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Since the mid-1990s, there has been a rapid increase in the international movements of medical and healthcare workers, primarily doctors and nurses. In addition to the general acceleration of movement across borders as a result of globalization, the declining birth rates and aging populations in developed countries have increased the demand for workers in the medical, nursing, and nursing-care fields [1]. International movement of healthcare workers is primarily from countries in Asia and Africa to Europe, North America, and East Asia [1]. Japan is not an exception. Japan started receiving nurse and care worker candidates from Indonesia in August 2008 under the Economic Partnership Agreement (EPA) that came into effect in July of that year. Subsequently, EPA candidates began to arrive in Japan from the Philippines and Vietnam in the following years, and this trend has strengthened the international movement of workers in the medical and nursing fields in Japan. Under the EPA, foreigners who meet certain application requirements come to Japan as “nurse candidates” or “care worker candidates,” and these candidates receive training at a hospital or caregiving facility in Japan; they sign a contract of employment before arriving [2]. They aim to pass the Japanese national exam and obtain Japanese national qualifications during their respective periods (a maximum of three years for nurse candidates and four years for care worker candidates) [2]. However, their national exam pass rate has remained much lower than the rate for all examinees; 17.7% for nurses (FY 2017), and 50.7% for care workers (FY 2017). The pass rate for all candidates for FY 2017 for nurses was 91.0% and 70.8% for care workers [3-5]. Quite a few candidates gave up and returned to their home countries. Moreover, 20% of the EPA candidates who passed the national qualification returned to their home countries even though that they can remain in Japan as nurses or care givers without restriction after obtaining national certification [6]. The major reasons for their repatriation were personal ones such as care for aged parents, marriage and so on. On the other hand, frustration with difficulties in communicating in Japanese and adjusting to a working environment that requires strict commitment to rules and long working hours were also reported [6].

Suggestion Regarding Support for Continued Employment of Foreign Healthcare Personnel Coming to Japan under the Economic Partnership Agreement