Background
In case of Indian diaspora population, healthcare and information technology are the two categories of workers, which have dominated the migration from India to overseas. Movement of Indian healthcare workers to industrialised countries and to the Gulf region has been a long-standing phenomenon, going back to several decades. While the movement of Indian healthcare workers to the Middle East and Gulf countries has mainly been under short-term arrangements, their movement to the industrialised countries has been mostly long-term in nature. The majority of Indian physicians, who are abroad and settled in Commonwealth countries.
However, the movement of these professionals under Mode 4 are subject to a range of restrictions, which include wage parity requirement, strict visa procedures, Economic Needs Tests, non-recognition of professional qualifications, imposition of discriminatory standards or burdensome licensing requirements, payment of social security without corresponding benefits, requirements of registration with or membership of professional organisations. Besides, in the aftermath of 9/11 terrorist attacks, security in the US became both an immediate and long-term concern. There are concerns that various domestic regulations and restrictions by the developed countries are essentially to protect their own domestic workforce.
Empirical studies further indicate that even marginal liberalization of barriers affecting movement of natural persons can produce large gains. Recent estimates indicate that if industrial countries increase their quotas on movement of skilled and low-skilled temporary workers by an equivalent of 3 per cent of their workforce, world welfare would rise by more than US $150 billion a year, with these gains being widely shared within the world economy. Thus, there is considerable scope to expand trade in services through movement of natural persons and to benefit from such trade.
Objectives
The study is conducted to achieve two main objectives. Firstly to examine the policy, administrative and implementation mechanisms employed by various governments at the national, bilateral and regional level to manage temporary migration of independent health service providers in India. The study would also analyse the domestic regulations of various countries viz: US, UK, Canada, Australia, Gulf countries, Singapore etc) to shed light on issues that have detrimental effect on the movement of Indian health service providers.
The second aim is to identify the barriers faced by Indian independent health service providers (namely, Medical and Dental Service providers and Services provided by midwives, nurses, physiotherapists & paramedical personnel) under Mode IV of GATS and appropriately gives recommendation to strategise to ensure access of Indian health professionals to opportunities for employment abroad through authorised channels. The study.
Methodology
First activity is to streamline issues in the light of objective of this work and develop structured questionnaires to conduct personal interviews in India (Delhi, Kerala, Hyderabad, Chennai and Mumbai) that will cover the following set of stakeholders:
- Regulatory authorities/Government Agencies
- Health Professionals
- Councils
- Indian Medical Association
- Other experts and practitioners in the field
- Placement/Facilitating agencies
It will be followed by focussed group discussion and multi-stakeholder consultation. A project National Reference Group of (four subject experts) will also be formed. These exercises aim to make the study more practically viable by taking into account diverse views of a wider set of stakeholders. Thus, it intends to address a democratic deficit as regards conducting stakeholder consultation by the government in the process of trade negotiations and trade policymaking.
A primary and secondary literature review will be carried out throughout the project tenure. This will analyse both quantitative and qualitative data. Data/information would be collected in light of the scope of work. The primary and secondary literature review, and the perception from the interviews will be combined and written as a draft discussion paper.
This research draft will be initially written in-house by the policy analyst/core researcher Once this paper is drafted, it will be sent to the National Reference Group for further comments, which inherently provides as a quality control mechanism.
Implementation
To begin with, CUTS CITEE/researcher would critically evaluate the current policy, administrative and implementation mechanisms employed by various governments at the national, bilateral and regional level to manage temporary migration of independent health service providers in India (literature survey). Along side, the study would examine the approach adopted by the various countries (favoured destinations) as regards their commitments on health services vis-à-vis potential for trade in services under GATS negotiations.
The duration of this study is 4 months and the proposed activities keeping in line with this period are shown in the week-wise time schedule below.
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Output
The main output of the project will be a research report that will be submitted to the Ministry of Health and Family Welfare. The research report will be divided into sections: (1) The assessment of governmental mechanism/domestic regulation for managing temporary movement of labour of independent health service provide; (2) Identification of hurdles (on the basis of experiences) faced by the service providers under Mode IV of GATS and ways to mitigate them; (3) Strategies for ensuring access of health professional to opportunities for employment abroad through authorised channels and addressing the concerns for protection of the rights and well-being of health professionals; and (4) Recommendations. The draft report will be discussed at a stakeholder consultation, which would be held in Delhi.
Furthermore, with the permission of the Ministry of Health & Family Welfare the research report will be distributed to international NGOs working on such issues – for example to International Centre for Trade and Sustainable Development, South Centre, Consumer Project on Technology to disseminate India’s position and concerns on the issues.
Research Team
The team would comprise of a core researcher, and two research officers. The team will work under the overall supervision of the Research Fellow of CUTS CITEE. Distribution of the tasks among the team members would be as follows:
- Core researcher will carry out the research work including preparation of structured questionnaires, analysis of primary and secondary information, literature review and writing of research report.
- The research officers will conduct field research and assist the core researcher in the analysis of primary and secondary information, literature review.
They would give research assistance to the core researcher in collecting primary information by sending structured questionnaires to identified people and organisations and doing the necessary follow up, following up with CUTS network partners in getting the relevant information, assist in correspondences, communications, facilitating meetings and visits, and all other necessary logistical arrangements. They will also help the core researcher in collecting secondary information and arrange for necessary literature.
Core researcher : Pranav Kumar
Research Officers : Simi T. B. , Chandan Mukherjee
CUTS Centre For International Trade,
Economics & Environment (CUTS CITEE)
D–217, Bhaskar Marg, Bani Park
Jaipur 302 016, India
Ph: +91.141.2282821
Fx: +91.141.2282485
Email: citee@cuts.org