Pakistan’s Nursing Workforce- Export Potential, Challenges, and Recommendations

Published in https://www.pbc.org.pk

This study titled, “Pakistan’s Nursing Workforce – Export Potential and Challenges” is part of the PBC’s “Serve More Serve Better” component of its “Make-in-Pakistan” initiative. The goals of the study are to promote exports of Pakistani nursing professionals; identify specific challenges that hinder their acceptance in global markets and finally suggest policy interventions to improve nurses skillsets and the overall quality of care.

Global Trends of Nurses Migration:

The global nursing workforce was estimated at 29.8 million in 2023, with a projected shortfall of 4.1 million nurses by 2030. The shortage is expected to be especially acute in Africa, South-East Asia, and the Eastern Mediterranean. Foreign nurses comprise the highest proportion of nurses in Gulf countries like Qatar (99.2%) and the UAE (98.8%), followed by Luxembourg (76.9%), Switzerland (27%), Germany (16.9%), Australia (41.9%), and the USA (16.7%). In terms of destinations for nurses to emigrate to, western countries offer nurses stable paths to permanent residency and social benefits despite higher taxes, while gulf countries provide tax-free salaries but temporary residency along with cultural restrictions.

Migration Trends of Pakistani Nurses:

Pakistani workers registered abroad are a significant segment of the Pakistani workforce. They contribute to the national economy through remittances and bring valuable skills and experience back to the country (ILO, 2020). A notable trend in Pakistani overseas employment is the prevalence of unskilled labour. In 2024, 50.1% of all Pakistani workers registered abroad were labourers, highlighting a significant lack of specialized skills.

Looking at the migration of highly qualified workers from Pakistan in 2024, managers led the way, followed by engineers and accountants. Nurses were ranked 5^th amongst the highly qualified workers migrating abroad from Pakistan.

Table: Percentage and CAGR (2014-2024) of Highly Qualified Workers Registered Abroad from Pakistan

Source: Data and Author’s Calculations from BE&OE (2025)

Managers accounted for 49.0% (24.8 thousand) of the highly qualified professionals registered abroad from Pakistan in 2024. In 2024, Engineers and Accountants accounted for 15.9% and 11.3%, respectively. Nurses were about 5.8% of the highly qualified workers registered abroad from Pakistan but in terms of CAGR, Nurses had the highest growth (31.4%) in registration abroad in 2024.

Major Findings:

State of Nursing in Pakistan

Pakistan’s healthcare system is doctor-centric, with a severe shortage of nurses (only 0.4% nurse-to-doctor ratio and 5.2 nurses per 10,000 people), far below international standards. The country produces a critically low number of nursing graduates (5,600 annually), which limits its ability to meet both domestic demand and international opportunities. This shortage is exacerbated by nurses leaving Pakistani hospitals due to low salaries, poor benefits, and heavy workloads, forcing hospitals to use less qualified staff.

Despite these challenges, the stigma associated with nursing is gradually decreasing due to rising global demand and better salaries, attracting more men to the profession. However, nurses are largely excluded from key decision-making roles within healthcare, and Pakistani media often portrays a negative image of the profession, deterring new entrants and harming the international reputation of Pakistani nurses.

Nursing Education in Pakistan

Significant efforts have been made to improve nursing education, including phasing out diplomas for a 4-year BSN degree and stricter affiliation criteria for private institutions. However, challenges persist. There’s a theory-practice gap, especially with graduates from substandard “mushroom institutes” that often lack proper facilities and internships, leading to a decline in practical skills and a risk of fake degrees. The Pakistan Education Endowment Fund (PEEF) offers scholarships but has inconsistent policies that hinder international mobility.

Additionally, a clinical-academia divide prevents nurses from holding both clinical and teaching roles, leading to a disconnect between education and current clinical practices. There’s also a lack of standardized admissions, assessments, and grading, and inadequate access to modern teaching technologies. Furthermore, monitoring of nursing educational institutions is insufficient, and there are limited specialization options in Pakistani nursing degrees, causing the country to miss out on global demand for specialized nurses.

International Mobility of Pakistani Nurses

There’s a high global demand for Pakistani nurses, particularly females, driven by affordability and supply, with new pathways emerging in Kuwait, Qatar, and Saudi Arabia. However, an imbalance exists between demand and supply, with a surplus of unemployed male graduates due to international preferences for female nurses and past negative incidents.

Pakistani nurses face several hurdles in securing international employment, including delayed document verification procedures by Pakistani nursing boards, expensive accreditations, pre-departure training, and exams, and fierce competition from Filipino and Indian nurses who are more abundant, possess better soft skills, and are more willing to exceed job descriptions. Furthermore, Pakistani missions and government bodies often fail to support and promote Pakistani nurses abroad. Other constraints include the unwillingness of female nurses to relocate without family, challenges with cultural integration and foreign accents, and vulnerability to fraudulent schemes. National curriculum barriers and inconsistent terminology also frequently hinder Pakistani nurses from passing international licensing exams. There is limited data availability on Pakistani nurse migration, which impedes strategic planning.

Recommendations:

For the Improvement of the State of Nursing in Pakistan

• Retain Nurses: Standardize salaries, benefits, offer tax concessions, reduce workload, and establish clear career paths to retain nurses.
• Undertake Research and Planning: Public-private partnerships are needed for manpower gap analyses for effective retention and export strategies.
• Elevate Nursing Leadership: Fill leadership positions based on meritocratic criteria.
• Involve Nurses in Decision Making: Establish a national task force with nursing professionals to advocate for the profession.
• Improve Media Image: Strategically use media to showcase the vital role and benefits of nurses.
• Regulate Allied Workers: Ensure clear role distinctions for patient safety and optimal skill utilization.
• Leverage Overseas Expertise: Incentivize returning Pakistani nurses for leadership roles to utilize their international experience.
• Recognize and Empower Advanced Practice Nurses: Formalize advanced nursing roles and empower them to establish clinics in underserved areas.

For the Improvement of Nursing Education in Pakistan

• Produce Specialized Nurses: Revamp BSN programs with specialized internships and establish advanced nursing roles.
• Subsidize Advanced Medical Equipment: Provide modern simulation technologies to all nursing institutes at subsidized rates.
• Standardize Teaching, Admissions, Assessments, and Training: Standardize across all Pakistani nursing institutes.
• Standardize Practical Application of Soft Skills: Implement consistent and deliberate practical teaching of soft skills in clinical settings.
• Integrate Clinical Practice and Academia: Mandate clinical immersion for nursing faculty and facilitate joint appointments.
• Train Teachers and Support Institutions: Fund “Training of the Trainers” programs for advanced teaching methodologies.
• Facilitate Nurses to Start Nursing Institutions: Encourage new nursing colleges through interest-free loans and streamlined procedures.
• Regulate Nursing Institutions Affiliations: Reduce affiliations per hospital and prioritize colleges in rural areas.
• Strategic Planning for Nursing Faculty: Establish criteria for overseas opportunities, retain qualified faculty, and facilitate international exchanges.
• Provide Scholarships and Loans: Offer scholarships and interest-free loans to boost enrolment.
• Introduce Multiple Annual Intakes: Adopt a multiple-intake model to increase the number of qualified nurses.
• Frequent Monitoring and Regulation: Establish an independent body to oversee quality assurance and faculty qualifications.

For the Improvement of International Mobility of Pakistani Nurses

• Train Nurses for Specific Countries: Revise the curriculum and provide targeted training to align with host country requirements.
• Address Curriculum Terminology and Accreditation: Revise the National Nursing Curriculum to align terminology with international standards and pursue international accreditations.
• Pakistani Missions and Government Bodies Need to Facilitate Nurses: Proactively market and promote Pakistani nurses and provide robust support services.
• Streamline Overseas Nurse Employment: Prioritize direct “Government-to-Government” collaborations to eliminate middlemen.
• Reduce Financial Barriers: Adopt an “employer-paid placement fees” model and reduce financial burdens on nurses.
• Streamline Overseas Nurse Deployment: Integrate police checks, subsidize licensing costs, offer support services, and create a job registration system.

The PBC is a private sector not-for-profit advocacy platform set-up in 2005 by 14 (now 100+) of Pakistan’s largest businesses. PBC’s research-based advocacy supports measures which improve Pakistani industry’s regional and global competitiveness. More information about the PBC, its members, objectives and activities can be found on its website: www.pbc.org.pk