Sonam Yangchen is a first year student pursuing a Bachelors’ Degree in nursing at a private institution. Her parents already arranged a potential “defacto”, meaning once they complete the course and get some work experience, they will leave the country to work abroad.
Institutions within the country providing nursing courses are seeing a good number of students. Some are even overwhelmed with the number of applicants. This is because the course is a “ticket” to live and work abroad.
There is an acute shortage of nurses in many developed countries. Expatriates from Asia, known for their care and services, are in huge demand.
Ironically, Bhutan, which has seen nurses leave in droves to work abroad and trains hundreds, is facing an acute shortage of nurses. To put this reality into context, between January and October 10 this year, 94 nurses resigned, while 106 were on extraordinary leave (EOL). Of the 106 nurses on EOL, 50 availed of this leave in 2024. Additionally, 58 nurses have recently served notice of resignation, with 18 others opting for EOL and are currently serving the notice period. Some are literally running away as officialdom restricts their choices.
As a desperate measure, the health ministry has decided to recruit nurses from outside Bhutan. The details are not shared from where the nurses would come, but notwithstanding the concerns of salary difference, the decision to hire 145 nurses is to ensure that nursing service, a critical service, is not hampered.
The government is criticised for the decision, particularly because expatriate nurses are paid higher than our own. Unlike other services, health services cannot be compromised. Shortage of nurses is a huge concern. There are reports that where there is the need for three nurses, for instance in the intensive care unit, there are only two or even one. Quite often, we say all services are important. But when it comes to life and death or when it concerns us individually, we feel health services are the most important.
As long as the prospects of living and working abroad are lucrative, we cannot stop our skilled people from migrating. Hiring expatriate nurses is a temporary solution. Nor is there a permanent solution to address the issue. The thousands of young women and men trained will ultimately want to, given the trend today, work abroad.
In Bhutan, health officials, like many others, are civil servants guided by the civil service rules. Notwithstanding the nature of work, they are remunerated according to grades and positions, a reason why many leave for better prospects in countries like Australia. We cannot stop the trend as long as there is the need for skilled and cheap health professionals.
The concern is the disparity of remuneration between expatriates and our own nurses. While we cannot pay our own nurses higher because of rules and regulations, we could look into who and from where we hire from. For instance, hiring from countries where they are paid poorer than us could be a win-win situation.
The health ministry, in hiring nurses, is cautious of differences in remunerations. We cannot hire expatriate nurses on the same salary scale unless they are desperate, nor will it be possible to get quality health providers at cheap rates.
Skilled or trained Bhutanese workers wanting to work in Australia is a good lesson.