India faces a striking paradox in its healthcare sector: while the nation experiences a significant shortage of doctors and nurses, a large number of its trained health professionals migrate to developed countries for work. 

Status of Exporting Health Care Professionals

• Trend of Exporting Health care professionals: Sri Lanka has 10–12% of their medical workforce of foreign doctors.
  • Philippines: Around 85% of Filipino nurses are employed abroad.
• Global Health Worker Shortage: The World Health Organisation (WHO) estimates a shortfall of 18 million health workers by 2030.
• India’s Contribution to Developed Nations: Approximately 75,000 Indian-trained doctors and 6,400 nurses are currently employed in OECD countries.

Reasons Behind the Outmigration of Health Workers

• Push Factors (Factors driving them from India):
  • Low Salaries and Limited Growth: Health professionals in India often receive lower salaries compared to developed nations, and there is perceived limited potential for rapid career progression or salary increases for many.
  • Poor Working Conditions: Hospitals in India may lack modern equipment, and working environments can be challenging, with instances of violence against doctors by patients’ relatives reported.
  • Political Instability: While less common in India, political instability in some developing countries (like Myanmar or the Philippines previously) can also prompt health workers to seek opportunities elsewhere.
• Pull Factors (Attracting them to Developed Countries):
  • High Salaries: Developed countries offer significantly higher remuneration, often in stronger currencies like the US Dollar.
  • Greater Respect and Better Working Conditions: Health professionals in these nations generally receive more respect and benefit from superior infrastructure and modern medical facilities.
  • Acute Shortage of Health Workers: Developed countries have ageing populations and lower birth rates, leading to a chronic shortage of doctors and nurses. This creates a high demand for foreign health professionals.
  • Liberal Recruitment Policies: Countries like the UK deliberately adopt liberal recruitment policies, making it easier for foreign doctors and nurses to obtain visas and work permits. During the COVID-19 pandemic, the UK even offered special fast-track visas for nurses.

Benefits of this migration to India

• Remittances: Money sent back by doctors working abroad significantly contributes to India’s foreign exchange reserves and economic growth.
• Skill Development: When doctors return to India, they bring back advanced skills and knowledge acquired from working in developed healthcare systems, which can enhance India’s medical practices.
• Diplomatic Influence (Soft Power): The presence of Indian professionals abroad can strengthen bilateral relations and enhance India’s soft power globally. 
  • Example: India deployed doctors to Africa and neighbouring countries during the COVID-19 pandemic.

Disadvantages of this Migration

• Depleted Workforce: The most direct consequence is a reduced number of skilled health professionals available to treat India’s own population.
• Rural and Small-Town Neglect: The impact is particularly severe in rural areas and small towns, where access to doctors is already limited. This exacerbates the existing urban-rural divide in healthcare.
• Crisis in Emergencies: A shortage of doctors can leave the country feeling “helpless” during health crises or emergencies.
• Moral Dilemma: It is often seen that Indian doctors are treating people in other countries while citizens in their home country lack adequate medical care.
• Brain Drain: Ultimately, the loss of highly educated and skilled professionals represents a significant “brain drain” that hinders India’s overall development and progress in healthcare. 

Way Forward

• Bilateral Agreements: India should engage in bilateral agreements with destination countries. 
  • These agreements should ensure fair compensation for Indian doctors, mandate investment in India’s medical colleges, and facilitate technology transfer in the medical field. 
  • The WHO can serve as a platform for facilitating such agreements between sending and receiving countries.
• Domestic Reforms:
  • Increase Medical College Seats: Significantly increase the number of seats in medical colleges to produce more doctors and nurses.
  • Improve Rural Facilities: Enhance healthcare infrastructure and facilities, especially in rural and underserved areas.
  • Provide Incentives: Offer better salaries, improved working conditions, and clear merit-based growth paths to encourage health workers to remain in India.
• Promote Circular Migration: There is a need to encourage a system where doctors work abroad for a few years to gain experience and then return to India to apply their enhanced skills. 
  • This prevents linear migration where professionals leave permanently.
• Establish a Centralised Agency: Create a national agency, similar to Kerala’s agency for Gulf migrants or the Philippines’ Department of Migrant Workers.
  • This agency would focus on the grievances of Indian health workers abroad and provide support to those returning to India.
• Leverage Telemedicine: Explore models where Indian doctors can provide medical consultation to international patients through telemedicine from within India. 
  • This allows them to earn competitive salaries while remaining in the country.
• Global Collaboration Against Brain Drain: India should collaborate with other “Global South” countries like the Philippines and Sri Lanka, which face similar challenges, to raise a collective voice on the international stage against the uncontrolled brain drain of health workers.

Conclusion

India’s response to the migration of its health workers must be proactive and balanced. 

• By implementing strategic bilateral agreements and robust domestic reforms, India can ensure that its highly skilled health professionals contribute significantly to national well-being rather than primarily to other nations.

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