With just around 1.38 lakh nurses and midwives for its population of more than 23 crore, the health system in Uttar Pradesh is struggling to take care of the ailing. While the World Health Organization norm is three nurses per 1,000 population, in Uttar Pradesh, it is just 0.6.
Though the State was allocated ₹270 crore from the Union Budget to build 27 new nursing colleges, there are two major challenges: the paucity of faculty for training, and the quality of students who pass out of such institutions.
Grappling with gaps
There are currently 23 government-run nursing colleges, 17 of which began admitting students only in 2021. Bearing in mind that a B.Sc. nursing degree is a four-year course, the six nursing colleges — two in Lucknow and one each in Jhansi, Kanpur, Meerut, and Etawah — produce 420 graduates annually. This will be enhanced to 620 from 2025. But not all who graduate will look at jobs in the health sector.
The State needs to ensure that quality nursing students get admission in both private and public colleges. “Now, 420 graduates are just 5% of the lot. Ninety-five per cent [of the nearly 7,860 seats in B.Sc. Nursing] are passing out of the private sector, which is largely unregulated,” U.P.’s Principal Secretary (Medical Education) Alok Kumar told The Hindu, adding that there are 329 nursing colleges in total.
To begin with, the State wants to gradually create 72,000 nursing positions in the government sector. U.P. has also launched ‘Mission Niramaya’ in 2022 to uplift the quality of its nursing workforce.
Mr. Kumar, a 1993-batch IAS officer who previously served in the Department of Health, and as an Adviser (Health) at the Niti Aayog, was considered a good fit by Chief Minister Yogi Adityanath to handle this nursing upgrade in terms of quality and quantity.
“The aim is to create infrastructure for nursing colleges co-located in the medical college campus, get more students from Class XII to enroll in nursing, and admit quality students by administering a NEET-like Common Entrance Test (CET) so that a certain standard is maintained at the input level,” he said, adding that he envisions bringing up the percentage of nursing graduates from government institutions to 20% over the next few years.
Currently, U.P. is playing a catch-up game and falls behind States like Kerala, which has a strength of nine nurses per 1,000 population and Tamil Nadu, which has six nurses per 1,000 population. “The shortage of trained nursing faculty is being plugged by sourcing teachers from these southern States,” said Mr. Kumar.
To incentivise nurses to come in as teachers, the State is offering better pay packages than western and southern India. “At a monthly salary of ₹1.4 lakh for the post of Principal, ₹1 lakh for Professors, and ₹80,000 for Associate Professors, U.P.’s pay is better than Gujarat and Tamil Nadu,” Prof. S. Balamani Bose, Principal, College of Nursing, Meerut, said.
Identifying the problem
In 2021, when Mr. Kumar was overlooking the recruitment of 4,500 nurses (both for new and existing positions) in State-run health facilities at all levels — medical colleges, district hospitals, and block-level and primary healthcare facilities — he realised that the supply of trained qualified nurses did not match the demand.
The U.P. Public Service Commission (UPPSC), the State-run body which conducts exams for government jobs, told Mr. Kumar that they could supply only 3,012 nurses. “When I asked why the number of nurses was low, UPPSC came back with a reply that not all nurses meet requisite knowledge benchmarks to qualify working for the State government,” he said.
On probing, Mr. Kumar realised that the phenomenon of “non-attending nurses”, those who never went to college but got their nursing degree, was rampant in private colleges. “The government has largely outsourced the nursing and paramedical fields to the private sector. There are issues of regulating these seats by the State Nursing Council. There are issues of questionable institutions — for instance, how do they get approved? Also, admission process SOPs (standard operating procedures) are not properly defined,” Mr. Kumar said.
He added that, sometimes, private colleges would feel pressured to pass students simply because they had paid a fee. The fee in a government college is ₹40,000 annually for a B.Sc. Nursing degree, and ₹55,000 for an M.Sc. (Nursing) degree. Private institutions charge more than double this amount.
These nurses would register with the nursing council and be “qualified” for practicing in health set-ups. “The council had no way of testing for quality,” Mr. Kumar said.
Cleaning up the system
To control the quality of nursing students right at the input level, the State introduced a Common Entrance Test in 2021, which was mandatory on admissions to all affiliated colleges for the Atal Bihari Vajpayee Medical University (ABVMU), U.P. “This year , in addition to the 23 government and 256 private colleges affiliated to ABVMU, which have to compulsorily admit students through the Common Nursing Entrance Test (CNET) process, we have given an option to 24 deemed universities, which have one nursing college each, to come under the ambit of CNET,” Mr. Kumar said. However, CNET is optional at the moment for all institutes except ABVMU.
For CNET 2022, while 31,000 students applied for admissions, only 26,000 appeared for the examination and 21,000 achieved above the 30 percentile mark cut-off. “But of 21,000 that qualified, only 6,700 students joined the course. Nearly 30% seats remained unfilled,” Mr. Kumar said, adding that most were in private colleges. “We did not mind this, as we require good quality students to join the course,” he said.
In a separate exercise, the State government is now monitoring exams of colleges offering nursing diplomas, with CCTV supervision. When they began in 2022, the pass percentage of candidates dropped from 90% to 60%.
Prof. Bose said that nursing is not considered aspirational as there is no awareness among the students about its scope and salary. “We are trying to change that by reaching out to students of Class XI and XII to educate them about its expanding scope in the State as the government is opening up more opportunities now,” she said.
Nurses who go on to join jobs in private hospitals and nursing homes get paid less than those in the government sector. Private nursing homes can pay anywhere from as low ₹3,000 to ₹25,000 a month, depending on qualification, experience, and previous place of work. “In government-run hospitals, freshly graduated nurses can easily make between ₹60,000 to ₹65,000 in U.P.,” Prof. Bose added.
Charting the future
This year, the State government is aiming to create 3,500 additional positions but they want to do it gradually to ensure efficient cadre management. “We are filling up positions at an increasing rate of 20% per year,” Mr. Kumar explained.
The State government is now asking the Indian Nursing Council to relax faculty norms for U.P. “For MBBS courses, post graduate medical students can be tutors and demonstrators, but that is not the same for M.Sc. Nursing students. The nursing students require some teaching experience too. Over and above that, nurses have no incentive to do an M.Sc. as they get the same jobs that they would get if they were B.Sc. graduates in nursing. We want to incentivise our nurses to do an M.Sc. and relax norms, where teaching experience can be flexible, so we can fill up the faculty gaps,” Mr. Kumar said.
But Prof. Bose said it will be tough for the Nursing Council to make special concessions for U.P. “We are currently trying to function at the best of our abilities and work as per council norms,” she said.