A literature review: the role of the private sector in the production of nurses in India, Kenya, South Africa and Thailand

Abstract

Background: The demand for nurses is growing and has not yet been met in most developing countries, including India, Kenya, South Africa, and Thailand. Efforts to increase the capacity for production of professional nurses, equitable distribution and better retention have been given high strategic priority. This study examines the supply of, demand for, and policy environment of private nurse production in four selected countries. Methods: A systematic review was undertaken to assess the evidence for the role of private sector involvement in the production of nurses in India, Kenya, South Africa, and Thailand. An electronic database search was performed, and grey literature was also captured from the websites of Human Resources for Health (HRH)-related organizations and networks. The articles were reviewed and selected according to relevancy. Results: The review found that despite very different nurse to population ratios and differing degrees of international migration, there was a nursing shortage in all four countries studied and as such, they were struggling to meet growing demand. In all four countries there was evidence that the private sector was playing an increasing role in nurse production. Policy responses varied from modifying regulation and accreditation schemes in Thailand, to easing regulation to speed up nurse production and recruitment in India. There were concerns about the quality of nurses being produced in private institutions. Conclusion: The study concludes that strategies must be found to ensure that private nursing graduates serve the public health needs of their populations. There must be policy coherence between producing nurses for export and ensuring sufficient supply to meet domestic needs, in particular in under-served areas. This study points to the need for further research - in particular assessing the contributions made by the private sector to nurse production, and to examine the variance in quality of nurses produced