A representative of the trade union Ver.di gave this positive assessment during a symposium organized by Public Services International (PSI), a global union federation of workers in public sectors, to discuss the recruitment of nurses from the Philippines to Germany from 2014:
Over sixty representatives from trade unions, government bureaus, employers, recruiters, and civil society organizations participated in the event. PSIâs trade union affiliates in the Philippines and Germany, PSLink and Ver.di respectively, monitor the recruitment project through a joint committee.We see the Germany-Philippines BLA [bilateral labor agreement] as an existing good practice in the international recruitment of health workers as it is based on UN [United Nations] and ILO [International Labor Organization] norms and standards as well as ethical recruitment principles such as transparency, non-discrimination and mutual reciprocityâŠIt ensures the right to decent work and social protection of migrant health workers and provides for safeguards to sustain the health system of the source country. For instance, the BLA promotes cooperation on human resource development ensuring that the source country is able to train and sustain the skills needed in the country. While dealing with the migration of health workers in view of the protection of their rights, we must at the same time ensure that we have the sufficient number of workers critical to deliver quality public health services.1
The case of the Germany-Philippines BLA opens up the current concerns on the phenomenon of health care worker migration, which have generated a considerable body of research and policy agenda in the health (nursing) literature, health planning, and the social sciences.2 It signals the changing mechanism of regulating cross-border migration of health care workers from a unilateral approach to a partnership between source and host states while respecting international codes. The focus on managing recruitment through channeling or recuperating discourses of migrant workersâ rights, sustainability of health workforce, and decent work can be taken as a significant signpost for the creation of an ideal and new normative framework of mobility regime today. That is, nurses who possess highly sought-after caring skills across the globe are recast as migrant workers whose human rights, encompassing labor and migrant rights, need to be protected in a place where they have not been trained but where their purported development potential can be harnessed. The framework of migration management constitutes novel actors, such as nurses, in an attempt to regiment their movements to intensify the chances that both source and destination countries and migrant nurses themselves can reap benefits from migration. It is also envisioned that such regulation should minimize the risks associated with the movement, especially from South to North, by taking into consideration the origin countries where nurses have been trained.
Efforts to control cross-border migration are not new, however, the current rationalities of global governance transmute into a complex range of practices, discourses, and actors.3 One of the main objectives of the book is precisely to exhibit this multifaceted web and more importantly, those moments of struggle and contestation within the changing socio-political conditions they emerge from. This means I analyze the current political agenda of normalizing international migration, which aims to change the perception of migration from one that incites fear from receiving societies to a source of opportunities for states to settle their multiple and differing interests on issues of recruitment or labor export, development, migrantsâ rights, and security.4 If adequately managed, cross-border migration could serve the interests of both sending and receiving states, which would necessitate international cooperation among states and non-state actors (international organizations, non-governmental agencies, think tanks, and experts).5
Thus, the book critically examines the emerging field of migration governance or management as a preferred policy response to harnessing the opportunities and dealing with challenges the cross-border migration of health care workers brings about. I have chosen to focus on how enrolling care provision in a lucrative international recruitment industry is instrumental in shaping the governance of nurse migration. Of particular importance is how the three intersecting trends of actors, discourses, and practices legitimize each other by embracing a wide array of what we might loosely call âmoral-laden discoursesâ; those ideas claiming for fair migration and globalization, decent work, ethical recruitment, and good governance. My usage of the term âmoral-laden discoursesâ allows for taking a critical approach to their emergence, importance in knowledge production, and implications for governance of migration, in general, and of health care workers, in particular. Does the materialization of such discourses mean a stepping away from the dominance of economic model of migration? How do social relations figure in recuperating these emerging discourses and global arena of action?
Firstly, I suggest here a reading of management of nursesâ cross-border movement through the analytical lens of governmentality as a productive means of providing a critical perspective on how cross-border migration and recruitment of nursing skills are constituted as manageable or governable. The policy approach of migration management should be spelled out in relation to broader political rationalities seeking to regulate the spatial circulation of human subjects across state borders as well as those governing the settlement of foreign subjects inside the state territory. The book offers analysis of relevant documents from international organizations such as the World Health Organization (WHO) and the International Labor Organization (ILO) involved in producing knowledge about the management of health care worker migration; and initiatives such as the International Conference on Population and Development (ICPD), the United Nations High-Level Dialogue (UN HLD) on International Migration and Development, the Global Forum on Migration and Development (GFMD), the Global Commission on International Migration (GCIM), and the Berne Initiative instituting narratives of global migration governance.
I have conducted ethnography of the Germany-Philippines nursing care flows, which means tracing nurse migration within historical, political, economic, and sociocultural contexts; from the guest worker era until recent developments. This case not only opens up the current concerns on the phenomenon of nurse migration but also stir up the old debates on the guest nurses program between the Federal Republic of Germany and India, the Philippines, and South Korea in the 1960s and 70s. Examining this case demonstrates the shifting mechanism of cross-border migration from a unilateral approach to interstate cooperation which would make certain that skilled migration leads to economic development. By focusing on the multi-level management of nurse migration from the Philippines to Germany, the exploration intends to reflect on how actors, discourses, and practices are connected, produced, and conveyed. It examines who the involved actors are, their degree of engagement and intervention, and their relations to each other, different responsibilities, and stakes in their participation in the management. The analysis of discourses entails the changes in rhetoric which underlies each actorâs participation in the governance over time and how moral-laden discourses are constructed; how or in what contexts these discourses have emerged and been disparately channeled as regards managing nursesâ mobility. Lastly, the examination of practices considers which ones are performed in relation to regulating the cross-border skilled migration process; and how each phase of the process is controlled and negotiated by state and non-state actors. The analysis, therefore, sheds light on the modes of knowledge production associated with the recent developments in the changing configurations in which cross-border skilled migration is governed today.
Secondly, I juxtapose the analysis of migration governance with the ways migrant nurses situate themselves in the increasing globalization of care work and how they embody both the positive and negative aspects involved in this profession within and across borders. The valorization of nursing skills, in the context of migration governance, seems incompatible with nursesâ daily task of facing the ânegativities of the bodyâdirt, decay, decline, deathâ.6 At the same time, the care sector is associated with occupations avoided by locals and produces a new class of people, predominantly women, migrants, and people of color, who are in the margins of society.7 How do health care workers negotiate their agency in cross-border care flows and a range of challenges posed by caring for their immediate and extended families across borders? How do they navigate the âcomplex web of careâ8 they are part of, mainly as care providers, as this network is considerably changed when they move across borders...