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

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

3. 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 8. TOURISM 9 Nov. 2012 Bangkok, Thailand

4. 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

5. 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

6. Health 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

7. 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

8. Professional Medical Regulatory Authority (PMRA or PRA) ASEAN Member States PMRA / PRA Brunei DarussalamBrunei Medical Board CambodiaCambodian Medical Council / Ministry of Health IndonesiaIndonesian Medical Council / Ministry of Health Lao PDRMinistry of Health MalaysiaMalaysian Medical Council MyanmarMyanmar Medical Council / Ministry of Health PhilippinesProfessional Regulation Commission Professional Regulatory Board of Medicine SingaporeSingapore Medical Council Specialists Accreditation Board ThailandThailand Medical Council Ministry of Public Health VietnamMinistry of Health

9. 1 Cross-Border Supply 2 Consumption Abroad 3 Commercial Presence 4 Movement of Natural Persons V. Services, unlike goods, have 4 modes of supply

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

11. Mode 4: Movement of natural persons Employee sent by firm from B Natural person Self-employed goes to Member A COUNTRY ACOUNTRY B Natural person Consumer A Commercial Presence Juridical person Service supply Service supply Modes of Supply

13. 1. Variation in qualification requirements across borders

14. 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 yearsDiploma of Medical Doctor

15. Comparability of ASEAN Nursing programs (Basic Nursing Education) COUNTRY COUNTRY NO. OF YEARS NO. OF YEARS DIPLOMA/DEGREE DIPLOMA/DEGREE Brunei Darussalam 3 years 4 years Diploma in Health Science (Nursing) Bachelor of Health Science (Nursing) Cambodia3 years 4 years Associate Degree in Nursing Bachelor Science Nursing Lao PDR 3 years 2.5 years 4 years Diploma in Nursing Continuing Bachelor in Nursing Science (Upgrade from diploma) Bachelor Science in Nursing Indonesia3 years 4 years Diploma in Nursing Bachelor in Nursing Malaysia3 years 4 years Diploma in Nursing Bachelor Science in Nursing

16. COUNTRY COUNTRY NO. OF YEARS NO. OF YEARS DIPLOMA/DEGREE 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 3 years full time 4 years full time 4 years part time Certificate Nurse Junior BsN (College of Nurse) Senior, BsN (Bachelor of Nursing Science) Bachelor of Nursing Comparability of ASEAN Nursing programs (Basic Nursing Education)

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

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

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

20.  Healthcare involves person-person interaction  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

21. 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

24. Quantity Quality Distribution Surpluses? Shortages? Actual needs?

25. 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 5. Nursing 491 ----301 89,000 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

26. 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 11. Respiratory Therapy 12. Veterinary Medicine 35.0% 4,496

27. 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

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

29. 1. Elevation of professional standards 1. Displacement of locals 2. Transfer of knowledge and skills2. Wage/salary inequality 3. Transfer of technology3. Rigid competition 4. Elimination of in-breeding4. Downgrading of quality standards 5. Job generation5. More expensive services 6. Solve maldistribution6. Problem in maintenance of labor standards 7. Encourage teamwork and collaboration between local and foreign health professionals

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

31. Dissemination Engagement Professional Regulatory Authorities Professionals / Professional Organizations Educational and Healthcare Institutions

32. ASEAN Integration Regional Standards Basic Qualification Postgraduate Qualification Professional Practice Continuing Professional Development

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

34.  Surgeons from Cambodia and Thailand  Anesthesiologist from Malaysia  Nurses from Indonesia and Philippines  Operating room in Cambodia

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