migrant health in the philippines

D O H - I O M J o i n t

E X EE X EE X EE X E

Migrant HChallenges, O

WHY MIGRANT HEALTH? With nearly 10 percent of its population l

working overseas, the Philippines has ind

one of the worlds countries of migration. Esp

the 1970s, the countrys policy of inst

overseas employment, as reflected in its so

suite of institutions and programs, allow

population movements of Filipinos to othe

Today, Overseas Filipino Workers (OFWs) a

bagong bayani (new heroes), given their

contribution to the countrys continuin

growth. In 2013 alone, OFW remittances

8.4% of the countrys Gross Domestic Produc

However, while international labor migration

many benefits to the country in terms of

opportunities and economic gains, it also

new challenges, such as in the area

health. For example, various reports revea

face problems pertaining to mental health

reproductive health concerns especially in

countries. Inability to access basic health ser

has also been noted especial

irregular/undocumented migrants. The De

Health (DOH) is also sought to extend medic

to Overseas Filipinos in distress who were

back to the Philippines due to crisis situation

WHAT IS THE GLOBAL PICTURE? Addressing the health of Filipino migrants i

aligned with international commitments

existing national policy instruments. The W

Assembly Resolution 61.17, approved by t

States of the World Health Organization in

countries to, among others, promote migr

health policies; promote equitable access

promotion, disease prevention and care f

and promote bilateral and multilateral coo

migrants health.

n t P r o j e c t o n M i g r a t i o

X E C U T I V E S U M M A R YX E C U T I V E S U M M A R YX E C U T I V E S U M M A R YX E C U T I V E S U M M A R Y

nt Health in the Philippines, Opportunities, and Ways Forw

on living and/or

indeed become

. Especially since

institutionalized

its sophisticated

llowed massive

other countries.

s) are hailed as

their substantial

nuing economic

ces contributed

duct (GDP).

tion has brought

s of employment

also introduced

rea of migrant

eveal that OFWs

ealth issues and

ly in destination

services abroad

cially among

Department of

edical assistance

ere repatriated

tions abroad.

nts is very much

nts as well as

e World Health

by the Member

n in 2008, urged

migrant-sensitive

ccess to health

re for migrants;

cooperation on

Policy-Legal Frameworks

Promote migrant

sensitive health policies

Include migrant health

in regional/national

strategies

Consider impact of

policies of other sectors

Migrant Sensitive Health

Systems

Strengthen health

systems; fill gaps in

health service delivery

Train health workforce

on migrant health

issues; raise cultural

and gender sensitivities

Figure 1. World Health A

Actio

Most recently, the Int

Migration (IOM) published

2013 which revolved arou

Development, the first of i

the center of migration disc

Furthermore, the Philippi

ASEAN Declaration on the

the Rights of Migrant Wo

obligations of sending

protecting the rights of

ASEAN region. Migrant hea

as a key component of the

on Health Development

Philippines, along with In

appointed as one of the lea

HOW IS MIGRATION LINAn important determinan

process itself influences

migrant, as well as his/her f

Determinant of other d

migration process also

determinants that may be d

i o n H e a l t h

pines orward

rks

cies

lth

tors

Monitoring Migrant Health

Develop health

information systems and

collect and disseminate

data

Assess and analyze

migrants health

Disaggregate information

by relevant categories

lth

rce

ties

Partnerships, Networks,

and Multi-Country

Frameworks

Promote dialogue and

cooperation among

Member States, agencies

and regions

Encourage a multi-

sectoral technical

network

lth Assembly Resolution 61.17

ction Points

International Organization for

shed the World Migration Report

around Migrant Well-being and

t of its kind, putting the migrant at

discourse.

lippines is also signatory to the

the Protection and Promotion of

Workers, which laid down the

g and receiving countries in

of migrant workers within the

health was also recently identified

f the ASEAN Strategic Framework

ent for 2010-2015 and the

h Indonesia and Thailand, was

lead countries for this endeavor.

N LINKED WITH HEALTH? inant of health. The migration

es the health of the individual

her family.

r determinants of health. The

so exposes migrants to other

be detrimental to health, such as

D O H - I O M J o i n t P r o j e c t o n M i g r a t i o n H e a l t h

E X E C U T I V E S U M M A R Y

Figure 2. Links between migration and health

unhealthy lifestyle, inadequate shelter, unsafe workplace

conditions, etc.

Driver of marginalization and vulnerability. Migrant

status may also serve as a barrier to health care access.

As vulnerable and marginalized part of the general

population, migrants may not be able to benefit from the

health system in the place of origin, destination, and/or

return.

Agent of disease spread. The migration process also

contributes to the spread of infectious diseases.

Traditionally, the migrant is seen as a source and carrier

of infection, especially to places of destination and/or

return.

Most importantly, migrant health is a human rights

imperative. The basic rights to health, employment, and

mobility are inextricably intertwined. Regardless of their

status, migrants are entitled to the right of everyone to

the enjoyment of the highest attainable standard of

physical and mental health as enshrined in international

human rights instruments and guaranteed by the

Constitution.

Healthy migrants lead to healthy communities and

healthy economies. Healthy and productive migrants

contribute to the uplifting of their families living

conditions and to the countrys socio-economic

development overall.

WHAT ARE THE MAJOR HEALTH ISSUES

FACED BY MIGRANTS? Filipino migrants face a wide range of health issues

throughout the migration cycle, from common illnesses

to barriers to health care access. However, more rigorous

research and closer monitoring still need to be done to

ascertain the extent of these health challenges.

Furthermore, health problems faced by migrants may

vary depending on the migration cycle phase or

geographic location. Below are some of the major health

issues experienced by migrants based on limited research

studies and reports.

HIV-AIDS. The Philippine HIV and AIDS registry recorded

that OFWs comprise 16% of all reported cases since

1984. In 2013 alone, 10% of the new cases are comprised

of OFWs. However, these figures may over-represent the

true share of OFWs in the total number of HIV-AIDS cases

in the country, as HIV testing is deemed compulsory for

migrant workers by many destination countries (while it

is voluntary for the rest of the population as provided by

the Philippine AIDS Act). Migrants living with HIV-AIDS

experience the double stigma carried by both the disease

and their migrant status. Migrant workers may not

receive pre- and post-testing counseling, while those who

were found positive may get deported back to the

Philippines and become unable to access appropriate

treatment and care.

Tuberculosis. The WHO considers migrants as one of the

populations at-risk for tuberculosis (TB). The disease is

identified as a common ground for disqualification from

overseas work, and patients may be unable to access

appropriate treatment. Occasionally, migrant workers

become disqualified or deported due to radiographic

findings of previous TB infection.

Emerging infections. Emerging viral diseases such as

Severe Acute Respiratory Syndrome (SARS), Influenza

A(H1N1), Middle East Respiratory Syndrome Corona Virus

(MERS-CoV), and most recently Ebola Virus Disease (EVD)

have become another major yet occasional threat to the

health of populations, including migrants. During the

period of November 2002-July 2003, the Philippines had

only 14 out of the 8,273 confirmed cases of SARS, and

only 2 out of 775 deaths. On the other hand, as of May

2014, five overseas Filipinos have already died from

MERS-CoV, while the Philippines remains MERS-CoV free

as of June 2014 despite one OFW returnee who tested

positive in April 2014.

Maternal, sexual, and reproductive health. In some

countries, pregnancy is not desired by employers

overseas, hence there were cases of women labor

migrants who tried to hide their situation until they got

eventually terminated from work and even deported

back to the Philippines. Furthermore, women migrants

also face the risk of gender-based violence (GBV)

throughout the migration process, especially in the

country of destination.



Non-communicable diseases. Given that today, both

globally and locally, two out of three deaths result from

chronic non-communicable diseases, the incidence of

hypertension, diabetes, cancer, and stroke among

migrant populations also needs to be examined.

For example, one study showed that among Filipinos in

Rome, a high prevalence of obesity, diabetes, and

hypertension was found, and about three

Filipinos with disease were unaware of being diabetic

and/or hypertensive. In addition, a news report

that stroke has become the most common illness among

Hong Kong-based OFWs, but robust data collection and

analysis are needed to verify the situation.

Mental health. There have been increasing reports of

mental health problems faced by migrant Filipinos

especially in destination countries. Stressors that were

identified include abuse and discrimination, work

pressure, loss of close family ties, and unfamiliarity with

the new socio-cultural environment. Particularly

susceptible to these mental and emotional stres

victims of domestic violence, human trafficking, and

sexual abuse.

Injuries. Migrants also face the risk of road traffic

accidents and work-related injuries leading to permanent

disability, which often result in termination from

employment and ultimately deportation back to the

Philippines.

Limited access to health care and financial risk

protection. Access to health care in destination countries

has also been identified as an important concern. Several

qualitative studies have noted various barriers to access

to health care especially during the destination phase,

such as preconceived ideas of health and disease, cultural

and language barriers, fear of deportation among

undocumented migrants, among others. Furthermore,

migrants have limited protection from health

expenditure leading to financial hardship.

To address these challenges, PhilHealth, the Philippines

national health insurance program, is now working

towards expanding benefit packages to also include

chronic outpatient care and rehabilitation; rais

awareness about coverage for dependents

Philippines; and easing the processing of

reimbursements. Overseas employers must also

complement social health insurance with additional

private health insurance in accordance with int

maritime standards and labor laws in destination

countries.

I O M J o i n t P r o j e c t o n M i g r a t i o n H e a l t h


Given that today, both

globally and locally, two out of three deaths result from

communicable diseases, the incidence of

hypertension, diabetes, cancer, and stroke among

migrant populations also needs to be examined.

howed that among Filipinos in

Rome, a high prevalence of obesity, diabetes, and

hypertension was found, and about three-fourths of

Filipinos with disease were unaware of being diabetic

and/or hypertensive. In addition, a news report revealed

s become the most common illness among

based OFWs, but robust data collection and

There have been increasing reports of

mental health problems faced by migrant Filipinos

estination countries. Stressors that were

identified include abuse and discrimination, work-related

pressure, loss of close family ties, and unfamiliarity with

cultural environment. Particularly

susceptible to these mental and emotional stressors are

victims of domestic violence, human trafficking, and

Migrants also face the risk of road traffic

related injuries leading to permanent

disability, which often result in termination from

timately deportation back to the

Limited access to health care and financial risk

Access to health care in destination countries

has also been identified as an important concern. Several

riers to access

to health care especially during the destination phase,

such as preconceived ideas of health and disease, cultural

and language barriers, fear of deportation among

undocumented migrants, among others. Furthermore,

ection from health

PhilHealth, the Philippines

is now working

to also include

ilitation; raising

awareness about coverage for dependents left in the

the processing of

reimbursements. Overseas employers must also

complement social health insurance with additional

private health insurance in accordance with international

maritime standards and labor laws in destination

Figure 3. The different layers of policy

for migration health

POLICY-LEGAL FRAMEWORKSFrom a health perspective, the Philippines guarantees the

right to health to all Filipinos as enshrined in its

Constitution and reflected in its adoption of various

international human rights instruments. Furthermore,

various laws and policies governing the migration and

labor sectors emphasize the need to protect the rights

and overall welfare of migrants. Particularly relevant

among these policy-legal instruments is the Migrant

Workers and Overseas Filipinos Act of 1995, which

emphasizes that the governments priority is to ensure

that the dignity and fundamental human rights and

freedoms of the Filipino citizens, shall not, at any time be

compromised or violated. The Act was then amended in

2010 to include the role of the DOH in the regulation of

clinics that provide Pre

Examination (PEME). This amendment helpe

existing rules and regulations governing OFW medical

clinics, including safeguarding the right of the aspiring

migrant to select the medical clinic and forbidding the

formation of medical clinic cartels.

Other specific health policies that

migrants include the Quarantine Act of 2004, which lays

down the principles and procedures of ethical and

scientifically-sound quarantine measures in airports and

seaports; the Philippine AIDS Prevention and Control Act

of 1998, which requires the provision of HIV

education to all OFWs even before departure; and the

National Health Insurance Act of 1995, which even

provides for an OFW member in the Board of Directors.

Migration and labor policies in the Philippines paved the

way to the creation of a broad network of government

agencies that are mandated to set standards, coordinate

efforts, and monitor developments in migration,

particularly international labor migration. While there is

no specific agency that is responsible for


. The different layers of policy-legal frameworks

for migration health

LEGAL FRAMEWORKS From a health perspective, the Philippines guarantees the

ll Filipinos as enshrined in its

Constitution and reflected in its adoption of various

international human rights instruments. Furthermore,

various laws and policies governing the migration and

labor sectors emphasize the need to protect the rights

rall welfare of migrants. Particularly relevant

legal instruments is the Migrant

Workers and Overseas Filipinos Act of 1995, which

emphasizes that the governments priority is to ensure

that the dignity and fundamental human rights and

freedoms of the Filipino citizens, shall not, at any time be

compromised or violated. The Act was then amended in

2010 to include the role of the DOH in the regulation of

clinics that provide Pre-Employment Medical

Examination (PEME). This amendment helped strengthen

existing rules and regulations governing OFW medical

clinics, including safeguarding the right of the aspiring

migrant to select the medical clinic and forbidding the

formation of medical clinic cartels.

Other specific health policies that relate to the health of

migrants include the Quarantine Act of 2004, which lays

down the principles and procedures of ethical and

sound quarantine measures in airports and

seaports; the Philippine AIDS Prevention and Control Act

ch requires the provision of HIV-AIDS

education to all OFWs even before departure; and the

National Health Insurance Act of 1995, which even

provides for an OFW member in the Board of Directors.

Migration and labor policies in the Philippines paved the

y to the creation of a broad network of government

agencies that are mandated to set standards, coordinate

efforts, and monitor developments in migration,

particularly international labor migration. While there is

no specific agency that is responsible for performing



coordination work on migration health (aside from the

role of DOH in the regulation of medical clinics), some

non-health agencies either are already performing

health-related functions or have incorporated health

elements in their activities.

With respect to DOH, while there is no specific unit that

coordinates efforts and addresses migration health in a

comprehensive manner, some offices do conduct

activities or provide services that relate to migration

health, such as the National Epidemiology Center (NEC),

National Center for Disease Prevention

(NCDPC) and Philippine National AIDS Council (PNAC)

which ensure monitoring and care of migrants living with

HIV-AIDS; the Bureau of Quarantine (BOQ) which

conducts health assessments in ports of entry; and the

Health Human Resources Development Bureau (HHRDB)

which monitors the international migration of health

workers. Nevertheless, other existing bureaus of DOH

can play various roles in mounting a department

effort towards advancing the health of international

migrants.

MONITORING MIGRANTS HEALTH It is important that monitoring systems are capable of

capturing relevant information about the movement as

well as the health needs of international migrants in

general, and the vulnerable subgroups of migrants as

defined by age, sex, occupational arrangements, among

others. In addition, while they are technically not

considered people on the move, there are two other

groups that need to be monitored: those who are about

to enter the migration process, such as those applying for

overseas employment and undergoing p

health assessments; and those who left the migration

process, such as those who were disqualified because of

an abnormal medical examination result as early as the

pre-departure phase or those who have already returned

to their country of origin. Most importantly, monitoring

of migrants health should provide timely and useful

information for effective policy-making and

implementation, but at the same time ensure the dignity

and privacy of the individual migrant.

Due to the fragmentation of the Philippi

information system, data about certain aspects of health

of international migrants are captured and reported

through four specific health programs: the Philippine HIV

and AIDS registry; the Overseas Filipinos Program of

PhilHealth; the BHFS which is responsible for the

regulation of OFW medical clinics; and the BoQ which is

in-charge of recording quarantine cases in airports,

seaports, and other locations of interception.



coordination work on migration health (aside from the

role of DOH in the regulation of medical clinics), some

health agencies either are already performing

related functions or have incorporated health

With respect to DOH, while there is no specific unit that

coordinates efforts and addresses migration health in a

comprehensive manner, some offices do conduct

activities or provide services that relate to migration

gy Center (NEC),

National Center for Disease Prevention and Control

(NCDPC) and Philippine National AIDS Council (PNAC)

which ensure monitoring and care of migrants living with

AIDS; the Bureau of Quarantine (BOQ) which

orts of entry; and the

Health Human Resources Development Bureau (HHRDB)

the international migration of health

workers. Nevertheless, other existing bureaus of DOH

can play various roles in mounting a department-wide

effort towards advancing the health of international

t monitoring systems are capable of

capturing relevant information about the movement as

well as the health needs of international migrants in

general, and the vulnerable subgroups of migrants as

defined by age, sex, occupational arrangements, among

. In addition, while they are technically not

considered people on the move, there are two other

groups that need to be monitored: those who are about

to enter the migration process, such as those applying for

overseas employment and undergoing pre-departure

those who left the migration

process, such as those who were disqualified because of

an abnormal medical examination result as early as the

departure phase or those who have already returned

mportantly, monitoring

of migrants health should provide timely and useful

making and

implementation, but at the same time ensure the dignity

Due to the fragmentation of the Philippine health

information system, data about certain aspects of health

of international migrants are captured and reported

through four specific health programs: the Philippine HIV

and AIDS registry; the Overseas Filipinos Program of

is responsible for the

regulation of OFW medical clinics; and the BoQ which is

charge of recording quarantine cases in airports,

seaports, and other locations of interception.

Figure 4. Monitoring the health of migrants and

vulnerable subgroups

In addition, other government agencies outside the

Department of Health also collect enormous amounts of

data about international migration to meet their

respective purposes. In fact, other non

government agencies capture some health

information as they are being reported, such as social

welfare cases, medical repatriation cases, etc. However,

the information system

will contribute greatly to the health of the community of

origin, is still a work in progress

information, whether migration

related, do exist, most of them are not summarized,

analyzed, and utilized for policy formulation and program

evaluation.

As relevant information about the health and well

of international migrants will come from different

sources, developing a data sharing culture and

strengthening coordination between agencies are crucial.

Unfortunately, the Shared Government Information

System for Migration, which was created by the Migrant

Workers Act in order to support exchange of migration

related information across government agencies,

needs to be realized.

MIGRANT-SENSITIVE HEALTH SYSTEMWhile traditionally, a health system refers to

institutions, policies, and services that direc

the health needs of the population, other actors that are

conventionally regarded as non

included to describe a network of stakeholders and

activities that comprise a migrant

system. With such a broad view

regarded as not lagging in terms of building institutions

that respond to the health needs of people on the move,

especially international migrants.


. Monitoring the health of migrants and

vulnerable subgroups

ddition, other government agencies outside the

Department of Health also collect enormous amounts of

data about international migration to meet their

respective purposes. In fact, other non-health-related

government agencies capture some health-related

ormation as they are being reported, such as social

welfare cases, medical repatriation cases, etc. However,

about return migration, which

will contribute greatly to the health of the community of

still a work in progress. Ultimately, while

information, whether migration- or migration health-

related, do exist, most of them are not summarized,

analyzed, and utilized for policy formulation and program

As relevant information about the health and well-being

ernational migrants will come from different

sources, developing a data sharing culture and

strengthening coordination between agencies are crucial.

Unfortunately, the Shared Government Information

System for Migration, which was created by the Migrant

kers Act in order to support exchange of migration-

related information across government agencies, still

SENSITIVE HEALTH SYSTEM While traditionally, a health system refers to

institutions, policies, and services that directly cater to

the health needs of the population, other actors that are

conventionally regarded as non-health have been

included to describe a network of stakeholders and

activities that comprise a migrant-sensitive health

system. With such a broad view, the Philippines can be

regarded as not lagging in terms of building institutions

that respond to the health needs of people on the move,

especially international migrants.



While there exists no overarching program for migration

health in the DOH, several services and activities consider

the health of migrants especially those who are in the

pre-departure and return phases. The PEME is the

standard basic examination which is mandatory for

aspiring migrants in order to be issued with an Overseas

Employment Certificate (OEC). Aside from the regulatory

function of DOH towards medical clinics offering

the BOQ, in tandem with other port authorities, also

handles medical examinations of intercepted individuals

suspected with infectious disease or those who are

chronically ill in need of medical assistance during travel.

Figure 5. Basic health services provided to migrants

during the pre-departure phase

International migrants have differential access to health

promotion and education throughout the migration

course. For example, through the Pre

Orientation Seminar (PDOS), OFWs who are about to

leave also receive health-related advice which are

relevant to their countries of destination, especially

regarding HIV-AIDS as required by the Philippine AIDS

Act. The challenge is how to effectively and uniformly

convey these messages, as there is a wide

health content across different PDOS providers. The

variation in health education levels further intensifies as

migrants arrive in countries of destination, as some

settings might not provide such services at all, whether

through embassies or from the health system of the

receiving country.

While not a requirement before departure, PhilHealth

membership offers some financial risk protection for at

least 10 million Filipino migrants and their dependents

through the Overseas Workers Program, whic

renamed Overseas Filipinos Program in order to expand

membership to include undocumented migrants,

immigrants, and other overseas Filipinos. While family

members left behind can directly avail of the benefits

guaranteed to Philippine-based members

Health Assessments

Pre-Employment

Medical Exam (PEME)

Who provides?

Who regulates?

Who pays?

Financial Risk Protection

PhilHealth

Mandatory

Insurance

Who is registered?

How much?

What is covered?

Education and Promotion

Orientation Seminar



While there exists no overarching program for migration

l services and activities consider

the health of migrants especially those who are in the

departure and return phases. The PEME is the

standard basic examination which is mandatory for

aspiring migrants in order to be issued with an Overseas

Certificate (OEC). Aside from the regulatory

function of DOH towards medical clinics offering PEMEs,

Q, in tandem with other port authorities, also

handles medical examinations of intercepted individuals

suspected with infectious disease or those who are

chronically ill in need of medical assistance during travel.

ided to migrants

departure phase

International migrants have differential access to health

promotion and education throughout the migration

course. For example, through the Pre-Departure

Orientation Seminar (PDOS), OFWs who are about to

related advice which are

relevant to their countries of destination, especially

AIDS as required by the Philippine AIDS

Act. The challenge is how to effectively and uniformly

convey these messages, as there is a wide variety of

health content across different PDOS providers. The

variation in health education levels further intensifies as

migrants arrive in countries of destination, as some

settings might not provide such services at all, whether

rom the health system of the

While not a requirement before departure, PhilHealth

membership offers some financial risk protection for at

least 10 million Filipino migrants and their dependents

through the Overseas Workers Program, which is now

renamed Overseas Filipinos Program in order to expand

membership to include undocumented migrants,

immigrants, and other overseas Filipinos. While family

members left behind can directly avail of the benefits

based members, overseas

members will still need to undergo some administrative

procedures in order to reimburse portions of their

hospital expenditures abroad.

Embassies and consulates of the Philippines in

destination countries also provide some welfare,

including health-related, services to overseas Filipinos in

distress. In addition, other agencies such as the Overseas

Workers Welfare Administration (OWWA) and the

Department of Social Welfare and Development (DSWD)

have been tasked to deploy additional staff to aug

these services in major destination countries.

Occasionally, overseas Filipinos in distress require

assistance for their eventual repatriation, either medical

repatriation for individuals with chronic illness, or mass

repatriation for groups of migr

situations such as armed conflict and disaster. The

embassies and consulates, under the direction of the

Department of Foreign Affairs (DFA), play a lead role in

the evacuation and repatriation process, with other

agencies coordinating to provide specific forms of

support. On an ad hoc basis, the DFA seeks the DOHs

involvement to provide assistance in terms of referring

returning migrant-patients upon arrival in the Philippines.

In 2014, the DOH was included in the Inter

Committee tasked by President Benigno

formulate and implement guidelines on giving

governmental assistance to OFWs in distress.

PARTNERSHIPS, NETWORKS,

AND MULTI-COUNTRY FRAMEWORKSThe Philippines is regarded as the country with the

greatest number of nongovernmental organizations

(NGOs) and networks focusing on migration

issues. While many of them have sought to address

issues concerning the overall welfare of migrants, some

NGOs such as Action for Health Initiatives and Scalabrini

Migration Center have conducted research

on many aspects of migration and health.

The DOH also has prior experience in network building;

one particular example is the Human Resources for

Health Network, which provides government agencies,

non-governmental organizations, and international

partners a platform for meaningful dialogue on critical

issues affecting the Philippine health workforce, from

health professional education to working conditions. The

international migration of Filipino health wo

been a major focus of the network, and many of the key

actors in migration management are also involved in this

coalition.

Health Education and

Promotion

Pre-Departure

Orientation Seminar

What is the

content?

Who provides?

How else?


members will still need to undergo some administrative

procedures in order to reimburse portions of their

hospital expenditures abroad.

Embassies and consulates of the Philippines in

destination countries also provide some welfare,

related, services to overseas Filipinos in

distress. In addition, other agencies such as the Overseas

Workers Welfare Administration (OWWA) and the

Department of Social Welfare and Development (DSWD)

have been tasked to deploy additional staff to augment

these services in major destination countries.

Occasionally, overseas Filipinos in distress require

assistance for their eventual repatriation, either medical

repatriation for individuals with chronic illness, or mass

repatriation for groups of migrants caught in crisis

situations such as armed conflict and disaster. The

embassies and consulates, under the direction of the

Department of Foreign Affairs (DFA), play a lead role in

the evacuation and repatriation process, with other

g to provide specific forms of

support. On an ad hoc basis, the DFA seeks the DOHs

involvement to provide assistance in terms of referring

patients upon arrival in the Philippines.

In 2014, the DOH was included in the Inter-Agency

tee tasked by President Benigno S. Aquino III to

formulate and implement guidelines on giving

governmental assistance to OFWs in distress.

PARTNERSHIPS, NETWORKS,

COUNTRY FRAMEWORKS The Philippines is regarded as the country with the

mber of nongovernmental organizations

(NGOs) and networks focusing on migration-related

issues. While many of them have sought to address

issues concerning the overall welfare of migrants, some

NGOs such as Action for Health Initiatives and Scalabrini

ation Center have conducted research and advocacy

on many aspects of migration and health.

he DOH also has prior experience in network building;

one particular example is the Human Resources for

Health Network, which provides government agencies,

ernmental organizations, and international

partners a platform for meaningful dialogue on critical

issues affecting the Philippine health workforce, from

health professional education to working conditions. The

international migration of Filipino health workers has

been a major focus of the network, and many of the key

actors in migration management are also involved in this



The Philippines has a history of forging bilateral labor

agreements (BLAs) with receiving countries, facilitating

overseas employment and ensuring adequate minimum

protection for OFWs. While BLAs in general mention the

importance of protecting the rights and welfare of

Filipino migrant workers, specific health provisions still

need to feature in these important policy instruments.

HOW DO WE MOVE FORWARD? To facilitate economically sound yet ethical and rights-

based migration, and in the spirit of the migration and

development nexus espoused by the international

community, addressing the health needs of migrants is of

critical importance now more than ever. Looking into

health and well-being puts the migrant at the center of

policy and practice, not at migration as a mere

contributor to economic development. As one of the

biggest source countries in the world, the Philippines is

rightly placed to champion the right to health of the

international migrant and to put in place domestic

policies and programs to advance this cause. Since most

efforts today originate from destination countries, the

Philippines also can serve as an exemplar in how a source

country can ensure the protection of health rights of

migrants overseas through the entire migration process.

With a long history of institutionalized labor migration,

supported by policies and institutions that evolved

throughout the decades, the Philippines is not starting

from scratch when it comes to managing migration and

labor at large, and migration health in particular.

Furthermore, while traditionally not seen as an actor in

migration governance, the DOH has a huge potential

leadership role in addressing migration health,

performing various functions such as norm-setting,

providing technical guidance, coordinating intersectoral

efforts, and monitoring progress. The Philippines can

better improve its existing efforts in migration health by

adhering to the following principles:

Adoption of a rights-based approach to migration,

labor, and health. Migrants, just like the rest of the

population, are guaranteed by various international and

national policy-legal frameworks with an inalienable right

to health, decent employment, and mobility within and

across national borders.

Use of the Health in All Policies (HiAP) paradigm as

framework for migration health governance. The HiAP

approach emphasizes that health should be considered in

the formulation and implementation of policies under

the auspices of other sectors.

Clarifying roles and strengthening coordination across

government. The challenge with addressing cross-cutting

issues is ensuring that each responsible agency or

stakeholder is able to perform its mandated duties while

in close coordination with others.

Ensuring equity in health within migrant populations

and between migrants and the larger society. The goal

of addressing migrants health is to reduce their

vulnerability to avoidable health risks and ensure

equitable access to essential health care services. Their

migrant status should not serve as a deterrent for them

to achieve the highest level of health possible.

Furthermore, special attention should be accorded to

subgroup of migrants who are in a worse position than

others to achieve health equity among migrants.

Implementing universal minimum approaches while

adapting to specific situations and destination country

contexts. To ensure that all migrants, regardless of their

situation, are guaranteed basic protections and services,

the Philippines must design universal approaches such as

the PhilHealth Overseas Filipinos Program while

considering migrants diverse situations and contexts.

Enshrining monitoring and evaluation to track progress

and improve programs. While the Philippines has been

lauded for establishing a comprehensive suite of policies

and programs that contribute to the countrys labor

migration policy, it also has to do better in terms of

regularly monitoring migrants and their well-being as

well as evaluating its performance for further

strengthening and improvement.

References International Organization for Migration and Scalabrini Migration Center

(2013) Country Migration Report: The Philippines 2013. Manila:

International Organization for Migration.

International Organization for Migration, World Health Organization, and

United Nations Office of the High Commissioner on Human Rights (2013)

International Migration, Health and Human Rights. Geneva: International

Organization for Migration.

National Epidemiology Center (2014) Philippine HIV and AIDS Registry: July

2014. Manila: Department of Health.

World Health Organization (2010) Health of migrants the way forward.

Report of a global consultation. Geneva: World Health Organization.

Zimmerman C, Kiss L, Hossain M (2011) Migration and Health: A Framework

for 21st Century Policy-Making. PLoS Med 8(5): e1001034.

doi:10.1371/journal.pmed.1001034

This Executive Summary was prepared by Dr. Renzo Guinto,

consultant for the DOH-IOM Joint Project on Migration

Health. Inputs were also provided by Director Maylene

Beltran, Dr. Aleli Annie Grace Sudiacal, and Dr. Joel

Buenaventura of the Bureau of International Health

Cooperation, Department of Health, and Dr. Poonam Dhavan,

Dr. Predrag Bajcevic, and Mr. Ricardo Casco of the

International Organization for Migration.

migrant health in the philippines

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