The Skill Circulation of Oral Care and Swallowing Function Rehabilitation: Developing a Career Path for Returned Healthcare Migrants from Japan to Asian Countries

April 2018–August 2021


Tri Budi W Rahardjo, Universitas Respati Indonesia, Indonesia
Susiana Nugraha, Universitas Respati Indonesia, Indonesia
Yuko Hirano, Nagasaki University, Japan
Marlin Marpaung, Asosiasi Senior Living Indonesia, Indonesia


The circulation of the long-term care workforce is recognized as one of the most important topics under the framework of the Asia Health and Wellbeing Initiative (AHWIN). Japan has opened its labor market for the healthcare industry through a series of bilateral Economic Partnership Agreements (EPAs) between Japan on the one hand and the Philippines, Indonesia, and Vietnam on the other. Under these EPAs, which seek to promote trade, Japan has accepted more than 4,700 nurses and care workers since 2008. Over the past decade, 250 nurses and 542 care workers have become licentiates in Japan.

One of the challenges facing this system, however, is that many of those who have spent a couple of years in Japan under the EPA program and then returned home have faced limited career paths in their home countries. According to a previous study by the authors, this is especially true in the case of certified care workers, since no such professional occupation exists in their countries of origin. For this reason, the certified care worker returnees—including those who were able to pass the national board examination for certified care workers in Japan, with which they are certified to be a competent care worker as a health care professional—cannot utilize the work experience they gained in Japan. The majority of them have been forced to abandon their careers as health professionals and take up alternate careers, such as working as Japanese interpreters.

In November 2017, the Japanese government announced that it would add care work as an eligible area of employment for trainees who enter Japan under the Technical Intern Training Program (TITP). The Japanese government stresses the benefit of the TITP program in that it allows trainees to “advance their careers and contribute to the development of industries and companies through the utilization of their acquired skills after returning to their home countries.” However, as noted above, that career path for returned care workers simply does not exist. Japan, as a receiving country, should provide a universal model for care work that sending countries—including Indonesia, the Philippines, and Viet Nam—can apply in order to develop a career path for returning care workers and fully utilize the skills of those workers. This is increasingly important as the populations in those countries are will be aging rapidly in the near future and thus caregivers will be in greater demand.

The goal of the project is to develop a training program for oral care and swallowing function rehabilitation that can be used by in-coming EPA and TITP trainees as pre-departure training and that can also contribute to educating health care workers in the sending countries. The result of this study can provide an example of the effective circulation of the care workforce and also contribute to the standardization of care skills.