GAMCA policies have elicited controversy over the past few years for two primary reasons: the first concerns the facilities' unfair monopoly over medical testing in labour-receiving countries, and the second regards outdated TB policies that discriminate against perfectly healthy workers. We profiled the latter issues here, here, and here, but this article is primarily devoted to GAMCA's unfair business practices.
GAMCA stands for G.C.C Approved Medical Centres' Association. These centres are the only medical facilities the Gulf permits to conduct pre-travel medical tests for prospective migrants. In late July, the Competition Commission of Pakistan (CCP) addressed complaints raised by the Pakistan Overseas Employment Promoters Association (POEPA) on behalf of exploited communities. The CCP fined 20 GAMC facilities and GAMCA administrative offices a total of RS 500 million for "collusive behavior." The CCP ruled that GAMCA "exploited customers by restricting their choice and imposing unfair terms and conditions."
The effect of the GAMCA monopoly on migrants is multi-fold: the absence of competition allows GAMCA to impose fees with little consideration to the financial circumstances of workers. Though GAMCA officials in Sri Lanka stated that a recent fee increase of RS 1,500 should not impact workers because foreign sponsors are responsible for such charges, many applicants do pay for their own medical testing, which adds to the exponential cost of pre-migration requirements. One prospective migrant worker explained,
Let us decide where we can undergone medical test with the cheapest but with the best facilities. Because more of this clinics they endorsed are collecting money and they are giving some false test just to repeat again the test with additional fee they collected. I am hoping that the government make priotize this kind of problem [to] remove the graft and corrupt practices not only in government but also in private sectors [Sic]. Source: StopGAMCA.org
The unfair privileges of GAMC facilities also affects the quality of medical service. Many migrants claim that the facilities are subpar and unprofessional. In regards to TB tests in particular, migrant workers complain that GAMC employees do not help them understand the procedures or their results. They are also endure long delays that add to the already stressful nature of pre-travel preparation. According to a resident professional identified as "Maynard,"
The main problem is most GCC nations did not provide GAMCA with any specific guidelines or standards in health screening. If you go to these clinics, you would not see any posters or leaflets showing their guidelines. Any spots or marks on one’s chest x-ray is labeled as TB, including marks and scars not even related to TB, for example, past infections from bronchitis or pneumonia." Source: StopGAMCA.org
Some also allege that the monopoly on testing begets corruption:
I even asked them if we can bring a result from outside hospital and if the result is negative, are they going to consider or evaluate result for comparison. They said that they will not honor it. …They don't even think that the people who consulted their clinic do not pick up the money from the streets to finance their medical exams!…I even consulted a rad tech friend who worked as a head radtech in a known hospital, he said that as for his profession "they can do magic with the film to show a false result!"… all we have to do is bribe them and the result will instantly remove all the findings in the film [Sic]. Source: StopGAMCA.org
Migrant Rights spoke with the founder of StopGAMCA.org, Abdul Rahman Asim, earlier this year. Asim explained that the pursuits of labour-sending countries can yield uncertain results:
A collective effort would have much better impact. GCC countries official attitude is very stubborn, if Nepal stops GAMCA centers, they will announce we will hire from Vietnam or some other country, instead of looking into the matter.
Additionally, prohibiting the monopoly of GAMCA facilities would have only limited effects on the most controversial component of GAMCA policy; the discriminatory TB policy itself would not change. But the opportunity to verify test results with a non-GAMCA facility, and the potential for greater patient support from these alternative facilities, would help reduce the stress on workers undergoing TB testing. Additionally, the success of labour-sending countries in influencing one sector of G.C.C migrant policies may establish a precedent to address other GAMCA issues.