Global demand of nurses – an opportunity to grab

Bangladesh has a serious lack of healthcare workforce; the situation is even dire when it comes to number of nurses. Nurse-doctor ratio for Bangladesh is the lowest in the world: 1:0.6. According to latest survey, there are only 0.3 nurses per 1,000 population, lowest in the South East Asia. Sri Lanka has the highest density of nurses in the region: 2.8 per 1,000 population. To reach the level of Sri Lanka, Bangladesh needs 2,25,000 (2.5 lakh) additional nurses at this moment - the current number of nurses being 48,000.

The poor participation in Nursing in Bangladesh is attributable to four major factors: a) Low Social Esteem; b) Professional Discrimination; c) Lack of Class-I job opportunity with limited space for qualification; and d) Lack of Role Models. Survey conducted by the Refugee and Migratory Movements Research Unit (RMMRU) at the University of Dhaka shows that migration opportunity to a developed country would increase the attractiveness of the profession along with increased social esteem.

Human resource export has been very vital for Bangladesh to attract foreign remittance. However, only a mere 2.0 per cent of total migrated population are professionals. The number of nurses migrating from Bangladesh has historically decreased since 1990s (Source: Bureau of Manpower, Employment and Training or BMET). Studies show that Bangladeshi nurses lack the professional standard required in the global market along with the desired communication and behavioural skills, cultural orientation, and leadership quality. Most developed economies do not allow diploma nurses to practice; whereas only recently the opportunity for BSc qualification has outpaced that of diploma in Bangladesh.

There is a global crisis in healthcare workforce, owing to the ageing problem. UN estimates that the number of people above 80 will triple from 125 million in 2015 to 434 million in 2050. The Organisation for Economic Cooperation and Development (OECD) estimates that by 2030 there will be 7.6 million shortfall of nurses around the world; China alone will require 1.0 million. US and Japan will require 0.44 million and 0.38 million nurses by the same timeframe.

With increasing need for healthcare forces, developed countries will move towards importing nurses and doctors. The five most important blocks as potential destination for nurses are: North America, Europe and UK, Gulf Countries, Easter Asia (Japan and China), and South Asia (Singapore, Malaysia, Thailand). Philippines produces the greatest number of nurses for global market. Kerala in India has recently become a popular source for international nurses. It is high time Bangladesh capitalised on the demand; but it needs long-term preparations to produce quality nurses for the global market.

Experiences of Philippines and India show that nursing education has to be led by private sector, and the migration process has to be promoted by the government. Bangladesh needs to take a similar approach.

At present the contribution of the public and private sectors in the nursing education in the country is equally distributed. A 2013 policy survey maintained that, the 2009 policy guideline on nursing education requires a huge investment for private institutions to offer nursing courses and this is the major obstacle for the expansion of nursing education in the private sector. The 2009 policy guideline needs to be revisited and the private sector should get more encouragement to invest in nursing education.

There are some innovative institutions which are raising the standard of nursing education in Bangladesh. Grameen Caledonian College of Nursing has social business in mind; it follows a self-sustaining model and offers soft loans to the students. Sonar Bangla Foundation-Nursing Institution, situated at Lamonirhat, plans to attract students from neighbouring countries (Nepal, Bhutan). These institutions are collaborating with foreign nursing schools to maintain a high quality of nursing education.

Communication and behavioural skills should be entailed in the nursing education focusing migration. A more focused approach could be to train the nurses with language and cultural orientation.

Migration for nurses requires considerable time and cost. For example, one has to cross at least eight steps to become a registered nurse in the United States. With at least four years' nursing course, two years of experience, it would take at least US$2,000 and an additional 1-2 years to settle in the US to become a registered nurse. The US requires a specialised exam named NCLEX for the foreign trained nurses to be registered; India and Philippines are among the few countries which have domestic test centres. Bangladesh needs to take a long-term view on this, and lobby hard to establish a domestic test centre. This will help reduce the time, cost and hassle of migration procedure significantly.

An accelerated growth in the number of nurses can help achieve a standard doctor-nurse ratio at home and also earn foreign remittances from qualified migrant nurses to developed countries. Migration of nurses can provide stability in remittance and foreign reserve. The global demand of nurses is a great opportunity to grab.

Sayma Zerin is enrolled in the MBA programme at IBA, University of Dhaka.

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