Brain Drain of Indian Nurses: A Systematic Review

 

Mr. Vijayreddy Vandali

Principal, Surendera Nursing Training Institute, H  H Gardens, Sri Ganganagar, Rajasthan-335001.

 

ABSTRACT:

Brain drain is defined as the migration of health personnel in search of the better standard of living and quality of life, higher salaries, access to advanced technology and more stable political conditions in different places worldwide. This migration of health professionals for better opportunities, both within countries and across international borders, is of growing concern worldwide because of its impact on health systems in developing countries. The solution to prevent nurse’s brain drain has to be done from Govt. and Private sectors, by providing best remuneration, working condition, facilities, individual and professional growth, health insurance, reduce workload, and increase mutual respect within the health care setup.

 

 

 

INTRODUCTION:

The term "brain drain" was coined by the Royal Society to describe the emigration of "scientists and technologists" to North America from post-war Europe.² Another source indicates that this term was first used in the United Kingdom to describe the influx of Indian scientists and engineers. Indian nurses, the backbone of the healthcare sector, are leaving the country in droves for higher salaries abroad,

 

·      Definition:

Brain drain is a slang term for a significant emigration of educated or talented individuals. A brain drain can result from turmoil within a nation, from there being better professional opportunities in other countries or from people seeking a better standard of living.

 

OBJECTIVES OF THIS ARTICLE:

·      To highlight the problems of nurses facing in India

·      To focus facilities available in abroad for nurses.

·      To identify key issues will enable immigrant health professionals to share their knowledge and skills.

 

Reasons of Brain Drain:

Push Factors:

·      Poor working condition

·      Gender difference

·      Low wages

·      Limited facilities

·      No extra remuneration for over time

·      Conflict between physicians and nurses

·      Inferiority feeling/low image.

·      No job security

·      Not have proper promotion opportunities

·      No timely increments and other facilities

·      No health insurance for self and family

·      No other benefits to dependents

·      Work stress

·      Lack of in-service education/training.

·      Not have job description properly.

·      Lack of promotion prospects,

·      Poor management,

·      Heavy workload,

·      Lack of facilities,

·      A declining health service,

·      Inadequate living conditions, and

·      High levels of violence and crime

 

Figure:02

 

Table: 01

List of Examples and Difference between Push and Pull Factors
Examples of Push Factors	Examples of Pull Factors
Inadequate services and facilities	Good infrastructure
Extreme weather conditions	better climate
Poor medical care	Good health care and hospitals
Natural disasters	Lower risk from natural hazards
Poverty	Opportunity for greater wealth
Unemployment	Varied employment opportunities
Fear: High levels of crime	Safer, better policing, less crime
Few opportunities	Better education and job prospects
Political fear or persecution	Political stability
Religious persecution	Religious freedom
Isolation: Family members have already moved	Family ties and links to communities
Poor lifestyle	Better standard of living
Fear: War, Revolution and violence	Peaceful Environment
Search for adventure	Excitement, new discoveries and a different culture

 

Pull factors:

·      Better remuneration,

·      Upgrading qualifications,

·      Gaining experience,

·      A safer environment, and Family-related matters

·      health insurance for self and family

·      Less workload

·      Extra salary for over time duty.

·      Travel expenses free of cost

·      Better facilities to self and family

·      Timely increments and promotion

·      Job satisfaction

·      Comfort feeling

·      Adequate leave facility

·      Very less violence and crime

 

Statistics:

·      With a total healthcare workforce of 2.2 million and a population of over one billion, India's nursing density (7.9 per 10,000 populations) is below international standards and is inadequate to meet the current domestic health services needs³.

·      In 2000 almost 175 million people, or 2.9% of the world’s population, were living outside their country of birth for more than a year. Of these, about 65 million were economically active.² This form of migration has in the past involved many health professionals³: nurses and physicians have sought employment abroad for many reasons including high unemployment in their home country⁴.

·      A recent study on the nursing brain drain in India says that up to one-fifth of the nursing labor force may be lost to wealthier states due to migration.

·      The top five countries that export nurses are the Philippines, Canada, India, Nigeria, and Russia/Ukraine.

·      Four countries (US, UK, Australia, Canada) together employ 72% of foreign-born nurses and 69% of doctors working in the Organization for Economic Co-operation and Development.

·      For its World Health Report 2006, the World Health Organization (WHO) noted that there is a global shortage of 4.3 million doctors, midwives, nurses, and support workers. Furthermore, “these [shortfalls] often coexist in a country with large numbers of unemployed health professionals. Poverty, imperfect private labor markets, lack of public funds, bureaucratic red tape and political interference produce this paradox of shortages in the midst of underutilized talent.” In addition, “Unplanned or excessive exits may cause significant losses of workers and compromise the system’s knowledge, memory and culture.⁸”

 

Converting Brain Drain into Wisdom:

Developing countries, especially South Asia, are now the main source of healthcare migration to developed countries. This trend has led to concerns that the outflow of healthcare professionals is adversely affecting the healthcare system in developing countries and hence the health of the population⁵.

 

 

Recruitment Hubs of India:

New Delhi in north India, Bangalore and Kochi in the south have emerged as the three main recruiting hubs of India.  Delhi-based agencies tend to focus on the U.S/UK/Canada market, while those in Kochi and Bangalore are mainly facilitating migration of nurses to other destinations like the Gulf countries, Australia, New Zealand, Singapore and Ireland⁶. Indian recruiting agencies that partner with the U.S. recruiters have mushroomed in Delhi since 2003. The largest ones are the Max Health Staff, Western International University (Mody Private group), Escorts Heart Institute, the Apollo Hospitals, and Jaipur Golden Hospital⁷ etc.

 

ADVANTAGES:

·      A brain drain is effectively an export of human resources such as "education services", which has inadvertently "become a money machine for country.

·      Remittances are a positive effect of the brain drain because they increase living standards in society

·      One study finds that sending countries benefit indirectly in the long-run on the emigration of skilled workers

 

DISADVANTAGES:

·      It has been argued that high-skill emigration causes nurses shortages in the country of origin.

·      Brain drains cause countries to lose high skilled nurses.

·      Brain Drain is an extremely serious problem for developing countries.

·      It also affects country’s standard of heath care services.

 

Solution or Measures to Prevent Brain Drain:

The solution to prevent nurse’s brain drain has to be done from Govt. and Private sectors, by providing best/satisfied remuneration, working condition, facilities, opportunity for individual and professional growth, health insurance, equal and tolerable workload, extra allowances for overtime work and establishment of mutual respect among all the health professional in hospital/institute/organization.

 

ACKNOWLEDGEMENT:

I must thank to my beloved parents, uncles, brothers and sisters of my family

 

FUND:

Self

 

CONFLICT OF INTEREST:

None

 

ETHICAL CLEARANCE:

Not required.

 

REFERENCES:

1.     Marie Percot and S. IrudayaRajan. Female Emigration from India: Case Study of Nurses: Economic and Political Weekly, Vol. 42, No. 4 (Jan. 27 - Feb. 2, 2007), pp. 318-325Available from: http://www.jstor.org/stable/4419189.

2.     Cervantes, Mario; Guellec, Dominique (January 2002). "The brain drain: Old myths, new realities". OECD Observer. Retrieved 02-03-2016.

3.     http://www.investopedia.com/terms/b/brain_drain.asp#ixzz41jBsqq5K

4.     United Nations Population Division. Populations Database. New York: UN 2002

5.     Mejia A. Migration of physicians and nurses: a worldwide picture. Bull World Health Organ 2004;82: 626–30 [PMC free article] [Pub Med].

6.     CGFNS. Philadelphia: Commission on Graduate Foreign Nursing Schools; 2004. “Global Connections: 2004 Annual Report”.

7.     CHAUS. “India Is Losing Its Nurses to the West” 2005. [March 9, 2006]. Article by Edward David, Health Progress, November/December, Catholic Health Association of the United States. Available athttp://www.findarticles.com/p/articles/mi_qa3859/is_200511/ai_n15745214. [Pub Med]

8.     Bull World Health Organ 2010; 88:321 | doi:10.2471/BLT.10.000510

 

 

 

Received on 24.08.2016          Modified on 29.08.2016

Accepted on 21.12.2016          © A&V Publications all right reserved