‘A limited resource’: As Australia recruits overseas health workers, their home countries bear the cost | Feeding with milk
Moving to Australia from New Zealand was not a decision Ava* took lightly.
“We moved to New Zealand for the big Kiwi dream,” she says. “The country was beautiful, the lifestyle we had was wonderful.”
Originally from the UK, Ava has been a nurse for over 20 years. But after more than a decade working in hospitals there, where she says she was bullied, she was breathless.
“When we decided enough was enough, my career was going nowhere…and the professional life of bullying and belittling was no longer worth it, we took a closer look at Australia” , she says.
Ava accepted a short-term contract in Australia before she and her family relocated for good. She now lives in Queensland and has worked throughout the Covid pandemic.
“I have a lot more money here than in New Zealand,” she says. “It wasn’t my big driver, but I know it’s a big driver for other nurses who have moved from New Zealand to Australia.”
When the New South Wales government announced a $4.5 billion pledge in early June to boost the state’s health workforce by more than 10,000 over four years, the news was welcomed. coldly throughout Tasman.
New Zealand Nurses Organization chief executive Paul Goulter has expressed concern that the recruitment drive – which is expected to hire 7,500 doctors, nurses and allied health professionals over the next 12 months – will result in the loss more personnel for Australia.
“Although there have always been a number of nurses and other healthcare workers coming and going, it really does feel like it is so bad here that we stand to lose more than what we normally would,” Goulter told Radio New Zealand.
Other Australian states have announced similar campaigns to attract healthcare workers from overseas. The Queensland government announced this week it will target overseas doctors and nurses for recruitment, while the Western Australia resettlement incentive, which ends this month, includes a $5,000 refund $ for flights to Perth.
Healthcare workers have been migrating overseas for decades, in search of better pay, better working conditions or the lure of a different lifestyle. But as countries focus recruitment efforts internationally to ease domestic pressures, experts warn this could deepen existing inequalities amid a global shortage of healthcare workers.
A global deficit
The Covid-19 pandemic has taken a heavy toll on healthcare systems around the world. The World Health Organization estimates that up to 180,000 healthcare workers died worldwide between January 2020 and May last year due to Covid.
More than 75 countries have regulatory mechanisms in place to facilitate the recruitment of international health professionals, says James Campbell, Director of Health Workforce at WHO.
“The long-standing underinvestment in health systems meant that when additional demands were placed on health systems, they lacked the capacity to respond,” he says. “Many countries around the world had to quickly seek additional recruitment mechanisms.”
Even before the pandemic, there was a great lack of health professionals. A WHO report estimated that in 2018 there was a shortage of 5.9 million nurses, who make up the majority – around 59% – of the health workforce. The report also revealed that one in eight nurses worldwide work in a country different from where they were born.
The United States, United Kingdom, Germany, Finland, Australia and New Zealand are among the top destination countries for migrant nurses, says Howard Catton, chief executive of the International Council of Nurses, which represents more than 130 national nursing associations.
India and the Philippines – which “very deliberately educate[es] more nurses than they need” – have always been the source of large numbers of migrant nurses, he says.
ICN noted that the pandemic has increased the demand for nurses in destination countries, with the number of vacancies for nurses nearly doubling in Canada and the UK.
Recruitment drives in wealthy countries risk exacerbating gross inequalities that predate the pandemic, Catton says. “If you look at the statistics on the number of nurses per capita…you can see a tenfold difference, sometimes more, between low- and lower-middle-income countries and high-income countries.”
Figures range from 10 to 15 nurses per 10,000 people in some African and Southeast Asian countries to more than 100 per 10,000 in the US or UK, Catton says. “If you’re a high-income country and you haven’t trained enough nurses to meet your own needs and then decide to recruit elsewhere to meet those needs…you offload the training costs from this nurse.”
But the migration of health workers is “not just a south to north movement,” says Campbell, noting that there have been changes in OECD countries as well.
Dana*, who works for an international nurse recruitment agency in Australia, says most health workers she meets are migrating from the UK and Ireland, many of whom previously worked in Covid wards or units intensive care.
“They’ve struggled in Europe for the last couple of years or so,” she says.
“The opportunities are better here too. The healthcare system is flawless [in Australia]so it’s not as hard to be a nurse here as it is [there]especially in times of Covid.
Before the pandemic, the WHO estimated a shortage of 18 million health care workers by 2030, most in low- and lower-middle-income countries.
Burnout among tired health workers can only compound the problem. The ICN estimates that 3 million more nurses could quit prematurely as a result of Covid-19 and is concerned about the increase in industrial action around the world.
Greater investments in health systems are needed to manage future increases in demand for health care due to growing and aging populations, Catton said.
“We believe that all countries should aim for self-sufficiency,” he says. “That’s not to say people can’t move and migrate, but…we would like countries to consider producing enough nurses to meet their own needs.
“We have the global ambition of universal health coverage as part of the Sustainable Development Goals,” says Campbell. Achieving this requires more than just the international movement of a finite – and insufficient – number of health workers.
“You can’t have global competition for a limited resource,” he says. “You need global collaboration.”
*Some names have been changed