The departure of over-qualified Pacific Island nurses who are taking up aged care jobs in countries such as Australia has experts concerned the "brain drain" is leaving critical gaps in the region's healthcare systems.
Health systems worldwide are struggling with chronic understaffing — exacerbated by the pandemic — and many countries are looking abroad to solve the shortages.
In April, the Australian government increased the number of workers coming to Australia through the Pacific Australia Labour Mobility (PALM) scheme to work in hospitality, tourism, and aged care in a bid to address critical skills shortages here.
Fiji Nursing Association president Dr Alisi Vudiniabola said many of the country's "very experienced and well qualified" nurses had since left to work in jobs they were over-qualified for, like aged care.
"Some of them are midwives, some advanced clinical nurses, some are managers in primary healthcare centres," she said.
"It's a big loss for Fiji when we lose such qualified nurses."
There is no data available on the total number of Fijian nurses now working overseas, but Dr Vudiniabola estimates about half have left for Australia, New Zealand, the Middle East and the United States during the past six months.
Despite mounting pressure on the health system, she said the Fiji government was keeping tight-lipped about the figures.
"They just keep all the information to themselves; we are not seeing the numbers that are leaving, but we know that nurses are leaving almost every day," she said.
The Fijian government, which is in the midst of an election campaign, has been approached for comment.
Dr Vudiniabola said she hoped that at least Pacific nurses would have opportunities to increase their skills.
"I'm just hoping that … Australia looks at pathways for professional development, and does not just leave them being an aged care worker."
A 'small proportion' of nurses in aged care
Minister for International Development and the Pacific Pat Conroy said only a "small proportion" of Pacific workers training to work in aged care were qualified nurses.
"Australia wants to contribute to the economic development of our region. We do not want to deprive the Pacific of its health workforce," he said.
Mr Conroy said the PALM scheme had been "win-win" for Australia and the region.
"It's making a significant contribution to economic development in our region, through workers sending their Australian earnings home, and at the same time helping with worker shortages in Australia," he said.
"Countries sending workers to Australia have control over who is able to participate. We will keep working closely with them to target participants who are not nurses in their home countries."
Concern over gaps
It's a similar story in Solomon Islands, where the country's busy emergency department recently lost a handful of its "very senior" nurses to the Australian scheme.
"Their departure from that place has left a gap, so for us, that is a concern," Solomon Islands Ministry of Health national director of nursing Michael Larui said.
Mr Larui said Solomon Islands should manage the flow of workers out of the country, "because it will certainly have an impact on the services we provide".
In Vanuatu, Midwifery Society president Harriet Obed said interest in the PALM scheme was growing among nurses and midwives because of the pressure already mounting on its teams.
"This pushes nurses to look for better options like aged care outside the country," she said.
The ABC has seen ads on Facebook in Vanuatu, recruiting nurses to work as aged care workers in Australia.
Labour scheme expanding
The Australian government recently committed to expanding the PALM scheme in the aged care sector to help address shortages.
Australia needs to fill a gap of 35,000 aged care workers per year, according to a recent report by the Committee for Economic Development.
A spokesperson for the Department of Foreign Affairs and Trade said most of those working in aged care as part of the scheme were from Fiji.
At the end of July, 300 Pacific Islanders were employed in aged care through the PALM scheme, comprising:
- 172 workers from Fiji
- 65 workers from Kiribati
- 34 workers from Samoa
- 29 workers from Solomon Islands
"This is an increase from 145 workers as at December 2021," the spokesperson said.
'Careful management' amid brain drain
Professor Stephen Howes, a labour mobility expert at the Australian National University, said the PALM scheme created "great opportunities to work overseas" but had potential pitfalls.
While it has historically been difficult for Pacific nurses to get Australian visas, Professor Howes said that had changed.
"They can now apply to come to Australia under PALM to work in an aged care home not as a nurse, but as a sort of lower paid, personal carer," he said.
"On the Pacific side, the key issue to watch out for is brain drain, so we don't want to be causing or contributing to worker shortages but you don't hear anyone saying, 'well, let's shut down these programs'.
"It's a challenge that needs to be met by careful management."
Professor Howes said more nurses should be trained to meet demand.
"It's not a great outcome because they're basically over-qualified for the job," he said.
"The scheme is offering financially attractive opportunities by Pacific standards, but in relatively unskilled positions."
Labour mobility expert Rochelle Bailey warned there was "always that potential for brain drain".
"We really need to look at what is actually happening in the employment market of the countries to ensure that we are not taking too many from a country at a time," she said.
New Zealand also recently boosted its intake of Pacific nurses to address local shortages.
A 'brilliant' opportunity for care workers
Not all the Pacific Islanders coming to Australia to work in aged care are over-qualified.
For 29-year-old Dee Naikidi, the PALM scheme is a perfect fit.
Ms Naikidi worked as a home-based carer in Fiji before taking on work in a care home in Western Australia.
Since there is not a huge demand for aged care in Fiji, it is a win for both her and her new Australian employers.
"For me, it's a really, really big step and a big change from my work, because back home, we were not really exposed to equipment, like computers," Ms Naikidi said.
"I find it brilliant for my skills."
She now lives on site in her care home for free, and says she and the other Fijian carers are being looked after well.
Cape Care chief executive Joanne Penman said Ms Naikidi and the five other Fijians — who were all care workers back home — were "absolutely fantastic" and hoped they would stay for at least three years.
"We actually do not know what we would have done without them," she said.
"They're such an important part of our workforce."
Training program established
The Australian government also established a pilot with Fiji this year to train Fijian aged care workers under the PALM scheme.
The first group of 40 workers arrived in late August, with a second group of 40 to arrive by the end of the year.
"Participants complete 12 weeks of intensive theory and practical training in Fiji before commencing supervised work placements," it said.
"Upon completion, participants will be awarded a Certificate III in Individual Support (ageing) and then continue working for the same employer under the PALM scheme."
