Written by Ying-da Wong. Translated and edited by Isabelle Cheng.
Since the outbreak of COVID-19 in Taiwan, the government has launched several waves of public awareness campaigns. One of the consistent messages concerning face masks is that healthy individuals don’t need to use them regularly. However, it is advisable to put them on when going to a hospital, visiting public places and taking public transport. For those who are already ill, they are particularly advised to wear a face mask. What I would like to point out in the following is grounded on this understanding. Nonetheless, as a labour activist who works closely with, and for, migrant workers, I would like to raise public attention to some critical issues migrant workers are facing, which may not be known by the general public.
Controlling the distribution of face masks by NHI identification number
According to the National Health Insurance Act, foreign nationals who legally reside in Taiwan for more than six months are entitled to the National Health Insurance (NHI). For those whose residency is less than six months, they cannot be included in the NHI unless they are in legal employment. On 3rd February 2020, the government announced a suite of measures controlling the sale of face masks. Under this policy, face masks are sold only by pharmacies that are chartered by the National Health Insurance Administration (NHIA). All citizens and foreign residents may only purchase two face masks in one week. They may not purchase face masks without presenting their National Health Insurance Certificate (henceforth the NHI Card), in which an IC chip is embedded that allows users to access their personal data. Those whose NHI identification number ends on an odd number purchase on Monday, Wednesday and Friday. While those whose NHI identification number ends on an even number purchase on Tuesday, Thursday and Saturday. There is no restriction on eligibility placed on Sunday. On 4th February, this controlling measure was modified to allow foreign residents to purchase masks by presenting their Alien Resident Certificate (ARC) or passports—their purchase is subject to the same number system. On 2nd March, with the enhanced production capacity, the CDC announced that from 5th March onwards, adults are allocated to 3 face masks and children 5 face masks in a week’.
I trust that this controlling system is a result of the government’s careful assessment. Nevertheless, the government seemed to take it for granted that all citizens and foreign residents are issued with an NHI Card, and that their NHI Card is valid. As a matter of fact, as detailed below, there is a wide gap between this presumption and reality. This gap may affect people’s rights or adversely curtail the effectiveness of disease prevention. So, before I move on, a fundamental question must be asked: are migrant workers entitled to the NHI, and are they issued with an NHI Card?
A cautious answer is yes. The NHI shall include those who are recruited according to the Employment Services Act applied through their employers. This refers to home-based caregivers, and those who are employed by nursing homes; factory workers, and those who work on construction sites; butchery workers, and a fractional number of agricultural workers (legalised in January 2019) Finally, it also includes fishermen from Indonesia, Vietnam, the Philippines and Thailand, who work on inshore fishing vessels. However, this excludes foreign fishermen who are recruited abroad, and who work on offshore fishing vessels. Even if they work on an ROC-flag fishing vessel, they are not entitled to statutory labour rights. Thus, they are not covered by labour insurance or the NHI. Private insurance purchased through their employers only protect them.
Against this cautious answer, I would like to point out potential issues and challenges that may not be factored into the government’s control measures.
Foreign fishermen ineligible for the NHI
First, as mentioned above, fishermen recruited abroad on offshore fishing vessels cannot purchase face masks given their NHI ineligibility. This affects more than 20,000 foreign fishermen. It may be argued that they may not stay in Taiwan for long, and thus they may not need face masks in a significant number. Nevertheless, the government’s policy should not be made with the implication that it may exclude a specific group and make them vulnerable to health risks. A potential scenario will be that a foreign fisherman is hospitalised and, since he does not have the right to a family reunion, he may be cared by other fishermen from the same vessel or from a different ship. If neither their employers, nor the medical staff at the hospital, provides face masks, they will be exposed to risks, and their exposure will increase the difficulty to contain the disease.
NHI Cards confiscated by employers
Secondly, some migrant workers’ NHI Cards are confiscated by their employers so they will not be able to make purchases. It is widely known that in Taiwan, some migrant workers are forced to leave personal documentations to the care of their employers. These may include their passports, ARCs, NHI Cards and employment contracts. Most often their employers confiscate their passports, leaving the ARC and NHI Card with them. There is no official figure to ascertain how many migrant workers do not have their NHI Cards in their own possession. Anecdotal evidence suggests that there are such cases, although not in a considerable number. Therefore, although any of these identification documents can be used for purchasing face masks, some migrant workers may not be able to present any of them.
On the other hand, it is also reported that some pharmacies have refused to sell to individuals who did not present NHI Cards. This may be because pharmacies have to type their passport or ARC numbers into the system to check their purchasing record, whereas a card reader can scan an NHI Card to access the cardholder’s purchasing records quickly. Manually typing identification numbers takes time and slows down their service.
Home-based caregivers less free to purchase but in a higher need
Thirdly, most home-based caregivers are restricted by their employers and cannot freely leave their employers’ home—i.e. their workplace. They cannot have a day off regularly. Thus, it is difficult for them to purchase their face masks. Their lack of freedom may be part of their job description since they are employed for providing around-the-clock care for their patients. On the other hand, their restricted mobility may also be a result of their employers’ control. If they cannot leave their workplace freely, then how will they purchase their face masks?
Fourthly, even if migrant workers (particularly home-based caregivers) are free to leave their workplace and purchase their face masks at a nearby pharmacy, they may not be able to remain in the long queue, since most employers are less tolerant to their absence from work.
Fifthly, many caregivers and their patients have a demand for face masks more than the allocated number—two in one week. Many caregivers frequently, if not regularly, escort their patients to go to hospital or clinics for rehabilitation or dialysis. In some cases, rehabilitation therapy requires a daily visit to the health institution. Given that there is a higher risk for infection at hospitals or health institutions, it is advisable to wear face masks. Therefore, two face masks in a week may not meet the needs of caregivers and their patients.
Migrant workers’ irregular time off
Sixthly, migrant workers may not be able to abide by the policy of purchasing on the allocated weekdays. Many factories run shifts, and migrant workers’ weekends and days off may be adjusted accordingly. Employers often put migrant workers on overtime. Therefore, migrant workers may not be able to purchase on the allocated weekdays. They will indeed have time off, yet their time off is also subject to their employers’ approval. This further restriction limits the time available for them to purchase face masks outside of their workplace. As mentioned above, fishermen working on inshore fishing vessels are entitled to the NHI. However, their work time is mostly determined by the weather, so their time off is unpredictable. When they are not working due to bad weather, their employers may assign them to other tasks. Thus, they are further constrained, and may not be able to go to a pharmacy on the allocated weekdays.
Migrant workers in transition uncovered by the NHI
Finally, a critical challenge arises amongst those who are in transition between two employers, but who have not legally resided in Taiwan for more than six months. My shelter has assisted such a fisherman who had fallen seriously ill during transition. We accommodated him in our shelter after his plea for help to his broker was refused. However, our application to the NHIA regarding him was stonewalled. The NHIA maintained that he was ineligible because he had not resided in Taiwan for more than six months. We, as a sheltering institution, could not apply for him since he was not employed.
On the other hand, we also encountered those migrant workers who, despite being out of a job, were eligible since they had legally resided in Taiwan for more than six months. Nevertheless, reluctant to pay the monthly NHI premium, they chose not to be covered, even though my shelter could apply on their behalf. In sum, migrant workers in between jobs may not be covered by the NHI, which renders their NHI Card invalid. With an invalid NHI Card, they will have to present their passports or ARCs for purchasing face masks.
To conclude, I understand that the supply of face masks as controlled by the government cannot meet everyone’s demand. I also appreciate that the controlling measures adopted by the government serve a critical purpose. To the issues raised above, I am aware that employers, hospitals, sheltering institutions or recruitment agencies have the care of responsibility to provide face masks for migrant workers. It can also be argued that what I detailed above are ‘extreme’ cases where the number of needed face masks is small. Nevertheless, my point is that more than 710,000 migrant workers who reside and work in Taiwan should have the right to purchase their face masks for their health— thus protecting them will also contribute to the public interest. Lacking multilingual information provided by the government, migrant workers managed to grasp information about COVID-19 as much as they could. The government should make an effort to reach out to those included in the aforementioned scenarios to curtail the spread of the disease effectively.
Ying-da Wong is Director of Service Center and Shelter for Migrant Workers, Serve the People Association (SPA), Taoyuan
Isabelle Cheng is Senior Lecturer in East Asian and International Development Studies, University of Portsmouth. This article is part of a special issue on Covid-19.
Along with Taiwan Insight’s special issue on Covid-19, we also introduce a timely special issue of the International Journal of Taiwan Studies (IJTS) on “Taiwan, Public Diplomacy, and WHA”. Taiwan’s exclusion from the WHO and the WHA is now a major cause for concern. To understand the reasons, consequences and possible remedies for Taiwan’s exclusion, one has to adopt a multi-disciplinary perspective. In this IJTS’s special issue, we have brought together political scientists, IR specialists, communication scholars, and health experts. For more details, please visit here.