Brain drain in the health sector – Explained, Pointwise

Introduction

India is facing a health emergency due to Covid-19 Pandemic. At present, India is registering a little less than 3 lakh cases and more than 4,000 deaths in a day. Now, India is also undertaking one of the largest vaccination programs in the world. Management of this huge task would not have been possible without the contribution of health workers. The contribution of Indian health care workers amid the pandemic is extremely commendable.

However, India is facing a shortage of health workers at this crucial point in time. The present workforce is overburdened with their work for more than a year. A part of this problem is due to a large-scale brain drain in the health sector. If India was able to retain its workforce, India’s health sector would have been in a better position now.

Status of brain drain in the health sector in India

As per government reports, India has 1.7 nurses per 1,000 population and a doctor to patient ratio of 1:1404. But both of these are well below the WHO norms. The WHO recommends three nurses per 1,000 population and a doctor to patient ratio of 1:1100. The distribution of doctors and nurses is also heavily skewed in favour of some regions. Higher concentration present in some urban pockets. Brain drain in the health sector is also the reason for this.

• For several decades, India has been a major exporter of healthcare workers to developed nations. Indian health care workers are highly prevalent in the Gulf Cooperation Council (GCC) countries, Europe, and other English-speaking countries.
• As per OECD data, around 69,000 Indian-trained doctors and  56,000 Indian-trained nurses worked in the UK, US, Canada, and Australia in 2017.
• There is also a large-scale migration of health workers from India to the GCC countries. But there is no credible data available.
• The British Association of Physicians of Indian Origin (BAPIO) estimates that the UK alone has more than 40,000 Indian doctors.

According to the FICCI, The UK and the US are the top two destinations for foreign-trained doctors. Canada and Australia are other preferred destinations. Many developed and Gulf countries provide the red carpet for the best Indian doctors and nurses. India on the other hand not only facing challenges in retaining health professionals and also facing huge demand and supply gap in Doctors, nurses in rural areas.

Reasons for brain drain in the health sector

Like any migration trends, the migration of health professionals also has both push and pull factors.

Push factors

• Low Wages: Developed countries offer better wages compare to India. For example, nurses in India receive low wages in private sector outfits. Also, they have only less opportunity in the public sector(Low employment due to lower hospitals in the public sector). So, they generally migrate to developed countries that offer better wages.
• Lack of government investment in health care: India’s health care investment to GDP ratio is just 1.2 per cent. This is the lowest figure if we compare spending by OECD and BRICS nations. This reduces better employment opportunities for health professionals.
• Lack of health care educational Institutions: India only has around 550 institutions for MBBS education. So, Many Indian students prefer to study abroad due to high course fees, limited seats in government medical colleges, etc. Once they study abroad they prefer to pursue higher studies or practice abroad alone. China is attracting a lot of Indian students in this regard.
• Other factors: This includes unethical practices of some Indian private hospitals, lack of government policy to protect the vulnerable is also a reason for a health care worker to move abroad.

Pull factors

• Access to advanced technology: Developed countries offer better opportunities to pursue research in health care. Health care professionals also get access to advance technology, research facilities and even get higher scholarship amounts for their research.
• Better standard of living and life quality: Many developed and GCCs offer a higher salary, tax benefits, higher standard of living, etc. These act as a pull factor for Indian health care professionals.
• Policies of developed countries: Developed countries adopted migrant-friendly policies towards health care professionals. For example, with the onset of the pandemic, there is a greater demand for healthcare workers across the world. The developed countries implemented various policies to retain health care employees. Such as,
  • OECD countries exempted travel bans for the health professionals with job offers.
  • Some countries processed visa applications of healthcare workers even during the lockdown period.
  • The UK has granted free one-year visa extensions to healthcare workers and their dependents
  • France has offered citizenship to frontline immigrant healthcare workers during the pandemic.

Government measures to tackle the brain drain in the health sector

The government introduced many schemes to retain the brain drain in the health sector. For example,

• Stopped issuing NORI certificates: In 2014, India stopped issuing No Objection to Return to India (NORI) certificates to doctors migrating to the US. The US government requires a NORI certificate for doctors who seek to extend their stay beyond three years. As India stopped issuing these certificates, the Indian doctors will have to return to India after three years.
• Inclusion of nurses in the Emigration Check Required (ECR) category: This policy requires nurses recruitment from other countries to be done only through the six state-related employment agencies. Further, this also makes it mandatory for the nurses to accept international contracts that are approved by the government. This increases the transparency in nursing recruitment and reduces the exploitation of nurses in the destination countries.

But these policies fail to stop the brain drain from India and not focus on the long-term prevention of brain drain.

Suggestions to reduce brain drain in the health sector

National level practices:

1. Adequate investment in the health sector: Indian Budget 2021 aims to increase the Health sector spending from 1.2 percent to 2.5 percent in three years. This will increase adequate health infrastructure, adequate employment opportunities, etc.
2. Creating adequate health care institutions: The government has to allow private medical educational institutes to open up medical colleges along with capping the maximum fee per seat. Further, the government can ease land requirement norms for medical and nursing colleges and ease the teachers per students ratio for post-graduate medical courses.
3. Bringing in cutting-edge technology labs: The government has to create more cutting-edge research facilities to bring back health care professionals to India. For example, About 20 NRI doctors from the US and Europe relocated to Kolkata to set up the West bank Hospital as it has high-tech equipment and facilities.
4. The government also has to regulate any unethical practices, exploitation of nurses in private hospitals in India. The government can even incentives the whistleblowers of such malpractices by amending the whistleblowers’ Act.
5. Engage in bilateral agreements: The government can sign bilateral agreements with countries like the US, the UK, Canada, Australia towards working on a policy of “brain-share”. For example, destination countries would be obliged to supply healthcare workers to India in times of need, crisis situations like a pandemic, etc.

Global level changes

1. Creating a code of conduct for ethical recruitment: The global countries have to come together and create a consensus code for ethically recruiting health care professionals. This will reduce the exploitation of health care worker abroad.
2. Facilitating circular migration: Almost 37 percent of health care workers concentrated in North and South American countries. But they share only 10% of the global disease burden. On the other hand, countries in Africa and Asia share more disease burden and less health care worker presence. So, the world nations have to come together and facilitate circular migration of health care professionals in terms of crisis situations.

Conclusion

India needs systematic changes such as increased investment in health infrastructure,  ensuring decent pay to workers and building an overall environment to retain health care professionals. With the advent of the pandemic, India can import medical oxygen, import vaccine, but India cannot import health professionals. So, It is high time for Indian government to not only increase public spending but also increase the Doctor and nurses ratio and prevent brain drain in the health sector