The global healthcare sector faces an acute and growing shortage of qualified professionals, a challenge exacerbated by aging populations, pandemic disruptions, and the increasing complexity of healthcare needs. In this context, India has emerged as a critical source of healthcare workers for countries worldwide, supplying doctors, nurses, and allied health professionals to meet the growing demand. This feature story explores the dynamics of sourcing healthcare workers from India, the factors driving this trend, its benefits and challenges, and the impact on healthcare systems globally.
According to the World Health Organization (WHO), there will be a projected global shortfall of 10 million healthcare workers by 2030, particularly in low- and middle-income countries. Developed nations, such as the United States, Canada, the United Kingdom, and Australia, are also grappling with shortages due to aging populations and increased demand for healthcare services.
Aging Populations in Developed Nations is the bane of their existence. In the United States, nearly 20 percent of the population will be over 65 by 2030, increasing the demand for healthcare services. In Europe, healthcare systems are similarly strained, with countries like Germany facing a shortage of 400,000 nurses by 2030, as per the European Commission.
The post-pandemic challenges have further exacerbated this. The COVID-19 pandemic placed unprecedented strain on healthcare systems, leading to burnout and an exodus of healthcare professionals in many countries. This has further intensified the need for qualified workers from abroad.
Why India is a key source for healthcare workers? India has become a leading supplier of healthcare professionals for several reasons.
First, the strong educational infrastructure. India has over 600 medical colleges and 1,000 nursing institutions, producing approximately 90,000 doctors and 200,000 nurses annually. Many Indian institutions follow rigorous curricula aligned with global standards, making graduates highly competent and employable abroad.
Second, the English proficiency is a big plus. As English is the primary language of instruction in Indian medical schools, graduates are well-prepared to work in English-speaking countries like the US, UK, Canada, and Australia.
The cost-effectiveness is certainly add to the value. Hiring Indian healthcare professionals is cost-efficient for foreign employers, as wages in India are significantly lower than in developed countries.
Further, the candidates’ willingness to relocate to distant countries seem to be an advantage to source from India. Economic opportunities, better working conditions, and career growth prospects motivate many Indian healthcare workers to seek employment abroad.
Among the popular destinations for Indian healthcare workers, USA, UK and Australia sit on the top. United States’ H-1B and Green Card programs are the big draw. Indian doctors and nurses benefit from visa programs designed for highly skilled professionals. There are well over 100000 Indian-origin physicians accounting for some 10 percent of the total physician population. It is noteworthy that India provides the largest number of International Medical Graduates to the US in absolute numbers. As of June 2024, there were approximately 32,000 Indian nurses working in the United States. This number represents about 6percent of all immigrant registered nurses in the country. India is the second most common country of origin for immigrant registered nurses in the United States. The top states for immigrant nurses are California, Nevada, and New Jersey. The United States has a massive shortage of healthcare professionals, especially registered nurses.
The UK’s National Health Service (NHS) relies heavily on Indian healthcare workers. In 2022, more than 30,000 Indian nurses were registered with the NHS. The UK introduced expedited visa processing for healthcare workers, benefiting Indian professionals significantly. India is now the largest international provider of nurses to the UK nursing register. According to recent data from the Nursing and Midwifery Council (NMC), there are currently around 67,576 Indian nurses registered to work in the UK, representing a significant portion of the total nursing workforce there. A score of British social care agencies have been accused of exploiting foreign workers, leaving people living on the breadline as they struggle to pay off debts run up while trying to secure jobs that fail to materialise.
The UK is currently experiencing a significant "care worker crisis", characterized by a major shortage of available care workers, primarily due to low pay, high staff turnover, and a growing demand for care services from an aging population, leading to high vacancy rates and difficulties in providing quality care to those who need it; this situation puts immense pressure on existing care workers and can limit access to care for many people. Care workers often earn low wages, making the job less attractive and contributing to high turnover rates. The aging population is driving a growing demand for care services, further exacerbating the shortage. The sector heavily relies on migrant workers to fill gaps, but recent changes in immigration policies have impacted recruitment. The demanding nature of the job, coupled with low pay and inadequate support, can lead to burnout among care workers. According to Skills for Care, the vacancy rate in adult social care is significantly higher than the national average, with thousands of unfilled positions across the UK.
In order to obtain a visa to work in a care facility or as a carer in someone's home, many care worker residents paid immigration officials and, in certain situations, the care provider themselves, thousands of pounds (often as much as 40,000 pounds) in fees. The majority said that the brokers assured them that the funds would pay for their visa, airfare, and a month's lodging, and that they would be assured full-time employment with an annual salary of more than £20,000. Many claim they were informed that the remuneration would swiftly pay off any debt acquired to cover the initial expenses. However, employees say they were informed shortly before they arrived in the UK that they would be responsible for covering their own airfare and lodging. They were promised jobs, but they did not receive them when they got there. Most of the time, there was either no employment at all or far less money and hours than had been promised. According to other employees, their employers urged them to look for part-time employment elsewhere, as permitted by their visa. One company's employees said they were pressured to work as cleaners or drivers for the corporation instead. Some claimed to have been sharing rooms and even beds with other immigrants in order to make ends meet, while others claimed to have been using food banks.
Workers who have expressed dissatisfaction with the conditions in multiple instances claim they were informed that their sponsorship would be revoked and they would be sent back to India if they did not keep quiet. Some said that immigration officers stationed in India had also intimidated their relatives if they attempted to speak out. According to solicitors, UK care providers may have violated the law if they give exploitative or low-paying jobs upon arrival after promising regular full-time employment. Many people feel imprisoned since the sponsorship system ties a person's immigration status to a specific employer.
Care workers are paid hundreds of pounds each by agencies in the UK, India, and other nations to arrange care positions and handle their paperwork. The UK government refers to these fees as "modern slavery" because they frequently leave the care workers heavily indebted and obligated to their contracts. Some organisations defraud applicants by making false promises about services that never come to pass. Others have questionable credentials or unclear identities and were hastily established within the last year and a half.
Lot of these are masqueraded as both training and placement agencies, such as Envoy International founded by Jaimin Naresh Shah, an individual who had an earlier dubious history as a provider in the space of higher education in the UK. There is a ground swell of reports, corroborating evidence and disgruntled clients suggesting that Envoy International received huge sum from clients and sourcing agents towards training and placement without delivering on its promises. ‘’We paid him 42000 pound for training and placement of our clients and it is nearly a year the company has reneged its promises,’’ says Dr S A Basha, who owns multiple skill development and manpower consultants in Europe, Asia and Africa.
There are several other skill development and manpower consultants such as H Raval have claimed to be on the receiving end from these fraudulent organisations. ‘’We lost 29000 pound to a reprobate consultant Arvind (who goes by alibi Sunny) in the Seven Kings/ Ilford area of Essex who promised to deliver the training and placement for our healthcare candidates,’’ despairs Raval.
In recent years, the care sector has relied on hundreds of thousands of foreign workers to fill labour shortages brought on by the COVID-19 pandemic and Brexit. 350,000 health and care visas, or 75percent of all skilled worker visas, were issued by the government to employees and their dependents in 2023. However, it seems that system abuse has increased along with the numbers.
From March 11, 2024 the health workers were restricted from bringing family to the UK and care providers must register with the Care Quality Commission (CQC) if they are sponsoring migrant workers in the UK. But there are concerns about suspected fake companies sponsoring visas after hundreds of licences were reportedly granted to firms that are just a few months old and have no history of providing care. More than 250 businesses who have never been inspected by the CQC are also believed to have been granted licences to sponsor workers from abroad.
The problems facing social care are deep-rooted. Some stem from the decade of austerity that began in 2010, which cut council budgets to the bone and left them unable to fully respond to rising demands for support. The challenges of the job – stressful and sometimes exploitative conditions, a lack of career progression and high turnover – have been cited in reports as far back as 2015. There were also warnings of staff shortages ahead of Brexit, when the care sector relied on EU nationals. “Shutting off the ‘relief valve’ of EU migration,” the Nuffield Trust said, “put additional pressure” on a system that didn’t have an effective way to train and keep British care workers.
Migrant workers have been part of the UK’s social care sector for decades. Overseas workers plug vital labour gaps across almost every healthcare profession, while one in four care workers and home carers was born outside of the UK, according to the Office for National Statistics. These carers are most likely to be from Africa, Asia and the Middle East. Numbers have grown, especially since the government recognised the lingering impact of the pandemic on care worker recruitment and turnover. In February 2022 the Home Office added care workers to its shortage occupations list, a list of the jobs where the government considers there is a shortage of workers. For the first time, any care worker could apply for a health and care worker visa, whereas before only senior professionals were eligible. The hope was that these additional carers would address the challenges that the pandemic had compounded. Since then, international recruitment has grown significantly, according to Skills for Care, the body in charge of planning paths into care work across the UK.
The demand for care workers in Gulf Nations has never waned. Countries like the UAE, Saudi Arabia, and Qatar employ thousands of Indian nurses and doctors to support their rapidly growing healthcare infrastructure. Dubai’s Healthcare City employs a large number of Indian expatriates in various specialties.
Further, both Australia and Canada are large employers of Indian care workers. Both countries offer permanent residency pathways for healthcare professionals. In 2021, 25 percent of new nurses registered in Canada were of Indian origin. Recent political crisis in Canada and its deteriorating relationship with India seems to have affected this.
Indian healthcare workers help fill critical gaps in healthcare systems, ensuring continuity of care in understaffed facilities. Indian healthcare professionals often excel in diverse environments due to their experience in treating a wide range of conditions and their ability to adapt to different cultures. It is always found that the host countries benefit from the economic activity generated by skilled migrants. Indian healthcare workers remit billions of dollars annually, contributing to India’s economy. In 2021, India received $87 billion in remittances, a significant portion from healthcare professionals abroad
There is also a downside to this. The migration of healthcare workers exacerbates shortages in India, particularly in rural areas. WHO reports that India needs an additional 1.8 million doctors and nurses to meet its population's needs.
The credentialing and recognition of Indian healthcare qualifications seem to be a problem sometimes. Indian qualifications are not always immediately recognized abroad, requiring workers to pass additional licensing exams or training programs. Nurses moving to the US must pass the NCLEX-RN exam, while doctors often face extensive residency requirements.
The cultural and social adjustments too can be demanding. Relocating healthcare workers often experience cultural shock and challenges integrating into foreign societies. Reports of underpayment, long hours, and poor working conditions have surfaced in some countries, particularly for nurses in the Middle East.
India need to balance migration with domestic needs. India should invest in healthcare infrastructure and incentives to retain talent, particularly in underserved regions. Host countries can collaborate with India to establish exchange programs that benefit both sides. The streamlining credentialing processes need to be put in place. Harmonizing licensing requirements can facilitate smoother transitions for Indian professionals. For example, the bilateral agreements, such as the UK’s recognition of Indian nursing degrees, simplify the migration process.
Most importantly, the ethical recruitment practices certainly need to be place. Adopting ethical recruitment standards ensures that healthcare workers are not exploited and that their rights are protected. Expanding the training programs also must get attention. Collaborative efforts between India and host nations can expand training programs to prepare workers for international roles.
The sourcing of healthcare workers from India is a testament to the global interconnectedness of healthcare. Indian professionals are addressing critical shortages in countries worldwide while advancing their own careers and contributing to both host and home economies. However, this trend also highlights the need for a balanced approach to ensure ethical recruitment, recognition of qualifications, and support for India’s domestic healthcare system.
With the right policies and collaborations, the migration of healthcare workers from India can continue to be a win-win solution, addressing global healthcare challenges while fostering international cooperation and development.
By Sarat C. Das
(The content of this article reflects the views of writers and contributors, not necessarily those of the publisher and editor. All disputes are subject to the exclusive jurisdiction of competent courts and forums in Delhi/New Delhi only)
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