Indian Council of World Affairs

Abstract: There is an acute global shortage of workers in the healthcare sector despite renewed demand in light of demographic trends. The ageing of the population combined with an increase in the need for elderly care has reinforced the existing shortage of health and care workers. This shortage has resulted in the migration and mobility of health and care workers from middle-income countries of origin like India to high-income countries of destination in Europe. While this movement of care workers alleviates the “care crisis” in Europe, it poses a significant burden on India, which has to grapple with its own care crisis, addressing the care crisis in countries of destination and also protecting the well-being of its care workers abroad. The paper argues that, in light of the demographic changes in India and its pre-existing care crisis, attention needs to be paid to the retention of its health and care workers. The incentives for migration to destination countries in Europe need to be reduced, as the care crisis in India means it can no longer address the crisis there without harming its interests. The paper highlights the unsustainability of this migration corridor for countries of origin and destination.

Introduction

The care crisis, defined as a deficiency in the quantity of the health and care workforce, is an emerging central challenge. This care crisis has accelerated consequent to a rise in the median age and growing numbers of elderly, a rise in chronic diseases, pandemics like COVID-19 and other factors. The World Health Organization (WHO) provides much-needed data and information about this pressing challenge, with its latest estimates projecting a global shortage of 11 million healthcare professionals by 2030.[i]

This care crisis poses a huge challenge to the sustainability of health systems across the globe. One of the associated problems of the care crisis pertains to the migration of health and care workers from low- or middle-income countries to high-income countries. In this era of globalisation and liberalised market structuring, people have individual autonomy to migrate abroad in search of better employment opportunities to match their skills. This is particularly evident in several European countries, which offer higher salaries and stronger long-term career prospects to attract health and care workers. These incentives make migration an attractive pathway for health workers in India, a talent pool for the health and care sector. Destination countries strengthen the sustainability of their health systems by drawing on talent form source countries, while the latter may face shortages and weakened public health capacities. However, this migration trend creates an imbalance in global social responsibilities.

Europe is currently experiencing an acute care crisis driven by demographic changes, with an increased elderly population, having significantly increased demand for health care services and geriatric care. Further, ageing of health and care workers has also been seen as a factor in intensifying the shortage of workers. In 13 Europe, 40 per cent of the doctors are over the age of 55, reflecting the ageing of their workforce in the health sector.[ii] This trend has prompted many European countries to ease immigration policies and expand recruitment of foreign trained health professionals.

At the same time, India, a source country for the health workers in Europe, also faces shortages in the healthcare sector domestically. Demographic changes and rising healthcare demands have also deepened these challenges in the Indian context. India has been a pivotal country of origin for doctors and nurses. In this respect, a WHO study conducted after 2008 financial crisis identified India as the largest country of origin for medical doctors in the UK, the US, and Australia. [iii] Research also points to the healthcare sector as being among the most migration-prone sectors globally, with healthcare workers migrating for increased financial remuneration and growth opportunities.

This paper examines the care deficits in both countries of origin and destination and argues that, what is often described as a “care chain” invariably turns into a “care drain” for the origin countries, where workforce shortages are exacerbated. It offers policy recommendations underpinned by an equitable and cooperative sharing of responsibilities between origin and destination countries in addressing health worker shortages. For the purpose of this study, the care crisis is defined primarily as a shortage of health and care workers, specifically doctors and nurses. This criterion has been set as reliable quantitative data are more nearly available for these professions compared to informal caregivers and domestic care workers. Further, the literature on the former is also more extensive, providing strong rationale for focusing primarily on doctors and nurses/midwives as healthcare personnel in this study. For the latter, the data, if available, is fragmented and limited.

Methodologically, this paper adopts a descriptive and qualitative approach. India and selected European countries are examined as paradigmatic case studies. This framework aims to analyse the positions of both countries of origin and countries of destination. The analysis draws on data derived from international organisations such as the WHO, reports and policy documents from the EU, journal articles addressing health workforce shortages in India and Europe, and relevant news articles.

Conceptualising Care Crisis

The care crisis can be broadly understood as a shortage of workers in the healthcare sector emerging from the convergence of multiple interlinked challenges. While the care crisis manifests differently in developing countries like India and developed countries like the European states, its core tenets remains the lack of healthcare workers like doctors and nurses. The care crisis is unfolding in both origin and destination countries. The vulnerability of the origin countries like India became especially evident during the pandemic, when the stress on the healthcare infrastructure exposed existing workforce gaps.

In developed countries, the crisis is primarily characterised as worker crisis, underlined by the growing inability of health systems to recruit new workers and retain experienced personnel. Increasing resignations of health workers, coupled with deteriorating work conditions, have intensified pressures on the health systems. At the same time, the ageing of the workforce without sufficient people to replace them has further exposed the structural vulnerabilities, making this worker crisis more evident. Looking at Europe, national health systems are decrying the lack of investments, which makes it difficult to provide quality healthcare. Reports commissioned by the European Parliament allude to the chronic underinvestment and persistent undervaluation of health and care workers.[iv]

For developed countries, embedded in this crisis is a deepening mental health crisis among health and care workers. Multiple reports indicate that a majority of healthcare providers and workers face an overarching decline in their mental health. The pandemic and the stress it fostered emerged as a compounding factor in the declining mental health of healthcare workers. A substantial number of doctors and care workers have reported experiencing burnout. Studies suggest that approximately 52 per cent of the health workers experience “high burnout”, worsening the severity of the problem.[v] This deterioration in the mental well-being of workers is emblematic of the care crisis, has contributed to lower productivity and increased attrition rates, providing fertile ground for policy frameworks considering the migration of health workers from other countries to gain ground.

For developing countries like India, the crisis is characterised by a worker shortage and an uneven distribution of health workers across the country. While urban areas have a high concentration of doctors and nurses, rural areas with public health systems struggle to hire and retain qualified doctors and nurses for providing health services. There have been clamours for increased governmental spending on the health sector. Although the Indian government has incrementally increased spending on healthcare, this increase falls short of the National Health Policy recommendation of spending about 2.5 per cent of the GDP.[vi] The reported 9.46 per cent increase in government expenditure on the healthcare sector is insufficient to address deep-rooted structural challenges, including infrastructural problems, lack of beds in hospitals and workforce shortages. While India has seen robust private financing in the health sector, the predominant profit-driven model poses many challenges. High treatment costs make private healthcare inaccessible to large segments of the population, thereby increasing the burden on already stretched public health systems.

The care crisis also reflects and reinforces global asymmetrical power relations and developmental hierarchies. The World Bank designated high-income countries in the US, Europe and Oceania address their labour shortages by actively recruiting the healthcare talents from countries coming under the heading of low- or middle-income countries. This migratory pathway poses challenges to the health security of countries of origin like India, the Philippines and several African countries. While individuals are attracted to the higher pay and also remit money back to their families in their home country, the sustained outflow of skilled professionals makes it difficult for these origin countries to retain their health workforce.

The WHO’s adoption of the Global Code of Practice on International Recruitment of Health Personnel stands testament to the prominence of the migration issue in the health sector. This Global Code of Practice aimed at strengthening ethical recruitment of healthcare personnel from other countries. Article 1 clause 4 stipulates that countries should “facilitate promote international discussion and advance cooperation on matters related to the ethical international recruitment of health personnel as part of strengthening health systems, with a particular focus on the situation of developing countries”.[vii] While the code is voluntary and non-binding in nature, it can be seen as a guiding principle for underlining how the needs of the developing countries and countries of origin also need to be taken into account.

Recent WHO reports also indicate a blurring of the distinctions between origin and destination countries for health personnel. Some countries that were historically origin countries exporting healthcare professionals have gradually transitioned into pivotal destination countries. This report shows how migratory patterns are shifting, with the low- and middle-income countries now relying on foreign workers to fulfil their worker shortages in the health sector as their own nationals are no longer there. This dynamic is contributing to the formation of a “care chain”, with countries at the lower end of the care chain facing the most challenges.

The Care Crisis in Europe

The deficit of care workers in Europe is well-documented in the academic and policy literature. Demographic ageing has been identified as the root cause threatening the health systems. An ageing population has increased the demand for healthcare services, particularly geriatric and long-term care, while healthcare workforce itself is ageing. With 33 per cent of the doctors and 25 per cent nurses in the European Union (EU) expected to retire in the next decade, the slow increase in graduates from medical and nursing institutions draws attention to the shortage of skilled workers.[viii] This shortage of workers in the health sector has been premised to have cropped up as a result of dual demographic challenges and the lack of interest of the young population in the health sector.  Specifically, this shortage is expected to considerably impact the member states of Italy, Germany and France. Germany, for instance, will lose about 45 per cent of its doctors to retirement within a decade, while the entry of only 28 new graduates per year remains inadequate to close the workforce gap.

Acute health worker shortages have, thus, been identified in European countries, and most policy briefs and reports posit inclusion of migrant workers as a key strategy towards stabilising the healthcare system in European countries.[ix] According to the OECD 2024 report “Health at a Glance: Europe”, 20 EU member states have reported shortages of doctors, and 15 member states have expressed their need for nurses.[x]

Countries like Sweden and the Netherlands have innovated with a “community-centred governance approach”, aimed at reducing the demand on healthcare services.[xi] However, these innovative approaches necessitate the introduction of community-level health workers equipped to handle these health issues, reiterating the demand for care workers. Countries have also sought to incorporate existing migrants and refugees to achieve stability in their health workforce. This is evident in the case of Czech Republic, which saw an increased inflow of migrants post the Ukraine war. These migrants have been integrated into the Czech Republic’s health systems through governmental support to deal with their care deficits.

Across Europe, the shortage of health and care workers has been positioned as a leading cause for the decline in the quality of health services. In the UK, insufficient nursing staff in a Mid Staffordshire hospital was seen as a causal factor in the higher number of patient deaths.[xii] These domestic shortages and their implications have heralded a reliance on foreign workers. The 2024 OECD report indicates a respective 17 per cent and 72 per cent increase in the influx of foreign-trained doctors and nurses in Europe.[xiii]

The migration of healthcare professionals within Europe has also severely undermined the sustainability of health systems in the countries of origin. Here, Romania provides an important example. Although Romania has one of the highest numbers of medical professionals graduating compared to other EU member states, a large number of health workers migrate to more developed and wealthier European states and other OECD nations. This trend has underlined the asymmetry in how the care crisis is constructed and perceived. Despite Romania also witnessing shortages of workers and these migratory flows being detrimental to its health systems, the flows continued. However, recently, there has been a considerable decline in the outflow of health workers in light of salary increases and governmental interventions to strengthen the public healthcare systems.[xiv]

Intra-EU mobility of healthcare workers has also been observed in the case of Greece. Owing to the sovereign debt crisis and subsequent austerity measures, Greece experienced a sharp decline in social spending. This decline resulted in a reduction of the salaries of health professionals in the national health system. These reductions, combined with the worsening of the working conditions due to long hours and expanding work, prompted the migration of healthcare workers.[xv] This migratory pattern is expected to negatively impact the quality of healthcare services, given the loss of the highly skilled professionals, whose education and training had been taken care of by the government.

A 2025 report commissioned by the European Parliament has also acknowledged that migration of health and care workers from third countries (any country not part of the EU as per their nomenclature) would have an adverse impact on the health system’s resilience and stability in the country of origin.[xvi] Preceding this report, the adverse impact of migration of health professionals from countries of origin was discussed in the 2024 OECD report.

Care Crisis in India

While there is no dearth of literature on the care crisis in European countries of destination, literature on the health care crisis materialising in India seems inadequate considering the depth of the issue. Insufficient healthcare workers combined with growing demand for healthcare services depicts an accelerating care crisis. This deficit is further accentuated due to the migration of health workers to other countries, especially in Europe, for better opportunities. Recent projections state that India needs 1.8 million doctors, nurses and midwives, underscoring the shortage of health and care workers.[xvii] This requirement is necessary to meet the prescribed minimum threshold of 44.5 professional health care workers per 10,000 population.[xviii] Presently, addressing the worker shortages is the most pertinent policy issue in the health sector.

India intends to achieve health-related targets under Goal 3 on “Good Health and Well-being” of the Sustainable Development Goals (SDGs). NITI Aayog has recorded India’s progress on this SDG, with an overall increase of 15 points from a score of 52 in 2018 to 77 in 2023 to 2024.[xix] Despite this progress, significant challenges persist in terms of shortages of manpower in the healthcare sector, with particular reference to rural areas. Specificities on India’s worker shortages include a shortfall of specialist doctors. In India, allied health professionals like physiotherapists, lab technologists and optometrists are also low in density. The allied health professionals sector has also been marked by a profound workforce shortage, with estimates indicating a deficit of 95 per cent.[xx]

India’s care crisis is not a recent phenomenon but can be traced back to the Joint Learning Initiative in 2004, which reported about the crisis of health workers in India. This report highlighted on the availability of workers in the healthcare sector and elaborated on India occupying a spot among the low-health manpower density countries.[xxi] Subsequent to the publication of that report, estimates on the available personnel for healthcare (doctors, nurses and midwives) from different sources, be it international (WHO) or national (Population Census and National Sample Survey), indicate a constant lack of an adequate number of workers in the health sector.

This care crisis is most acutely felt in the rural areas, which see a dire absence of healthcare workers. This imbalanced distribution of health workers reflects urban-rural disparities. Most healthcare workers are concentrated in the urban areas, and rural areas, calculated to be home to about 70 per cent of the population, only possess about 40 per cent of the total health workers.[xxii] In such cases, it becomes incumbent on the patient and their family to make the travel to urban areas to receive treatment due to the lopsided distribution of health workers.

Despite the efforts of the National Health Mission, these shortages are difficult to fulfil. The difficulty lies in the reluctance of healthcare professionals to relocate to rural areas, the financial incentives operational in the private sector and the inability of the public sector to attract these workers. In this respect, it is essential for the government to work towards ensuring that there is a competitive salary and better working conditions for workers to see rural areas within the scope of their employment decision-making. Studies have pointed out the efficacy of offering higher salaries for rural areas.[xxiii] Benefits such as opportunities for growth, recognition and pension can also be used to incentivise health workers.[xxiv]

The migration of healthcare professionals from India compounds its exigencies in the healthcare sector. An OECD Health Working Paper had recognised India as the main country of origin for foreign-born and foreign-trained doctors in the OECD countries.[xxv] Echoing the financial disparity and working conditions issues present in the urban-rural debate, care workers consider the higher financial remuneration and conditions for work in destination countries in Europe to be their pull factors when determining their mobility pathways.

Demographic changes further complicate the situation. The proportion of elderly people, aged 60 and above, is rapidly increasing. United Nations Population Fund data reveal that 7 per cent of the India population is currently aged 65 or above.[xxvi] By 2050, around one in five Indians is expected to be over 60, constituting about 20.8 per cent of the Indian population and 36 per cent by 2100. [xxvii] Regional variations show higher concentration of elderly population in Southern and Western parts of India. 

These demographic shifts will substantially increase the demand for health services alongside the informal care required for the elderly. As the working age population proportion declines and elderly dependency arises, India’s health systems will face intensified pressure. These trends underscore the urgency of focusing on the retention of healthcare workers domestically.

Another overlooked dimension of India’s care deficit concerns the structures. Migration, both internal and international, has reduced the availability of informal caregivers within households. The smaller family sizes and declining fertility rates have further weakened traditional support systems.[xxviii] Case studies suggest that elderly often experience emotional and practical challenges when adult children migrate abroad.

This care deficit also has gendered implications, with women expected to bear a significant portion of caregiving responsibilities. Studies further show that female care workers who migrate abroad for caregiving work frequently experience emotional strain and guilt for leaving their children behind.[xxix] Their spatial mobility, despite providing much-needed care to people in destination countries, does not offset the guilt and stress brought on by separation from their family. Although migration may bring financial empowerment, the psychological stress persists.

With reduced family-based caregiving, the non-kin individuals start embodying a greater role in the care spectrum. Hired service providers, neighbours or care workers in nursing or old-age homes have assumed greater roles in the contemporary settings. However, professional palliative and geriatric care employees remain unaffordable to many households, bringing out a class dimension in the care system. Even at old-age homes, there are gaps in care, and the psychological toll of separation from kin is visible.[xxx]

Analysing Care Deficits in India and Europe

Globally, there is a dearth of worker shortages in the healthcare sector. This global shortage became particularly visible during the pandemic, as countries struggled to handle the additional stress. The pandemic further highlighted the growing gap in the health systems in different countries, as most high-income countries have taken to reducing their workforce shortages by recruiting workers from abroad. Such recruitment redistributes scarcity. This eases their shortage in the short term as a stopgap approach but does not address the underlying structural deficiencies, which cannot be attended to through increased migratory flows of health workers.

Data collated from the World Health Organization (WHO) indicates that India is significantly behind Europe in terms of healthcare worker density per 10,000 people. Figures 1 and 2 included below highlight this discrepancy. Naturally, it is difficult to discount the population metrics here, as India is currently the second most populous country in the world and European countries have a considerably smaller population. Still, India has not been able to meet the WHO’s recommendation of having 10 doctors and 20 nurses or midwives as the minimum threshold for a population of 10,000. These minimum thresholds or benchmarks are contested, with a higher ratio being suggested. The latest WHO figures put India at 7.23 for medical doctors in 2020 and the European countries as having an average of 37.52 in terms of medical doctors in the same year, reinforcing the deficit faced by India.[xxxi] India approximates two doctors per 1,000 individuals, while Western European countries employ 4.5 doctors for the same number of inhabitants.[xxxii]

Figure 1: Medical Doctors per 10,000 People in 2020

Source: WHO 2025

Similar to the recommendation for medical doctors, the WHO’s recommendation for nursing and midwifery personnel highlights that the care deficits in India are higher than in European countries. India, according to WHO estimates, had 17.2 nursing or midwifery personnel per 10,000 people in 2020.[xxxiii] Simultaneously, the average figure for Europe in 2022 was far higher at 83.10 per 10,000 people. While India fell short of the recommendations provided by WHO on the minimum threshold for nurses (identified to be 20), Europe surpassed these figures by a substantial degree.

Figure 2: Nursing/Midwifery Personnel per 10,000 People in 2020

Source: WHO 2025

The gravity of the care crisis in India does not see requisite representation in policy circles despite research positioning India as one of the countries with a low density of healthcare professionals, especially in relation to its population. Further, with demographic trends shifting in India, with some societies in stages of demographic ageing, it becomes necessary to map out a long-term strategy for ensuring that the care crisis in India does not intensify.

Primary focus needs to be given to the migratory patterns of health and care workers from India to Europe. This migratory pattern reflects an asymmetrical and uneven social accountability system, which prioritises the care needs of the destination countries over the origin countries. Research indicates that governments in destination countries in Europe and other high-income countries play an active role in the recruitment of health and care workers to ensure the existing and anticipated shortages are fulfilled. India’s English speaking workforce and established medical training infrastructure make it a preferred source country. The primary beneficiaries of this migration of health and care workers remain the migrants and then the destination countries, which benefit from the skills and expertise of the migrants.

This active recruitment leads to a drain of care personnel from countries of origin, including India, further augmenting the pre-existing care deficits. The domestic healthcare system becomes vulnerable due to the exodus of health workers, and the sustainability of the health system is threatened. Broadly, research indicates a consensus on the data that the migration and mobility of healthcare workers is detrimental to the origin country. This migration of healthcare workers does not address the global shortage of workers but merely displaces the problem from one region to another and one country to another. Even when countries do not have active recruitment policies for health workers aligned to the WHO code, there are multiple modalities for migration of health workers, which allows them to be consistent in portraying their commitment to the Code of Practice while still fulfilling their worker exigencies.

This broad consensus is challenged by some voices claiming that remittances sent back by the healthcare workers benefit the country of origin. However, it is important to contest this argument, as remittances cannot equate to the cost borne by the country of origin in educating and training the worker. Further, the healthcare worker could have contributed to the domestic health system and their individual household unit as well in terms of care work. There are also associated costs of knowledge loss through this migration. Further, migration also creates cumulative effects. Remaining workforce may become demotivated and seek mobility pathways outside, undermining the health system as a whole. The decrease in the quality of care and services provided in the healthcare sector is a key outcome of this migration corridor, impacting the overall health outcomes.

Furthermore, another important point for consideration here is the overall working conditions of health and care workers, which determine their attrition rates in both countries of origin and destination. These workers are frequently subjected to poor working conditions with increasing work hours and growing aggression. Migrant health workers in destination countries may additionally face discrimination and racial hostility. Research points to violence against health workers, but there seems to be a lack of strategy to address this issue. These negative indicators are further combined with a lack of mental health support for the care workers and provide plausible reasoning behind the low retention rates for health and care workers.

It is also imperative to recognise that there is an abundance of data and statistics on the shortfalls of health workers in Europe. Policy documents from the EU institutions (Parliament, Commission and Council), OECD and national government communications and reports are important source materials for understanding the depth of the healthcare worker shortages. This can be contrasted with the Indian case, wherein there is no dedicated policy document systematically addressing the health workforce and its impact migration related implications. There is information from the WHO, sourced from national authorities and secondary literature, but a dedicated policy document outlining this health worker gap would go a long way in strengthening domestic planning efforts.

The Way Forward

This paper provides an understanding that the care crisis is not merely limited to countries of destination but also present, perhaps to a greater extent, in countries of origin like India. In the case of countries of origin such as India, this care chain can essentially be surmised as a “care drain”, as the migration and mobility of workers has invariably put a larger burden on countries of origin. India, similar to other source countries of healthcare workers, is tasked with addressing the care crisis in destination countries across Europe, dealing with its existing care deficits, which are further augmented by the migration of healthcare workers, and also ensuring the protection and well-being of its healthcare workers abroad, who still face mistreatment on racial and social lines despite their monumental contributions to countries of destination. It has been well-established in reports and studies that migrants are much more likely to experience violence when violence is directed towards health and care workers, especially in the European context.

A way forward in addressing this care crisis can only emerge once there is an acknowledgement about the care crisis in India as well. The existing framework and policies underscore the need to establish a cooperation-based mechanism so that the care crisis in the countries of origin is not aggravated while it aids the countries of origin in addressing their care needs. The impetus given to migration corridors of health workers needs to be reconsidered in light of its care crisis. The disproportionate burden shouldered by India is not a sustainable solution. The migration and mobility pathways for care workers need to be reconfigured so as not to compound the shortages in India as the origin country.

The WHO Global Code of Practice on International Recruitment of Health Personnel may be seen as a blueprint for ethical recruitment and shared responsibility, as it talks about destination countries taking a greater role and providing technical and financial aid to origin countries to ensure that their health systems can become robust. According to this blueprint, bilateral agreements on the migration of health and care workers can ensure origin countries are reimbursed accordingly for their care deficits.

One recommendation pertains to the country of origin, i.e., India, making a concentrated effort to increase the monetary and non-monetary incentives for health workers, prompting a decline in the pull factors. Recognising individual autonomy over their mobility pathways, this recommendation for competitive compensation would level the playing field. Countries of destination in Europe can also assist in financing equipment or donor funding for increasing staffing levels in India, which plays a critical role in determining workers’ mobility, especially in the healthcare sector. This recommendation draws from the example from Malawi, which was able to restaff its chronically understaffed healthcare sector post migration of its health workers by launching a six-year programme to raise staffing levels through financial support from the UK. This programme introduced pay raises and incentives to work in rural areas alongside the availability of medical supplies.

One more policy recommendation emerges from the examples of Brazil and Thailand, who have implemented policies focused on increasing the professional satisfaction of healthcare workers and enhancing their working conditions. One of the reasons behind the mobility to Europe lies in the assumption that the working environment and opportunities for growth would be better there. In this context, governmental intervention aimed towards improving the professional satisfaction of workers in the health sector is necessary.

For destination countries, it becomes imperative to reduce their reliance on recruitment of foreign workers and have a comprehensive health workforce policy that puts in adequate investment and funding, allowing for the retention rates to increase, thereby reducing the policy imperative to recruit from origin countries, who are also facing their care deficits. At the same time, with proper planning and coordination, these destination countries can also look at the mobility of skilled professionals to origin countries for knowledge and expertise sharing. Destination countries can also co-invest in the education of health workers in countries of origin. While the migration of health workers can address destination countries’ care deficits in the short term, a long-term approach requires them to look beyond and recognise the care crisis in origin countries. This is particularly necessary for EU countries, as some of them adhere to the WHO code and also ensure that their normative projections are not diminished.

Another recommendation is with respect to circular mobility, wherein care workers can go and learn the best practices from these countries of destination and then come back and utilise those skills in India. This suggestion aligns with Article 3.8 of the WHO Global Code of Practice, which mentions fostering circular migration of health personnel to the benefit of both countries of origin and destination. A structured mobility pathway with limited time periods of stay in the country of destination can help ensure that the care drain does not magnify.

The systematic issues governing the global shortage of workers cannot be addressed through migration and mobility of health and care workers, as this migration only displaces the shortages from one country to another. These issues can be addressed through increased capacity for students in medical and nursing schools as well as increased incentives for employees to retain their jobs. These efforts require collaboration and need to be incorporated into the national health policies of countries. Technology can also be harnessed to help mitigate shortages. Digital health systems, telemedicine and administrative automation would improve efficiency and reduce workforce burden. Estimates suggest that technology could eliminate administrative work by 30 per cent.[xxxiv]

At the end, research on the migration and mobility of health and care workers also needs to be given due attention. Lack of data on the migration of health workers and their absorption in the health systems of destination countries remains one main difficulty in outlining an accurate picture of this corridor. While there have been advancements pertaining to the availability of data on the national health workforce, migration-specific data remains absent. With adequate research and systematic monitoring of migratory flows, policy recommendations can be further tailored to the specific needs of the origin and destination countries. Further, mapping out the migratory patterns and their impact on the care sector would generate crucial knowledge, and depending on the severity of the impact, it can be reflected in the G2G engagements.

*****

*Yashna Agarwalla, Research Associate (CMMDS), Indian Council of World Affairs, New Delhi.
Disclaimer: Views expressed are personal.


Endnotes

[i] World Health Organization (WHO), “Health Workforce”, 2025, https://www.who.int/teams/health-workforce#:~:text=Key%20figures,10%20million%20shortage%20by%202030).

[ii] Natasha Azzopardi-Muscat, Tomas Zapata, Hans Kluge, 2023, “Moving from health workforce crisis to health workforce success: the time to act is now”, The Lancet Regional Health - Europe, 35 (100765), ISSN 2666-7762, https://doi.org/10.1016/j.lanepe.2023.100765.

[iii] Mark Britnell, 2019, Human: Solving the Global Workforce Crisis in Healthcare.

[iv] European Parliament, “The health workforce crisis in the European Union”, Policy Department for Transformation, Innovation and Health, September 2025, https://www.europarl.europa.eu/RegData/etudes/BRIE/2025/772481/ECTI_BRI(2025)772481_EN.pdf.

[v] Mark Britnell, 2019, Human: Solving the Global Workforce Crisis in Healthcare.

[vi] K.S. Uplabdh Gopal, “Union Budget 2025: A pulse check on healthcare”, Observer Research Foundation, February 4, 2025, https://www.orfonline.org/expert-speak/union-budget-2025-a-pulse-check-on-healthcare.

[vii] World Health Organization (WHO), WHO Global Code of Practice on the International Recruitment of Health Personnel”, WHO, May 21, 2010, https://iris.who.int/server/api/core/bitstreams/4cea41eb-2488-4ce4-a5a8-6d51402e939d/content.

[viii] European Parliament, “The health workforce crisis in the European Union”, Policy Department for Transformation, Innovation and Health, September 2025, https://www.europarl.europa.eu/RegData/etudes/BRIE/2025/772481/ECTI_BRI(2025)772481_EN.pdf.

[ix] European Parliament, “The health workforce crisis in the European Union”, Policy Department for Transformation, Innovation and Health, September 2025, https://www.europarl.europa.eu/RegData/etudes/BRIE/2025/772481/ECTI_BRI(2025)772481_EN.pdf.

[x] OECD, “Health at a Glance: 2024”, November 18, 2024, https://www.oecd.org/en/publications/health-at-a-glance-europe-2024_b3704e14-en.html.

[xi] European Parliament, “The health workforce crisis in the European Union”, Policy Department for Transformation, Innovation and Health, September 2025, https://www.europarl.europa.eu/RegData/etudes/BRIE/2025/772481/ECTI_BRI(2025)772481_EN.pdf.

[xii] Mark Britnell, 2019, Human: Solving the Global Workforce Crisis in Healthcare.

[xiii] OECD, “Health at a Glance: 2024”, November 18, 2024, https://www.oecd.org/en/publications/health-at-a-glance-europe-2024_b3704e14-en.html.

[xiv] Rafila, Alexandru, et al. "Addressing the Healthcare Crisis-The Bucharest High-Level Regional Meeting on Health and Care Workforce in Europe: TIME TO ACT." Journal of Medicine and Life 16.7 (2023): 963.

[xv] Charalampos Economou et al., “The impact of the crisis on the health system and health in Greece”, in Economic crisis, health systems and health in Europe, edited by Anna Maresso, Philipa Mladovsky, Sarah Thomson, Anna Sagan, Marina Karanikolos, Erica Richardson, Jonathan Cylus, Tamás Evetovits, Matthew Jowett, Josep Figueras, and Hans Kluge, 2015. Copenhagen: WHO Regional Office for Europe.

[xvi] European Parliament, “The health workforce crisis in the European Union”, Policy Department for Transformation, Innovation and Health, September 2025, https://www.europarl.europa.eu/RegData/etudes/BRIE/2025/772481/ECTI_BRI(2025)772481_EN.pdf.

[xvii] The Lancet Regional Health, 2022, “India @ 75: Investing in a healthy workforce for a healthy future”, Lancet Regional Health: Southeast Asia (Editorial), 2 (100049), https://www.thelancet.com/journals/lansea/article/PIIS2772-3682(22)00064-6/fulltext.

[xviii] World Health Organization, “Health Workforce in India: Why, Where and How to Invest?”, World Health Organization and Public Health Foundation of India, 2021.

[xix] NITI Aayog, “Goal 3: Ensure healthy lives and promote well-being for all at all ages”, 2025, https://www.niti.gov.in/competitive-federalism/sdg/Goal-3-Ensure-healthy-lives-and-promote-well-being-for-all-at-all-ages.

[xx] Salik Khan (2025), “India’s Allied Health Crisis – A Call for Unified Action”, Current Medical Issues 23(4): 343-345, Oct–Dec 2025.

[xxi] Dilip Saikia (2018), “India’s struggle with manpower shortages in the primary healthcare sector”, Current Science, 115 (6): 1033-1034.

[xxii] Ibid.

[xxiii] Malik, M. M. U. D., et al. "Addressing the Healthcare Workforce Shortage in India: Strategies for Recruitment and Retention." South Eastern European Journal of Public Health (2024): 934-943.

[xxiv] Vini Mehta, Puneeta Ajmera, et al. 2024, “Human resource shortage in India’s health sector: a scoping review of the current landscape”, BMC Public Health, 24, https://doi.org/10.1186/s12889-024-18850-x.

[xxv] OECD, “International migration and movement of doctors to and within OECD countries - 2000 to 2018: Developments in countries of destination and impact on countries of origin”, OECD Health Working Papers No. 126, http://www.oecd.org/els/health-systems/health-working-papers.htm.

[xxvi] United Nations Population Fund, “50 Years Forward: Navigating Demographic Changes”, UNFPA India, 2024, https://india.unfpa.org/sites/default/files/pub-pdf/2025-05/Annual%20Report_2024_web.pdf.

[xxvii] International Institute for Population Sciences & United Nations Population Fund 2023. India Ageing

Report 2023, Caring for Our Elders: Institutional Responses. United Nations Population Fund, New Delhi.

[xxviii] Sinjini Roy, “Living in Care Crisis: The Case of the Urban Middle-Class Elderly in India”, Social Trends, 10, March 31, 2023; ISSN: 2348-6538.

[xxix] Lisa Isaksen, Uma Devi and Arlie Hochschild, “GLOBAL CARE CRISIS: Mother and child’s-eye view”, SOCIOLOGIA, PROBLEMAS E PRÁTICAS, 56, 2008, 61-83.

[xxx] Sinjini Roy, “Living in Care Crisis: The Case of the Urban Middle-Class Elderly in India”, Social Trends, 10, March 31, 2023; ISSN: 2348-6538.

[xxxi] World Health Organization, “Medical Doctors (per 10,000 population)”, 2025, https://www.who.int/data/gho/data/indicators/indicator-details/GHO/medical-doctors-(per-10-000-population).

[xxxii] Daniel Tobias Michaeli et al. “The Healthcare Workforce Shortage of Nurses and Physicians: Practice, Theory, Evidence, and Ways Forward”, Policy, Politics, & Nursing Practice, 2024, Vol. 25 (4) 216–227.

[xxxiii] World Health Organization, “Nursing and Midwifery personnel (per 10,000 population)”, 2025,

[xxxiv] OECD, “Health at a Glance: 2024”, November 18, 2024, https://www.oecd.org/en/publications/health-at-a-glance-europe-2024_b3704e14-en.html.