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An Analysis of Factors Influencing the International Migration of Indian Nurses

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Abstract

Based on our survey conducted in Tamil Nadu, this paper analyses the characteristics of Indian migrant nurses and the factors influencing their migration. India is considered the second largest exporter of nurses after the Philippines. Many Indian nurses have migrated to work in OECD countries, the Gulf countries and some ASEAN countries. While Indian nurses are migrating overseas to fill shortages at their destinations, India has itself been suffering from an acute scarcity of nurses since its independence in 1947. Therefore, the large scale of nurse migration is a serious threat to the Indian healthcare system. The results of the survey imply that international migration by nurses can be explained in part by the gap between the private sector and the public sector in terms of salary and working environment. Since the impact of social status on the migration decisions of nurses has lessened, economic factors are the crucial determinant of international migration of nurses. Policy intervention in this area is the necessary first step to solving this long-standing problem. The priority in any policies formulated should be given to nurses working in the private sector whose salaries are considerably lower than those in the public sector and whose voices are unheard.

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Notes

  1. This tendency might be changing. Efforts have been made to train nurses locally in the United Arab Emirates (UAE) as part of the Emiratization of the health workforce (Hannawi and Al-Salmi 2013, Brownie et al. 2015).

  2. It is at least the second source country of nurses to OECD countries (OECD 2015).

  3. Figures were from Nurse and Midwifery in India, Ministry of Health and Family Welfare. http://nursingandmidwifery.gov.in/state_nursing_councils.html#.WMa9x2-LT3h (Data extracted on Mar. 5, 2017).

  4. For a comprehensive review of literature on nurse migration from India, see Garner et al. (2015).

  5. Figures were extracted from the Health Workforce Migration section of OECD. Stat. http://stats.oecd.org/ (Data extracted on March 10, 2016).

  6. See Tsujita et al. (2017) for the case of Kerala.

  7. See Prescott and Nichter (2014) for their criticism on push-pull analyses of migration.

  8. http://www.tamilnadunursingcouncil.com/snregistered.php

  9. http://www.tamilnadunursingcouncil.com/syw04.php

  10. https://www.tamilnadunursingcouncil.com/snp03.php and https://www.tamilnadunursingcouncil.com/snp04.php

  11. During the British colonial era, a substantial number of Tamil workers were sent to Malaysia to work in plantations by the British authority (Irudaya Rajan et al. 2016). Most Malaysian Indians and Singaporean Indians are of Tamil descent, and Tamil language is one of Singapore official languages.

  12. For example, our ongoing project on Indian nurses in Singapore suggests that the overwhelming majority of nurses who were born and educated in India and currently work in Singapore are placed there through private recruitment agencies.

  13. This information was obtained during interviews with nurses in Chennai. Times of India (2017a) reported that nurses working in government hospitals are paid Rs. 33,045 per month on average, which corroborates the information provided by the interviewed nurses.

  14. Some private hospitals pay well, but the pay is not on a par with the salary paid to nurses at government facilities, other than the very few who work as part of a specialized operation and treatments team. Rather, we came across cases of young nurses absconding from well-known hospitals in big cities in India because of their low salary and poor working conditions.

References

  • Alonso-Garbayo, A., & Maben, J. (2009). Internationally recruited nurses from India and the Philippines in the United Kingdom: the decision to emigrate. Human Resources for Health, 7, 37.

    Article  Google Scholar 

  • Brownie, S. M., Williams, G., Barnewall, K., Bishaw, S., Cooper, J. L., et al. (2015). Pedagogy and culture: an educational initiative in supporting UAE nursing graduates prepare for a high-stakes nurse licensing examination. International Journal of Higher Education, 4(1), 200–216.

    Article  Google Scholar 

  • Buchan, J. & Calman, L. (2013). The global shortage of registered nurses: an overview of issues and actions. International Council of Nurses, Geneva, Switzerland. Available at: http://www.icn.ch/publications/the-global-shortage-of-registered-nurses-an-overview-of-issues-and-actions/ (accessed on 8 Feb 2017).

  • Garner, S. L., Conroy, S. F., & Bader, S. G. (2015). Nurse migration from India: a literature review. International Journal of Nursing Studies, 52(12), 1879–1890.

    Article  Google Scholar 

  • George, G. & Rhodes, B. (2017). Is there a financial incentive to immigrate? Examining of the health worker salary gap between India and popular destination countries. Human Resources for Health, 15, 74.

    Article  Google Scholar 

  • Gill, R. (2011). Nursing shortage in India with special reference to international migration of nurses. Social Medicine, 6(1), 52–59.

    Google Scholar 

  • Gill, R. (2016). Scarcity of nurses in India: a myth or reality? Journal of Health Management, 18, 509–522.

    Article  Google Scholar 

  • Grignon, M., Owusu, Y. & Sweetman, A. (2012). The International migration of health professionals. Discussion Paper No. 6517, IZA.

  • Hannawi, S., & Al-Salmi, I. (2013). Health workforce in the United Arab Emirates: analytic point of view. International Journal of Health Planning and Management, 29(4), 332–341.

    Article  Google Scholar 

  • Healey, M. (2013). Indian sisters: a history of nursing and the state, 1907–2007. New Delhi: Routledge.

    Google Scholar 

  • Irudaya Rajan, S. & Nair, S. (2013). Assessment of existing services for skilled migrant workers: India Project Site, ILO Promoting Decent Work across Borders: a Pilot Project for Migrant Health Professionals and Skilled Workers. Draft Report submitted to International Labour Organization.

  • Irudaya Rajan, S., D’Sami, B., & Raj, S.A. (2016). Non-resident Tamils and remittances: Results from Tamil Nadu Migration Survey 2015, Report submitted to the Government of Tamil Nadu.

  • Irudaya Rajan, S., D’Sami, B. & Raj, S. A. (2017). Tamil Nadu Migration Survey 2015. Economic and Political Weekly, 52(21), 85–94.

    Google Scholar 

  • Jaisankar, C. (2017) ‘GH suffers from shortage of nurses and doctors’ Hindu, Feb 2, 2017. (http://www.thehindu.com/todays-paper/tp-national/tp-tamilnadu/GH-suffers-from-shortage-of-nurses-and-doctors/article17130821.ece) accessed on 25 Oct 2017.

  • Johnson, S. E., Green, J., & Maben, J. (2014). A suitable job? A qualitative study of becoming a nurse in the context of a globalizing professions in India. International Journal of Nursing Studies, 51(5), 734–743.

    Article  Google Scholar 

  • Keshri, K. & Bhagat, R. B. (2012). Temporary and seasonal migration: regional pattern, characteristics and associated factors. Economic and Political Weekly, 47(4), 81–88.

    Google Scholar 

  • Kingma, M. (2006). Nurses on the move: migration and the global health care economy. Ithaca: Cornell University Press.

    Google Scholar 

  • Kline, D. (2003). Push and pull factors in international nurse migration. Journal of Nursing Scholarship, 35(2), 107–111.

    Article  Google Scholar 

  • Nair, S. (2012). Moving with the times: gender status and migration of nurses in India. New Delhi: Routledge.

    Google Scholar 

  • Nair, S., & Irudaya Rajan, S. (2017). Nursing education in India: changing facets and emerging trends. Economic & Political Weekly, 52(24), 38–42.

    Google Scholar 

  • Nair, S., & Percot, M. (2007). Transcending boundaries: Indian nurses in internal and international migration, CWDS Occasional papers no. 47, New Delhi: Centre for Women’s Development Studies.

  • Nair, M., & Webster, P. (2012). Health professionals’ migration in emerging market economies: patterns, causes and possible solutions. Journal of Public Health, 35(1), 157–163.

    Article  Google Scholar 

  • Nair, S., Timmons, S., & Evans, C. (2016). Nurses in the private health sector in Kerala: any lessons from their strikes in recent years? Indian Journal of Gender Studies, 23(1), 8–25.

    Article  Google Scholar 

  • New Indian Express (2017). ‘Gulf’ between pay, opportunities cerates male nurse shortage in TN, 8 Feb 2017 (http://www.newindianexpress.com/states/tamil-nadu/2017/feb/08/gulf-between-pay-opportunities-creates-male-nurse-shortage-in-tn-1568192.html) accessed on 25 Oct 2017.

  • OECD (2007). Immigrant health workers in OECD countries in the broader context of highly skilled migration. In: International Migration Outlook 2007, Paris, OECD Publishing.

  • OECD (2015). International migration outlook 2015. Paris, OECD Publishing. https://doi.org/10.1787/migr_outlook-2015-en.

    Book  Google Scholar 

  • Percot, M. (2006). Indian nurses in the Gulf: two generations of female migration. South Asia Research, 26(1), 41–62.

    Article  Google Scholar 

  • Percot, M., & Irudaya Rajan, S. (2007). Female emigration from India: case study of nurses. Economic and Political Weekly, 42(2), 318–325.

    Google Scholar 

  • Prescott, M., & Nichter, M. (2014). Transnational nurse migration: future directions for medical anthropological research. Social Science & Medicine, 107, 113–123.

    Article  Google Scholar 

  • Rajagopal, K. (2016) Private sector nurses to get facilities like those in govt. service. The Hindu. Retrieved from lhttp://www.thehindu.com/todays-paper/tp-national/Private-sector-nurses-to-get-facilities-like-those-in-govt.-service/article14995161.ece (accessed on 15 Feb 2017).

  • Rao, K. D., Bhatnagar, A., & Berman, P. (2012). So many, yet few: human resources for health in India. Human Resources for Health, 10, 19.

    Article  Google Scholar 

  • Rao, K. D., Ryan, M., Shroff, Z., Vujicic, M., Ramani, S., et al. (2013). Rural clinician scarcity and job preferences of doctors and nurses in India: a discrete choice experiment. PLoS One, 8(12), e82984. https://doi.org/10.1371/journal.pone.0082984.

    Article  Google Scholar 

  • Reynolds, J., Wisaijohn, T., Pudpong, N., Watthayu, N., Dalliston, A., et al. (2013). A literature review: the role of the private sector in the production of nurses in India, Kenya, South Africa and Thailand. Human Resources for Health, 11, 14.

    Article  Google Scholar 

  • The Hindu (2016). Set up panel to fix salary of nurses in private hospitals: SC. The Hindu, Jan. 30, 2016 electronic version (accessed on 28 Feb 2017).

  • Thomas, P. (2006). The international migration of Indian nurses. International Nursing Review, 53(4), 271–283.

    Article  Google Scholar 

  • Times of India (2017a). Private hospital nurses ask for better pay, work conditions. Times of India, Aug. 11, 2017 electronic version (accessed on 11 Nov 2017).

  • Times of India (2017b). Nurses hold protests over salaries. Times of India, Oct. 17, 2017 electronic version (accessed on 28 Oct 2017).

  • Timmons, S., Evans, C., & Nair, S. (2016). The development of the nursing profession in a globalized context: a qualitative case study in Kerala, India. Social Science & Medicine, 166, 41–48.

    Article  Google Scholar 

  • Tsujita, Y., & Oda, H. (2014). Caste, land, and migration: analysis of a village survey in an underdeveloped state in India. In Y. Tsujita (Ed.), Inclusive growth and development in India: challenges for underdeveloped regions and the underclass. UK: Palgrave Macmillan.

    Chapter  Google Scholar 

  • Tsujita, Y., Oda, H., & Irudaya Rajan, S. (2017). Nursing students under the growing global demand for nurses: the case of Kerala, India, mimeo.

  • Walton-Roberts, M. (2010). Student nurses and their post graduation migration plans: a Kerala case study. In S. Irudaya Rajan (Ed.), India migration report 2010. London: Routledge.

    Google Scholar 

  • Walton-Roberts, M. (2012). Contextualizing the global nursing care chain: international migration and the status of nursing in Kerala, India. Global Network, 12(2), 175–194.

    Article  Google Scholar 

  • Walton-Roberts, M., Runnels, V., Irudaya Rajan, S., Sood, A., Nair, S., et al. (2017a). Causes, consequences, and policy responses to the migration of health workers: key findings from India. Human Resources for Health, 15–28.

  • Walton-Roberts, M., Bhutani, S., & Kaur, A. (2017b). Care and global migration in the nursing profession: a north Indian perspective. Australian Geographer, 48(1), 59–77.

    Article  Google Scholar 

  • WHO (2010). Wanted: 2.4 million nurses, and that’s just in India. Bulletin of the World Health Organization. http://www.who.int/bulletin/volumes/88/5/10-020510/en/ (accessed on 5 Mar 2017).

  • WHO (2016). Global health observatory data repository, World Health Organization. http://apps.who.int/gho/data/node.main.HWF1?lang=en&showonly=HWF (Data extracted on 28 Feb 2017).

  • Yasmeen, A. (2014). Ideal nurse patient ratio 1:4 the state’s average is 1:40. The Hindu, July 14, 2014 electronic version (accessed on 7 Mar 2017).

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Acknowledgements

We thank two anonymous reviewers for their many insightful comments and suggestions, which helped us to improve the quality of our paper. We would like to thank Father A. M. Francis Jayapathy S. J. and Dr. Bernard D’Sami of Loyola College, Chennai, Tamil Nadu for their support in conducting surveys. Without their assistance, we could not have completed our study. We also benefitted from comments by at the workshop on Human Resource Development and Mobility of Skilled Labour in Southeast Asia, held at Faculty of Nursing, Chulalongkorn University in Bangkok on Feb. 6–7, 2017. We are grateful to Institute of Developing Economies (IDE-JETRO) for funding this research. Any error remains solely our responsibility.

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Authors and Affiliations

  1. College of Policy Science, Ritsumeikan University, 2-150 Iwakura, Ibaraki, Osaka, 567-8570, Japan

    Hisaya Oda

  2. Bangkok Research Center, JETRO Bangkok, 16th Fl. of Nantawan Bldg., 161 Rajadamri Road, Pathumwan, Bangkok, 10330, Thailand

    Yuko Tsujita

  3. Centre for Development Studies, Prasanth Nagar, Medical College P.O, Ulloor, Thiruvananthapuram, Kerala, 695011, India

    Sebastian Irudaya Rajan

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  1. Hisaya Oda
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Correspondence to Hisaya Oda.

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Oda, H., Tsujita, Y. & Irudaya Rajan, S. An Analysis of Factors Influencing the International Migration of Indian Nurses. Int. Migration & Integration 19, 607–624 (2018). https://doi.org/10.1007/s12134-018-0548-2

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