Healthcare workforce migration from Pakistan: Pivoting from brain-drain to collective gain with structured and circular migration plans.
By : Dr. Sheraz Ahmad Khan, PHD, MPH, MBBS
Dr. Maidah, IPFPH, MBBS
Population, youth bulge, and love for medicine
Pakistan can transform healthcare workforce migration from brain drain to collective gain by leveraging its young population, addressing workforce shortages, and capitalising on global job market demands. According to the 2023 digital census, Pakistan has an estimated population of 241 million, the fifth most populous country in the world. A significant proportion of the population (64%) is under 30, with medicine and allied sciences being their default and preferred career choice. The nation can leverage this youth bulge, train them, and enable them to address the global workforce shortage. Healthcare can be one field for consideration. The health workforce can play a pivotal role by adding more white-collar jobbers alongside the existing blue-collar workers abroad. Health workforce migration, typically considered a brain drain, can be a collective gain if done sustainably. On the one hand, employment leads to successful, empowered persons and families. On the other hand, their remittances can support and contribute to the nation’s development and financial stability.
Health workforce migration: opportunities and threats
However, the health workforce proposition has challenges for Pakistan. According to the World Health Organization (WHO), Pakistan is one of the 57 countries facing health workforce crises. Pakistan has one doctor per 1300 population compared to the WHO-recommended 1:1000, and against the WHO-recommended nurse-to-population reaction of 3.28 to 1000, Pakistan has only 0.49 nurses for a population of 1000. The doctor-to-nurse ratio is also reversed, which means we have fewer nurses than doctors, which should be the other way around for the proper healthcare system functioning.
Pakistan faces challenges in absorbing its trained health workforce due to various issues, and there is potential for them to benefit from opportunities abroad. As per the Labour Force Survey 2020-21 by Gallup in Pakistan, 36,000 female doctors are either jobless or have chosen not to serve. This is because of wage disparities, political challenges, working circumstances, lack of career pathways, and personal safety concerns. This out-of-work trained health workforce can benefit from structured programs to secure their placement abroad in better, secure, and predictable careers. Hence, it will become a collective gain rather than a brain drain.
One of the immediate benefits of healthcare workforce migration is the remittances sent back home by overseas Pakistanis. Other benefits are people-to-people diplomacy and circular migration, which have a net positive effect on the health systems in Pakistan. Currently, these remittances stand at USD 31 billion. However, Pakistan can enhance its foreign exchange reserves by promoting citizens’ access to white-collar jobs globally, e.g., by exporting healthcare professionals.
The global health workforce landscape
Pakistan can reasonably enhance training a health workforce; however, its absorption capacity, particularly in the public sector, is limited. Tapping into the global job market with the right human capital is timely. Data from the United States (US) job market projections show that between 2023 and 2033, 197,000 new jobs are expected for registered nurses, with an annual salary of 86,070 US Dollars (USD). Medical and health services managers will see 161,000 new jobs, earning about 110,680 USD annually. Home health and personal care aides will have the largest job growth, with an estimated 821,000 new positions and an expected salary of 33,530 USD annually. The American Hospital Association estimates the industry will face a shortage of up to 124,000 physicians by 2033.
Meanwhile, it will need to hire at least 200,000 nurses annually to meet rising demands. The Middle East, a popular choice for healthcare migration among Pakistanis, needs more health workers. A report indicates Saudi Arabia will need an additional 175,000 doctors, nurses, and other healthcare workers by 2030 to tackle shortages. The countries of the Arab world are not alone in facing struggles in training and retaining qualified medical personnel. WHO estimates a global shortfall of 10 million health workers by 2030, concentrated in low- and lower-middle-income countries. The international healthcare workforce can fulfil this huge demand. By training surplus health workers, Pakistan can benefit from this untapped potential.
Capitalising on the global job market
The government of Pakistan (GoP) can Invest in surplus nurses, enhance healthcare education, and negotiate technology transfers. Strengthen economy. The government should take several steps in tapping into the global market. First, GoP should invest in producing surplus nurses to fill the global job market’s needs. GOP should invest in high-quality medical education, resulting in excess healthcare workers for export, similar to how the Philippines supplies nurses worldwide. This will increase Pakistan’s Gross National Product (GNP) and strengthen the country’s international soft image, helping with prestige diplomacy. Pakistan might also use its surplus healthcare professionals to negotiate technology and patent transfers for drugs and vaccines from advanced nations, enhancing local production.
Health diplomacy can attract investment in medical education to produce global health workers. Suppose the country needs more resources to produce this surplus; diplomacy can mobilise investment in medical education from developed countries like the United States, the United Kingdom and the Middle East, the prime destinations for Pakistani health workers. By training health professionals in developing countries like Pakistan, advanced economies can have a sustained flow of health workers with a limited investment compared to homegrown professionals. A part of this workforce can bridge Pakistan’s international workforce deficiencies, and a predefined proportion of the graduates can serve the destination countries. Such initiatives can strengthen domestic and international health systems.
Pakistan should embrace healthcare workforce migration for collective gain and invest in human capital. Rather than viewing healthcare workforce migration as a brain drain, Pakistan must embrace it as a pathway toward collective gain. The country needs the financial influx from remittances, the transition from blue to white-collar diaspora, and the development of local healthcare systems. By investing in its human capital and enabling it to compete for global opportunities, Pakistan can harness the full potential of its demographic dividend.
Circular migration and health diplomacy
While abroad, they can share their expertise online with colleagues in Pakistan and build professional education networks, knowledge exchange, and investments to develop healthcare in Pakistan. Their experiences foster cultural exchanges, innovation, and people-to-people diplomacy. Healthcare workforce migration, if planned and executed methodically at the government level, can strengthen Pakistan’s international ties and achieve broader diplomatic goals.
There is also the possibility of circular migration. Many longtime Pakistani health workers from abroad return with the capital and expertise to invest in healthcare, improving medical and financial outcomes. Shifa International Hospital in Islamabad is an excellent example of circular migration. As Pakistani healthcare professionals integrate into global healthcare systems, they create networks that can facilitate knowledge exchange, best practices, and potential partnerships in research and development with peers in the home country. This export-driven approach, however, shall not be at the cost of worsening the current health workforce-to-population ratio. Pakistan should instead focus on placing the out-of-work professionals and the surplus it can produce globally.
