National Policy on the Health of Migrants and Overseas Filipinos

March 7, 2016

DOH ADMINISTRATIVE ORDER NO. 2016-0007

 

I. Background

Addressing the health of migrants and overseas Filipinos (OF) is vital and relevant in realizing the Department of Health's (DOH) current centerpiece agenda of Kalusugan Pangkalahatan or Universal Health Care, which primarily seeks to ensure equitable access to quality health care by all Filipinos, whether in-country or abroad. Every migrant, just like any Filipino citizen, should enjoy the fundamental human right to the highest attainable standards of health. Migrants benefit from attaining good health and having an improved standard of physical, mental and social wellbeing, enabling them to substantially contribute towards the social and economic development of their home communities and host countries. Healthy migrants, demonstrate improved productivity and participate better in society, and as a result, they help shape healthy communities and healthy economies.

In the Philippines, the protection of the rights and the promotion of the welfare and interests of all OFs is one of the three pillars of the Philippine foreign policy. The Commission on Filipinos Overseas' Compendium of Statistics on International Migration estimates that there are about 10.5 million Filipinos currently living and/or working overseas, representing around 10 percent of the Philippine population (Philippine Country Migration Report, 2013). Although international labor migration has brought many benefits to the country in terms of employment opportunities, economic gains and inflow of remittances, it also introduced new challenges, such as in the area of migrant health, as some groups of migrants experience increased health risks. As of 2014, the Philippine HIV and AIDS registry recorded that OFs comprise 16% of all reported cases since 1984. Various reports reveal that OFs face problems pertaining to mental health, sexual and reproductive health as well as occupational health and safety, especially in destination countries. Reports of non-communicable diseases are also frequent, due to lifestyle and behavioural changes and diet modification. Inability to access basic health services abroad has also been noted especially among irregular migrants.

Currently, the DOH's efforts related to migrant health are focused on regulating medical clinics providing Pre-Employment Medical Examinations (PEME), as detailed in DOH AO No. 2013-0006. DOH is also occasionally sought to extend medical assistance to OFs who are repatriated back to the Philippines due to illness or crisis situations abroad. Further, the DOH signed a Memorandum of Agreement in April 2013 with the International Organization for Migration to collaborate on policy development, capacity building, research, and advocacy for improving the health of migrants.

Hence, to establish and further advance the Department's work on this area, this AO shall set the national policy direction on the health of migrants and OFs, which is to be adopted by the DOH, the broader health sector, and all other sectors and stakeholders who contribute to the promotion and protection of the health of migrants.

II. Objectives

A. General Objectives

Set the overall policy directions and the national policy framework for addressing the health of migrants and overseas Filipinos

B. Specific Objectives

1. Establish the policy framework, both within the Philippine health system and the broader society, for the promotion and protection of the health of migrants and overseas Filipinos

2. Define national guiding principles and strategies to be used in promoting and advancing the health of migrants; and

3. Initiate the establishment of a national program for migrant health within the DOH to handle issues and concerns related to the health of migrants and allocation of corresponding budget and funding thereof.

III. Scope and Coverage

This issuance shall apply to all units of the DOH, including its attached agencies. It shall also apply to local government units, nongovernmental organizations, private sector, professional organizations, academic institutions, international organizations and other relevant development partners involved in the promotion and protection of the health of migrants, particularly OFs.

IV. Definition of Terms

A. Migration — the movement of a person or a group of persons, either across an international border or within a State; a population movement; encompassing any kind of movement of people, whatever its length, composition and cause.

B. Migrant — is a person who moves from one place to another either across border or within a State.

C. Migration cycle — is the entire process of migration composed of different phases — pre-departure, travel, destination, return, and interception. CAIHTE

D. Overseas Filipino (OF) — any Filipino residing or working outside of the Philippines; includes Overseas Filipino Workers (OFWs), both land- and sea-based, and their families, as well as undocumented/irregular migrants, victims of trafficking-in-persons, permanent residents, dual citizens, Exchange Visitor Program participants, and international students.

V. Legal Bases

Globally, migrant health is increasingly becoming relevant. Addressing the health of OFs is very much aligned with international commitments, such as the:

• International Convention on the Protection of the Rights of All Migrant Workers and Members of Their Families (1990);

• Association of South East Asian Nations (ASEAN) Declaration on the Protection and Promotion of the Rights of Migrant Workers (2007); and

• World Health Assembly Resolution 61.17 (2008) on the Health of Migrants.

At the national level, various legislations and issuances support the advancement of the health of migrants, such as the:

• Migrant Workers and Overseas Filipinos Act (Republic Act (RA) 10022, amending RA 8042);

• Presidential AO No. 202 s. 2007, on the creation of an Inter-Agency Committee for the Celebration of the Month of Overseas Filipinos and International Migrants Day in the Philippines;

• National Health Insurance Act (RA 7875 and 10606);

• Philippine AIDS Prevention and Control Act (RA 8504);

• Quarantine Act (RA 9271);

• Executive Order (EO) No. 168, s. 2014 on the management of emerging infectious diseases such as the Middle East Respiratory Syndrome Corona Virus (MERS-CoV) and Ebola Virus Disease;

• Anti-Trafficking in Persons Act (RA 9208 and 10364); and

• Presidential AO No. 41, s. 2014 on giving governmental assistance to Overseas Filipino Workers (OFWs) in distress.

VI. Guiding Principles

In addressing the health of migrants, the DOH shall adhere to the following principles, in keeping with the overall goals of the Philippine health sector:

A. Migrant health is a human rights imperative. Health is a fundamental human right of all Filipino citizens, and shall include migrants, particularly OFs and their families.

B. Promoting migrants' health is a matter of equity. Society should strive to eliminate inequities in health between migrants and the general population, as well as between subgroups of migrant populations. Furthermore, special consideration should be accorded to vulnerable migrant subpopulations such as women, children, elderly, persons with disabilities, and undocumented migrants.

C. There can be no Universal Health Care without including migrants. In its pursuit to realize Kalusugan Pangkalahatan (Universal Health Care), the DOH shall strive for the inclusion of migrants in ongoing health reforms and programs, especially in ensuring financial risk protection, achieving the health-related Millennium Development Goals (MDGs) and improving health outcomes.

D. Addressing migrants' health requires strengthening the entire health system. The DOH shall employ a system-wide approach in addressing various issues affecting the health of migrants in the different phases of the migration cycle, ensuring that migrant health is mainstreamed and integrated in all relevant programs as well as cross-cutting health system components.

E. Multi-sector approaches will help promote migrants' health. The DOH shall foster inter-sectoral collaboration for migrant health and engage with other government agencies, as well as nongovernmental organizations, private sector, academic institutions, international organizations, and most importantly, associations of migrants and their families.

VII. Implementing Mechanisms

A. General Guidelines

The following strategies shall be initiated and adopted by the DOH, in collaboration with its partners, in the implementation of this National Policy and in the establishment of a National Program for Migrant Health:

1. Policy and planning — Ensure that the health of migrants is considered in the development of health policies and plans, whether they are system-wide (e.g., health financing/social health insurance) or program-specific in scope;

2. Standards setting and regulation — Develop standards and regulations that are deemed necessary for health-related services provided to migrants, such as health assessments and health education conducted throughout the migration cycle;

3. Research — Generate evidence for policy formulation and program evaluation by conducting and/or commissioning research projects that examine the specific health needs of migrants as well as gaps and challenges encountered in the health service delivery for migrants;

4. Service delivery — Facilitate provision of health services to OFs requiring medical assistance for critical health needs, such as migrants in crisis situations overseas, repatriates seeking medical assistance upon their arrival in the Philippines, and victims of trafficking-in-persons rescued by other government agencies;

5. Health promotion and advocacy — Develop communication interventions such as mass campaigns and educational programs to promote health and raise awareness about and influence action for migrant health across society;

6. Capacity building — Strengthen existing programs and services that cater to the health needs of migrants through training of health human resources, development of operational guidelines, and upgrading of health facilities;

7. Knowledge management and surveillance system — Establish knowledge management and surveillance systems for generating reliable, relevant, and up-to-date data essential for mounting timely and effective response to migrant health challenges; DETACa

8. Resource mobilization and financing — Generate and allocate resources from within the health sector and guaranteeing their equitable distribution for the effective implementation of migrant health policies and programs; also seeking additional resources from other stakeholders to support efforts in promoting migrant health;

9. Networking and partnership building — Engage with other agencies and organizations, whether government, non-government, or private, in order to influence other sectoral policies and programs and mount collaborative responses to major migrant health issues;

10. Monitoring and evaluation — Identify a commonly agreed set of indicators and conducting regular monitoring of progress and evaluation of outcomes and impact of migrant health activities, as well as documenting and sharing of good practices and lessons learned.

B. Specific Guidelines

1. Organizational Structure/Oversight Committees

1.1. Migrant Health Unit. The DOH shall establish a Migrant Health Unit, which shall be placed under and report to the Bureau of International Health Cooperation (BIHC). The functions of this unit are as follows:

a. Serve as the focal point in the DOH for all migrant health-related issues

b. Lead in the coordination and collaboration with other DOH bureaus, offices, and attached agencies, as well as other relevant government and non-government agencies, to operationalize the aforementioned strategies in addressing migrant health issues

c. Convene and serve as the Secretariat for the DOH Intra-Agency Task Force on Migrant Health and organize other technical working committees as appropriate and as necessary

d. Facilitate the delivery of specific services to OFs with critical health needs, such as medical repatriation assistance (provision of ambulance, hospital referral, etc.) and health assistance for migrants and OFs

e. Organize and maintain an inter-agency, multi-stakeholder network for migrant health (the Philippine Migrant Health Network) composed of other government agencies as well as other non-government stakeholders involved in migrant health

f. Foster collaboration, both local and international, on migrant health related activities and projects

g. Consolidate and disseminate information about the state of health of migrants from various DOH bureaus and attached agencies as well as other government and non-government stakeholders

h. Provide relevant updates and inputs to the Office of the Secretary

i. Monitor developments in migrant health as well as in the broader migration sector

1.2. DOH Intra-Agency Task Force on Migrant Health. The Migrant Health Unit shall regularly convene a task force on Migrant Health within the DOH that shall provide technical, substantive and policy direction on migrant health-related issues.

a. The task force shall be composed of the following:

i. Migrant Health Unit of the BIHC (Convenor)

ii. Disease Prevention and Control Bureau

iii. Health Facilities and Services Regulatory Bureau

iv. Bureau of Quarantine

v. Philippine Health Insurance Corporation (PhilHealth)

vi. Other offices as may be identified

b. The task force shall perform the following functions:

i. Review policies and programs that are relevant to migrant health, as well as the health status of migrants themselves;

ii. Identify gaps and challenges, develop collective policy and implement programmatic responses to pressing migrant health issues; and

iii. Recommend action on migrant health-related issues to the Secretary of Health.

c. The task force shall be the owner of its own outputs and decisions, and shall regularly report directly to the Office of Policy and Health Systems or the Secretary of Health through the Migrant Health Unit.

1.3. Philippine Migrant Health Network. The Migrant Health Unit shall organize and maintain an inter-agency, multi-stakeholder network for migrant health, composed of members from other government and non-government agencies, as well as the academe, civil society organizations, the private sector and international organizations.

a. The Network shall be composed of the following:

i. Department of Health (Convenor)

ii. Department of Foreign Affairs, Office of the Undersecretary for Migrant Workers Affairs

iii. Department of Labor and Employment and its attached agencies (i.e., Philippine Overseas Employment Administration, Overseas Workers Welfare Administration, National Reintegration Center for OFWs)

iv. Department of Social Welfare and Development

v. Commission on Filipinos Overseas

vi. Other representatives from non-government organizations, academic institutions, civil society organizations, international organizations and the private sector aDSIHc

b. The Network shall perform the following functions:

i. Discuss ideas, experiences and perspectives on migrant health issues and provide recommendations to appropriate agencies/organizations;

ii. Advocate and lobby support for migrant health program and issues;

iii. Develop and review proposals of migrant health related projects for resource mobilization; and

iv. Establish migrant health research agenda and review research proposals.

2. Budget

The DOH, through its designated focal office, the BIHC, shall allocate a corresponding budget and funding, for the establishment of a National Program for Migrant Health to develop and implement a plan of activities strategically directed at addressing issues and concerns related to the health of migrants and for the establishment of a unit in charge of the general oversight, coordination and management of projects and activities related to the Program. Existing activities and services within the DOH into which migrant health shall be mainstreamed, such as health system components or disease-specific programs, shall be funded by their respective implementing bureaus, offices, and attached agencies.

The DOH shall also encourage partnerships with other government agencies, as well as international organizations, nongovernmental organizations, academic institutions and the private sector, to implement and fund activities in support of the promotion and protection of the health of migrants and OFs.

3. Monitoring and Evaluation

The Migrant Health Unit shall develop systems, indicators, policies and standards to regularly monitor and evaluate the implementation of the National Program for Migrant Health and the status of the health of migrants and OFs.

VIII. Roles and Responsibilities

A. DOH Central Offices

1. Bureau of International Health Cooperation shall:

a. Perform the tasks of the Migrant Health Unit as described above;

b. Allocate and mobilize resources for migrant health programs and activities,

c. Renew and develop policies and ensure inclusion of migrant health in planning in coordination with the Health Policy Development and Planning Bureau;

d. Closely coordinate with relevant stakeholders in supporting the inter-sectoral approach to migrant health and in strengthening diplomatic relations and negotiations with other countries for the protection of migrant health; and

e. Facilitate international cooperation on migrant health with development partners;

f. Advocate for the promotion of migrant health in international health platforms.

2. Health Policy Development and Planning Bureau shall:

a. Assist in the development of policies, standards, protocols, and guidelines that promote or relate to migrant health;

b. Support research on migrant health issues for policy development; and

c. Facilitate the inclusion of migrant health-related bills or the consideration of migrant health in other health-related bills in the legislative agenda.

3. Health Human Resource Development Bureau shall:

a. Coordinate with other agencies for the development of programs that promote health and wellbeing among migrant health workers;

b. Provide inputs to international cooperation activities such as negotiations of bilateral agreements that relate to health worker migration; and

c. Advocate for the inclusion of migrant health in the orientation and training of health professionals.

4. Disease Prevention and Control Bureau shall:

a. Ensure migrant-sensitive interventions in all disease control and prevention programs relevant to migrants;

b. Develop protocols and guidelines on prevention, case definition, identification, and management of diseases that are relevant to migrant health; and

c. Provide technical input in the development of information, education, and communication materials on health conditions relevant to migrant health in coordination with the Health Promotion and Communication Service and key partners.

5. Bureau of Quarantine shall:

a. Ensure the effective and migrant-sensitive implementation of the Quarantine Act of 2004 and its Implementing Rules and Regulations;

b. Provide relevant reports on the health surveillance done on migrants arriving at Philippine ports and airports; and

c. Coordinate with relevant DOH offices, other government agencies, and non-governmental organizations in assisting returning migrants requiring medical intervention.

6. Health Emergency Management Bureau shall:

a. Provide technical assistance in the management of health emergency situations that affect migrants;

b. Facilitate coordination and/or networking with disaster/crisis agencies; and

c. Facilitate mobilization of response teams.

7. Health Facilities and Services Regulatory Bureau shall:

a. Regulate the activities and operations of all clinics which conduct Pre-Employment Medical Examinations (PEMEs) for OFWs, as provided by AO No. 2013-0006 and its amendments; and

b. Provide relevant reports on the state of migrant health during the pre-departure phases.

8. Bureau of Local Health Systems Development shall:

a. Ensure that migrants and OFs are provided essential health care in local settings or communities within the service delivery network framework ETHIDa

b. Support the Migrant Health Program in establishing intra and inter-sectoral collaboration and capacity building of health stakeholders

All other offices in the central office shall be called upon and mobilized to assist in the implementation of the Migrant Health Program according to their respective mandates and scope of responsibility.

B. DOH Attached Agencies

1. Philippine Health Insurance Corporation shall:

a. Through its Overseas Filipino Program, ensure the enrolment of migrants and their families into the National Health Insurance Program (PhilHealth) to provide financial risk protection;

b. Design benefit packages that cater to the health needs of OFs and their families; and

c. Develop information, education, and communication strategies in order to raise awareness about PhilHealth among migrants.

2. Philippine National AIDS Council shall:

a. Ensure the inclusion of migrants in the development of plans and strategies to prevent and control HIV-AIDS; and

b. Monitor the implementation of provisions of the AIDS Medium-Term Plan, especially in relation to migrants living with HIV AIDS.

C. DOH Regional Offices shall:

1 In coordination with the Office for Health Operations, provide direct medical assistance (ex. provision of ambulance, hospital referral) to OFs with critical health needs;

2. Facilitate provision of health services, through regional hospitals and other health facilities, that comply with standards and requirements set by the DOH Migrant Health Program;

3. Support the implementation by local government units of the DOH Migrant Health Program; and

4. Conduct health promotion and education activities on migrant health for staff and clients.

D. DOH-Retained Hospitals shall:

1. In coordination with the Migrant Health Unit (BIHC), provide direct medical assistance (e.g., provision of ambulance, hospital referral) to OFs with critical health needs and provide reports on the medical assistance provided

2. Provide health services that comply with standards and requirements set by the DOH Migrant Health Program

Furthermore, all other partners from different sectors and levels shall be enjoined to support and promote the programs. These shall include, but not limited to, the following:

A. Local Government Units shall:

1. Provide health services that comply with standards and requirements set by the DOH Migrant Health Program; and

2. Conduct health promotion and education activities on migrant health

B. Other Government Agencies, Non-government Organizations, Academia, Civil Society Organizations and Private Sector forming part of the Philippine Migrant Health Network shall:

1. Identify focal point to ensure smooth and orderly coordination with the DOH Migrant Health Unit;

2. Advocate migrant health and support the DOH Migrant Health Program, its policies and activities;

3. Coordinate with the DOH to ensure coherence between the DOH Migrant Health Program and their respective policies and programs; and

4. Conduct health promotion and education activities on migrant health

IX. Separability Clause

In the event that any provision or part of this Order is declared unauthorized or rendered invalid by any court of law or competent authority, those provisions not affected by such declaration shall remain valid and in effect.

X. Repealing Clause

Unless otherwise stated, provisions from previous issuances and other related orders that are inconsistent or contrary to this order are amended and repealed accordingly.

XI. Effectivity

This Order shall take effect fifteen (15) days after publication in an official gazette or a newspaper of general circulation.

 

(SGD.) JANETTE P. LORETO-GARIN, MD, MBA-HSecretary of Health

Published in The Philippine Star on March 22, 2016.