Penelope Smith and Juhani Capeding
What happens when the people who care for the world’s health are forced to leave their own communities behind?
Every year, on average 13,000 Filipino health workers migrate in search of opportunity not just for themselves, but for their families. In Australia, many find new roles in hospitals, aged care facilities, and clinics, yet their voices are often unheard in national conversations.
This article brings together two perspectives — one rooted in the country of origin, and the other in the country of destination — to reframe the conversation on health worker migration. We ask: how can we build a fairer, more ethical, and more human-centered future for those who keep health systems alive?
Two perspectives, one story
We are both Filipino, though our connection to the place and the culture is very different.
Penelope’s father, a mathematics teacher from Sorsogon City in the island of Luzon, took an opportunity through the Australian government in a faraway place called Rabaul, Papua New Guinea. His decision resulted in meeting Penelope’s mother, an Australian citizen selling books in Rabaul.
Juhani’s parents were given the opportunity to study abroad in Finland, a rare move at the time, given the limited opportunities and financial barriers facing most Filipinos. They eventually returned to the Philippines with an enduring belief that international education could be a pathway to national development.
The backdrop to both our stories is Philippines legislation and global change. In May 1974 then President Ferdinand Marcos enacted Labour code which would formalise and promote working overseas to Filipinos. It would create a system of economic dependence on remittances for the Philippines that is now seemingly impossible to undo.
Today, many Filipinos who pursue work and advanced training abroad cite better working conditions, higher pay, and greater professional recognition. For some, reintegrating into local hierarchies proves frustrating, especially when global experience is undervalued. The result is a system where working and studying abroad becomes less about national service and more about personal and familial survival.
These lived experiences and structural contexts inform both our work in public health today.
From personal to professional: Our work today
We are both interested in the experiences of international health workers. Together, we bring to the conversation the bookends of the migration journey—one grounded in the realities of departure and reintegration in the Philippines, and the other in the lived experiences of arrival and adaptation in Australia.
Penelope is a member of the Public Health Association of Australia, currently undertaking a PhD through University of Tasmania that explores the experiences of international health workers living and working in regional and rural Victoria. While not all these workers are Filipino, a significant number are. Early on in her PhD researching the WHO Global Code of Practice on the International Recruitment of Health Personnel (effective since 2010), she grasped the reality of the global story linked to the Philippines. This 2023 Al Jazeera article highlighted the pressure on health workforce capacity due to an exodus of Filipino nurses.
Alongside her PhD, Penelope undertakes higher education teaching for Victoria University in the Masters of Global Public Health course. Most students are individuals with previous clinical training, many who are working in health. Upon graduation, should they choose to remain in Australia they experience significant challenges and complexities.
Juhani is a member of the Philippine Society of Public Health Physicians. His fellowship with the World Federation of Public Health Associations took him to Norway. There, conversations with migration health experts, academic institutions, and embassy representatives revealed a recurring tension: the gap between ethical recruitment policies and the realities of global health workforce demand. Promising initiatives are beginning to address this — from OsloMet’s complementary study program for migrant nurses, to structured migration pathways like bilateral agreements under the Global Skills Partnership model.
The voices of international health workers
In Australia there has been little that elevates and privileges the voices of the international health workers. They become lost in the process of seeking to meet Full time Equivalent (FTE) needs for an organisation. In the Philippines, there has been a longstanding framing of migrant health workers as heroes whose remittances keep the economy afloat. However, this narrative often romanticises sacrifice while overlooking the structural conditions that compel migration, as well as the complex realities health workers face abroad.
Efforts to meaningfully capture their voices — their motivations, struggles, and contributions — have been limited. Research and policy discussions have tended to focus on money, rather than the lived experiences and aspirations of the workers themselves.
Toward a Fairer Global Health Future
Recent global health conversations have increasingly emphasized equity and decolonisation as central to building a more just world. The urgent need to reimagine global health strategies that not only fill workforce gaps but also uphold fairness and dignity; for those who leave, and those who are left behind.
For the foreseeable future Australia will continue to rely, particularly in regional, rural and remote areas, on international health workers as a strategy to address workforce capacity.
As active members of our respective national public health associations we see an opportunity to build a meaningful dialogue, one that explores deeply the full journey of international health workers. As fellow Filipino, Genevieve Gencianos from Public Services International stated in a recent speech about international health workers, “Solidarity knows no borders”.
Image: A collage of Filipino family and cultural momentos from Penelope’s collection.
Penelope Smith is a member of the Public Health Association of Australia, undertaking a PhD through University of Tasmania. Follow her on LinkedIn.
Juhani Capeding is a member of the Philippine Society of Public Health Physicians and is based in Manila. Follow him on LinkedIn.
Both authors wish to recommend a recent publication Mirage or oasis? Iranian immigrant nurses share their stories of working in overseas healthcare settings: a phenomenological hermeneutic study to readers interested in this topic
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