pacific island healthcare system

Unmanaged labour migration from Pacific Island nations to Australia and Aotearoa New Zealand is undermining the already fragile sustainability of their health care systems. Nurses and other skilled health workers are leaving underfunded public systems at home in the Pacific, only to face de-skilling, underpayment, and exploitation abroad.

A new report from Public Services International (PSI) and the Centre for Future Work at the Australia Institute warns this trend is accelerating toward a serious workforce crisis.

Consultations with health unions across Pacific Island countries – the first of its kind to use Talanoa-style consultations – unrooted these serious concerns.

Talanoa-style consultations uses open, relational conversations grounded in Pacific traditions, allowing workers to speak freely about their lives, fears, and hopes. Through this, many reaffirmed their commitment to serving their communities through public health care but described mounting pressures as labour migration continues to deplete the health workforce.

The report identified poor pay, lack of career progression, unsafe working conditions, and weak staffing in Pacific health systems as the main driving forces to migrate overseas; however, once in Australia or New Zealand, many end up in underpaid positions well below their skill level.

Dr. Paul Popora Bosawai, Minister for Health and Medical Services from the Solomon Islands, underscored the seriousness of the situation, noting that health unions and stakeholders across the Pacific are increasingly alarmed by the loss of healthcare workers to Australia and New Zealand.

“This trend poses a threat to sustainability and resilience of our national health systems, which are already under significant pressure.”

Michael Whaites, Assistant General Secretary of the NSW Nurses and Midwives Association, expressed strong support for addressing unmanaged labour migration and has urged the government to step in and intervene.

“Workers have a right to cross borders in the pursuit of better wages, working conditions and career progression, and they must be able to do so free from exploitation. [A]s demonstrated by this report, exploitation is occurring through Pacific Australia Labour Mobility (PALM) and skilled migrant pathways, and we’re seeing it on a massive scale, hidden in plain sight.

“The federal government must take stronger action to stop the exploitation of workers arriving in Australia and must act in reciprocity towards the Pacific Islands through greater funding for healthcare and worker training.”

The report calls for urgent regional reforms, including developing and reinforcing labour and migration agreements, tighter regulation of labour hire agencies, developing safe and secure methods for workers to report concerning behavior and treatment without risking their visas, and removing barriers to union membership.

A recent report by Public Services International (PSI) on the migration of skilled migrants from Pacific Island nations to Australia and New Zealand, has highlighted the urgent challenges facing these systems.

The report, based on consultations with health unions and workers across six Pacific nations, shows Pacific Island healthcare systems are under strain as skilled professionals increasingly migrate to Australia and New Zealand.

Health workers in the Pacific operate in underfunded environments, often in deteriorating facilities with limited equipment. Many travel to remote areas with poor infrastructure, facing risks such as isolation, inadequate housing, and gender-based violence. Professional development opportunities are scarce, and the lack of experienced mentors threatens the sustainability of future healthcare delivery.

Low public recognition and poor working conditions further erode morale. Combined with climate-related disruptions and rising service demands, these pressures are driving skilled workers to seek opportunities abroad.

Pacific Island skilled professionals are taking lower-skilled roles abroad

Despite their qualifications, many Pacific Island health care workers are migrating to Australia and New Zealand to work in aged care as personal care assistants. This shift is often facilitated by private recruitment firms that misrepresent job roles. Nurses report discovering their downgraded positions only after arriving in destination countries.

The lack of regulation and oversight in international recruitment leaves workers vulnerable to exploitation. Unions in both origin and destination countries have called for greater transparency and involvement in recruitment and onboarding processes to protect workers’ rights and ensure ethical practices.

Challenges in aged care migration workforce integration in Australia and New Zealand

Australia and New Zealand’s aged care sectors are increasingly reliant on migrant labour, including skilled nurses from Pacific Island countries. In response to domestic shortages, both countries have expanded migration pathways for aged care roles, many of which are low-paid and poorly regulated.

Private recruitment firms often mislead Pacific health workers, placing them in personal care roles that don’t reflect their qualifications. Once they arrive in their country of employment, employer sponsorship arrangements and imbalances in power limit their options, leaving them vulnerable to exploitation.

Excessive overtime, inadequate training, and high injury rates contribute to hostile working environments. Without reform, these conditions will continue to exploit migrant workers while failing to meet the needs of ageing populations.

This dynamic not only undermines the professional dignity of Pacific health workers but also depletes skilled labour from under-resourced Pacific health systems into precarious roles abroad.

What needs to be done

Current migration policies offer short-term relief for Pacific Island workers in the aged care sectors in Australia and New Zealand. However, they undermine long-term healthcare sustainability in the Pacific and perpetuate exploitative practices.

To address this, PSI is calling for coordinated regional action, including:

The development of holistic labour migration agreements that support Pacific Island countries’ social and economic development

Improved transparency in recruitment, with mandatory union involvement and oversight

Support for sustainable health workforce development, including retention strategies and pathways for returning professionals

Reforming the two countries’ aged care sectors to ensure decent work conditions, professional growth, and adequate support for migrant workers

Unions across the Pacific are playing a pivotal role in strengthening and expanding access to public health systems. In Australia, the New South Wales Nurses and Midwives’ Association (NSWNMA) is supporting the establishment of the Fijian Nurses and Health Care Workers Association – the international counterpart to the Fiji Nursing Association (FNA). This emerging organisation is a network for Fijian healthcare workers and aims to support the FNA in its advocacy for advancing the nursing profession and improving outcomes across the broader healthcare sector.

With purposeful intervention, labour mobility can be reshaped to benefit all parties involved, preserving healthcare capacity in the Pacific while ensuring fair treatment and opportunity for migrant workers.