Intended for healthcare professionals

Feature Workforce Planning

Why is India short of nurses and what can we do about it?

BMJ 2013; 346 doi: (Published 25 June 2013) Cite this as: BMJ 2013;346:f4024
  1. Soumyadeep Bhaumik, medical doctor, independent researcher, and freelance writer, Kolkata, India
  1. soumyadeepbhaumik{at}

They’re underpaid, overworked, and exploited, says Soumyadeep Bhaumik, but is there any enthusiasm to improve nurses’ pay and conditions?

Nurses have been described as the “sheet-anchor” in India’s health system that aims to provide primary healthcare to all citizens irrespective of ability to pay.1 But India’s urgent need for healthcare reform is constrained by shortages of health workers at all levels.2 Although shortages of doctors are often discussed, shortages in nursing tend not to get the same airtime. The quality of services that nurses provide as well as their status, pay, and working conditions also need immediate attention.

A massive change in thinking is needed from “the current physician centric healthcare approach wherein the huge contributions and critical role of nurses and other allied health professionals are seen as sheer auxiliary inputs,” Raman V R, principal fellow at the health governance hub of the Public Health Foundation of India (PHFI), told the BMJ.

Quantifying the problem

India has an average of one nurse for every 2500 residents, compared with one for every 150-200 in richer countries.3 The union health minister, Ghulam Nabi Azad, recently said that the Planning Commission had projected a deficit of 955 000 nurses by 2012 of which 200 000-300 000 would be in the government facilities.4

Mercy John, principal at the School of Nursing, Christian Hospital, Bissamcuttack, Odisha, said that it is not clear whether these numbers include registered and unregistered nurses, and those who are registered but unemployed, because until recently live registers did not exist. In February 2013, however, the non-governmental organisation Family Health International, the ministry, and the Indian Nursing Council launched a database of all nurses.5

India has various educational programmes that train different types of nurse—the public health nurse or auxiliary nurse midwife (ANM), the do it all general nurse …

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