Health Beyond Borders Healthcare Challenges in ASEAN and

Health Beyond Borders Healthcare Challenges in ASEAN and Issues Concerning Health Professionals St. Lukes Medical Center August 24, 2015 Healthcare Professionals: Issues Jose Y. Cueto Jr. , MD, FPCS, FPSGS, MHPEd Dean MMSU College of Medicine

ASEAN ECONOMIC COMMUNITY Single Market and Production Base Competitive Economic Region 1. Free Flow of Goods 2. Free Flow of Services Equitable. Economic Development Integration into the Global Economy 1. Competition Policy 1. SME Development 2. Consumer Protection 2. Initiative for ASEAN Integration 1. Coherent approach towards external economic relations 3. Free Flow of Investment 3. Intellectual Property Rights 4. Free Flow of Capital 4. Infrastructure Development 5. Free Flow of Skilled Labor 6. Priority Integration Sectors 7. Food, Agriculture 5. Taxation 6. E-Commerce 2. Enhanced participation in global supply networks

The ASEAN MRAs PROFESSIONAL SERVICES DATE / PLACE OF SIGNING 1. ENGINEERING 9 Dec. 2005 Kuala Lumpur, Malaysia 2. NURSING 8 Dec. 2006 Cebu, Philippines 3. SURVEYING 19 Nov. 2007 Singapore 4. ARCHITECTURE 19 Nov. 2007 Singapore 5. DENTISTRY 26 Feb. 2009 Cha-am, Thailand 6. MEDICINE 26 Feb. 2009 Cha-am, Thailand 7. ACCOUNTANCY 26 Feb. 2009 Cha-am, Thailand 9 Nov. 2012 Bangkok, Thailand 8. TOURISM

ASEAN Framework Agreement on Services: Article V ASEAN Member States may recognize the education or experience obtained, requirements met, or licenses or certifications granted in another ASEAN Member State, for the purpose of licensing or certification of service suppliers

Objectives of the MRA for Health Practitioners 1. Facilitate mobility of health practitioners within ASEAN 2. Exchange information and enhance cooperation in respect of mutual recognition of health practitioners 3. Promote adoption of best practices on standards and qualifications 4. Provide opportunities for capacity building and training of health practitioners

Recognition and Eligibility of Foreign Health Practitioners 1. In possession of a qualification recognized by PRA of country of origin and host country 2. In possession of a valid professional registration and current practising certificate to practice profession issued by PRA of country of origin 3. Has been in active practice in country of origin: Dentistry: 5 years Medicine: 5 years Nursing: 3 years

Recognition and Eligibility of Health Practitioners 4. In compliance with CPD requirements 5. Has been certified as not having violated any professional or ethical standards, local and international 6. Has declared that there is no investigation or legal proceeding pending against him/her in the country of origin or another country 7. In compliance with any other assessment or requirement as may be imposed by host country

Professional Medical Regulatory Authority (PMRA or PRA) ASEAN Member States PMRA / PRA Brunei Darussalam Brunei Medical Board Cambodian Medical Council / Ministry of Health Indonesian Medical Council / Ministry of Health Lao PDR Ministry of Health Malaysian Medical Council Myanmar Medical Council / Ministry of Health Philippines Professional Regulation Commission Professional Regulatory Board of Medicine Singapore Medical Council Specialists Accreditation Board Thailand Medical Council Ministry of Public Health Vietnam Ministry of Health

V. Services, unlike goods, have 4 modes of supply 1 2 3 4 • Cross-Border Supply • Consumption Abroad • Commercial Presence • Movement of Natural Persons

Modes of Supply COUNTRY A COUNTRY B Mode 1: Cross border supply Consumer A The service crosses the border Service Supplier Mode 2: Consumption abroad Consumer A Service supply Service Supplier Mode 3: Commercial presence Consumer A Service supply Commercial Presence Establishes a commercial presence in A Service Supplier

Modes of Supply COUNTRY A COUNTRY B Mode 4: Movement of natural persons Consumer A Self-employed goes to Member A Service supply Natural person Consumer A Service supply Commercial Presence Em plo yee sen t by Natural person firm fro m. B Juridical person

AEC 2015

Challenges 1. Variation in qualification requirements across borders

Medical Education Data COUNTRY DURATION DEGREE CONFERRED Indonesia 5 years MD Malaysia 5 years MBBS Philippines 5 years MD Singapore 6 years MBBS Thailand 6 years MD Vietnam 6 years MD Lao PDR 6 years MD Myanmar 7 years Cambodia 8 years Diploma of Medical Doctor

Comparability of ASEAN Nursing programs (Basic Nursing Education) COUNTRY NO. OF YEARS DIPLOMA/DEGREE Brunei Darussalam 3 years 4 years Diploma in Health Science (Nursing) Bachelor of Health Science (Nursing) Cambodia 3 years 4 years Associate Degree in Nursing Bachelor Science Nursing Lao PDR 3 years 2. 5 years Diploma in Nursing Continuing Bachelor in Nursing Science (Upgrade from diploma) 4 years Bachelor Science in Nursing Indonesia 3 years 4 years Diploma in Nursing Bachelor in Nursing Malaysia 3 years Diploma in Nursing Bachelor Science in Nursing

Comparability of ASEAN Nursing programs (Basic Nursing Education) COUNTRY NO. OF YEARS DIPLOMA/DEGREE Myanmar 3 years 4 years Diploma in Nursing Bachelor of Nursing Science Philippines 4 years Bachelor of Science in Nursing (BSN) Thailand 2 years 4 years BSN for Associate Diploma Nurses Bachelor of Science in Nursing (BSN) Singapore 3 years 12 months 3 years/4 years Diploma in Nursing Bachelor of Science Conversion Program for RNs Bachelor of Science (Nursing)/(Hounors) Vietnam 2 years full time Certificate Nurse 3 years full time Junior Bs. N (College of Nurse) 4 years full time Senior, Bs. N (Bachelor of Nursing Science)

Challenges 1. Variation in qualification requirements across borders 2. Differences in religion and culture

Religion RELIGION COUNTRY / COUNTRIES Buddhist Cambodia Lao PDR Myanmar Thailand Vietnam Muslim Brunei Indonesia Malaysia Catholic (predominant) Diverse Philippines Singapore

Challenges 1. Variation in qualification requirements across borders 2. Differences in religion and culture 3. Differences in language and difficulty in communication

Language Ø Healthcare involves person-person interaction Ø Licensure examinations in native language *For Filipino health professionals, proficiency in English, which is an added advantage in going to traditional destinations, may not be an advantage in the ASEAN

Challenges 1. Variation in qualification requirements across borders 2. Differences in religion and culture 3. Differences in language and difficulty in communication 4. Mismatch in available and needed health professional

Health Professions

Labor Market Conditions Quantity Quality Distribution Surpluses? Shortages? Actual needs?

Number of Schools / Graduates Profession Number of Schools Number of Graduates/Year 1. Dentistry 26 1, 210 2. Medical Technology 76 1, 600 3. Medicine 42 4, 500 4. Midwifery 252 7, 380 491 ----301 89, 000 5. Nursing 6. Nutrition and Dietetics 36 484 7. Optometry 9 100 8. Pharmacy 80 3, 000 9. Physical/Occupational Therapy 90 725 10. Radiologic Technology 69 2, 000 11. Respiratory Therapy 16 321 12. Veterinary Medicine 20 380

Number of Registered Professionals Profession Passing Percentage Number of Professionals 1. Dentistry 41. 8% 27, 999 2. Medical Technology 77. 0% 30, 891 3. Medicine 70. 4% 70, 418 4. Midwifery 43. 9% 73, 682 5. Nursing 41. 3% 526, 897 6. Nutrition and Dietetics 67. 0% 6, 834 7. Optometry 66. 0% 4, 778 8. Pharmacy 52. 2% 35, 912 9. Physical/Occupational Therapy 51. 5% 13, 202 10. Radiologic Technology 48. 0% 8, 678 35. 0% 4, 496 11. Respiratory Therapy 12. Veterinary Medicine

Challenges 1. Variation in qualification requirements across borders 2. Differences in religion and culture 3. Differences in language and difficulty in communication 4. Mismatch between available and needed health professional 5. Adjustment to local rules/regulations 6. Acceptance by local practitioners

Way Forward CHALLENGES HEALTHCARE PROFESSIONALS 1. Qualifications 2. Religion 3. Culture 4. Language 5. Mismatch 6. Local rules 7. Acceptance HOST COUNTRIES

Consequences of Influx of Professionals Favorable Unfavorable 1. Elevation of professional standards 1. Displacement of locals 2. Transfer of knowledge and skills 2. Wage/salary inequality 3. Transfer of technology 3. Rigid competition 4. Elimination of in-breeding 4. Downgrading of quality standards 5. Job generation 5. More expensive services 6. Solve maldistribution 6. Problem in maintenance of labor standards 7. Encourage teamwork and collaboration between local and foreign health professionals

Form of Mobility Limited Practice PMRA ASEAN Medical Practitioners Expert Visit PMRA Qualification Recognition Process Confer Temporary Registration Licensing Education Training Research Humanitarian Missions

Engagement of Stakeholders Dissemination Engagement Professional Regulatory Authorities Professionals / Professional Organizations Educational and Healthcare Institutions

Summary ASEAN Integration Regional Standards Basic Qualification Postgraduate Qualification Professional Practice Continuing Professional Development

Summary ASEAN Integration ASEAN MRA: Mobility Comparability Studies Identification of Challenges Labor Market Conditions Engagement of Stakeholders

The Future Surgeons from Cambodia and Thailand Anesthesiologist from Malaysia Nurses from Indonesia and Philippines Operating room in Cambodia

THANK YOU FOR YOUR KIND ATTENTION! email: jcuetomd@gmail. com