Circular migration of health workers: a view from the ground in Kochi

Picture: M.G Road Medical Trust Junction. Credit: Rojypala, via Wikimedia Commons

Circular programmes in health worker migration have been hailed by many as a ‘triple win’ solution, benefiting host and source countries as well as the workers themselves. The Global Learners Programme (GLP), commonly referred to as Earn, Learn and Return, a UK government accredited course for overseas nurses and other health workers to work in the National Health Service (NHS) for three years, is one such programme. In this ethnographic field note, Sibille Merz describes the urban landscape of the industry behind health worker migration in Kochi, India. She finds that attention to the return element of such programmes is noticeably scant, challenging claims about triple benefits.

Kochi’s M.G. Road winds northwards from the Theverara Autostand in Ravipuram and along the Malabar Coast, ending at the lively M.G. Road metro station. At first sight, the bustling street sports the usual mix of Indian city life: small eateries, tea stalls, clothes shops and department stores for bridal outfits, gifts and homeware. But spend a few minutes wandering down the jam-packed pavements and it quickly becomes apparent this is a hub for emigrating Malayees, or Keralites. Nearly every building along the roughly 4km long road is plastered with advertisements for the various agencies of this thriving industry: overseas education consultancies, visa services, recruitment agencies, travel agents, language training centres and migration lawyers. It is an industry to fulfil the dream of a better life abroad.

Amongst this eclectic ensemble, we are searching for the agencies that recruit nurses for the increasingly stretched healthcare systems of the Global North, specifically the UK[i]. While the UK NHS has, from its inception, been plagued by staff shortages especially in nursing, the latest figures show shortages are worsening and nearly 47,000 nursing positions are now unfilled. Kerala has become a leading source of nurses as NHS organisations look to fill those positions.

Advertisements from nurse recruitment agencies are dotted widely across the entire city of Kochi. They promise to build a truly global health workforce by recruiting health professionals to the UK and elsewhere. “Colour your dreams”, writes Ripple International Recruiters, while Envertiz Consultancy claims “UK is calling all nurses” and INSCOL commands to “be a global nurse”. Others, such as Elizabeth International advertise more plainly, stating what they offer: “Study Abroad. Nurses to UK”.

As we enter some of the recruitment offices on M.G. Road, their heterogeneity presents itself: some command huge spaces, similar to transnational call centres; others are small, two-man operations with just a reception and a consultation room. Most are somewhere in-between. Some specialise in one service, country or subject, others offer a range of different services for longing emigrants-to-be, and often their families and dependents as well.

Strikingly absent in these offices, and on the streets of M.G. Road, are any signs of the kind of ‘earn, learn, return’ or circular schemes that are now being hailed as a solution to the depletion of health resources and the often-poor quality of health education in the Global South. These schemes aim to use a temporary migration model to provide new skills and knowledge, support and training to nurses while also addressing nursing staffing shortages. For example, Health Education England’s Global Learners Programme is cast as a work-based educational programme in which trainee nurses and other health workers return to their home country after 3 years to apply and share their acquired clinical practices. According to a 2019 report by THET, there were 500 nurses enrolled in the programme by 2019, with 160 receiving training in the UK and 400 preparing in their respective country before travelling to the UK to join the programme. From M.G. Road, the potential for such programmes to be ‘circular’ looks limited at best, however. While some companies offer exam coaching for returning medical students, nurses’ migration routes appear to be geared towards permanent settlement abroad. The many recruiters we spoke with confirmed that nurses who have secured a job in the so-called West rarely return to India. Exact figures do not exist but some estimated that only around 1% return, usually upon reaching retirement age. Nurses from Kerala have gone abroad since at least the 1960s, but many now even leave earlier in their career, for example to acquire degrees and further education as a route to permanent settlement. Many nurses also select their destination according to the family reunion and settlement options, a key reason the UK remains a popular destination. While this might ameliorate staffing shortages in the West, as for example in the UK NHS, and provide specialised training for the nurses who travel, it seems doomed to fail on the other end of the promise – the upskilling of nursing in India.

[i] This entry is part of the ongoing, ESRC-funded research project “Analysing the transnational provisioning of services in the social sector. The case of commercialisation of NHS services in China and India”