Despite the tremendous growth in the Indian healthcare sector in India, the gains have not trickled down to all the professionals in the industry uniformly. The recent strikes by doctors against the KPMEAct or the series of strikes by nurses, in Kerala, Karnataka and Tamil Nadu have brought into the open the canards in the industry's cupboard.

The strike by the nurses was the last straw that broke the camel's back. It had a big impact and made people sit up and take note of the problems faced by the nursing community. Nursing, pioneered by Florence Nightingale, though not considered mainstream in the healthcare profession, is still the backbone of the healthcare sector.

India had 1.43 million nurses in 2015. This came to just 13 nurses per 10,000 people in 2015. Compare this to the 108 for New Zealand or 60 for Philippines. The opportunity exists, but there is no interest.

Nursing: Not a fancy career!

Nursing is a very demanding profession that requires a lot of dedication from the practitioners. It is unfortunate that this significant cog in the healthcare machine is feeling so much stress and pressure. The issues are not far to seek.

Lack of career progression

The profession of nursing is losing its sheen these days. There was a time when quite a good number of people were furiously pursuing nursing, especially in places like Kerala where it has been in vogue for decades. However, many of them fly abroad to seek better growth prospects. In fact, in India the growth in nursing career is stunted. In India, a nurse's career path is defined from the day they start work till they retire. Progression is minimal.

Poor remuneration

Despite being one of the largest workforces, nurses' salaries do not match the salary levels of many others in the healthcare sector. In fact, the salaries are often below the minimum wages of the central and state government employees. Only a few private healthcare providers pay decent salaries. But, when compared to the others, it is very distressing. There are nurses working for even Rs. 10,000 or less per month, which is very unfortunate. With the Indian healthcare sector having the urban and rural divide, the rural healthcare professionals are given a raw deal. However, given the quantum of work, their remuneration does not match with the hard work they put in.

Erratic working hours

The not so flexible working hours of the profession has been a major issue for many. This is especially so since a major proportion of nursing professionals are women; the erratic working hours is a constraint in woman having a work-life balance.

The receding number

The acute shortage of nurses is quite evident with the recent agitation by nurses in Kerala. The burden of work on nurses is having an impact on both their physical and mental well-being. Furthermore, working very long hours for a not so satisfactory remuneration makes think twice before choosing the profession.

There is definitely an urgent need to address the numerous problems faced by the nursing community. The need for reforms in the sector has to be undertaken by the Centre to ensure there are enough nurses to man the growing healthcare sector. Even though agitation by the community might not have been the right method, it definitely brought to light the condition of the nurses.

As the Centre is making efforts to promote a human resources policy that aims to make the working conditions of employees better, can the people in such an important profession as nursing be allowed to languish in such conditions which often are not conducive work conditions.

A stringent implementation of regulations,by the authorities concerned, pertaining to nurses must be ensured to protect the rights of nurses.

Furthermore, the opportunity to have a career growth through progressive methods have to be introduced by the government to alleviate the conditions of nursesfrom dismal state.It was the state of affairs that made them take to the streets in Kerala to bring to light what's wrong with the profession.

WHO's Global Strategy for Human Resources for Health: Workforce 2030, is explicit in including a global health labour market perspective. It said that India's efforts at strengthening the health care delivery system would be ineffective if we were not able to deploy sufficient numbers of trained professionals in the public clinics and other health facilities proposed to be set up.

In the absence of a supply response on the human resource side, creating more health facilities would only drive up the wages of scarce health personnel.

(The writer is  Director, Institute of Health Management Research, Bengaluru)