The demand for Indian nurses has risen across the globe since the outbreak of Covid-19 and has now hit record levels as countries begin vaccination drives and prepare their healthcare systems for possible future waves or pandemics.

India is known as the second-largest nurse-sending country after the Philippines. Many Indian nurses work in the Gulf countries, OECD countries, and some Asian countries such as Singapore and Malaysia. It was reported that the number of overseas Indian nurses was a little bit more than 640,000 in 2011. As globalization progresses and the demand for nurses continues, this number should increase by now. In India, many nurses, mainly Malayali nurses from Kerala, migrated to the Gulf countries to work in the growing numbers of hospitals.

The second demand comes from developing countries where the demand for nurses has been rapidly increasing due to ageing while the younger population has been declining in these countries. The United States has the largest number of foreign-trained nurses with around 246,000 foreign nurses (2012), which is around 6% of total nurses in the U.S. The United Kingdom is the second largest employer of foreign nurses. It recorded 86,000 nurses in recent years.

The third demand arises from the growth of popularity in medical tourism. Not only developed countries but also developing countries are promoting this new line of tourism.

Other reasons are, the large salary gap between developed and developing countries, better working environments, and higher living standards are luring nurses from developing countries.

While many nurses work in foreign countries, India has been suffering a shortage of nurses. This is a critical issue in India where the number of doctors is not sufficient and access to basic health facilities is limited. To maintain the standard of public health, nurses can play important roles in a country like India.

According to a WHO report, there is an estimated shortfall of 2.4 million nurses in India (WHO 2010). To fill this gap, India needs to double the number of domestic nurses. Even if all overseas Indian nurses came back, the shortage problem would remain; however, it is important to examine how the situation evolved and to identify factors that influence the intention of international migration among nurses.

“Prospects of nurses from Kerala have certainly improved. Many hospitals from abroad are waiting for the resumption of flights,” said Mohammed Shihab, general secretary of, Indian Nurses Association.

Nurses in Kerala have been on strike demanding better wages since June 2017, with the support of the Indian Nurses’ Association and the United Nurses’ Association. In Delhi, with the support of local associations and the Trained Nurses Association of India, nurses, including those in government hospitals, have been on strike, with the government invoking the Essential Services Maintenance Act to deal with striking nurses in the city.

“Nurses should be given more importance and acceptance at a level near to the doctors, as patient care is given by nurses. Most of the nurses wish to work abroad because of the high salary and respect they receive there.” — Student, Private Nursing College, Kerala

The movement of people in search of better opportunities, education, and quality of life is not new. Such mobility can foster the interaction and exchange of ideas, technology, and knowledge among countries. However, the migration of skilled human resources, particularly health workers, which is usually from poorer “source” countries to richer “destination” countries, and its implications for the distribution of the health workforce and health sector planning in low-resource settings, has been a cause of concern since the 1970’s. In India too, the mobility of health workers, including that of nurses, reflects the tendency to move from settings with low availability of resources to settings with more resources and better opportunities. This may be in the case of internal migration within the country — from rural to urban areas, or from smaller towns to larger cities — or in the case of international migration, usually from India to high-income countries. This conveys the factors governing the migration of nurses from India to other countries.

The migration of nurses from Kerala has been demand-driven to the extent that nurses have responded to opportunities where they were available and altered their movement in response to incentives arising from policies in destination countries. As noted above, access to networks and information has been crucial to this process. Unlike IT professionals, nurses receive little recognition as contributing to India’s social profile as a source of skilled labour or to remittances. Nurses have received little official support for migration until recently but also importantly the Indian state did not erect barriers to their movement. Indian nurses have relied extensively on social networks and commercial agencies as mechanisms that channel information and provide support for migration. Networks and agencies have shaped the aspirations of nurses towards potential destinations and defined the perspectives of aspirants concerning the migration process.

Nurses from developing countries emphasize the economic motive as the principal reason for migration because the compensation packages in their home countries are far from attractive. Here we slog for more than eight hours a day and are paid a pittance. However, the onward migration of nursesfrom countries that provide high salaries to others is only one indication of more diverse motivations. This preference is likely to make them look for destinations that are relatively more secure.

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