can the private sector help overcome nursing shortages: evidence from 4 countries

THAILAND Can the private sector help overcome nursing shortages? Evidence from 4 countries GROWING DEMAND FOR NURSES SHORTFALLS IN THE SUPPLY OF NURSES INCREASING IMPORTANCE OF THE PRIVATE SECTOR IN TRAINING NURSES NUMBER AND DENSITY OF NURSES AND MIDWIVES SOUTH AFRICA KENYA Changing health system policies • Introduction of new financing or insurance systems. • Increased focus on primary health care. • Increased focus on achieving the Millennium Development Goals. • Expansion of private provision of health care (Thailand). Societal factors • Ageing populations • Increased prevalence of non-communicable diseases • Spread of new and re-emerging diseases • Increased public demand for health services FACTORS AFFECTING THE DEMAND FOR NURSES INDIA India Kenya South Africa Thailand 1.30 1.18 4.08 1.52 143,055 Density per 1000 pop. No. of nurses and midwives 37,113 184,459 96,704 In Thailand, the density of nurses working in Bangkok was more than 5 times higher than in the rest of the country. The demand for nurses is growing and has not yet been met in most low and middle-income countries. In India, Kenya, South Africa and Thailand, there has been a rapid proliferation of private training institutions to increase the supply of nurses. RESYST researchers are examining the role of these private institutions, their contribution to the wider health systems, and how governments in these countries have managed the opening of markets to the private sector. 88% of all nurse training institutions in the private sector. 95% of all nurses trained in the private sector. 51% of all nurse training institutions in the private sector. 2001 2004 45% 66% Increase in the proportion of enrolled nurses that are privately trained (2 year training programme). 26% of all nurse training institutions in the private sector. 27% of new nurses were trained in the private sector in 2010. Private nurse training institutions are playing an increasingly important role in producing nurses in many low and middle- income countries. Governments need to ensure that graduates from both private and public institutions are of sufficient quality to meet the health needs of their populations, and that training institutions have the capacity to train more nurses. In some countries including India and Kenya, the benefits of expanding nurse production through the private sector have been hindered by high levels of international migration. A balance needs to be struck between producing nurses for export, and ensuring sufficient supply and skill-mix for domestic markets. CONCLUSIONS RESYST is funded by UKaid from the Department for International Development. However, the views expressed do not necessarily reﬂect the department’s oﬃcial policies. Infographic produced by Rebecca Wolfe. http://resyst.lshtm.ac.uk Based on “The role of the private sector in the production of nurses in India, Kenya, South Africa and Thailand: a review of the literature” J Reynolds et al, Human Resources for Health 2013, 11:14

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THAILAND

Can the private sector help overcome nursing shortages? Evidence from 4 countries

GROWING DEMAND FOR NURSES SHORTFALLS IN THE SUPPLY OF NURSES

INCREASING IMPORTANCE OF THE PRIVATE SECTOR IN TRAINING NURSES

NUMBER AND DENSITY OF NURSES AND MIDWIVES

SOUTH AFRICAKENYA

Changing health system policies

• Introductionofnewfinancingorinsurancesystems.

• Increasedfocusonprimaryhealthcare.

• IncreasedfocusonachievingtheMillenniumDevelopmentGoals.

• Expansionofprivateprovisionofhealthcare(Thailand).

Societal factors

• Ageingpopulations

• Increasedprevalenceofnon-communicablediseases

• Spreadofnewandre-emergingdiseases

• Increasedpublicdemandforhealthservices

FACTORS AFFECTING THE DEMAND FOR NURSES

INDIA

India

Kenya

SouthAfrica

Thailand

1.30

1.18

4.08

1.52

143,055

Densityper1000pop.No.ofnursesandmidwives

37,113

184,459

96,704

In Thailand, the density of nurses working in Bangkok was more than 5 times higher than in the rest of the country.

Thedemandfornursesisgrowingandhasnotyetbeenmetinmostlowandmiddle-incomecountries.InIndia,Kenya,SouthAfricaandThailand,therehasbeenarapidproliferationofprivatetraininginstitutionstoincreasethesupplyofnurses.RESYSTresearchersareexaminingtheroleoftheseprivateinstitutions,theircontributiontothewiderhealthsystems,andhowgovernmentsinthesecountrieshavemanagedtheopeningofmarketstotheprivatesector.

88%ofallnursetraininginstitutionsintheprivatesector.

95% ofallnursestrainedintheprivatesector.

51%ofallnursetraininginstitutionsintheprivatesector.

2001 2004

45%66%Increaseintheproportion

ofenrollednursesthatareprivatelytrained(2yeartrainingprogramme).

26%ofallnursetraininginstitutionsintheprivatesector.

27% ofnewnursesweretrainedintheprivatesectorin2010.

Privatenursetraininginstitutionsareplayinganincreasinglyimportantroleinproducingnursesinmanylowandmiddle-incomecountries.Governmentsneedtoensurethatgraduatesfrombothprivateandpublicinstitutionsareofsufficientqualitytomeetthehealthneedsoftheirpopulations,andthattraininginstitutionshavethecapacitytotrainmorenurses.

InsomecountriesincludingIndiaandKenya,thebenefitsofexpandingnurseproductionthroughtheprivatesectorhavebeenhinderedbyhighlevelsofinternationalmigration.Abalanceneedstobestruckbetweenproducingnursesforexport,andensuringsufficientsupplyandskill-mixfordomesticmarkets.

CONCLUSIONS

RESYST is funded by UKaid from the Department for International Development. However, the views expressed do not necessarily reflect the department’s official policies.

InfographicproducedbyRebeccaWolfe.

http://resyst.lshtm.ac.uk

Basedon“TheroleoftheprivatesectorintheproductionofnursesinIndia,Kenya,SouthAfricaandThailand:areviewoftheliterature”JReynoldsetal,HumanResourcesforHealth2013,11:14

http://resyst.lshtm.ac.uk

http://resyst.lshtm.ac.uk/resources/role-private-sector-production-nurses-india-kenya-south-africa-and-thailand-review

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