Nepal’s nurse flight

If nurse salaries and work conditions do not improve, we will have to ask why nurses stay, rather than why they leave.

News of Nepali migrant workers being cheated, abused and exploited make headlines every day, but they overshadow stories of many who return with earnings and exposure to start anew back home, or contribute from afar.  

Recruitment and employment malpractices obscure the predictability of emigration outcomes. It can be transformative, but in many cases it is not.

We have in this paper previously likened it to a lottery in which desperate Nepalis are forced to gamble with their future

Bilateral labour agreements between Nepal and host countries can ensure a better managed migration process in which there is a greater guarantee of worker welfare. One such government-to-government (G2G) agreement is between Nepal and the UK.

Since 20 July, Britain and Nepal have started accepting applications for nurses under the bilateral scheme. In its pilot phase, 100 nurses will be recruited at zero cost, and enjoy equal benefits and protection with others in the UK.

Such transparency can allow more predictable consequences for workers seeking jobs overseas. A bonus is their ability to take their spouse and children along, and that the agreement will benefit mainly female workers.

Nurse emigration also highlights the sorry state of their employment conditions in Nepal. One nurse listed three problems nurses face: lack of respect, low wages and overwork. Indeed, nurses have to work for as little as Rs15,000 a month in private hospitals in Nepal after spending millions on their degrees.

These are all results of neglect of the nursing profession by the state. It is therefore hardly surprising that nurses are moving overseas to meet a global shortage of healthcare professionals.

If not the UK, Australia or the US, it is the UAE or Saudi Arabia. A Saudi-based nurse said she left because she had to do one full time and one part time job to make Rs23,000 a month in Nepal, while she saves more than four times the amount in Saudi Arabia for an 8 hour shift with all expenses covered.

If working conditions and salaries do not improve, the more apt question may soon be why nurses stay, rather than why they leave.

There are challenges abroad as well. Britain is itself facing strikes over pay disputes for nurses. But as one UK-based nurse told us, despite the struggle, earning and learning prospects are better there.

Emigration is linked to aspirations and desires. And improving the domestic labour market and outmigration are not mutually exclusive. What nurses are escaping from merits attention, but so does what they will be facing abroad. 

Those who choose to leave can then maximise the benefits of overseas opportunities that are rife with high recruitment fees and insufficient protection.

In the UK, there are also voices being raised about importing nurses for cheap from Red Zone countries with fragile health systems like Nepal.

A managed bilateral agreement makes migration better for nurses who will benefit from the scheme as they can compete in a fair environment. 

But Nepal should also go beyond traditional labour agreements to enter into mutually beneficial skills partnership models that would also support health training and infrastructure back home. This requires proactive diplomacy, thinking outside the box and a realisation that benefits of migration can go beyond remittances.

Nepal needs to view its diaspora as its strength and seek ways to engage those abroad. As UK-based nurse Binod Simkhada says, “To contribute to Nepal, one does not need to be in Nepal.” At the Nepal Nursing Association in UK, he was involved in establishing a birthing center in Jumla that was recently handed over to the local government.

In many cases, Nepalis can provide more help from outside than from within Nepal, given better access to resources and networks. And for those who come back, reintegration policies are overdue to leverage the social and financial remittances returnees bring home.

As the Nepali Times Diaspora Diaries series show, good migration can be transformative and help families break out of intergenerational poverty. Because the government took a proactive initiative on managed migration of nurses to the UK, the 100 nurses could have life-changing stories.

But that by no means absolves the Nepal government from its responsibility of ensuring that nurses here are treated with respect and earn liveable wages. It is the least the state can do.