In economics, ‘creative destruction’ means tearing down outdated systems to make way for progress. It is painful, it unsettles the old order, but it creates opportunity.
Pakistan’s nursing and allied health sector is at that crossroads. If we fail to act boldly now, we will remain mediocre in providing quality healthcare at home and lose billions in potential nursing exports abroad.
The problem is not in a lack of numbers alone. Pakistan has plenty of nursing schools. The crisis is quality. Too many institutions are little more than degree mills – without simulation or skills labs. Faculty are underqualified, curricula are outdated and students graduate with diplomas but not competence. They are unprepared for the demands of our hospitals, let alone the rigorous standards of the UK, US or Gulf.
The consequences are predictable. Our patients suffer under unskilled care and our nurses are locked out of global opportunities. Pakistan has only 20 per cent of the nurses and allied health workers it needs under WHO standards – a shortfall of 620,000 professionals. Instead of filling this gap, poor training and weak regulation widen it. Every undertrained graduate is not an asset but a liability – to patients, to our reputation and to our foreign exchange earning capability.
Contrast this with the Philippines and India. The Philippines has more than 240,000 nurses overseas and nurses alone account for $8 billion in annual remittances; 13,000 nurses leave each year for jobs abroad, compared to less than 1300 Pakistani nurses. India has nearly 600,000 nurses working overseas. Recruiters in Europe, North America and the Gulf trust these countries because their graduates are trained to global nursing standards, fluent in English and prepared for licensing exams.
Pakistan lags badly and graduates are unprepared for English-based licensing exams. We lack a national database for verification of qualifications. Migration pathways are left to manpower exporters who treat nurses like unskilled labour.
Issues run deep. Regulation is weak, allowing substandard schools to thrive. Faculty shortages mean students learn from teachers with little clinical experience. Approval of new institutes can take a year when it could be done in half. Principals are required to hold master’s in nursing, but Pakistan has a total of 444 such professionals for 369 nursing institutes, so schools hire part-timers on paper. A practical fix would be to allow principals with bachelor’s in nursing with 20 years of experience, including five in teaching. These details decide whether we build a functioning pipeline or keep a broken one.
Fixing this demands creative destruction. Non-compliant schools must be shut down. Accreditation must be strict and aligned with global standards, with audits that focus on the quality of training and not the size of the principal’s office. We must invest in simulation and skills labs, and digital systems to prepare students for modern healthcare. Faculty training must be upgraded, with higher hiring standards and continuous professional development.
Soft skills are as critical as technical ones. Nursing is not only about inserting IVs. It is about communication, empathy and cultural fluency. English proficiency and bedside manner must be treated as core competencies. Licensing exam preparation must be built into every programme, so graduates are not just employable at home but export-ready – able to sit for NCLEX or Gulf exams.
We also need creativity. The government owns dozens of empty or underused buildings. Instead of pouring scarce funds into construction, these could be leased to quality-focused nursing schools. Public–private partnerships can accelerate this transformation, blending private efficiency with public infrastructure.
Expansion for its own sake is a trap. More schools, more diplomas, more certificates – without quality – are meaningless, even dangerous. Poorly trained nurses put patients at risk, undermine our national reputation, and shut us out of global nursing opportunities.
The stakes are enormous. By 2030, the WHO projects a global shortage of 10 million health workers. Wealthy nations will continue to recruit from developing countries. Pakistan, with its youth bulge and healthcare needs, is ideally positioned to supply this workforce – if, and only if, we reform. Success would mean billions of remittances, hundreds of thousands of dignified jobs for youth, stronger healthcare at home and global credibility.
Building a better healthcare training system through creative destruction will be painful. But the alternative is far worse: preventable deaths in our hospitals, youth deprived of careers abroad and lost remittances.
This is nation-building. The Philippines and India have shown what’s possible when governments enforce standards and align training with global demand. Pakistan still has time, but the window is closing fast.
The writer is a venture builder, a private equity investor and investment banker. He tweets/posts AhmadJalal_1