Pooja Basyal, a critical care nurse who recently completed her Bachelor of Nursing Science, is excited about the bilateral “health partnership” agreement signed between Nepal and the United Kingdom.

A local from Rambha Rural Municipality-5, Palpa district, Basyal said that the agreement between the two governments has opened up new avenues for her career.

“We (me and my friends) are planning to take the International English Language Testing System (IELTS) exams,” said Basyal. “Even if I do not get selected for the UK in the government programme, I will try for other countries.”

Under the government-to-government agreement, Nepali citizens aged between 20 and 45 can apply for high-paying nursing jobs. Potential candidates are not required to pay any recruitment fees. The annual pay for registered nurses ranges from Rs4 million (27,000 pounds sterling) to Rs4.8 million (32,000 pounds sterling), according to the Ministry of Labour, Employment and Social Security statement.

Basyal is among thousands of nurses excited by the news that avenues of opportunities have opened in the UK and other developed countries. Due to a lack of opportunities at home and low wages, thousands of nurses are already overseas and others are looking for an opportunity.

There, however, is a global ban on employing healthcare workers from a country where there is a staff shortage of its own.

Nepal is among the 47 countries identified in 2020 by the World Health Organisation as facing the most pressing health force challenges related to universal health coverage (UHC).

The countries listed have a UHC Service Coverage Index lower than 50 and a density of doctors, nurses and midwives below the global median (i.e. 48.6 per 10,000 population).

The UN health agency says that listed countries should be prioritised for health personnel development, and health system-related support; and provided with safeguards that discourage active international recruitment of health personnel.

Nepal has 0.17 doctors per 1,000 population and 0.5 nurses per 1,000 population. This represents 0.67 doctors and nurses per 1,000 population, which is significantly less than the WHO recommendation of 2.3 doctors, nurses and midwives per 1,000 population.

The deal also comes amid concerns over the UK NHS's overreliance on foreign nurses. This is also the first health worker recruitment agreement by the UK with a country on the WHO’s Healthworker Support and Safeguard List 2020.

For Nepali nurses, who are struggling for an opportunity, this deal could be a godsend.

“It is tough to get good opportunities in government sectors and there is no motivation factor in the country,” said Aauyushi Joshi, a critical care nurse from Phidim Municipality-4, Panchthar. “Nurses have been working for meagre wages in private sectors and authorities concerned have overlooked the issue despite being aware of it.”

Multiple officials the Post talked to from the Health Ministry to Nursing and Social Security Division, Nepal Nursing Council and Nepal Nursing Association concede that nurses serving in the private sector have been underpaid and labour exploited.

“Nurses have been working at Rs5,000, Rs8,000 and Rs10,000 a month,” said Mana Kumari Rai, president of the Nursing Association of Nepal, the umbrella organisation of medical nurses. “As the UK government has offered the opportunities, it’s a good thing for nurses.”

Experts say sending technical human resources like trained nurses to developed countries like the UK is very good, as Nepali migrant workers will get the same rights, privileges, protection and dignity as health professionals in the destination country.

They, however, cautioned about the consequences of sending trained technical human resources in the long run.

According to Jeeb Narayan Kafle, member secretary of the Council for Technical Education and Vocational Training (CTEVT), the production of staff nurses has declined to 1,300 in the country from some 5,000 a few years ago.

State-run health facilities have faced an acute shortage of health workers, mostly nursing staff. Moreover, some posts of nurses have been vacant in state-run health facilities for years.

For years, the Ministry of Health and Population has not carried out an organisation and management survey.

According to data provided by the Nepal Nursing Council, there are 72,550 registered nurses in the country. Of them, around 15,000 have been serving in state-run health facilities.

Around 17,000 have been serving in private centres—hospitals, nursing homes and clinics. Thousands have changed their profession due to a lack of opportunities and exploitation in the private sector. And it is estimated that over 20,000 nurses have already gone abroad in search of opportunities.

Officials at the council conceded that the number of registered nurses provided by the Council is not authentic, as some have died and some have been registered multiple times after completing (proficiency certificate level, Bachelor’s Degree and Master’s degree).

“All surplus nurses may not go to the UK but opportunities will be opened to them in other countries as well,” said Bandana Thapa, chief of Bir Hospital Nursing Campus. “Authorities can neither prevent nurses from exploring opportunities abroad nor can they prevent nurses serving in state-run health facilities from quitting their jobs and going abroad.”

Experts say that along with exploring opportunities to send trained human resources to the lucrative job markets, authorities concerned should also work to retain trained human resources in the country.

Goma Devi Niroula, director of the Nursing and Social Security Division under the Department of Health Services, concedes that if the authorities concerned complete organisation and management surveys at the earliest, thousands of nurses would get opportunities in state-run health facilities immediately.

“Authorities concerned can activate the monitoring mechanism and enforce the minimum wage rules in the private sectors efficiently,” said Niraula. “We must think of retaining nurses in the country also.”

Dr Arjun Karki, former vice chancellor at Patan Academy of Health Sciences, said that nurses have been seeking foreign jobs and further studies abroad on their own and the government cannot prevent anyone from going abroad for a better future.

“When the government took an official decision to send trained human resources abroad and signed an agreement with the UK government, it should have asked for help to improve our education system and quality improvement,” said Karki. “A lot of resources are spent to prepare technical human resources like nurses.”