Migration of Doctors and Nurses from India

WHO Global Code of Practice on the International Recruitment of Health Personnel

There is no health without health workers.

With migration of health workers from lower-income countries to higher-income countries in search of better wages and working conditions, the need for well-trained health workers is only going to increase. WHO projects a growing shortfall of health workers required to achieve the Sustainable Development Goals.

The meeting highlighted the need for a formal and comprehensive policy on Human Resource for Health(HRH) that addresses challenges and opportunities related to health workforce in the country. India is facing shortage of skilled human resources in the health sector and to bridge the ‘skill’ and ‘availability’ gap, the meeting focused on the issue of international migration of health professionals from India.

Addressing the key issues of migration of doctors from India, Mr Rajeev Sadanandan, Additional Chief Secretary, Department of Health and Family Welfare, Government of Kerala, pointed out that broadly there are two types of factors leading to migration: push and pull factors. He emphasized that apart from monetary benefits, better scope for skill development and improved work environment are amongst other key factors that drive people to seek opportunities outside India. It is, therefore, important that the health sector should work on addressing the range of concerns pertaining to the recruitment and retention policies and processes for health personnel in the state.

The discussions encouraged adoption of the WHO Global Code of Practice on the International Recruitment of Health Personnel, its guiding principles and how different stakeholders can implement it for securing potential of human resources in the health sector.

Prof Rajan of Center for Development Studies, Trivandrum highlighted issues and challenges in the migration of nurses from Kerala, emphasizing the need for real time data and the key role of strong information systems in estimating the real burden of a problem that in turn will contribute to better HRH panning and evidence-based decision-making processes.

According to findings of a WHO research study that estimated up to 40% of migration of doctors from the state of Kerala were presented at the meeting. Dr Sreelatha from the Directorate of Health Services (DHS), Kerala presented the human resources situation in the state including migration of health workers.

Ms Kavita Narayanan from the Ministry of Health and Family Welfare, Government of India and Dr Dilip Singh from National Health Systems Resource Centre (NHSRC), discussed recent developments and ongoing efforts at the national level to improve human resource for health situation in the country. Ms Narayanan highlighted the need to eliminate the root cause of migration rather than to address its consequences only, and called for creating a strong system across all dimensions to retain people in the country.

The current HRH situation and initiatives undertaken by the states of Tamil Nadu, Karnataka and Telangana were also discussed by the representatives from these states, suggesting varying standards and wide variations in overall HRH situation and management context among the states.

In the concluding session, Dr. B Ekbal, a public health specialist highlighted the need for countries to respect and adhere to the WHO Global Code of Practice on the International Recruitment of Health Personnel, which should be used as the reference point in bilateral and other such agreements.

WCO India reiterated that the negative implications of migration outweigh the positive effects. Migration of HRH should not be treated as an isolated issue; it needs to be seen in the wider political, legal, organization, socio-economic and cultural context of the country. It should be aligned with overall health system goals and broader policies and be part of overall health system strengthening efforts.

Following are some of the key areas identified by participants for further action: Strengthening information systems for HRH; improving HRH management; fostering coordination and multi-sectoral approach alongside establishment of strong accountability mechanisms; strengthening provisions for continuous medical education; and creating more opportunities and better working conditions for all cadres of health workers.

The participants agreed that the HRH agenda goes beyond the Indian borders and bilateral and multilateral agreements between Member States; it is becoming a global priority area that is clearly reflected in the Sustainable Development Goals.

The WHO Country Office for India, in the third year of the project, will conduct research study on the migration of nurses from India.

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