Pay, Perks, & Pride: Why India's Best Nurses Migrate Overseas?

Twenty-nine-year-old Rita Jacob from Kerala left her job as a contract nurse in a Mumbai hospital after working there for four years.

"I would give everything to take care of people in my ward. But I would be treated like a help, and not as a healthcare professional. I wanted respect," she tells FIT.

Rita migrated to Germany in early 2020, just before the COVID-19 pandemic, and has been working as a nurse since then.

Fifty-year-old Sheela, who comes from a family of nurses, is working in a government-aided hospital in Delhi, regrets missing several opportunities to migrate for work.

"I sometimes wonder if I would have been more than a bedside nurse, more than someone to blame when things go wrong, had I taken up opportunities that came my way."

India ranks only second after the Philippines in the number of nurses working overseas – sending nurses to top destinations of the UAE, Oman, Saudi Arabia, and the UK.

Data from Kerala government-run Overseas Development and Employment Promotion Consultants (ODEPC) shows that the body was sending at least 40 nurses abroad every single month before the pandemic.

So, what's pushing India's best nursing minds to find employment overseas?

Pay & Perks: 'No Comparison to Nurses In India'

In India, more than 60 percent of doctors and 50 percent of nurses are employed in the private sector. Further, while two-thirds of the country’s population is rural, only a third of the healthcare workforce is available in these areas.

"Most states have stopped recruiting permanent nurses. Everyone is hired on a contract basis – basically, meaning they can be hired any time and fired any time. This is not justified for the work that is being put in, and the number of patients they treat," Santha Sivarajan of Delhi's Ram Manohar Lohia's Nurse Union tells FIT.

This is true, says Dr N Devadasan, public health policy expert and co-founder and director of Institute of Public Health, Bengaluru.

"They are paid pittance as compared to the monetary benefits reaped by doctors. So after toiling for over four years, the freshers get paid meagre Rs 15,000, in place of the Rs 40,000 that they would have been working had they been hired by the government as regular nurses."

When hired on a contract basis, the chances of a significant increment is also bleak. However, a nurse who works at a leading multi-specialty hospital in Hyderabad, tells FIT that the picture is not better in private hospitals either.

"Even if you are in a government contract, your job is more secure than in private hospitals. The pay is just as much as they are in government hospitals, if not worse if you are starting. For someone like me who has three years experience, getting a significant raise is very difficult."

Rita, who was making Rs 20,000 as a contract nurse, is making 2,800 euros (Rs 2 lakh) per month.

Her friend Aparna S, who is working in Dubai, is making 12,000 dirhams (Rs 2.4 lakh) monthly – which is helping her take care of her parents back in Tamil Nadu.

"My father had to retire early due to health issues. I have two younger sisters, and their education and future would not have been secure if I was working in India still. I am sending most of my earnings back home, but still living a dignified life here."

Aparna to FIT

According to ODEPC, following the pandemic, salary offers from Dubai have doubled from 4,000-5,000 dirhams (Rs 80,000- Rs 1 lakh) to 10,000-12,000 dirhams (Rs 2 lakh-2.4 lakh), reported The Print in 2022.

The UK, another country where Indian nurses are sought after, had granted one-year visa extensions to overseas health workers in April 2022.

The extension under the new Health and Care Visa is said to make it “easier, cheaper and quicker” for global health professionals to work in the NHS and affiliated social care sector.

"I was given free accommodation till I found housing. I was also taken care of in terms of food for a month after I arrived. I have worked in three different states, in big private hospitals, these are not things they worry about. But that doesn't mean we should stop asking for what we deserve."

Is Asking For Respect Too Much?

Dr Devadasan points that another reason for nurses to migrate overseas is the general lack of respect for nurses.

"In hospitals abroad, nurses are treated as a part of the healing process. As a part of the team that is providing healthcare services. Their opinions are sought, because they have the maximum contact with the patient. The doctor works with the nurse to figure out what is the best treatment plan. In India, this is completely absent. There is a hierarchical, class-based attitude."

Sheela, who has been working as a nurse for more than 25 years now, says that in most situations, nurses are treated as lesser than humans.

"Forget the respect for healthcare workers, we are treated as less than humans. This starts right from a doctor who is one year into profession to someone who has been working for a long time. The juniors see the seniors shouting at us, and they think this is the treatment we are entitled to. Is asking for respect too much? We put up with it, the younger ones shouldn't do so," she tells FIT.

In many cases, nurses, both in private and government jobs are overworked, with no scope of career advancement.

"We are as much a backbone of the healthcare system as doctors but this recognition does not come. Moreover, there is no scope for career improvement. You start as a bedside nurse, and then take many years to be ward in-charge but after all that, there is one person who becomes a chief nurse. Else, you are doing the same thing, and not being consulted for any treatment plans."

In Philippines, for example, nurses start at the bottom of the rung after 2.5 years to be eligible to work at primary healthcare nurse, after further training, they are stationed at health centre. After three years, they can enroll in medical school – therefore, giving them a path to climb up their career.

Why India Cannot Ignore the Gap?

To put it simply, India cannot choose to simply ignore the number of nurses migrating overseas – as it could further weaken our healthcare services.

A report released by FICCI and KPMG shows a significant shortage of nurses in India's healthcare system over the past few years. While the country has a capacity of more than 3 lakh nursing seats annually, there has has been a 9-fold increase in the number of institutions offering diploma nursing programs over the past 12 years. But this has not translated into jobs.

India stands at 1.7 nurses per 1,000 people against the World Health Organisation (WHO) norm of three nurses per 1,000 people.

Kerala has the most nurses and midwives in the country. the state tops the list with 96 nurses and midwives per 10,000, while Goa and Uttar Pradesh have the least with 0.5 and 0.8 per 10,000 people.

"We do not need another pandemic to realise that India should not be ignoring this trend. For example, most delivers in villages are being referred to the district hospital because there is just one nurse at primary health centre. This is how the burden increases on the patient, the nurse and the healthcare system in general. This gap needs to be fixed."

Yes, doctors are providing healthcare services, but so are nurses and this should be recognised, says Aparna, who is working in India.

"Else, India is going to lose the best of minds – who act as bridge between both doctors and patience. Give us pay, then respect will follow. This is the only way to ensure that the backbone is not completely broken," she says.

"Without nurses, there is no quality care," she adds.