Brain Drain of Health Workers

Context: India has been a major exporter of healthcare workers to developed nations particularly to the Gulf Cooperation Council (GCC) countries, Europe and other English-speaking countries. This Brain Drain in the health sector is part of the reason for the current shortage in nurses and doctors.

What is Brain Drain?

  • Brain drain is a term indicating substantial emigration or migration of individuals. A brain drain can result from turmoil within a nation, the existence of favourable professional opportunities in other countries, or from a desire to seek a higher standard of living.
  • The majority of migration is from developing to developed countries. This is of growing concern worldwide because of its impact on the health systems in developing countries.
  • As per the Organisation for Economic Co-operation and Development (OECD) data, around 69,000 Indian trained doctors worked in the UK, US, Canada and Australia in 2017. In these four countries, 56,000 Indian-trained nurses were working in the same year.
  • There is also large-scale migration of health workers to the GCC countries but there is a lack of credible data on the stock of such workers in these nations.There is no real-time data on high-skilled migration from India as in the case of low-skilled and semi-skilled migration.

Present Situation of India:

Healthcare Workers:

  • For several decades, India has been a major exporter of healthcare workers to developed nations particularly to the Gulf Cooperation Council countries, Europe and other English-speaking countries.
  • As per OECD data, around 69,000 Indian trained doctors worked in the UK, US, Canada and Australia in 2017.
  • In these four countries, 56,000 Indian-trained nurses were working in the same year.
  • There is also large-scale migration of health workers to the GCC countries but there is a lack of credible data on the stock of such workers in these nations.
  • There is no real-time data on high-skilled migration from India as in the case of low-skilled and semi-skilled migration.

Shortage of nurses and doctors

  • The migration of healthcare workers is part of the reason for the shortage in nurses and doctors.
  • If we look at the figures for countries where we export our healthcare workers, we see just how big the difference is between the sending and the receiving countries. As per government reports, India has 1.7 nurses per 1,000 population and a doctor to patient ratio of 1:1,404. This is well below the WHO norm of 3 nurses per 1,000 population and a doctor to patient ratio of 1:1,100.
  • But, this does not convey the entire problem. The distribution of doctors and nurses is heavily skewed against some regions. Moreover, there is high concentration in some urban pockets.

Which factors are responsible for such Brain Drain?

  • With the onset of the pandemic, there has been a greater demand for healthcare workers across the world, especially in developed nations. Countries in dire need of retaining their healthcare workers have adopted migrant-friendly policies.
  • There are strong pull factors associated with the migration of healthcare workers, in terms of higher pay and better opportunities in the destination countries. There are strong push factors that often drive these workers to migrate abroad.
  • In case of nurses in India the low wages in private sector outfits along with reduced opportunities in the public sector plays a big role in them seeking employment opportunities outside the country.
  • The lack of government investment in healthcare and delayed appointments to public health institutions act as a catalyst for such migration. The government’s policies to check brain drain are restrictive in nature and do not give a real long-term solution to the problem. In 2014, it stopped issuing No Objection to Return to India (NORI) certificates to doctors migrating to the US.
  • The government has included nurses in the Emigration Check Required (ECR) category. This move was taken to bring about transparency in nursing recruitment and reduce exploitation of nurses in the destination countries.

Suggested Measures:

  • Over the years, the government has taken measures to check the brain drain of healthcare workers with little or no success. In 2014, it stopped issuing No Objection to Return to India (NORI) certificates to doctors migrating to the US. The NORI certificate is a US government requirement for doctors who migrate to America on a J1 visa and seek to extend their stay beyond three years. The non-issuance of the NORI would ensure that the doctors will have to return to India at the end of the three-year period.
  • The government has included nurses in the Emigration Check Required (ECR) category.
  • This move was taken to bring about transparency in nursing recruitment and reduce the exploitation of nurses in the destination countries. The government’s policies to check brain drain are restrictive in nature and do not give us a real long-term solution to the problem. We require systematic changes that could range from increased investment in health infrastructure, ensuring decent pay to workers and building an overall environment to motivate them to stay in the country.
  • The government should focus on framing policies that promote circular migration and return migration — policies that incentivise healthcare workers to return home after the completion of their training or studies. It could also work towards framing bilateral agreements that could help shape a policy of “brain-share” between the sending and receiving countries.
  • The 2020 Human Development Report shows that India has five hospital beds per 10,000 people — one of the lowest in the world. Increased investment in healthcare, especially in the public sector, is thus the need of the hour. This would, in turn, increase employment opportunities for health workers.