Heterogeneity in the background and earnings of nurses in India: evidence from a cross-sectional study in Gujarat.

Abstract

It is important to understand the service conditions of nurses because these influence nurses' motivations and ability to provide care. Although nurses are estimated to constitute 30% of India's health workforce, limited empirical information is available about them. This paper attempts to address this gap in research. A cross-sectional survey of 266 nurses in the state of Gujarat was conducted to understand the demographic characteristics, qualifications and employment features of nurses working in India's private and public health sectors. Descriptive and univariate analyses were performed using the collected information. A multivariate regression model was also estimated with monthly earnings as the dependent variable, and workplace, type of employment contract, caste background and years in the nursing workforce as independent variables. The three main findings presented in this article highlight considerable heterogeneity in the background and employment of nurses in India. First, 49% of nurses working in private hospitals and as temporary employees in public facilities belonged to historically disadvantaged social groups (deemed Scheduled Castes and Scheduled Tribes) and were estimated to earn 9% less than similarly qualified and practiced nurses from general caste categories (P = 0.02). Second, 18% of nurses working in private hospitals did not have formal nursing qualifications. Third, nurses working in private hospitals and as temporary employees in public facilities earned less than the minimum wage stipulated by the Government of India. Permanent public sector nurses were estimated to earn 105% more than private sector nurses with the same qualifications, years of work and caste background (P < 0.001). This study finds that the disproportionate presence of women and socially discriminated caste groups in the nursing workforce, coupled with the failure of governmental agencies to regulate the health sector, might help explain the low wages and lack of job security that most nurses in India contend with.