Private sector nurse training institutions

Why it matters

In many low and middle income countries, there has been a rapid proliferation of private training institutions to increase the supply of nurses. Private institutions have notable differences with conventional public training institutions including in ownership and governance, organisational goals and culture and sources of finance. These differences also determine nursing graduates’ employment choices and their likelihood of working in public or private facilities. 

What we did

We conducted research in Thailand, Kenya and India (Tamil Nadu state) to examine the emerging role of private nurse training institutions and how they compare with public institutions in terms of: resources and nancing, the quality of teaching and students and students’ exposure to rural health.

In India and Thailand, the research also investigated differences between graduates’ employment choices and their likelihood of working in public or private facilities after graduation. Study methods included: a cross-sectional survey of public and private institutions, document reviews and key informant interviews.

What we found 

  • Privately trained nurses are more likely to work in the private health sector and in urban areas compared to publically trained nurses. 
    Whilst there has been a rapid expansion of private institutions, they are unlikely to reduce nurses shortages in rural or underserved areas. 
  • Public sector institutions are best placed to respond to a country’s health workforce requirements.
    In terms of aligning student intake and training programmes with changing population needs, maintaining healthcare standards, setting up training schools in rural areas and collaborating with the public healthcare system to place trainees/graduates in underserved facilities. 
  • In Kenya and India, a large proportion of (public and private) nursing graduates are unable to find relevant employment due to insufficient government funding for health workers
    This disjuncture between production and employment is one explanation for the high levels of nurse migration in these countries (20% in Kenya, and 25% of privately trained graduates in India). 

Recommendations for policy and practice

  1. Maintain investment in public training institutions: Ministries of Health must continue to demonstrate the value of public training institutions to the government and secure their funding. 
  2. Ministries of health should develop clear policy objectives regarding the desired role of private training institutions in relation to their national human resources for health goals.
  3. Regulatory/professional bodies should put in place guidelines and rules to ensure minimum standards for the quality of both public and private training institutions.
  4. Whether through the public or private sector, increasing the production of nurses alone will not solve the problem of shortages. The research identi es several critical health workforce issues that must be addressed alongside nurse production.

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