Impact of Migration on Health

System

K. Srinivasan PhD
Professor
Achutha Menon Centre for Health Science Studies,
Sree Chitra Tirunal Institute for Medical Sciences
and Technology, Trivandrum
 Organization

●Human Resources in Health

●Migration and HR

●Migration and Health

●Migration in India
 Human Resources in Health

● Human Resources(health workforce) is prime in

advancements in health
● Health depends more on people to carry out its
mission
● Health workers
– Professionals
– Technicians
– Auxiliaries
● Human Resources for health are, the stock of all
individuals engaged in Promotion, protection of
population health
 Human Resources for Health

● All men and women who work in health field

– Not just physicians and nurses but also
– Public health workers
– Policy makers
– Educators
– Clerical staff
– Scientists
– Pharmacists
Ref: Not Enough Here... Too Many There... Health Workforce In India, WHO Country Office for India 2007
 Human Resources for Health
For every 30,000 – 1 PHC 1 Store keeper and ancillary
2 to 3 Physicians, staffs and attendants
1 ISM Physician, For every 5,000 – SC
1 Male Health Assistant, 1 MPW, 1 FMPW, For every
1 Female Health Assistant, 1000 Community Health
1 BEE, Volunteer
1F Health Worker(ANM), There are 23236 PHCs, 3346
1 LT CHCs and 146026 SCs
1 Statistician (GoI)and Taluka, Dist
1 Driver Hospitals
For every 5,000 – SC
1 MPW, 1 FMPW, For every 1000 Community Health Volunteer
There are 23236 PHCs, 3346 CHCs and 146026 SCs (GoI)and
Taluka, Dist Hospitals

Population of India 1,028 million (2001 Census)

Ref: Not Enough Here... Too Many There... Health Workforce In India, WHO Country Office for India 2007
 Human Resources for Health
● There are 6,43,520 Allopathic Medical
practitioners practicing in different states in
India registered with different MCs
(76925 +23858 = 1,00,783 in Public)
● There are 55000 dental surgeons registered
with different DCs (up to 2005)
● There are 8,39,862 General Nursing
Midwives, 5,02,503 Auxillary Nursing
Midwives and 40,536 Health visitor and
Health supervisors(Upto 2002) Nursing
Councils
● (in Public 1,79,495 – 2005)
● Ref: Not Enough Here... Too Many There... Health Workforce In India, WHO Country Office for India
2007
 Human Resources for Health
● Shortages and Vacancies (2006)
– 6.5 % PHCs without Doctor
– 4.7 % of SCs without HW(F)
– 39.2 % of SCs without HW (M)
– Short fall of 19,311 MPW (F)
– Shortfall of 64,211 MPW(M)
– Shortfall of 4,214 LHV/HA
– Shorfall of 5290 HA(M)
– 4.8% MPW(F) posts vacant
– 24.1 %MPW(M) Vacant
– 13.2 % LHV/HA Vacant
– 25.4 % HA(M) Vacant
– 17.5 % Doctors at PHCs Vacant
● Ref: Not Enough Here... Too Many There... Health Workforce In India, WHO Country Office for India
2007
 ● The nurse-doctor ratio in India is heavily
skewed in favour of doctors.
● According to a computation from census
there are approximately 1.2 nurses and
midwives per allopathic physician
● USA and UK have nurse-physician ratios of 3
and 5 respectively.
● According to the 2001 Census, almost 60 per
cent of health workers reside in urban areas,
● The density of health workers per 10,000
population in urban areas (42) rural areas
(11.8).
● The majority (70 per cent) of health workers
are employed in the private sector
Reference: Annual Report to the people on health, 2010 by MoHFW, GoI, Sept 2010
http://mohfw.nic.in/WriteReadData/l892s/9457038092AnnualReporthealth.pdf
● Major factors related to the growth of the health sector
that are responsible for the acute
● shortage of health personnel that we were faced with
are:
● 1. States with the greatest human resource needs also
have the lowest capacity of producing them.
● 5 south-western states of Andhra Pradesh, Maharashtra,
Karnataka, Kerala and Tamil Nadu (31% of the country’s
population) account for 58% of medical colleges in India,
both public and private; and 63 % of GNM nursing
colleges in the country, 95 % of which are private.
● States with poor health records like Bihar, Madhya
Pradesh, Rajasthan, and Uttar Pradesh have nurse
densities lower than the national average, and account
for only 9 per cent of the nursing schools in the country.

Reference: Annual Report to the people on health, 2010 by MoHFW, GoI, Sept 2010
http://mohfw.nic.in/WriteReadData/l892s/9457038092AnnualReporthealth.pdf
● 2. Migration of health workers depletes the available
stock in the country: This also creates
● vacancies for teaching staff which further hinders
the production of professionals.
● 3. Better economic and professional opportunities and
better working and living conditions make for an urban
preference.
● Specialisation makes government employment and rural
services even less attractive.
● Public sector efforts to recruit and retain health workers
to rural posts are also compromised by a number of
workforce-management issues.
● 4. The failure to provide for adequate sanctioned posts
in the public sector, and often not even replace staff
retirements over long periods, due to decreasing public
investment in health in the earlier period is another
major reason for the crisis
 Human Resources for Health
● Migration of Health Personnel
● Estimation 50% of AIIMS students migrated
to overseas or to the private sector
● Around 1,00,000 doctors of Indian origin
settled in the USA and UK alone(WHO 2007)
● Around 81,091 nurses migrated to USA from
India
● Ref: Not Enough Here... Too Many There... Health Workforce In India, WHO Country Office for India
2007
 Migration

● In 2000
● almost 175 million people or 2.9% of world
population, were living outside their country of birth
for longer than one year.
● Of these, 65 million are economically active
● It is significant for many resource poor countries as
they lose their better education nationals to richer
countries
● 65% of all economically active migrants who have
moved to developed countries are classified as
'highly skilled'

(Stilwell et. al)

 Migration in Health Sector
● In health, this refers to physicians, nurses,
dentists, and pharmacists
● Nurses are in high demand
● USA and UK have shortfall of nurses in 10-
20 years time. They pay high compensation
to attract

● There is an international concern expressed

about the loss of skilled health professionals
from health-care systems in poorer
countries that are already weak.
● For policy options for managing migration,
evidence of the magnitude of the problem
and an understanding of the context of the
labour markets is needed(Stilwell et.al.2004)
● health workers migration
● Migration of health professionals not been
studied extensively
● Last study was in 1970s
● Ref: Barbara Stilwell, Khassoum Diallo,Pascal Zurn, Marko Vujicic,Orvill Adams, & Mario Dal Poz,
"Migration of health-care workers from developing countries: strategic approaches to its management"
Bulletin of the World Health Organization August 2004, 82 (8)
 Portuguese speaking African
countries to Portugal
migration
No of Phys icians No of Nurs es
Source country In Portugal In Source Country In Portugal In Source Country
Angola 820 961 383 14288
Guinea-Bis s au 358 197 253 1299
Sao Tome and Principe 238 67 84 183
Cape Verde 231 71 40 232

Ref: Barbara Stilwell, Khassoum Diallo,Pascal Zurn, Marko Vujicic,Orvill Adams, & Mario Dal
Poz, "Migration of health-care workers from developing countries: strategic approaches to its
management" Bulletin of the World Health Organization August 2004, 82 (8)
● Migration of health workers is primarily
demand led
● Especially to UK and USA
● Increase in number of nurses leaving the
Philippines and certain African countries
influenced by high rates of nursing vacancies
in Canada, USA, UK
● Disparities in working conditions and pay are
"pull" factors
● Ref: Barbara Stilwell, Khassoum Diallo,Pascal Zurn, Marko Vujicic,Orvill Adams, & Mario Dal
Poz, "Migration of health-care workers from developing countries: strategic approaches to its
management" Bulletin of the World Health Organization August 2004, 82 (8)
● Survey on African countries found the factors
affecting migration
● In Cameroon
● lack of promotion opportunities, working
conditions, and desire to gain experience
were reasons for migration
● In Uganda and Zimbabwe, wages were the
most important factor
● Ref: Barbara Stilwell, Khassoum Diallo,Pascal Zurn, Marko Vujicic,Orvill Adams, & Mario Dal Poz,
"Migration of health-care workers from developing countries: strategic approaches to its management"
Bulletin of the World Health Organization August 2004, 82 (8)
● Factors affecting health professionals'
decision to migrate from five African
countries were
● Desire to work in better managed health
system
● Desire to continue education or training
● Want a more conducive working environment
● Desire for better or more realistic
remuneration
● Ref: Barbara Stilwell, Khassoum Diallo,Pascal Zurn, Marko Vujicic,Orvill Adams, & Mario Dal Poz,
"Migration of health-care workers from developing countries: strategic approaches to its management"
Bulletin of the World Health Organization August 2004, 82 (8)
 In India
● A Case study
● The reasons for medical professionals want to
go abroad mainly to gain professional
experience- highly valued in India when they
come back
● Other attraction - higher earnings, perks, high
quality of life
● Nurses want to settle down abroad permanently
- career prospects are not bright in India
● Doctors some settle abroad
● Ref: Khadria, B. (2004), "Migration of Highly Skilled Indians: Case Studies of IT and the Health
Professionals", OECD Science, Technology and Industry Working Papers, 2004/6, OECD Publishing.
doi:10.1787/381236020703
 Health workers
● Health workers
● Out-migration of health workers
● Dr.s and nurses from India to developed
economies
● Foreign educated (mainly Russia) returning
doctors
● the official recognition of their educational
credentials for practicing medicine in India
● AIIMS - 56% of graduating doctors migrated
between 1956 - 80 - 1992 study
● Ref: Khadria, B. (2004), "Migration of Highly Skilled Indians: Case Studies of IT and the Health
Professionals", OECD Science, Technology and Industry Working Papers, 2004/6, OECD Publishing.
doi:10.1787/381236020703
 Intended reasons for out
migration
● The purpose of intended(reasons) out migration of
doctors
● to get jobs with better training opportunities
● to ensure rapid progress in the medical profession
● to obtain a specific kind of training not easily available
in India
● to move abroad for getting good employment
opportunities
● medical experience not easily available in India
● to get a job with better training opportunities overseas
● to progress at a comparable faster pace in the
professional career
● Ref: Khadria, B. (2004), "Migration of Highly Skilled Indians: Case Studies of IT and the Health Professionals",
OECD Science, Technology and Industry Working Papers, 2004/6, OECD Publishing. doi:10.1787/381236020703
 Motivating factors
● Motivating factors for out-migration of doctors
● Better education institutions for children in host
country
● Relatives in the host country
● Easy access to communication facilities overseas
● scope for self employment / entrepreneurship
● Conducive immigration and settlement policies of
the host country
● proficiency in English language
● Satisfactory health facilities overseas
● Comparatively lower real earnings in India
● Ref: Khadria, B. (2004), "Migration of Highly Skilled Indians: Case Studies of IT and the Health
Professionals", OECD Science, Technology and Industry Working Papers, 2004/6, OECD Publishing.
doi:10.1787/381236020703
 Motivating factors
● Bleak employment prospects in India
● Better professional infrastructure overseas
● Increasing employment opportunities
overseas
● To get experience that will later be highly
valued in India
● Quality of day-to-day life in host country
● Better income prospects overseas
● Availability of experts in the host country
● Higher education in the host country
● Ref: Khadria, B. (2004), "Migration of Highly Skilled Indians: Case Studies of IT and the Health
Professionals", OECD Science, Technology and Industry Working Papers, 2004/6, OECD
Publishing. doi:10.1787/381236020703
● Favourite destinations

● USA - for medical professionals

● UK - second preferred destination
● Australia - third preferred destination

● then

● Canada, Kuwait, New Zealand, Germany

● Ref: Khadria, B. (2004), "Migration of Highly Skilled Indians: Case Studies of IT and the Health
Professionals", OECD Science, Technology and Industry Working Papers, 2004/6, OECD
Publishing. doi:10.1787/381236020703
 Specialisations
● Cardiology and internal medicine are the most
preferred specialisation for the prospective
migrant doctors for those with the USA as
destination
● internal medicine was the most preferred
specialisation for those intending to go to the
United Kingdom, and surgery was the preferred
specialisation
● Majority reported 4-6 years as intended duration
of stay overseas after their planned migration
● Ref: Khadria, B. (2004), "Migration of Highly Skilled Indians: Case Studies of IT and the Health
Professionals", OECD Science, Technology and Industry Working Papers, 2004/6, OECD Publishing.
doi:10.1787/381236020703
 Doctors' perceptions
Doctors' perceptions about the Quality of medical
education and training in India

● Majority felt they were moderately satisfied

Level of satisfaction with present salary in India

● Many reported dissatisfied followed by moderately

satisfied

● Ref: Khadria, B. (2004), "Migration of Highly Skilled Indians: Case Studies of IT and the Health
Professionals", OECD Science, Technology and Industry Working Papers, 2004/6, OECD Publishing.
doi:10.1787/381236020703
 Nurses
● Majority of nurses are married - 88 %

● Half are from Kerala

● Most completed diploma in nursing

● Majority 27/36 planning for one to two years

to overseas
● Ref: Khadria, B. (2004), "Migration of Highly Skilled Indians: Case Studies of IT and the Health
Professionals", OECD Science, Technology and Industry Working Papers, 2004/6, OECD
Publishing. doi:10.1787/381236020703
 Source of inspiration
Source of inspiration for emigration for nurses
(in order)
● self

● friends overseas

● family

● friends in India

● Relatives

● Mentor/ Teacher / Senior doctors

● Career counsellor

● Ref: Khadria, B. (2004), "Migration of Highly Skilled Indians: Case Studies of IT and the Health
Professionals", OECD Science, Technology and Industry Working Papers, 2004/6, OECD
Publishing. doi:10.1787/381236020703
 Purpose of out-migration
Purpose of intended out-migration of nurses

● better training opportunities

● obtain a specific kind of training
● Progress faster in medical profession
● get employment
● permanent settlement in host country
● research assignments
● Ref: Khadria, B. (2004), "Migration of Highly Skilled Indians: Case Studies of IT and the Health
Professionals", OECD Science, Technology and Industry Working Papers, 2004/6, OECD
Publishing. doi:10.1787/381236020703
 Motivating factors
Motivating factors for out-migration of nurses
● Better income prospects overseas

● Quality of day-to-day life overseas

● Better infrastructure overseas

● Better education institutions for children

● Get valuable experience

● Higher education overseas

● Increasing employment opportunities overseas

● Relatives in the host country

● Ref: Khadria, B. (2004), "Migration of Highly Skilled Indians: Case Studies of IT and the Health
Professionals", OECD Science, Technology and Industry Working Papers, 2004/6, OECD Publishing.
doi:10.1787/381236020703
 Motivating factors
● Proficiency in English language
● Lower real earning in India
● Bleak employment prospects in India
● Satisfactory health facilities
● Conducive immigration and settlement policies
● scope for self employment entrepreneurship
● availability of experts in host country
● easy access to communication facilities
● Ref: Khadria, B. (2004), "Migration of Highly Skilled Indians: Case Studies of IT and the Health
Professionals", OECD Science, Technology and Industry Working Papers, 2004/6, OECD Publishing.
doi:10.1787/381236020703
 Preferred destination
Preferred destination countries for out-migration of
nurses ( In order)
● USA

● UK

● Australia

● Canada

● African Countries

● Gulf Countries

● Ref: Khadria, B. (2004), "Migration of Highly Skilled Indians: Case Studies of IT and the Health
Professionals", OECD Science, Technology and Industry Working Papers, 2004/6, OECD Publishing.
doi:10.1787/381236020703
 Level of satisfaction with
education in India
Moderately satisfied with education, training,
and experience in India

Moderately satisfied with present salary in

India

● Ref: Khadria, B. (2004), "Migration of Highly Skilled Indians: Case Studies of IT and the Health
Professionals", OECD Science, Technology and Industry Working Papers, 2004/6, OECD
Publishing. doi:10.1787/381236020703
Mobility or Migration Management

● India was the largest source country of

physicians for the US and the UK in the
1970s (Mejia et al., 1979).
● Indian trained doctors accounted for 18.3 per
cent of the total foreign physician workforce
in the UK in the year 2001 (OECD, 2006).
● India is the second largest source of foreign
nurses who have qualified the US
certification programme with about 6,962
nurses passing this requirement in 2004.
Migration of health professionals from
developing to developed countries beneficial

a. remittances from health professionals who

migrate abroad

b. can acquire advanced skills by migrating

abroad and bring back those skill sets and
disseminate the same in their home country
 Other related facts
● In India, the health service system is affected
severely by the shortage of staff and other
resources.
● While the WHO recommends a minimum of 100
nurses per 100,000 people,
● India had 62 nurses per 100,000 people in 2004.
● The National Commission on Macroeconomics and
Health estimates 2005
● only 40 % of the nearly 1.4 million registered nurses
are currently active in the country, because
● low recruitment, migration, attrition and drop-outs
owing to poor working conditions. (Push Factor)
Ref: (NCMH, 2005)
● There is a much higher density of qualified
providers in urban areas than in rural areas.
The other issue of import is the presence of
unqualified and illegal private providers
catering to the rural and urban poor
(Gautham, 2006).
● Despite 229 medical colleges with an annual
admission capacity of 25,600, nearly 700
primary health centres are without a doctor
(Rural Health Statistics, 2005).
 Policy response

1.in India the policy thrust appears to

encourage international migration and
removes barriers

2.no indication of any requirement to ensure

the return of health care professionals or any
policy to ensure an adequate supply of
workforce
● Senewiratne (1975), through his study
argues that there are many developed
countries, such as the UK, the USA, Australia
and New Zealand that rely on the supply of
foreign trained doctors to maintain their
health services and these doctors come
especially from developing countries such as
India, Philippines, Pakistan and Sri Lanka
● Doctors’ migration to the UK reflects Britain’s
past historical and language ties with its
former colonies
● According to him most of these doctors had
their basic training in the country of origin but
came to the UK to complete their training
with the intention of returning after a few
years
● Most immigrant doctors to the UK came from
the commonwealth countries; of who about
half of them were from India (Mejia, 1979).
international migration of health workers pull
factors
● opportunities for professional training and

● better employment opportunities in the host

country besides better salaries and perks

Push factors
● less attractive pay and working conditions,

high unemployment rate,

● political instability and insecurity in the home

country
● Poor remuneration, socio-economic and
living conditions the
● lack of civic amenities such as schools for
children, electricity, piped water, and
telephone connections in remote areas
discourage the retention of the health care
professionals in these parts.
● Besides these the other reasons including
professional isolation, heavy workload and
lack of better career prospects
● Indian physicians account for 9.6 per cent of
foreign trained professionals in Canada
(1998),
● 18.3 per cent for the UK (2001) and
● 19.5 per cent for the US in 2001

● (Forcier et al., 2004).

● Other factors
● Increasing aging population in host countries
● For example, approximately 40 per cent of
the US nursing workforce will be over 50
years of age (USGAO, 2001) at the end of
the decade. (Demand)
● In the UK, 25 per cent of the nurses are
expected to retire in five years (ICN, 2008).
(Demand)
● In Nigeria and other countries in sub-
Saharan Africa, most of the medical research
institutions have collapsed because of
massive emigration of highly skilled
professionals (Ojo, 1990).
 Other side of migration

● Literature shows that in the US and the UK, migrant

physicians are used as a supplement to the local labour
in host countries.
● They are more willing to practice in certain organizational
settings and certain geographical areas where the local
physicians are unwilling to go.
● In the US, international medical graduates significantly
contribute to care in rural areas (Bauer et al., 2002).
● In the UK, general practitioners who have graduated from
South-Asian medical schools (Bangladesh, India,
Pakistan and Sri Lanka) are concentrated in the less
attractive areas with large patient lists and relatively
deprived populations (Taylor and Esmail, 1999)
 Trends of Migration

Global Estimates and Trends of Migration

● In 2005, there were an estimated 191 million

migrants worldwide, nearly half of them women.

● The total amount of remittances sent home by

international migrants via formal channels in 2005
amounted to an estimated US $232 billion, with
US $167 billion going to developing countries.
Source: International Center of Nurse Migration: Fact Sheet (2007) from Centad report
on Migration of Healthcare professionals in India
● This figure does not, however, take into
● account remittances passed through informal
channels, which suggests the actual figure
may be doubled, or by some estimates,
tripled.
● Remittances are the second most important
source of external funding for developing
countries after foreign direct investment and
ahead of overseas development assistance.
● The World Bank reports remittance flows to
be twice the size of international foreign aid
flows.
● Remittances of overseas Filipinos are
expected to reach US $14.7 billion in 2007,
up $1.9 billion from 2006.
● In many low-income countries, remittances
represent a significant percentage of the
gross domestic product (eg, 26.5% in
Lesotho; 16.2% in Nicaragua; 5.8% in
Burkina Faso).
● In Sri Lanka, remittances surpass earnings from
tea export and exceed income gained through
tourism in Morocco.
● US $1 in remittances generates US $2 in local
economic activity.
● In 2004, the top five remittance-receiving
countries were: India, China, Mexico, France and
the Philippines.
● The United States, Saudi Arabia and Belgium
were among the top three remittance-sending
countries in 2001.
● Remittances are a lucrative income-generating
activity for banks worldwide
 Major classifications
Classification of countries based on migration

● Major donors ● Major recipients

● India, ● US
● Pakistan ● UK
● Sri Lanka, ● Canada
● Philippines ● Australia
● South Africa, ● Germany
● Nigeria
● Ghana,
● UK,
● Canada
● Germany, ● Both donors& recipients
● New Zealand ● UK
● Germany
● Canada
 Top Five Source Countries of
Emigrating Physicians, 2000
Country Number of emigrated
physicians
in thousands
India 20.3

U.K. 12.2

Philippines 9.8

Germany 8.8

Italy 5.8

Sources: Docquier and Bhargava (2006); http://go.worldbank.org/P9Y9CG7DF0

 Doctors and nurses trained abroad
working in OECD countries
Country Doctors Nurses

# % # %

Australia 11122 21 NA

Canada 13620 23 19061 6

US 213331 27 99456 5

UK 69813 33 65000 10

Germany 17318 6 26284 3

Ireland NA NA 8758 14

New Zealand 2832 34 10616 21

Source World Health Report 2006

Registered records of Indians
abroad in the medicine field
Med Per Abroad
4500

4000

3500

3000

2500

2000 Med Per Abroad

1500

1000

500

0
1958 1960 1962 1964 1966 1968 1970 1972 1974 1976

Ref:Roy 1975
Share of Indian physicians in the
immigrant medical graduates
Country Rank

US 1

UK 1

Canada 3

Australia 2

Source: Mullan 2005- Centad study

Nurses appearing for CGFNS
exam from India
Year Nurses

1990-95 900

1996-2000 1981

2000-2006 24242

India outnumbered Philippines 2004-05

 Cendat study
● Motivation for nursing profession
● assured employment followed by to go abroad and
followed by relatives in same profession

● Intention to migrate is high among students and

nurses

● Reasons for migration

● Better wages, better working conditions

● Destinations for nursing students

● USA, UK and Middle East
 My Study(2010-12)
Migration Plan (in %)

Migration plan

Frequency Percent
Yes 51 4.1

No 1178 95.9

Total 1229 100.0

Source :Primary Data

● Among those who wanted to migrate the
reasons mentioned for intended migration
are listed below.

● Better prospects in the destination

● Heavy workload
● Poor working conditions
● Problems with co-workers
● Low social acceptance for the profession
● To stay with the spouse

Source :Primary Data

 Other issues
● Philipines - the nurses and doctors migrate to
western countries, Australia and Japan
● There are instances Dr.s enrole for nursing
course to migrate easily to USA
● In Philipines even the certificate course
holders in Auxilary Nursing migrate.
● Many at times they have tuff time getting a
job and end up working in other sectors.
● This happened to nurses from India as well.
● The nurses migrated in the recent past to
Australia are found to be working in
restaurants and gas stations
● In Australia, people who are qualified from
UK do not have to appear for the local
qualifying exam. Directly recruited.
● Now, the government is planning to restrict
the numbers.
● The agency in-charge of Australia and New
Zealand has a data on shortage of health
professionals in their continent. (Health
Workforce Australia)
● In Japan, there is a severe shortage for
Health workforce.
● The health professionals trained and
auxiliary nurses are in high demand.
● They need to pass an exam conducted by
Japan Government at Japan. If qualified,
they are expected to appear for Japanese
Language course which is a requirement in
Japan.
● In the first level exam about 50% pass the exam.
In the language course there are some more
drop outs.
● The Philippines auxiliary nurses spend a year in
Japan preparing for this exams. If they do not
qualify, they will be sent back.
● This causes hardships for the professionals as
there no guarantee of employment even after a
year.
● There are agents who recruit these nurses and
charge huge charges for migration, even they
were not offered the job.
● I recently conducted a short study on the
quality of nursing graduates in nursing
colleges in Kerala along with two experts in
nursing. This was for the Kerala University of
Health Sciences.
● The study found that the newly established
colleges do not have necessary facilities for
compulsory postings in different specialty.
● They do not have sufficient patient strength
for training. This makes the newly trained
nurses low skilled.
● Part of the report, we come across a nursing
administrator from the state.
● The administrator stated that, there was a call
from an Australian Hospital, complaining the poor
quality of Kerala trained nurses.
● Earlier, the nurses trained in Kerala considered
to be good and there were no rigorous screening
been done. Now, they are screened strictly as
the quality is deteriorating. It was also found that
they are not trained in some basic procedures
● When I was discussing about this with a
Thailand researcher, they have also
mentioned that due to high demand for the
nurses in other countries, there are new
nursing colleges and schools opened across
the nation without worrying about the quality
of training. Things such as many do not have
medical college for their courses. If they have
their own medical colleges there no much
patients who visit the hospital.
● In some of the nursing colleges attached to
medical colleges, the patient occupancy rate
was very low. For nursing training the
hospitals require to have minimum of 250 to
500 beds. And there should be at least 75%
of bed occupancy(rate). These norms are not
followed many times. That leads to poor
quality of nursing education.
● Hence, they were engaged in other sectors
after migrating to host countries.