The nurses of India have won a battle, but the war continues. Responding to a two-month-long agitation by over two lakh nurses (most of them women) in Kerala, the State government has instructed hospital managements in the State to implement the 2016 Supreme Court order which fixed nurses’ minimum monthly pay at ₹20,000. However, healthcare workers across the country continue to work under precarious conditions and abysmal levels of remuneration. This was amply brought out in this paper’s recent enquiry into this issue (‘Nursing distress’, September 12). The agitation has, however, put the spotlight on the working conditions of nurses and the huge disparities in the remuneration of healthcare workers, particularly in the dominant private sector. Nurses are, even in high-end private hospitals, paid a tiny fraction of doctors’ salaries. This is despite the fact that in States such as Kerala, nurses are often qualified to dispense elementary care, if not more. Besides, the work of nurses entails both physical and psychological stress, and coping with occupational hazards such as unsafe environments and dangerous diseases, and the risk of gender and sexual abuse, both by staff and patients. The job of nurses needs to become both respectable and attractive to youngsters (men and women), and the best way of doing that is to pay better. Even after the 2016 Supreme Court ruling, only a fraction of the hospitals in the country has implemented the revised wage structure. In some private hospitals, according to nurses’ unions, the annual increment of a full-time nurse is hardly ₹100-150.
The WHO and the World Bank have pointed out that India stares at a serious shortage of qualified nurses and midwives. The National Rural Health Mission is struggling to find qualified healthcare assistants, especially in the rural sector. However, recent moves to dilute the training process and standards for nursing are not in the right direction. The States should borrow a leaf out of Kerala’s book and invest more in hospitals, and medical and nursing colleges. India needs nurses not just in larger numbers, but also with higher levels of competence. Nurses will continue to be in demand in the prosperous western countries with greying populations.
A salary correction is the immediate first step. A health regulator that checks malpractices and protects both consumer and producer interests is called for. Erring hospitals should be penalised and a performance-linked appraisal system can be introduced in the case of assessing and incentivising nurse work. Shadowy players engaging in sweat shop practices should not be spared. Enabling nurses to perform community health services under the supervision of doctors can also go a long way in helping the nursing community regain its lost esteem. At a broader level, a public health spend that goes beyond the current level of 1.5 per cent of GDP will ring in the requisite ecosystem change — be it nursing colleges, medical colleges or hospitals.