- A new ADB-Inje University brief warns that Asia-Pacific nations are falling behind on universal health coverage due to persistent gaps in nursing education and workforce strength.
- Researchers highlight severe nurse shortages, poor working conditions, and high migration issues made worse by limited training capacity and uneven licensure systems across the region.
- The report stresses that without stronger education frameworks, fair pay, and better career pathways, countries cannot build resilient health systems for future challenges.
The new brief Enhancing Nursing Education and Training in Asia and the Pacific, prepared by researchers from the College of Nursing at Inje University in the Republic of Korea along with the Asian Development Bank, offers a stark look at the widening distance between public health ambitions and on-ground realities across the region. Despite years of policy commitments, progress toward universal health coverage has slowed, and several countries continue to lag behind global benchmarks for basic health outcomes.
Life expectancy in Bangladesh, the Lao People’s Democratic Republic, the Philippines, Sri Lanka, and Vietnam remains far lower than the averages registered across OECD nations, and infant mortality in the Lao PDR still exceeds 35 deaths per 1,000 live births. Financial constraints deepen the challenge: Bangladesh and the Lao PDR each spend below USD 200 per capita on health annually, and high out-of-pocket costs continue to limit access to essential services for millions. These indicators, the report notes, signal systemic weaknesses that cannot be resolved without strengthening the workforce at the heart of healthcare-nurses.
According to the brief, the region faces an acute and sustained nursing shortage, with nurse-to-population ratios falling well beneath global norms. Bangladesh counts only 6.6 nurses per 10,000 people and has more physicians than nurses-an unusual imbalance that strains the system's ability to deliver quality care. Sri Lanka and Vietnam face similar deficits, while the Philippines-long known for producing a large nursing workforce-continues to see its trained professionals migrate in significant numbers due to better overseas opportunities.
The pandemic further exposed and deepened these vulnerabilities, accelerating burnout and attrition across the workforce. Low salaries remain a central deterrent; in most of the focus countries, nurses earn less than half of physicians' salaries, despite increasingly heavy workloads. Without improvements in compensation, recognition, and career progression, the brief emphasizes that educational reforms alone will not stabilize or grow the profession.
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The report also provides a comparative look at how nursing education is structured across the five countries. Bangladesh operates more than 400 diploma, bachelor’s, and master’s programs but still cannot meet domestic needs. The Lao PDR relies almost fully on the University of Health Sciences the only provider of a full four-year BSN program leaving the regional colleges constrained by limited faculties and outdated curricula.
Rapid growth in the Philippines after a decade-long moratorium on new programs led to more than 400 BSN offerings in 2024. Sri Lanka revised its BSN curriculum with the support of Korea, transitioning from unstructured clinical hours to competency-based training. Vietnam retains relatively strong standards for BSN and advanced degree pathways but lacks sufficient qualified educators.
Quality assurance, however, remains uneven in the region: The Philippines' long-established licensure examination sets a high benchmark, while Bangladesh and the Lao PDR are still firming up their recently established systems. Sri Lanka has no national licensure examination in place at all. Vietnam intends to implement one by 2028. Similarly, the mechanisms of accreditation are uneven, with many rural institutions clearly incapable of meeting the standards laid down due to weak infrastructure and a lack of resources.
The most telling insights from the brief are from focus group interviews, demonstrating the realities of nurses, educators, and students speaking about crushing workloads, outdated training environments, and a consistent struggle to seek out better prospects abroad. Their accounts reinforce the report’s central message: meaningful reform must prioritize stronger education systems, better working conditions, and clear professional pathways. Without elevating the role and recognition of nurses, the region cannot build resilient health systems that can meet future challenges.
