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Pakistan's next Billion Dollars - Export of Nurses
Young population, aging rich world & need for Dollars.
Dear Friends, AoA
Look around you. You will find a lot of people struggling to live a respectable living standard. Let’s put a hypothetical value of $300-400/month of salary. Mind you the minimum wage in the US itself is north of $2200-2400/month. Whereas, majority of Pakistanis live at near poverty levels. It’s a matter of shame that we - policy makers & policy advisors - haven’t been able to solve our problems.
However, with every challenge there is an opportunity. Often we read & cry over repeated boom-and-bust cycle in Pakistan. Problems arise at the beginning; low exports unable to finance imports. Firstly, wants increase with income. Or imports would increase with income. Unless, we have import-substitution industries or bring efficiencies to reduce need for imports (specially food items). Secondly, the exports are in an eternal low-trap. Even with a near ~45% Rupee depreciation in 3 years, needle has barely moved while imports are ramping up. What’s the solution?
One very underrated potential Pakistan can harness is export of labor. Previously, our prime exports of human resources were largely concentrated in the Middle East and were predominantly blue-collar jobs, necessitated by massive economic growth in oil-rich nations. That was one opportunity we effectively captured; Arab-Muslim friendly countries & local over-population.
Let’s look at the dynamics of Nursing exports today;
1- 5th Most populous country (Pakistan) - 338,000,000 citizens by 2050
2 - Young population - 55% or 110,000,000 citizens today are under 24 years of age
3 - Low GDP/Capita & local wages - Opportunity cost is lesser
4 - Ageing population in developed countries: Due to lowering birth rate, higher female labour participation, birth control policies, delayed marriage/children & increased lifespan the population mix is tilting towards Senior citizens. In contrast, Pakistan’s “demographic dividend” is more than necessary & can be effectively put to use for nursing needs of ageing global population.
5 - English speaking citizens: Nearly, 150m English fluent global citizens are aged above 65 today. Half of them - ageing 70 & above - are Pakistan’s target clients. Yes, we would be competing against a) home grown nurses b) competition from Philippines, India, EU, Bangladesh, Malaysia etc c) better health standards leading to lesser needs. Nonetheless, as the aged population increases over time, so shall the need for the governments to take care of ever-rising nursing needs.
6 - Lower domestic employment opportunities: Admittedly, the people entering the labour force - skilled & unskilled - are far higher in number than the availability of jobs. Hence, the wages have remained much lower. And until the economy grows at 6-7% for a decade - higher salaries & vacancies would remain a distant dream popped by boom-and-bust cycles. Hence, better to “reskill” the nation for onward exports.
7 - Balance of Payment crises: Pakistan’s utter reliance on aging Textile exports & Remittances have increased the concentration risks & blindsided the policy makers for out-of-box measures to radically increase exports. For sustainable prosperity, double digit $ earnings are a must. Hence, export of qualified nurses can further add cushions to our economic vulnerabilities. By today, everyone is (or should be) aware that Current Account deficits put pressure on Rupee in 2017-19 & caused significant loss of wealth.
8 - Prevalent “family” culture: Intertwined by the family bonds, Pakistanis pride themselves for their family values. Although the race to materialism & nuclear families is accelerating, an overwhelming population is used to/aware of taking care of older family members. That’s rule number 1 for the nurses. Often termed as “care givers”, hopefully, it would be easier to kickstart the training/skilling of nursing students.
9 - Globalization of the families: With increased travel, global economic integration & single parenting, many children are not able nor willing to assume responsibilities of their parents. The governments - “care givers of last resort” - thus are forced to offer old houses & nursing services to take good care of senior citizens. As their wellness - and lack thereof - severely affects healthcare budgets.
10 - Automation CAN NOT replace the HUMAN TOUCH: Despite the Industrial Revolution 4.0 & the advent of digitization, AI, quantum computers, robotic engineering and what not, clearly the need for care-givers can not be replaced by mechanical machines. This is a universal hypothesis which may never be challenged.
What should Pakistan do?
Amend regulations & silence the Naysayers: In Pakistan, Naysayers start with all the reasons for not doing the job. Rules, regulation, red-tape, bribery, complacency & resisting the change etc. Change the rules, amend the laws & do them fast to facilitate these 5 years targets.
Set higher targets: Create necessary infrastructure for exponential growth in Nursing schools by setting ambitious targets.
Market the program: Villages, cities, Tehsils, provinces, districts etc must be digitally targeted to attract talent with tag lines of minimum $1500-1800 salary per month for those able to secure jobs abroad. This will sell.
Incentivize schools: Offer interest free loans to Nursing institutes for civil & other infrastructure costs to increase their Return on Investments
Involve Public-Private-Partnerships (PPPs): Guarantee minimum returns to instructors/institutes provided that they exponentially increase the student intake to produce quality nursing staff
Ensure global accreditations: Nursing staff trained locally must be able to compete on global levels with our competitors to maximize their chances of employment
Use diplomatic channels: Embassies should be targeted to engage with respective countries for affordable, quality, reliable & humane export of nurses. Provide them incentives on each nurse export.
Offer best wages: Government should enter into a legally binding contract with local exported nurses to a) deposit X % of their incomes to national government nursing program b) Pakistan should reimburse nursing costs to importing country to make it more affordable than competing nations
Claw-back provision: Nurses exported via government to government arrangements should be mandated to send X% of their incomes back into the country to increase remittances
Brush the English Language: Every student should be trained to speak, write & read in English by globally recognized institutes (Berlirtz?) and mandated to undertake IELTS or similar courses to ensure that enrolled students set their sight on global employment from day 1.
Penalize those who fail to do their job: Often nurses are (rightly) blamed for negligence & mistreatment of patients. Contractual obligations should make it a criminal offense for those going abroad on government schemes to breach the patient-nurse trust & simultaneously, bring disrepute to the country.
Community-based incentives: If a village/family/district is able to generate quality exportable nurses which benefit Pakistan at large, the development budget of that area should be enhanced along with welfare protection. The family /citizens must see tangible benefits of their efforts. Seeing is believing.
Billion Dollars Exports - Math behind the numbers:
This is a start. Even low numbers don’t defy the logic & economic case behind it. The numbers below are minuscule given the growth in older population & nursing needs. Pakistan can easily fetch $1b per year in less than 5 years if aggressive push is given. That’s not expecting much is it?
Unfortunately, in Pakistan everything needs to be pushed hard. Be it the housing scheme, Ehsaas program & preparation of the policies. By that time, Elon Musk would have already sent people on Mars. Radically improving the lives of the hundreds of thousands of Pakistanis is a collective responsibility.
People at the helm of the affairs - politicians & bureaucrats - may or may not have the technical expertise, human hours, right incentives or willingness to execute projects. This is where you act “Fatherly/Motherly” and create an enabling environment. Like we always say, there might be plenty of missing pieces of the puzzles. But at least we need to create a debate (thoughts) around the ideas. The experts would (hopefully) do the rest.