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158 QUANTIFICATION OF BENEFITS FROM ECONOMIC COOPERATION IN SOUTH ASIA commitments under the GATS, as discussed in Part 1 of this report, the Nepal medical council typically provides temporary registration for foreign doctors a maximum period of one year. Recognition of Foreign Qualified Nurses: The Nepal Nursing Council has the power to recognise qualifications from other countries. It reportedly does not as yet have any arrangements for reciprocity with any other Nursing Councils. 42 Pakistan FDI-related Requirements The foreign investment framework in Pakistan is governed by Foreign Private Investment (Promotion and Protection) Act 1976 read with the Protection of Economic Reforms Act, 1992 and the Board of Investment Ordinance, 2001. The Board of Investment is the body that regulated foreign direct investment in Pakistan. Under the foreign investment regulatory framework ‘hospitals and medical’ services fall under ‘social sector’ and 100% FDI 43 is allowed subject to minimum investment US$ 300,000/. 44 Domestic Regulations Regarding Qualification and Licensing Criteria for Medical Practioners and Dentists and Nurses Regulatory Authority: The Pakistan medical and dental council established under the Pakistan Medical and Dental Council Ordinance, 1962, is the authority responsible for the regulation of the medical and dental profession in Pakistan. 45 The Pakistan nursing council established under the Pakistan Nursing Council Act, 1952, is the authority responsible for registration and licensing of nurses and midwives. Only persons possessing degrees recognised by the relevant councils and registered with such council can practice the profession of medicine, dentistry and nursing in Pakistan. Recognition of Foreign Qualifications and Reciprocal Arrangements: Section 13 of the ordinance relates to the power of the medical and dental council to enter into negotiations with appropriate authority within or outside Pakistan, for settling a scheme of reciprocity for the recognition of medical and dental qualifications. Section 14 provides that the federal government after consulting the council may accord recognition to a medical qualification granted by medical institution outside Pakistan. Section 16 provides for recognition of additional medical qualification granted by foreign or domestic medical institutions. Section 17 provides for registration of medical licenses and diplomas granted by medical institutions in or outside Pakistan, in accordance with the provisions of the ordinance. Sections 18 and 19 contemplate recognition of qualifications granted by dental institutions in or outside Pakistan and their certification by the council. Under Section 23, the council maintains a register for registration of medical practitioners possessing qualifications, which are recognised medical qualifications under the ordinance. The schedule to the ordinance listing the specific foreign degrees recognised, could not be obtained. However, since the Indian Medical Council Act specifies several medical degrees from Pakistan under the principle of reciprocity, it is likely that the Pakistan ordinance too lists degrees from several Indian universities that would be reciprocally recognisable in Pakistan. With regard to Nursing, a copy of the Pakistan Nursing Council Act could not be obtained. It is therefore not clear whether nursing degrees from other countries are recognised in Pakistan. Sri Lanka FDI-related Requirements The Controller of Foreign Exchange (under the Exchange Control Act) and the Board of Investment (earlier called the Greater Colombo Economic Commission created under the Greater Colombo Economic Commission Law, 1978), are the regulatory authorities for investment in Sri Lanka. Applications for foreign investment need to be made to the Controller of Foreign Exchange which refers applications to the Board of Investment. Sri Lanka has three lists of sectors – one prohibiting 42 http://www.anmc.org.au/international/index.php 43 http://investinpakistan.org/investment-laws.php 44 http://www.pakboi.gov.pk/sectors.htm 45 However, the main functions of the Pakistan Medical and Dental Council are summarised in the judgement of the Pakistan Supreme Court, Pakistan Medical and Dental Council v. Ziauddin Medical University & Others, dated December 15, 2006, available at http://www.pmdc.org.pk/judge.pdf.
H EALTH AND RELATED SERVICES 159 foreign direct investment, the other limiting foreign direct investment and a third list where prior approval of the Government is required for foreign direct investment. The hospital/health sector is not listed in any of the three lists. 46 Consequently, 100% FDI is allowed in the hospital sector in Sri Lanka. However, in order to get incentives for development of hospitals a foreign investor should obtain approval of Board of Investment and undertake a minimum level of investment. 47 BOI incentives are granted to construct hospitals under the categories of ‘Small or Large-scale Infrastructure’. In the case of other categories of investment, incentives will be granted depending on project characteristics. Domestic Regulations Regarding Qualification and Licensing Criteria for Medical Practioners and Dentists and Nurses Regulatory Authority: The Sri Lankan Medical Council is the regulatory authority for the medical, and nursing dental professions in Sri Lanka. Persons possessing qualification recognised by the Council are required to undertake a qualifying examination administered by the Council, before being registered for the practice of the medical or dental professions in Sri Lanka. Recognition of Foreign Qualifications and Reciprocal Arrangements: The Council also prescribes the procedure for recognition of foreign medical degrees. The foreign degrees committee of the medical council is the authority responsible for evaluating applications for recognition of foreign medical and dental degrees. A foreign applicant seeking such recognition needs to apply to the committee. If the committee, after evaluation of the relevant documentation, recognises the degree, it may still require members of the medical council to visit the relevant school before according recognition. If a foreign degree is accepted, the applicant is required to sit for a qualifying examination before registering with the medical council. Although a list of degrees recognised by the council could not be obtained, it is likely that medical degrees from at least India and Nepal are recognised under the principle of reciprocity, since these countries have recognised degrees awarded by colleges in Sri Lanka. With regard to nursing, however, Sri Lanka reportedly recognised foreign degrees only from New Zealand, Australia, England and some countries in the middle-east. 48 CONSTRAINTS AND OPPORTUNITIES FOR TRADE IN HEALTHCARE SERVICES IN THE SAARC COUNTRIES This section assesses the impact of the regulatory constraints discussed above on the delivery of healthcare services under each of the modes of service supply. It also highlights how in certain aspects, presence of several operational level constraints also impacts delivery of service under a particular mode. These are then consolidated as aspects for discussion and negotiation under the SAARC framework for liberalisation of healthcare services. Mode 3 and FDI issues will be discussed first, followed by issues relating to Mode 2, i.e. ‘consumption abroad’ or medical tourism. Mode 1 on cross-border services and Mode 4 on movement of natural persons across borders to deliver medical services, will be discussed together since the regulatory opportunities and constraints for this aspect are very similar. Mode 3 Access: Regulations relating to FDI in the SAARC Countries UNCTAD’s World Investment <strong>Report</strong> 2007 49 points out that social services such as health and education are among the industries with the lowest level of explicit restrictions on FDI. This is further corroborated in the above analysis. All the SAARC members, with the exception of Bhutan, allow for 100% FDI for setting up of hospitals, subject to certain terms and conditions. In fact this liberalisation is upwards of their GATS commitments discussed above. This is typically the case for most WTO members, partly because countries have been more willing to liberalise unilaterally than multilaterally, for various reasons, including their desire to maintain policy space. 50 With respect to India there are no major regulatory constraints in the setting up of hospitals, 51 and this 46 http://www.boi.lk/BOI2005/content.asp?content=investinc3&SubMenuID=29 47 http://www.boi.lk/BOI2005/content.asp?content=investopp14&SubMenuID=94 48 http://www.anmc.org.au/international/index.php 49 UNCTAD, World Investment <strong>Report</strong> 2007, available at http://www.unctad.org/en/docs/wir2007_en.pdf 50 Ibid. 51 Rupa Chanda, Foreign Investment in Hospitals in India: Status and Implications, Study for WHO and the WTO-Cell, Ministry of Health and Family Welfare, 2007, page 14.
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QUANTIFICATION OF BENEFITS FROM ECO
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QUANTIFICATION OF BENEFITS FROM ECO
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Preface Our consultations with seni
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viii CONTENTS 7. Revenue and Welfar
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Executive Summary OBJECTIVE This st
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EXECUTIVE SUMMARY xiii Table 1 EAMA
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EXECUTIVE SUMMARY xv India A full S
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EXECUTIVE SUMMARY xvii indicates th
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EXECUTIVE SUMMARY xix ments on basi
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Part I BENEFITS FROM TRADE, INVESTM
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4 QUANTIFICATION OF BENEFITS FROM E
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10 QUANTIFICATION OF BENEFITS FROM
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2 Literature Review and Rationale f
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4 Effective Additional Market Acces
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6 Impact of SAFTA on Member Countri
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7 Revenue and Welfare Implications
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8 Impact of SAFTA on Inward and Out
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Part II BENEFITS FROM DEEPENING INT
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11 Construction and Related Enginee
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Appendix 8 Intra SAARC FDI Collabor
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Appendix 11 Table A11.1 On an Emplo
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Appendix 12 Original Commitments/In
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Appendix 14 Table A14.1 Telecommuni
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Appendix 15 REFERENCE PAPER Scope T
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Bibliography Abelson, P. (1996),
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BIBLIOGRAPHY 241 Cuba (2002), Negot
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BIBLIOGRAPHY 243 (2004), Impacts of
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BIBLIOGRAPHY 245 Silva, Patricia an
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BIBLIOGRAPHY 247 (1998), Tourism Se
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