Commentary: Pandemic brings hard lessons to Philippine migrant health policy

by Jeremiah Opiniano (Philstar.com), 7 Jun 2020

A supposedly festive Migrant Workers’ Day for 2020 cannot be any more subdued and cruel than this: A pandemic is threatening the lives of overseas Filipino workers (OFWs).

June 7, 1995 saw the country enact a Migrant Workers and Overseas Filipinos Act (then Republic Act 8042, now amended by Republic Act 11299) to roll out an overarching Philippine policy for migrant workers’ recruitment, rights and welfare protection.

That law was enacted in response to Singapore domestic worker Flor Contemplacion’s death, an example of how OFWs face occupational safety and health risks.

Migrants’ health is thus part and parcel of the nation’s approach to ensure safe and orderly migration. Healthy overseas Filipinos will not only make them economically empowered for their families and for their Philippine homeland. Safe, orderly and healthy overseas migration boosts the upholding of the rights of migrants.

The health conditions of countries then matter. On this score, migrants traverse between origin and destination countries and confront different health determinants, and may be carrying or be exposed to certain diseases during their journeys. Migration epidemiologists Brian Gushulak and Douglas MacPherson wrote this in 2006: “Migration across health and disease disparities influences the epidemiology of certain diseases globally and in nations receiving migrants.”

Access to health thus becomes critical for migrants and refugees. Unfortunately, not all of them, more so those in irregular or undocumented status, have access to health services — or are even eligible for such.

For migrant health policies to work, a responsive health system may have to be perfectly complemented by a functional migration management system. A migration management bureaucracy, like what the Philippines fortunately has in place, may help countries handle the epidemiological impacts of migration.

Migrant health has been a staple sub-tale of the broader Filipino migration story. Historically, the Philippines boldly confronted public health risks and had provided economic and health services to repatriated OFWs and to OFWs who stayed put overseas. This was seen in previous epidemics (SARS and MERS-Cov), in long-running health issues such as HIV transmission, and in assisting distressed OFWs whose physical lives and mental health conditions may be in peril.

But amid the tireless efforts of our civil servants to assist OFWs, this COVID-19 pandemic is simply the toughest challenge the country’s migration agencies had faced. Unfortunately, at least 1,028 returnees are confirmed COVID-19 cases. These returnees are now unduly tagged as pathogen carriers, and they make up nearly 5% of the country’s 20,626 confirmed COVID-19 cases (as of June 5).

It may matter that countries have policies and programs on migrant health. Some five years ago, the Department of Health (DOH) got assisted by the International Organization for Migration (IOM) to craft a national migrant health policy. Then Health Secretary Janette Garin issued DOH Administrative Order 2016-007 (“National Policy on the Health of Migrants and Overseas Filipinos”) that cemented the DOH’s role in migration governance.

A situation analysis on OFWs’ health issues was done. A multi-sectoral Philippine Migrant Health Network (PMHN) was formed. A migrant health strategic plan (2016-2022) was even developed. DOH had also streamlined policies concerning the required medical checkups for departing OFWs, as well as medical repatriation for returnee-OFWs. The Philippines even lobbied the inclusion of health-related provisions in non-binding international instruments for migrant workers.

Migrant health has also enjoyed recent global policy attention that can complement national-level efforts. The recently-approved Global Compact on Migration (December 2019) carried provisions on migrant health. Months earlier, the 72nd World Health Assembly (May 2019) saw the World Health Organization (WHO) approve a 2019-2023 Global Action Plan for Migrant and Refugee Health. This WHO policy instrument now calls on countries to recognize health as “an essential component of refugee assistance and good migration governance”.

However, the COVID-19 pandemic is now seeing countries like the Philippines putting on rapid pilot test both the Global Action Plan and national migrant health policies and programs.

The pandemic has also brought hard lessons on how the Philippines’ migrant health policies may not only have to be reviewed, but be expanded. One major lesson is this: How the country usually helps OFWs, as well as how migrant workers are prodded to be enrolled in social health insurance and pension instruments (by PhilHealth and the Social Security System, respectively), may not be enough to address their health concerns.

Another lesson is further studying the epidemiology of Filipinos’ overseas migration and their vulnerabilities to certain diseases, not just COVID-19. These migration-specific epidemiological issues impact on current national quarantine measures. Daily tales from quarantined OFWs during this pandemic all but provided a wealth of hard lessons for prospectively reforming quarantine and medical repatriation procedures.

PhilHealth’s social health insurance product for OFWs was a subject of intense criticism in early May, given its now mandatory membership and the corollary payment of higher premiums. A memorandum order from PhilHealth was then suspended.

Yet if PhilHealth’s OFW members had diminished significantly — from a high of 3.14 million in 2013 to a low of over-330,000 in 2018 — prior to the new policy, there may be a need to be review this social health insurance product for OFWs.

But migrant health policy is all but part of how the country’s prevailing health system is shaped, and is delivering health services. OFWs return to their home country which has these hard realities: Costs for health care are expensive, forcing Filipino families to largely foot the bill as PhilHealth benefits can only cover so much. Local and national health programs are uncoordinated. Private health facilities only benefit the moneyed patients and their families. And poorer regions have feeble health services and facilities, as well as fewer health workers and specialists.

The major arsenal that overseas Filipinos have to address their health concerns is their remittances. These incomes serve as their “social health insurance” product in case man-made and natural disasters, as well as work-related incidents, happen.

And during this pandemic, the Philippines has been piloting an ambitious but underfunded universal health care program (kalusugang pangkalahatan) for Filipinos at home and abroad. Given how the health system continues to struggle in battling COVID-19, the transition to universal health care will be a painful one for the Philippines. This is the environment in which current migrant health policies may have to be contextualized in.

It’s hard to be festive today, June 7, when quarantined seafarers continue to teeter from mental torture, and when some of the returning land-based OFWs will be the new pathogen carriers in the coming months. If we were to put a happy face unto this year’s Migrant Workers’ Day, reforms and (re)formulations on the country’s prevailing health policies and services for overseas Filipinos may be in order.