Friday, February 18, 2011

Comprehensive Economic Partnership Agreement, Health Services and Sustainability

Most of the googled news item of 17th February, 2011 showed vigorously about the snippets of Comprehensive Economic Partnership Agreement (CEPA) between India and Japan that aims to reach a trade target of $25 billion by 2014. As a glancing reader of the news item, my eyes however got stuck in one detailing fact of the Comprehensive Economic Partnership Agreement. It mentioned that as a part of this CEPA, India and Japan would establish a social security agreement for Indian qualified nurses and Japanese certified care workers. The question sparkled – “Will that mean more Indian qualified nurses will go to Japan and serve them and more certified care workers from Japan will come here”? This did not stop here as the next question which arose was – “How qualification of the nurses are defined and recognized by Japan and how India recognizes the certification of Japanese careworkers”? Another question came and then it stopped – “Who gives these certifications and recognitions and how”?
Immediately the geek identity within me was searching for an essential linkage between this CEPA and sustainability. An important aspect of sustainability of any human race is the quality of health. Better quality of living should make people happy and it caters to the social dimensions of sustainability or sustainable development. A social security agreement as a part of CEPA should therefore have an overarching objective of addressing the health, quality of life dimensions of the people of the two countries who have signed the agreement. At this juncture, the important question to ask is does a social security agreement like the one I mentioned here allow a better and equitable type of health services between the two nations. If it does, all people in the two countries should get access to larger and better quality health service through this exchange of skills and human beings between the signing nations. This should therefore enhance the social living standards and can improve upon the societal indicators of sustainability and sustainable development in the two signing countries.
But in reality the connections as reflected above doesnot work so smoothly. So a signing of a security deal might not necessarily imply that all the people of India who really need the skilled service of Japanese care workers for a better quality of living would get an access to that. Different kinds of domestic regulatory barriers can hinder the access of the people to the skilled service of the care workers. A mere signing of a deal might not guarantee that the care workers can actually come and start working in the hospitals, health care centres of India. To do that, they might have to get some certificates through some exams that need to be recognized by the hospitals and health care centres of India. Mutual recognition between the two countries need to be put in place. So an absence of this mutual recognition can in reality lead to an absence of Japanese care workers in the hospitals, health care centres. So signing of a security agreement will not necessarily imply that care from skilled Japanese care workers is exchanged between India and Japan and provided to the people who need them in India. Typically, it has been seen that owing to strong domestic regulatory barriers in the health sector of U.K, exchange of nurses from Phillippines, doctors from developing countries have faced hindrances. The strong domestic regulatory and protectionist measures in the health service sector of U.K. have impeded smooth transfer of Phillippine nurses to hospitals in U.K. Often visa issuance, work permits, high cost of living have been a problem too. So even if a deal or agreement is signed a realization of the exchange of skill transfer from one country to another in health service might not happen. This thereby stops people to get access to a better quality health care skill that could have enhanced their quality of living and had enhanced the overall sustainability and development of the society at large.
Similar situation can arise between India and Japan also if the domestic regulations of India, Japan are not congenial to create an exchange of skills, health care in between the two nations through actual realization of the people working in the health sector of the signing countries. To ensure social sustainability of two signing countries through an improvement of health of the people by means of exchange of human skills, it is essential to also fine tune, modify the domestic regulations so that the people of the two countries finally get an access to better quality health care.
The next question is who in the two countries get access to the better quality health care once the smooth exchange of that starts happening out of this social security agreement. If the skill in health care segment that is exchanged is concentrated in certain hospitals, health care centres that are accessible only to the wealthy middle, upper middle and rich income classes then it still doesnot address the social sustainability dimensions of the two signing nations. The domestic health sector governance have to be adjusted and modified to ensure that the skills in health care which are exchanged are accessible to major sections of the society to improve the health standards and overall quality of living of the society. The equity question will become very important to the address social sustainability dimension once real trade, market access of health services start happening.
So there is a strong role of regulation, domestic governance that ensures first of all that after signing of the agreement an exchange of health care actually happens. Once that happens, governance mechanisms within the signing countries have to ensure that they are well distributed in all sections of the society to cater to the needs of social sustainability of the people of the two countries. Transparent, well governed, efficiently functioning domestic institutions will come into picture to ensure that distribution.

So in a nutshell, trade in services between two nations of CEPA through exchange of natural persons can play a major role in sustainability of two nations by raising the health and quality of living standards of the people of signing nations of a CEPA. But that can only happen with the able support of domestic regulations, institutions, governance mechanisms. The future ahead of us will raise more questions and also answer many questions arising from the confluence and convergent areas of trade in services between CEPA partners and social sustainability of the people of partnering countries.

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