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India’s Brain Drain in Health Sector

  • 19 May 2021
  • 6 min read

Why in News

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.

Key Points

  • 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 favorable 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.
  • Reasons:
    • Need in the Pandemic:
      • 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.
        • The UK has granted free one-year visa extensions to eligible overseas healthcare workers and their dependents whose visas were due to expire before October 2021.
        • France has offered citizenship to frontline immigrant healthcare workers during the pandemic.
    • Higher Pay and Better Opportunities:
      • There are strong pull factors associated with the migration of healthcare workers, in terms of higher pay and better opportunities in the destination countries.
    • Low Wages and Lack of Investment in India:
      • 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.
    • Policies of the Indian Government :
      • 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 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 move was taken to bring about transparency in nursing recruitment and reduce exploitation of nurses in the destination countries.
  • Concerns in India’s Health Sector:
    • Lack of Human Resource:
      • India has 1.7 nurses per 1,000 population and a doctor to patient ratio of 1:1,404 — this is well below the World Health Organization (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. Moreover, there is high concentration in some urban pockets.
    • Poor Infrastructure:

Way Forward

  • 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.
  • India needs systematic changes to building an overall environment that could prove to be beneficial for them and 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.
  • India could also work towards framing bilateral agreements that could help shape a policy of “brain-share” between the sending and receiving countries.


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