TOKYO — Ms Dewita Tambun wants to become a nurse in Japan, a country with an ageing population and a shortage of hospital staff. But the 29-year-old Indonesian first has to battle the country’s tough immigration policy.

The biggest obstacle she faces is a seven-hour, 240-question test in Japanese that has been passed by only 96 of 741 nurses brought here from Indonesia and the Philippines in the past five years.

Ms Tambun, who has been in Japan since 2011, has failed the test twice and has one more shot at it in February before being sent home.

“I became a nurse because I wanted to work overseas. But Japanese is a very difficult language, and the exam is so hard,” she said.

An influx of people like Ms Tambun should make economic sense for Japan. The country faces a shortage of young, productive workers because of a falling birth rate. About a quarter of the country’s 130 million people are older than 65, and this is expected to grow to 40 per cent by 2055, adding to strains on the social security system.

Already, there is a shortfall of 43,000 nurses, according to the Health Ministry, and nurses attribute this fact to poor pay and work conditions.

The difficulty of balancing work and family responsibilities forces many Japanese women to stay home to care for elderly relatives, further deepening the shortage.

“Facing this demographic bomb, Japan simply needs to accept a significantly larger number of foreigners in its workforce, including nurses and caregivers,” said Mr Hidenori Sakanaka, Director of the Japan Immigration Policy Institute, an immigration advocacy group.

Immigration is equally contentious in Japan, where an insular, island nation mentality still prevails. According to a national poll last year by the Japan Association for Public Opinion Research, only 1.7 per cent of respondents said the country should promote immigration. There are currently only two million foreigners in Japan, or 1.6 per cent of the population.

Despite police statistics showing that crime by immigrants is declining, many Japanese fear that allowing in more foreigners will lead to rising crime, dilute Japan’s culture and undercut wages.

Five years ago, Japan agreed to accept nurses from Indonesia and the Philippines as part of broader economic pacts with those nations.

A nurse must pass the annual national exam in Japanese within three years or go home. In the meantime, they work as nursing aides. Hospitals pay their board and provide Japanese language training. However, only 11 per cent of 415 foreign nurses who took the test last year were successful.

“The programme is a complete failure. The test is throwing almost everybody off. It’s almost as if the government is not interested in accepting them in the first place,” said Mr Sakanaka.

A spokesman for the Health Ministry said the programme was never intended to fill a nursing gap, but was in response to a request from Indonesia and the Philippines, which face high unemployment.

Japan is instead focusing on luring back some of the nation’s 700,000 licensed nurses through counselling and other placement services.

However, morale is poor due to low base wages near US$2,500 (S$3,100) a month and long hours, said Mr Yusuke Ito, a spokesman for the Japanese Nursing Association. Senior members of the group have raised concern that an influx of foreign nurses could further lower wages for Japanese workers.

Others say the government should do more to help foreign nurses settle in, including helping to move their families to Japan.

“I just can’t see the government really working to facilitate the anchoring of foreign nurses in Japan. Even those who struggled hard to pass the exam often decide to return home,” said Dr Yuko Hirano, a professor at Nagasaki University’s Graduate School of Biomedical Sciences. Dow Jones