Where have all the nurses gone??

In 2015, 2.8 million Indians migrated to Saudi Arabia. At a CAGR of 16.1%, this number was at 1.79 million in 2012. Along with Saudi, UAE, USA, Kuwait, Oman, Qatar and Bahrain, ten more countries saw a total of 11 million Indians migrating to them in 2015 itself.

The leading Indian states for outward migration, in 2014, included Uttar Pradesh, Bihar, Tamil Nadu, Kerala, Andhra Pradesh, West Bengal, Punjab, and Rajasthan. Together, these states accounted for over 80% of the migration from India at 6.7 million outward migrants; Uttar Pradesh was the top contributor at 230,000 outward migrants.

Moreover, wage rates, particularly for low-skilled workers, in states like Kerala are fairly high compared with the rates in Bihar and Uttar Pradesh. This situation encourages low-skilled and less educated workers in poorer states to migrate abroad in hopes of earning greater income. The average monthly minimum wage in Europe, Saudi Arabia, Oman, and Australia is over USD 1,600 in PPP terms, which is over 850% of the Indian monthly minimum wage (USD 175). Below is the table for monthly wages in Purchasing Power Parity (PPP) terms:

immigration trends5

The migration trend has experienced a relative shift from prosperous states such as Kerala and Karnataka to poorer states like Uttar Pradesh and Bihar due to the excessive and sudden population growth in these states, leading to a high demand for jobs. Below is the table for source state and destination country mapping of Indian migrants:

immigration trends7

The key reasons for migration include low wages in India, growing working-age population, and low employment generation rate.  Employment growth during the recent decade (2005-12) has been much lower at 0.4% compared with that recorded during the previous decade, 1994-2005, at 1.8%. Moreover, the rate of unemployment among the youth (15-24 years) is almost double the overall rate.

Since independence, nurses from India have been migrating abroad in the hope of earning a better livelihood and dignity of their job.nurse stats4.png

The share of migrant nurses going to Saudi Arabia declined from 32% in 2011 to 22% in 2016. The proportion of migrant nurses going to the United States declined from 12.2% in 2011 to 6% in 2016, while the share of nurses migrating to Canada slightly increased from 3.3% in 2013 to 5.5% in 2016. Nurse migrants to Australia also increased in this period. These trends suggest that while overall overseas nurse migration levels are falling, there appears to be a shift in destination countries away from the Gulf countries to Canada and Australia.

However, the numbers of nurses trained in India entering Canada annually are not comparable with the high levels that were witnessed earlier in the United Kingdom and the United States. Indian nurses comprise a sizeable section of foreign trained nurses in USA(9%), Australia(3.3%), New Zealand(4.9%), the United Kingdom(3.3%) and, to a certain extent, in Canada(0.9%).  It is estimated that over 30% of nurses who studied in Kerala work in the United Kingdom or the United States of America, with 15% in Australia and 12% in the Middle East (15). An estimated 33,147 nurses from India were working in OECD countries in 2016. 

As can be observed from above, nurses trained in India form a significant portion of internationally educated nurses working overseas, second to nurses trained in the Philippines. One study found that almost 42% of nurses from Kerala and Punjab had some inclination to migrate overseas, and this was higher than for doctors (32%).
A significant number of nurses also migrate to other parts of India.  These numbers are much lower than the number of nurses migrating overseas, which indicates the much stronger appeal of working overseas. The major destination states in terms of share of internal nurse migrants in 2016 were New Delhi (57.2%), followed by Rajasthan (28.7%) and Maharashtra (14.1%).

In recent decades, India has undergone a remarkable growth in the capacity to produce medical doctors and nurses. At the national level, the number of institutions offering Bachelor of Science (BSc. Nursing) increased from 349 in 2005 to 1831 in 2016, and Master of Science (MSc) degree institutions increased from 54 to 637 over the same period. Diploma-granting institutions also witnessed a rise—institutions offering
Auxiliary Nursing and Midwifery qualifications rose from 254 to 1986, and those providing General Nursing and Midwifery qualifications rose from 979 to 3123 between 2005 and 2016 (Indian Nursing Council data). nurse stats.png

Despite this, in 2012, the country had only 6.4 doctors, nurses and midwives per 10 000 population, one seventh of the World Health Organization (WHO) benchmark of 44.5 workers in these categories per 10,000 population. Estimated densities of qualified workers indicate that there were 3.3 allopathic doctors and 3.1 nurses and midwives per 10,000 population in 2012.

Further, Indian nurses on the whole are often faced with long working hours, lower salaries, stigma against the profession, and lack of autonomy and dignity in the workplace within the country, giving rise to push factors that influence decisions to migrate.

With such startling facts, where does that leave India with a burgeoning population and a steady rise in no of elders and patients with chronic ailments. Till and unless, the government and private players make a beeline in improving professional conditions for our nurses, we will see a steady exodus of the most critical helping hand in our medical industry. Three initiatives which will go a long way can be:

  1. Government`s expenditure in healthcare needs to rise as a percent of GDP. Thus, more hospitals, more jobs, more nurses are absorbed within the system.
  2. To plug the deficiency, skill development courses should be offered to semi-skilled workers in India as an alternate to skilled nursing.
  3. To generate jobs, the government must regularise unorganised sectors such as home healthcare, home services like carpentry, masonry, plumbing, domestic servants and construction workers where the bulk of  migrant population works in. This will help improve the dismal LFPR in India and bring these professions under the gamut of white collar jobs.

At #YouCare, we are not only creating awareness for semi-skilled freelancers and amateurs to take up meaningful training in nursing and nanny courses but are also providing them with jobs as caregivers at home.

Follow our work on Facebook and Twitter for more.

Till next time, #YOUCARE!!!

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