Healthcare and Brain Drain

Context: An overview of brain drain of healthcare workers from India to developed nations, which unfortunately has culminated in the shortage of nurses and doctors amid pandemic.

 

Analysing the brain drain of healthcare workers:

• India as a major exporter: For several decades, healthcare workers are exported 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, along with 56,000 nurses in 2017.
• Shortage of healthcare workers: 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 three nurses per 1,000 population and a doctor to patient ratio of 1:1,100.
• Skewed distribution: The distribution of doctors and nurses is heavily skewed against some regions, e.g. there is a high concentration in some urban pockets.
• Lack of migration data: There is no real-time data on high-skilled migration from India as in the case of low-skilled and semi-skilled migration.
• Strong pull factors: Countries in dire need of retaining their healthcare workers have adopted migrant-friendly policies.
  • For e.g. At the beginning of the pandemic, OECD countries exempted health professionals with a job offer from the travel bans, while some relaxed visa requirements.
  • France has offered citizenship to frontline immigrant healthcare workers during the pandemic.
• Push factors:
  • The low wages in the private sector outfits along with reduced opportunities in the public sector.
  • The lack of government investment in healthcare and delayed appointments to public health institutions act as a catalyst for such migration.
  • For e.g. The 2020 Human Development Report shows that India has five hospital beds per 10,000 people — one of the lowest in the world.
  • Indian nurses (after completing education by taking loans) struggle to pay back loans due to low wages and are seen to be driven towards IELTS preparation.

Measures taken by the government to check the brain drain:

• In 2014, GoI 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 government has included nurses in the Emigration Check Required (ECR) category. This increased transparency in nurses recruitment, reducing exploitation.
  • Nurse recruitment to be done through six state-related employment agencies and makes it mandatory for them to accept international contracts approved by the government.

Way Forward:

• Increase investment in healthcare: This would increase employment opportunities for health workers.
  • This would include increasing payouts for the healthcare workers.
• Promote circular migration and return migration: Policies that incentivise healthcare workers to return home after the completion of their training or studies
  • Work towards framing bilateral agreements that could help shape a policy of “brain-share” between the sending and receiving countries.