Implications of and Policy Direction for International Trade in Health Services in the Philippines

Abstract

International trade is a growing global process driven by the perceived economic benefits to trading partners, but little is known about its negative implications for societies, particularly its adverse effects on health. Recent years have seen increasing controversies associated with trade in health services in many nations in the Asian region, specifically Thailand, India, China and Pakistan. However, these emerging problems have not been systematically investigated in most countries in the region, including smaller developing countries such as the Philippines. Trade in health services in the Philippines is flourishing. However, though it can give economic benefits to the health service providers, it has social, ethical and legal implications, such as possible exploitation of poor and marginalized Filipino people. Although the Philippine health system strives to provide equitable healthcare to all Filipinos, for a resource limited country, it is a major challenge to deal with complex global issues such as international trade in health services. More importantly, there is a research gap in understanding their various implications in order to provide evidence-based policies and mitigation strategies for the Philippines. The aim of this research is to examine the implications of international trade in health services sought by foreigners in the Philippines in order to recommend policies for the future. To this end, the research will focus on two case studies, the trade in kidney transplant services and the trade in assisted reproduction and surrogacy services. Of the health services pursued by foreigners in the Philippines, these two cases have the greatest social, ethical and legal implications, in particular the exploitation of kidney donors and surrogate mothers. The research employs a qualitative methodology. Apart from an extensive literature and document review, the researcher collected data through key informant interviews and an expert workshop. There were 51 in-depth interviews with transplant surgeons, kidney specialists, transplant ethicists, fertility specialists, would-be surrogate mothers, government officials and non-government organisation representatives between July-November, 2015, in the Philippines, followed by an expert workshop to produce the policy direction for the country. It is attended by 60 participants in December 2016 in Manila. In order to ensure the validity of the research and to consider the matter through the eyes of the interviewees, the researcher continues to follow up with some of the interviewees through emails. The researcher later became an active member of the Declaration of Istanbul Custodian Group in combatting global organ trafficking and transplant tourism and eventually participated in the Global Summit for Organ Trafficking sponsored by the Pontifical Academy of Sciences at the Vatican City. By connecting to this network, the researcher was able to expand the study from the Filipino interviewees to international well-known experts who have rich experience in dealing with policy and global trafficking landscape. The research findings showed that there are existing regulations to control the adverse implications of trade in kidney transplant services in the Philippines. However, there is a gap between the regulations and their enforcement. Little has been done in the monitoring of the transplant centers in the Philippines and there is no referral mechanism if a health professional suspects an illegal case of organ trafficking. The consequence of a weak regulatory enforcement is the rise of a new landscape of organ trafficking in the Philippines. Unnoticed by the Philippine government, illegal transplants have happened in the Philippines between unrelated foreign kidney recipients and foreign kidney donors and which were coordinated by a kidney broker from another country. By contrast with the trade in kidney transplant services, there is no comprehensive national law in the Philippines to regulate assisted reproduction and surrogacy services. Fertility specialists in the Philippine have the capacity to do assisted reproduction, but their practice is restricted due to the religious (Roman Catholic) convictions of most of the population. The Roman Catholic Church condemns any form of assisted reproduction. However, there are vulnerable Filipina women who advertise themselves as would-be surrogate mothers who could be the target of exploitation and trafficking. Assisted reproduction and surrogacy services are still unregulated by the Philippine government. This research provides policy recommendations as a safeguard against the adverse implications of the trade in kidney transplant services and in assisted reproduction and surrogacy services in the Philippines. It is a comprehensive policy framework anchored in international regulations and national regulations with recommended implementation by multiple disciplines and multiple levels of authority. Given the rapidly growing global trade in health services, the findings of this research should be timely and useful to developing countries facing a similar scenario faced by the Philippines.