Moving to Australia from New Zealand was not a decision Ava* made lightly.
"We moved to New Zealand for the big Kiwi dream," she says. "The country was beautiful, the lifestyle we had was magnificent."
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 encountered bullying, she was at the end of her tether.
Ava took up short-term contract work in Australia before she and her family made the move permanently. She now lives in Queensland, and worked throughout the Covid pandemic.
"I'm on a hell of a lot more money here than what I was in New Zealand," she says. "That wasn't my big driving force, but I know that's a big driver for other nurses who have moved from New Zealand to Australia."
When the New South Wales government announced a $4.5bn pledge in early June to boost the state's health workforce by more than 10,000 over four years, the news was received frostily across the Tasman.
The chief executive of the New Zealand Nurses Organisation, Paul Goulter, expressed concern that the recruitment drive - which is set to hire 7,500 doctors, nurses and allied health professionals over the following 12 months - would result in more staff being lost to Australia.
"Whilst there's always been a number of nurses and other healthcare workers go backwards and forwards, there's a real sense that it's so bad over here that we may lose more than what we would normally," Goulter told Radio New Zealand.
Other Australian states have announced similar campaigns to attract healthcare workers from overseas. The Queensland government announced this week that it would target foreign doctors and nurses for recruitment, while Western Australia's relocation incentive, which ends this month, includes a reimbursement of $5,000 for flights to Perth.
Health workers have been migrating internationally for decades, moving for better pay, better working conditions, or the allure of a different lifestyle. But as countries focus recruitment efforts internationally to ease domestic pressures, experts warn that it may worsen existing inequalities amid a global shortage of healthcare workers.
The Covid-19 pandemic exerted a heavy toll on health systems around the world. The World Health Organization estimates that up to 180,000 healthcare workers died globally between January 2020 and May last year as a result of Covid.
More than 75 countries have put in place regulatory mechanisms to make it easier to recruit international healthcare workers, says James Campbell, the director of health workforce at the WHO.
Even before the pandemic, there was a large shortfall in healthcare professionals. A WHO report estimated that in 2018 there was a shortage of 5.9 million nurses, who account for the majority - about 59% - of the health workforce. The report also found that one in eight nurses globally works in a different country from where they were born.
The US, UK, Germany, Finland, Australia and New Zealand are among the top destination countries for migrating nurses, says Howard Catton, the chief executive of the International Council of Nurses, which represents more than 130 national nurse associations.
India and the Philippines - which "​​very deliberately educat[es] more nurses than they need" - have historically been sources of high numbers of migrant nurses, he says.
The ICN has noted that the pandemic has driven up the demand for nurses in destination countries, with the number of nurse vacancies almost doubling in Canada and the UK.
But healthcare worker migration is "not uniquely a movement from the global south to the global north," Campbell says, noting there had also been shifts across OECD countries.
Dana*, who works for an international recruitment agency for nurses in Australia, says most of the health workers she encounters are migrating from the UK and Ireland, many of whom previously worked in Covid wards or intensive care units.
"They've had a hard time in Europe over the last two years or so," she says.
"Opportunities are better here as well. The healthcare system is impeccable [in Australia], so it's not as tough to be a nurse here as it is [there], especially during Covid times."
Prior to the pandemic, the WHO estimated a shortage of 18 million health workers by 2030 - most of these in low- and lower-middle-income countries.
Burnout among fatigued health workers may only worsen the problem. The ICN estimates an additional 3 million nurses may quit early as a result of Covid-19, and has been concerned by an increase in industrial action globally.
Greater investment in health systems are needed to handle future increases in healthcare demand due to growing and ageing populations, Catton says.
"We have the global ambition of universal health coverage as part of the sustainable development goals," Campbell says. Achieving this requires more than just the international movement of a finite - and insufficient - number of healthcare workers.
"You can't have global competition for a finite resource," he says. "You need global collaboration."
*some names have been changed
