This presentation was given at the International Health Economics Association (iHEA) World Congress in Milan, in July 2015.

1. Job choices of nurses trained in
private and government institutions in
Tamil Nadu, India.
Elsa Mary, Sathish Kumar, V R Muraleedharan and Umakant Dash.
Dept. of Humanities and Social Sciences, Indian Institute of
Technology (Madras). India.
http://resyst.lshtm.ac.uk
@RESYSTresearch

2. Introduction
• Nursing personnel form a vital component of a country’s health
system.
• In the past decade, the number of nursing training institutions (with
BSc degree in nursing) have increased in Tamil Nadu:
• TN; Production of Nurses on the increase (in private institutions in
particular); But in terms of “absorption” (employment) in public and
private delivery system, there is an acute shortage. Leading to
migration (within and outside India). Shortage about 40 -50Koverall
in TN (2012).
2006 2011 2012 2015
Private 40 135 151 169
Public 2 4 4 4

3. Objectives
Knowledge gaps
 What are the Implications of expansion of private training
institutions?
 Are the public/private nursing students likely to have distinct job
preferences?
Research objectives
 Compare and contrast the characteristics of privately and publicly
trained nursing students
 Compare and contrast their work intentions
 Analyze the factors associated with these work intentions

4. Study design
Public Private Mission
Number of institutions N= 4 N= 145 N= 16
Number of institutions
surveyed
N=2 N= 12 N= 3
Number of students
surveyed
N= 93 N= 527 N= 138
• Stratified random survey of nursing training
institutions in Tamil Nadu
• All final year (BSc) nursing students interviewed

5. Data
• Self-administered questionnaire:
• Main socio-demographic characteristics
• Job intentions
• Total sample: N=758 final year nursing students
• Data entry in Epi data ; analysis in SPSS

6. Socio-demographic characteristics
of nursing students.
Gender Social background
74%
77%
55%
1%
9%
28%
0% 50% 100%
Public
Mission
Private
Sc/St Lower caste Upper caste
90%
97%
95%
0% 50% 100%
Public
Mission
Private
Male Female

7. Socio-demographic characteristics
of nursing students - Continued
49%
33%
18%
Public
56%
38%
6%
Mission
village small town city
38%
41%
21%
Private

8. Job intentions of privately and
publicly trained nurses
Intentions to work in
the public sector
Intentions to work in
Tamil Nadu
96.4%
3.6%
72%
28%
78.2%
21.8%
0
20
40
60
80
100
120
Tamil nadu Rest of India
Public Mission Private
63.6%
32.7%
63.6%
24.2%
12.1%
63.4% 35.4%
0
20
40
60
80
100
work in
public
work in
private
work in
mission
public mission private

9. Factors associated with intentions to work in
the public sector
OR 95%CI P-value
Type of Institution
Public 1
Private 1.38 0.80 – 2.38 0.23
Mission 1.84 0.45 – 1.55 0.58
Sex
Male 1
Female 0.97 0.45 – 2.08 0.95
Social Class
Upper caste 1
Lower caste 2.76 1.50 - 5.07 <0.01
Sc/St 2.52 1.43- 3.54 <0.01
Language in high School
English 1
Mother tongue 1.92 1.30-2.8 <0.01
Can earn more in private sector
Agree 1
Disagree 1.78 1.24- 2.56 <0.01

10. Factors associated with intentions to
work in Tamil Nadu
OR 95%CI P-value
Type of Institution
Public 1
Private 0.94 0.56 -1.55 0.8
Mission 0.77 0.43 -1.37 0.38
Sex
Male 1
Female 4.38 1.99-9.65 <0.01
Social Class
Upper caste 1
Lower caste 2.63 1.48 -4.67 <0.01
Sc/St 2.38 1.51 -3.76 <0.01
Language in high School
English 1
Mother tongue 1.68 1.15 - 2.46 <0.01
Rank first while considering a job
Good salary 1
Secure Job 1.24 0.84-1.83 0.26
Help others 1.66 1.10- 2.48 0.01

11. Discussion
• Irrespective of the type of training institution, nursing
students would like to take up a public sector job and
socially backward students (lower castes/SC-STs)
 job security: culturally strong preference to Government
Jobs.
• Female Nurses show less preference to migrate outside
TN state; (reasons: family concerns); Male nurses and
those with preference for higher salary, prefer to migrate
outside TN and country.

12. Discussions
Policy Implications:
Given 1. High preference for Govt jobs; 2. Low absorption
of nurses (despite acute shortage), and 3. High
migration outside the country, the policy question is:
Should Government allow further expansion of private
nursing Institutions in TN?
Future research: Actual job choices and associated
factors, to be carried out with follow up of cohort (under
progress); This might throw light on the actual career
options for nurses available for addressing the above
policy question.

13. Thank you