[COLUMNIST] Improving medical screening in view of the Foreign Worker Employment Relaxation Plan

The recent Foreign Worker Employment Relaxation Plan (FWERP) announced by the government makes it easier for employers from five sectors (farming, agriculture, construction, manufacturing, services – restaurants only) to hire foreign workers from 15 source countries. This scheme targets the entry of around 500,000 foreign workers (“Government approves entry of 500,000 foreign workers”, New Straits Times, January 18, 2023).

As of December 2022, 1,459,196 foreign works held a Temporary Work Visit Pass or VP (TE) in Malaysia. The FWERP will only increase the number of VP (TE) holders in the coming months.

Therefore, in view of the FWERP, there is a need to improve medical screening as a policy priority under the broader management of foreign migrant workforce in the country.

The Foreign Workers Medical Examination Monitoring Agency (FOMEMA) is an independent organisation appointed by the government to manage the medical health screening of foreign workers.

There are two phases of medical screening for foreign workers:

1. Phase 1 (Pre-Arrival) – Foreign workers are required to undergo a medical screening in their source country prior to departing for Malaysia; and

2. Phase 2 (Post-Arrival) – After arriving in Malaysia, foreign workers are required to undergo another medical screening at any of FOMEMA’s accredited health clinic within 18 days of arrival.

Only upon clearing the FOMEMA health check-ups, they will be issued a VP (TE). Should they fail the medical exam, they will not be allowed to stay and work in Malaysia and employers are required to apply for the repatriation process.

A foreign worker detected with any of the following diseases or conditions is said to fail the FOMEMA health screening:

Foreign workers are required to undergo the medical examination annually for up to three years after arriving in Malaysia after which they are only required to do so every alternate year (“Frequently Asked Questions”, FOMEMA).

Ten years is the maximum number of years a foreign worker can reside in Malaysia.

Rise In Communicable Diseases

Despite these precautions taken by FOMEMA, contagious diseases are increasing in Malaysia.

In 2022, Penang experienced a malaria crisis after the entry of foreign workers in the state (“Penang facing urban malaria crisis following influx of foreign workers, says state health DG”, The Star, August 12, 2022).

A 2010-2017 study on the health status of migrant workers in Selangor found an increasing trend of communicable diseases (“Health Status of Migrant Workers Attending Primary Care Clinics in Malaysia: Basis for Health Intervention Programme”, Faller & Miskam, Andalas University).

Of the 5,819,426 foreign workers that underwent FOMEMA medical screenings from 2014-2018, 141,577 (2.43%) failed and had to be sent back to their countries. Amongst these, 84,982 (60%) failed due to having communicable diseases with tuberculosis being the most prevalent (62,380) (“The Next Pandemic: Factors of Failure in FOMEMA Tuberculosis Screening Amongst the Foreign Workers in Malaysia”, European Journal of Molecular & Clinical Medicine, Vol. 7, Issue 6, 2020).

The Auditor General’s Report 2018 reported that “the Home Ministry’s control on foreign workers is incompetent … the weakness in the system includes having no accurate record of foreign workers failing FOMEMA tests and of those sent back to their home countries” (“Lax control on alien workers”, The Star, July 16, 2019).

Identity Theft

Identity theft is commonly used wherein a healthy individual is sent to the screening in substitution of an unhealthy worker to enable the issuance of a work permit for the unhealthy worker.

In order to combat this, FOMEMA included two measures to verify the foreign worker’s identity at the healthcare clinic: presenting their passport and biometric fingerprint verification (“Fomema rolls out foreign worker biometric fingerprint verification system”, MalayMail, March 17, 2019).

The standard operating procedure (SOP) states that the medical examination is only carried out if the worker’s identity is confirmed.

Maximum Period for Post-Arrival FOMEMA Screening

Previously the SOP required employers to have their workers take the medical screening within 30 days of arriving in Malaysia. However, according to the Auditor General’s Report, in 2017 and 2019, over 11,000 foreign workers took their medical screening post the 30-day time frame.

This long-time frame allows for workers to roam around freely unknowingly transmitting any possible communicable disease. This is especially concerning in the case of airborne communicable diseases such as tuberculosis.

As such, this time frame was reduced to 18 days recently.

While this decreases the amount of time a migrant interacts with locals and hence decreases the possibility of transmission, 18 days is still too long a period of time to ensure no transmission.

Hence, EMIR Research recommends exploring methods of quarantining foreign workers post-arrival with employers providing for accommodation costs until they are medically screened.

Multiple Entry Visa

The visa received by the foreign workers is a multiple entry permit. When they go back to their home country for visitation, they can still be exposed to any communicable disease whilst there. Foreign workers are not screened after returning from their visitations – only the first time they come to Malaysia and then year two and year three and thereafter the alternate year afterwards, as stated before.

EMIR Research recommends devising a mechanism which prevents the spread of diseases that might be acquired during visitations (to the home/source country) while ensuring that the worker’s right to do so is protected. Those with experience in this field suggest that annual screening is an effective method to detect any disease acquired upon visiting the home/source country.

Source Clinics

Between 2016 to 2018, around 17,520 foreign workers that passed the medical tests in their home/source country failed the screening in Malaysia.

Potential reasons include the time gap between both the screenings wherein the worker could have acquired a disease after their screening in the home/source country.

In 2019, the Immigration Department issued an order to review and blacklist home/source country clinics that were found to have repeatedly approve foreign workers who failed the medical screening in Malaysia.

The Ministry of Health (MoH) does not undertake the accreditation of home country clinics. A reliable source stated that “the MoH is not ready to expand their responsibility to source countries. To them it is not within their jurisdiction.”

However, the same source also claims that jurisdiction should not be a problem since home countries already allow Bestinet (a local private company which outsources the management of recruiting foreign workers) to operate there ("Foreign Workers Centralized Management System (FWCMS) aims for global expansion”, FWCMS, July 9, 2019).

EMIR Research recommends that the MoH in collaboration and coordination with the Ministry of Human Resources (MoHR) and Ministry of Home Affairs (MoHA) take a more pro-active role in source country medical screening oversight since their involvement is critical.

Harsher Penalties for Employers

Some employers continue to employ foreign workers regardless of their health screening status.

When a foreign worker is to be repatriated, employers are supposed to obtain a Check-Out Memo (COM) which “indicates that the worker has been erased out of the Immigration Department’s system and is no longer in Malaysia”. However, many employers take such procedures lightly and do not obtain the COM.

From 2016 to 2018, only 29.6% (12,319) of the 41,607 foreign workers who failed the FOMEMA screening were issued a COM. There was no data on the remaining 70.3% (29,288) of workers. Hence, it is unclear whether the 70.3% workers are still in Malaysia or not.

EMIR Research recommends educating employers on the security and health risks by employing foreign workers who failed the medical screenings or by not following the due process of obtaining the COM. Stricter penalties such as preventing employers to hire foreign workers should be implemented if they violate these guidelines.

Lack of Clear Repatriation Guideline

The main issue is how to manage foreign workers who have failed their medical screening.

It is unclear whether there are any clear guidelines regarding the repatriation process of a foreign worker. Employers are responsible for repatriating the workers who failed the FOMEMA screening to their home country within 30 days of being notified.

Sometimes workers run away to avoid being repatriated since they have usually taken loans to come to Malaysia to work. Runaway foreign workers turn into illegal foreign workers. The 30-day time frame provides workers with ample opportunities to abscond.

As such, EMIR Research recommends that the MoHA and FOMEMA publish a clearer guideline regarding the repatriation process.

The 30-day period should also be decreased and workers should be quarantined until they are repatriated back. Furthermore, it is imperative to make it mandatory for employers to report any run-away worker to the Royal Malaysian Police and Immigration Department so that they are blacklisted and would not be able to renew their work permit in the future.

Additionally, if foreign workers fail their medical screenings, it is hard to revoke the VP (TE) since it is issued as a physical card. The worker can continue using the card while illegally staying in Malaysia. As such, it is recommended that alternative methods to using a physical card be used.

Lack of FOMEMA Oversight

Being a private entity, FOMEMA does not publish any reports on its operations and does not need to be publicly audited. FOMEMA’s lack of transparency is worrying given it is the sole organisation appointed by the government but seemingly not required to be transparent regarding the medical screenings of foreign workers in Malaysia.

The coming influx of 500,000 foreign workers in Malaysia warrants the MoHA to impose stronger and closer oversight on FOMEMA.

Importance of Foreign Workers

It is easy and common for locals to baulk at the hiring of foreign workers and also stigmatise them due to the potential threat and spectre of diseases transmitting and circulating and originating/emanating from the migrant community whilst ironically ignoring how heavily reliant the economy is on the latter. In 2019, they made up for over 30% of the workforce in the agriculture sector and over 20% in both the manufacturing and construction sectors (“The Economic Case against the Marginalization of Migrant Workers in Malaysia”, London School of Economics, 1 October, 2020).

Currently, 200,000 workers are needed for the palm oil sector, one of Malaysia’s main sources of exports and a critical contributor to its gross domestic product (GDP). A 1% increase in GDP is expected through this scheme ("Approval for foreign labour now takes only 3 days, says Saifuddin”, Free Malaysia Today, January 10, 2023).

EMIR Research strongly urges that while the government takes extra steps to make FOMEMA’s medical screening more rigorous, it should also ensure that there is no increased prejudice and discrimination towards the foreign migrant labour population.

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* Jason Loh and Juhi Todi are part of the research team at EMIR Research, an independent think tank focused on strategic policy recommendations based on rigorous research.

** The views and opinions expressed in this article are those of the author(s) and do not necessarily reflect the position of Astro AWANI.