Global Health Economics
Health Worker Migration
Why doctors and nurses move from poorer to richer countries, the costs and benefits for source countries like India, and efforts to manage the flows ethically.
Rich countries face shortages of doctors and nurses as populations age. Many fill the gap by recruiting from abroad. India, the Philippines and several African countries are major sources.
Why health workers migrate
- Higher pay: salaries abroad can be many times higher.
- Better working conditions, equipment and training.
- Career opportunities and specialisation.
- Active recruitment by rich-country health systems and agencies.
- In some countries, low pay, delayed salaries and limited jobs at home push workers out.
Scale
A large share of doctors and nurses in countries such as the United Kingdom, the United States and the Gulf states were trained abroad. India is one of the largest sources of foreign-trained doctors and nurses in many of these countries, and Kerala in particular has a long tradition of nurses working overseas.
Costs for source countries
- Lost investment: governments and families spent money training workers who then leave.
- Shortages: some African countries with very few doctors per person have seen significant shares migrate.
- Weaker health systems in rural areas.
Benefits for source countries
- Remittances support families and local economies.
- Skills and networks: some return with new expertise.
- Brain gain: the prospect of migrating encourages more people to train. Research on the Philippines found that growth in overseas nursing opportunities led to a large increase in nursing graduates, more than replacing those who left.
Managing migration
- The WHO Global Code of Practice on the International Recruitment of Health Personnel, adopted in 2010, encourages ethical recruitment and discourages active recruitment from countries with critical shortages.
- WHO maintains a list of countries with the most severe health workforce shortages, where active recruitment is discouraged.
- Some countries sign bilateral agreements that include training support for source countries.
India’s perspective
India trains large numbers of nurses, many hoping to work abroad. Policymakers aim to expand training capacity so that migration and domestic needs can both be met.
A nurse from Kerala works in a hospital in the Gulf, earning several times her salary at home. She sends money to her family, helping her sister study nursing too. Her local hospital struggles to fill vacancies, but a new nursing college has opened in her district to meet demand from students hoping for similar opportunities.
Migration brings remittances and can encourage more people to train. The effects depend on training capacity and the severity of shortages.
- Doctors and nurses migrate for pay, conditions and careers.
- India and the Philippines are major sources of health workers abroad.
- Source countries lose training investment but gain remittances and more trainees.
- The 2010 WHO Code promotes ethical recruitment.
No recording for this one yet - EconReader can read it aloud for you.