General Studies Paper-2
Context
- India has long held the reputation of being a global supplier of skilled medical professionals, however, struggles to meet its own healthcare demands.
Global Demand Of Medical Professionals
- Countries with aging populations and shrinking healthcare workforces actively recruit medical professionals from particularly in the Global South.
- It is projected to have a shortfall of 18 million health workers by 2030.
- Many of these countries in the Global South struggle with inadequate numbers of doctors and nurses, and experience significant outmigration of health professionals, further straining already overstretched systems.
- Estimates suggest tens of thousands of Indian health professionals migrate annually for better pay, working conditions, and career growth.
Migration Patterns: South to North Flow
- Health workers typically migrate from developing to developed nations, exacerbating the workforce gap in source countries while supporting healthcare systems in countries like Australia, Canada, the UK, and the US — where 25% to 32% of doctors are foreign-trained, primarily from South Asia and Africa(2009–2019, OECD).
- India: Approximately 75,000 Indian-trained doctors and 640,000 Indian nurses work overseas.
- Philippines: Renowned for exporting nurses, with over 193,000 working abroad — about 85% of all Filipino nurses.
- Sri Lanka: Faces heavy outmigration, partially addressed by recruiting foreign professionals.
Drivers of Migration
- Push Factors: Economic: Low wages, limited career advancement; Political: Instability, conflict, and weak governance.
- Pull Factors: Higher pay, better working conditions.
- International demand due to ageing populations and declining birth rates in developed countries.
- Policy support like trade agreements and targeted recruitment drives.
- Countries such as India and the Philippines even encourage the export of health workers as part of national policy, largely due to remittance inflows and global presence.
Arguments in Favor of Exporting Health Workers
- Medical Diplomacy & Soft Power: Indian health professionals help fill acute shortages due to aging populations and declining birth rates, especially in the OECD countries.
- Economic Gains through Remittances: Migrant health workers send back significant remittances, contributing to India’s foreign exchange reserves and household incomes.
- It is seen as a strategic economic benefit, especially by states like Kerala.
- Skill Development & International Exposure: Working abroad allows professionals to gain advanced training, experience with cutting-edge technologies, and exposure to global best practices, which can benefit India if they return.
- Employment Generation: Exporting health workers helps absorb the growing number of graduates from India’s expanding medical and nursing colleges, reducing domestic unemployment in the sector.
Arguments Against Exporting Health Workers
- Domestic Shortages & Unequal Distribution: India has 13.86 lakh registered allopathic doctors, according to the National Medical Commission (NMC).
- India has 1 doctor per 811 people (Nov, 2024), which is technically better than the World Health Organization (WHO) recommendation of 1:1000.
- However, in rural areas, the ratio plunges to 1 doctor per 11,082 people, revealing a severe shortage.
- Community Health Centres (CHCs) report over 79% shortfall in required specialists.
- India has 1 nurse per 476 people, assuming 80% availability of the 36.14 lakh registered nurses.
- India falls short of the WHO recommended 3 nurses per 1,000 population, needing 4.3 million more nurses to meet global standards.
- Brain Drain & Loss of Investment: The government invests heavily in training health professionals. When they migrate, India loses valuable human capital and the return on public investment in education.
- Healthcare System Strain: The migration of skilled professionals exacerbates the burden on India’s already overstretched healthcare system, especially during crises like COVID-19.
- Ethical Concerns: Developed nations benefit at the expense of developing countries’ health systems—a form of ‘care drain’ or ‘brain robbery’.
- Commercialization of Training: Migration-driven demand has led to a rise in private nursing colleges focused on overseas placement, sometimes at the cost of quality and domestic relevance.
Strengthening Domestic Systems
- Migration policy should not come at the cost of domestic health systems. Countries need to:
- Expand health education capacity.
- Improve working conditions and career pathways.
- Incentivise circular migration over permanent relocation.
- Leverage digital health platforms to enable cross-border services without physical movement.
- Hold destination countries accountable to fair and balanced agreements.
Institutional Innovations and Lessons from the South
- India could benefit from a centralised agency for managing overseas workforce deployment and return migration.
- Kerala’s model of coordinated overseas employment and grievance redressal can guide national policy.
- Philippines’ Department of Migrant Workers provides a structured approach to managing health workforce migration.
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