Can the private sector help overcome nursing

shortages? Evidence from 4 countries

The demand for nurses is growing and has not yet been met in most low and middle-income countries. In India, Kenya,
South Africa and Thailand, there has been a rapid proliferation of private training institutions to increase the supply of
nurses. RESYST researchers are examining the role of these private institutions, their contribution to the wider health
systems, and how governments in these countries have managed the opening of markets to the private sector.

GROWING DEMAND FOR NURSES

SHORTFALLS IN THE SUPPLY OF NURSES

FACTORS AFFECTING THE DEMAND FOR NURSES

NUMBER AND DENSITY OF NURSES AND MIDWIVES

Societal factors

Density per 1000 pop.

No. of nurses
and midwives

Ageing populations

Changing health system policies

Increased prevalence
of non-communicable
diseases

Introduction of new financing or

insurance systems.

Spread of new and

re-emerging diseases

Increased focus on primary health

care.

Kenya

1.18

37,113

Increased public demand

for health services

Increased focus on achieving the

Millennium Development Goals.

South
Africa

4.08

184,459

Thailand

1.52

96,704

Expansion of private provision of

health care (Thailand).

India

143,055

1.30

In Thailand,
the density of
nurses working in
Bangkok was more
than 5 times higher
than in the rest of
the country.

INCREASING IMPORTANCE OF THE PRIVATE SECTOR IN TRAINING NURSES

INDIA

88%

KENYA
of all nurse training
institutions in the
private sector.

95% private sector.

of all nurses trained in the

51%

THAILAND

SOUTH AFRICA
of all nurse training
institutions in the
private sector.

Increase in the proportion

of enrolled nurses that are
privately trained (2 year
training programme).

66%
45%

26%

of all nurse training

institutions in the
private sector.

27% the private sector in 2010.

of new nurses were trained in

2001

2004

CONCLUSIONS

Infographic produced by Rebecca Wolfe.

Private nurse training institutions are playing an increasingly important role in producing nurses in many low and middleincome countries. Governments need to ensure that graduates from both private and public institutions are of sufficient quality
to meet the health needs of their populations, and that training institutions have the capacity to train more nurses.

Based on The role of the private sector in the production of nurses

in India, Kenya, South Africa and Thailand: a review of the literature
J Reynolds et al, Human Resources for Health 2013, 11:14

In some countries including India and Kenya, the benefits of expanding nurse production through the private sector have been
hindered by high levels of international migration. A balance needs to be struck between producing nurses for export, and
ensuring sufficient supply and skill-mix for domestic markets.

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RESYST is funded by UKaid from the Department for International Development.
However, the views expressed do not necessarily reflect the departments official
policies.