migration of nursing and midwifery workforce from …...2018/09/13 · 2005 2012 2016 general...

Migration of Nursing and Midwifery

Workforce from Kerala

Study Findings

Tomas Zapata

HRH Regional Advisor

WHO-SEAR

Outline

• Production of nurse and midwives

• Stock of nurse and midwives

• Migration of nurse and midwives from Kerala

• Conclusions & recommendations

Production

Total in 2016: 287

- 11% public – 89%

privateSource: Indian Nursing Council/KNMC

Number of training institutions in Kerala (2005-2016)

91

219204

12

126 133

15

20 20

0

50

100

150

200

250

2005 2012 2016

General Nursing andMidwifery

BSc (Nursing)

Auxiliary Nursing andMidwifery

Production

• Number of

college seats

in 2016:

17,600

(91% private)

• Growth in

seats faster

in public

colleges

seen from

2012-16

(marginal)

Source: Indian Nursing Council

Production capacity (number of seats, maximum production capacity)

0

2000

4000

6000

8000

ANM GNM BSc(Nursing)

MSc(Nursing)

PB BSc(Nursing)

PBDiploma

2012 2013 2014 2015 2016

Source: Indian Nursing Council

Number of nurse registrations with KNMC (2009-2016)

0

1000

2000

3000

4000

5000

6000

2009 2010 2011 2012 2013 2014 2015 2016


BSc (Nursing)


New registrations of

nurses and midwives

in 2016: 9,766Source: Kerala Nurses and Midwives Council

Production

Stock of Nurses & Midwives

0 10 20 305 15 25Density per 10000 population

KeralaDelhi

HaryanaMaharashtra

GujaratAndaman & Nicobar Islands

UttarakhandMizoram

PunjabTamil Nadu

LakshadweepNagaland

ChattisgarhKarnataka

Jammu & KashmirIndia

SikkimAndhra Pradesh

ManipurUttar Pradesh

GoaMeghalaya

West BengalMadhya Pradesh

Arunachal PradeshTripura

RajasthanOrissa

JharkhandAssam

Himachal PradeshBihar

Allopathic Doctors Nurses and Midwives

All

Source: Rao, KD, Shahrawat, R., & Bhatnagar, A. (2016). Estimates based on 2012 NSSO



KeralaDelhi

HaryanaMaharashtra


UttarakhandMizoram

PunjabTamil Nadu

LakshadweepNagaland





GoaMeghalaya



RajasthanOrissa

JharkhandAssam



All


India: 3.1 nurses

and midwives /10,000

(NSSO 2012)

3.1



KeralaDelhi

HaryanaMaharashtra


UttarakhandMizoram

PunjabTamil Nadu

LakshadweepNagaland





GoaMeghalaya



RajasthanOrissa

JharkhandAssam



All


3.1

18.5 61,619 nurses in Kerala

India: 3.1 nurses


(NSSO 2012)



KeralaDelhi

HaryanaMaharashtra


UttarakhandMizoram

PunjabTamil Nadu

LakshadweepNagaland





GoaMeghalaya



RajasthanOrissa

JharkhandAssam



All


18.53.1 6x

India: 3.1 nurses


(NSSO 2012)

61,619 nurses in Kerala

Position YearRequired

[R]

Sanctioned

[S]

In

position

[P]

Vacant

[S–P]

Shortfall

[R–P]

Health workers

(female)/ANMs at

subcentres and PHCs

2007 6 003 5 670 5 634 36 369

2012b 5 384 4 232 4 173 59 1 211

2016 5 399 7 929 7 950 * *

Health assistants

(female)/LHVs at PHCs

2007 909 830 740 90 169

2012 NA NA NA NA NA

2016 824 13 13 0 811

Nursing staff at PHCs

and CHCs

2007 1 658 2 811 3 064 * *

2012 2 328 2 099 2 014 85 314

2016 2 399 3 610 3 969 * *

Source: Bulletin on Rural Health Statistics 2016, MoHFW

Number of vacancies of nurses working in rural health facilities in Kerala (2016)


Position YearRequired

[R]

Sanctioned

[S]

In

position

[P]

Vacant

[S–P]

Shortfall

[R–P]

Health workers

(female)/ANMs at

subcentres and PHCs

2007 6 003 5 670 5 634 36 369

2012b 5 384 4 232 4 173 59 1 211

2016 5 399 7 929 7 950 * *

Health assistants

(female)/LHVs at PHCs

2007 909 830 740 90 169

2012 NA NA NA NA NA

2016 824 13 13 0 811

Nursing staff at PHCs

and CHCs

2007 1 658 2 811 3 064 * *

2012 2 328 2 099 2 014 85 314

2016 2 399 3 610 3 969 * *

Source: Bulletin on Rural Health Statistics 2016, MoHFW

Number of vacancies of nurses working in rural health facilities in Kerala (2016)

Vacancies in private sector???

Overseas migration from Kerala

Source: Kerala Migration Survey, 2011, 2013 and 2016; Analysis by Oxford Policy Management and CDS, Thiruvananthapuram

0

10,000

20,000

30,000

40,000

50,000

60,000

70,000

80,000

2011 2013 2016

Stock of Nurses andNurse Assistants

Nurse and NurseAssistant Migrants



0

10,000

20,000

30,000

40,000

50,000

60,000

70,000

80,000

2011 2013 2016


Nurse and NurseAssistant Migrants31%



0

10,000

20,000

30,000

40,000

50,000

60,000

70,000

80,000

2011 2013 2016


Nurse and NurseAssistant Migrants31%

Emigration rate: 32.8% (2011)23.2% (2016)

Source: Kerala Migration Survey 2016, Center for Development Studies

Percentage share of emigrant nurses and nurse assistants in major destination countries


Migration within India from Kerala

Karnataka

41%

Delhi

31%

Tamil

Nadu

14%

Uttar Pradesh

6%

West Bengal

2%

Gujarat

1%Rajasthan

1%

Madhya Pradesh

1% Chhattisgarh

1%

Andhra Pradesh

1%

Others*

1%

0

1000

2000

3000

4000

0

500

1000

1500

2012 2013 2014 2015 2016Total Delhi Nursing Council

Karnataka Nursing Council Tamil Nadu Nursing Council

Uttar Pradesh Nursing Council

Trends in migration of nurses from Kerala to other Indian States

Source: Data on issuance of certificates of no objection, Kerala Nurses and Midwives Council

Conclusions & Recommendations• Slowing down of overseas migration of nurses, high production capacity, low

vacancy rates & low internal migration: moving towards an oversupply of nurses

• Reasons for declining migration of nurses from Kerala to foreign countries ought

to be investigated further. Perceived low quality/skills?, soft skills, language? How

to address them

• Oversupply contributes to low salaries in private sector + wage differential between

Kerala and abroad could translate into demands for salary increases. Recent nurse

strike in Kerala reflective of this

- Ensuring enhanced working conditions, salaries, enforcement of minimum

wage in private sector

- Govt could create conditions for enhancing role of nurses in health system –

e.g. licensing nurse practitioners, creating prescription formulary for nurses

• Sign MoU between Kerala and destination countries, promote internal migration

• Methods

Spare slides

Migration from Kerala

YearStock of Nurses and Nurse

Assistants

Nurse and Nurse

Assistant Migrants

Net Emigration Rate

(%)*

2011 61,613 30,038 32.8%

2013 63,224 28,138 30.8%

2016 68,161 20,622 23.2%

*Calculated as: [Migrant nurses and nurse assistants /(Resident nurses and nurse assistants + Migrant nurses and nurse assistants)] * 100




Assistants

Nurse and Nurse

Assistant Migrants

Net Emigration Rate

(%)*

2011 61,613 30,038 32.8%

2013 63,224 28,138 30.8%

2016 68,161 20,622 23.2%



31%



Assistants

Nurse and Nurse

Assistant Migrants

Net Emigration Rate

(%)*

2011 61,613 30,038 32.8%

2013 63,224 28,138 30.8%

2016 68,161 20,622 23.2%



9.6%



Assistants

Nurse and Nurse

Assistant Migrants

Net Emigration Rate

(%)*

2011 61,613 30,038 32.8%

2013 63,224 28,138 30.8%

2016 68,161 20,622 23.2%



• Fall in net emigration rate of nurses and nursing assistants

• Over 90% of emigrant nurses employed in private sector before migration

• Nurses migrated for an average of 5-6.5 years


2152

0

1000

2000

3000

4000

5000

6000

2009 2010 2011 2012 2013 2014 2015 2016


BSc (Nursing)


7210 Number of seats in 2013

Source: Kerala Nurses and Midwives Council


2152

0

1000

2000

3000

4000

5000

6000

2009 2010 2011 2012 2013 2014 2015 2016


BSc (Nursing)


7210 Number of seats in 2013

70% gap

Source: Kerala Nurses and Midwives Council


22%

15%12%

10%

6% 6% 6% 4% 3% 3% 3%

%

10%

20%

30%

40%

Saudi

Arabia*

UAE Kuwait UK USA Qatar** Canada Others Germany Maldives Australia

2011 2013

Percentage share of emigrant nurses and nurse assistants in major destination countries(2011, 2013, 2016)

Factors influencing Migration Patterns

‘Push’ Factors ‘Pull’ Factors

• Low remuneration

• Difficult working conditions, including:

- Low patient-nurse ratio, high workload

- Limited training and education opportunities

• Unclear career pathways

• Shortage of nursing personnel in destination countries

• Ageing population

• Higher salaries, personal and professional

opportunities

• Migration to other Indian states: Employment in

major cities and leading hospital facilities (public/pvt)

• Drop in migration from Kerala to Gulf countries due to recent structural changes in policies:

- Nurses migrating to ECR (emigration checked required) countries require emigration

clearance

- Foreign employers to register with eMigrate system

- Recruitment only via state-mandated agencies – ODEPC, NORKA-ROOTS, TNAI

- Reduction of quality of trained nurses (English, soft skills)??

- Increased requirements in destination countries

• Interviews with nursing students indicate preference for permanent, full-time position in

Kerala public health system over migration (particularly to Gulf countries)

Conclusions & Recommendations

• Sign MoU between Kerala and destination countries

• Estimates of production, stock, and migration foreground extent of divergence

between data sources:

- Nodal institution in Kerala should track and compile information on

migrant health workers, including nurses – NORKA-ROOTS undertaking

steps on this

- Implement live register for nurses, interoperable with other info systems to

provide strategic information (including migration data)

Migration of Nurses from India

• Steady declines in annual inflow of Indian nurses to OECD countries since 2005

• US and UK see declining share of emigrant nurses, while Canada and Australia have

registered rises (absolute numbers much smaller than Gulf)

• Shifts in preference for destination countries may partly be result of destinations’ migration

policies – more family-friendly policies, longer term residency prospects

0

2500

5000

2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016

Canada United Kingdom United States New Zealand Italy

Source: Health Workforce Migration – OECD

migration of nursing and midwifery workforce from …...2018/09/13 · 2005 2012 2016 general...

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