’s article in this volume.
It took more than two years for the Philippine Senate to ratify JPEPA. In the Philippines, some
opposition politicians and cause-oriented groups formed the “Junk JPEPA Movement” andstrongly opposed JPEPA mainly because of the possibility of the entry of tariff-free toxic wastes
from Japan to the Philippines and of an “unfair deal” towards Filipino nurses and careworkers.
The official website of the Ministry of Foreign Affairs of Japan (MOFA) contains a seriesof documents on this. See Ministry of Foreign Affairs (2009). See also Nunoo (2016;
chapters four and five) for details.
There are differences in the content of nursing tasks between the Philippines and Japan,
both legally and in cultural practices. Such differences caused some Filipino nurses inJapan to feel that they are deskilled if they are told to perform the tasks which can be done
by a family member of the patient in the Philippines, such as changing diapers of the bedridden patients. In Japan, it is stipulated in the “Act on Public Health Nurses, Midwives
and Nurses” that nursing tasks include not only those pertaining to medical interventions,but also assisting in the daily lives of patients. In Japan, even the latter, like bedside care,is rendered with professional skill. It is observed that in Southeast Asian countries,
including the Philippines, only the tasks that reflect the medical model tend to be viewed
as “professional skills.” It is pointed out that nursing practice varies from a country toanother; a certain notion of professional skills is not universal and should not be squarely
applied in understanding nursing tasks in another country.
Nunoo (2016) informs us of the logically inconsistent discussions at the Diet and the Ministryof Health, Labour and Welfare (MHLW) before and after the implementation of EPAs. It isalso noted that illogical arguments were also given in the Philippines prior to the conclusion
and ratification of JPEPA. It was the Philippine government, responding to the criticisms by
opposition groups and mass media in the country, that proposed minimizing Japanese language
training period by claiming that Filipino nurses are ready to serve outside the country
immediately. It was considered that a long training period was tantamount to postponing theopportunity to execute their professional service and to delay their income, a violation of their
human rights. Meanwhile, Filipino Japanese language teachers and concerned Japanesecitizens suggested acquiring enough language proficiency helps Filipino nurses in the long run
in terms of career development and the smooth conduct of everyday life.
Based on an interview by an author of this article in March 2014.
Japan already ratified JPEPA as early as 2006.
A questionnaire that contains close-ended questions, except for an open-ended questionin the last part, which asks about their general impressions of accepting foreign nurses.

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15

16
17

18

19
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The 475 respondents are comprised of the following: 100 Filipino nurses from the firstbatch (2009); 46 from the second batch (2010); 70 from the third batch (2011); 28 from thefourth batch (2012); 65 from the fifth batch (2013); 36 from the sixth batch (2014); 72 fromthe seventh batch (2015); and 58 from the eighth batch (2016).
See Choi (2003) for American colonial historical background of Filipino nurses’ training
in English and their emigration to the United States.
The POEA has not published such figures since 2011.
It is informed that the 2005 figure of the United States (3,853) includes those who left for theUnited States through its Employment-based Immigration Scheme, while the figures forother years for the United States reflect only those who departed through official channels (e.g.,
POEA). The Employment-based (EB) Immigration Scheme is a process of acquiring lawfulpermanent residency through employment in the United States of America as provided for in
the country’s immigration law. There are five categories of Employment-based Immigration
Scheme based on the qualifications of the applicant. In ordinary circumstances, nurse
professionals can apply for EB third preference, and in extraordinary cases may apply for EB
second preference (Shah Peerally Law Group PC, n.d.) (See also U.S. Citizenship andImmigration Services website, https://www.uscis.gov/green-card/employment-based.)Japan’s occupation of the Philippines for three and a half years in the early 1940s left
little impact in terms of disseminating the Japanese language to Filipinos.
Interview by Japanese employers to Filipino applicants was introduced from the second batch.
See comments by Shun Ohno on this matter in “Open Forum: A Synthesis” in this volume.
For instance, one member of Japan’s House of Representatives labelled Japan’s EPA
policy as “blocking foreign nurse candidates from passing the exam by a nontariffbarrier, that is, the Japanese language” (Daily Manila Shimbun, 21 February 2011).
The same question was asked to the hospital that received the first batch of Indonesiannurses, and 75 percent of the respondents answered that they are satisfied/somewhat
satisfied with Indonesian nurses (Ogawa, Hirano, Kawaguchi, and Ohno 2010).
The authors of this article have observed that after several years, Japanese hospitals
became aware of the higher potential of younger nurses in passing the NBE; the younger
a nurse is, the better the result. Thus, hospitals have come to prefer younger nurses.
According to the data obtained through the survey conducted among the Filipino nurse
candidates each year before departure between 2009 and 2016, the average age of Filipino
nurse candidates dropped from 32 in 2009 to 27.4 in 2016.
IELTS is accepted as evidence of English language proficiency by over 10,000 organizations
worldwide. In 2012, more than two million took the test in the world. IELTS is recognized
as a secure, valid and reliable indicator of true-to-life ability to communicate in English foreducation, immigration, and professional accreditation. IELTS is jointly owned by British
Council, IDP: IELTS Australia, and Cambridge English Language Assessment. It is
conducted at more than 900 test centers and locations in over 130 countries (IELTS n.d.).
OET is recognized and trusted by more than twenty regulatory healthcare bodies andcouncils in Australia, New Zealand, and Singapore. Many organizations, including
hospitals, universities and colleges, use OET as proof of a candidate’s ability tocommunicate effectively in a demanding healthcare environment (OET 2013).

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Based on the interview with leading officers of the Australian Nursing and Midwifery
Accreditation Council in Canberra in December 2011.
Interview with a staff of Canberra Institute of Technology in Canberra in December 2011.

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ASIAN STUDIES: Journal of Critical Perspectives on Asia