Comments

Dear Dr Matthew Your paper does shine an important light in an area that affects healthcare in the Pacific island countries. However I believe that over the last decade strides have been made that might mute your discussion points, especially in regards to the Fiji Islands. Your paper quotes Pacific born Doctor numbers working in Australia over a 10 year period showed an increment by 34% in 2016 ( 455 -> 607). In the Fiji Islands, Doctors working in the country increased by 104% (400->815) over the last 5 years (Waqainabete, 2019). Moreover, Fiji as a country has developed, and in 2016 a massive increment in Healthcare professionals' salaries led to more retention of physicians. Additionally bonding and service contracts were strengthened for people sent for specialty training. These two changes are interlinked and seems controversial but is aimed to provide a more sustainable platform for the Fijian healthcare sector to train their own specialists in the future. However, solution one that you present seems quite conservative for aid giving nations at most. It is discriminatory. Why should the Fijian people or any others be penalised and not be hired if they were trained overseas? They may have already served their purpose. Soft evidence suggests that within the next few years, the medical field will be saturated in the small Fijian economy and therefore HCP's will most likely be groomed for export. Specific assessments and up to date data need to be collated in order to enhance meaningful change instead of generalising in the pacific. It may therefore be prudent to encourage developing island nations to better address and strengthen their retention tactics instead of using a totalitarian approach.

Thanks Duncan, I'm glad you got something out of it. As for the bit about my academic identity, I got my PhD from the ANU at the end of 2017, and do what I can.

Thanks. Nicely balanced and argued; I doubt the author is really an academic -his prose is too readable.

Very clear!

Thanks JK. Interesting comments & we'll certainly take on board as we develop our research. SD

I agree about cost of toursim in Timor Leste. I was there last week on holiday myself as a long time activist supporter. Another problem is that boats to Atauro have reduced and so ecotourism is suffering. We had hoped to spend 2-3 nights on Atauro but due to lack of boat transport I had to be content with a day trip on the Saturday ferry. There is huge potential in marine tourism but much more infrastructure and more supportive and strong regulatory environment needed to realise it so that Timor can actually benefit from it.

Slightly later in September 1990, a great promise was made in New York to the world's children: "On 29-30 September 1990 the largest gathering of world leaders in history assembled at the United Nations to attend the World Summit for Children. Led by 71 heads of State and Government and 88 other senior officials, mostly at the ministerial level, the World Summit adopted a Declaration on the Survival, Protection and Development of Children and a Plan of Action for implementing the Declaration in the 1990s." https://www.unicef.org/wsc/ This was part of the declaration issued that day: "The children of the world are innocent, vulnerable and dependent. They are also curious, active and full of hope. Their time should be one of joy and peace, of playing, learning and growing. Their future should be shaped in harmony and cooperation. Their lives should mature, as they broaden their perspectives and gain new experience." https://www.nytimes.com/1990/10/01/world/world-summit-for-children-excerpts-united-nations-declaration-children.html 30 years later this remains true - for the children of Syria, Iraq, Afghanistan or wherever war and civil disturbance shape their futures instead. Australia did sign up for the priority of putting children first for resources. Just how effectively has that commitment of 30 years ago been realised as priorities in Australia's aid program ?

Matthew, thanks for this thoughtful post on some important issues I am very glad are being discussed more. Three comments. First, I agree with Connell’s point that we lack the evidence we need for a complete cost-benefit-type analysis, and your point that harms are often presumed. Second, although there is not much evidence on the current scheme, a lot of high-quality work has been done (some of which you mention). In particular, the conceptual frameworks in McKenzie and Gibson (https://bit.ly/2G0JqMc) and Docquier and Rapoport (https://bit.ly/2L8a75P) provide useful starting points for thinking about the channels and what might go on each side of the ledger. Systematic studies credibly estimating these impacts from both the Pacific and other countries indeed give mixed result. However, for the most part, it does not suggest we should presume a drain (see, e.g., these two careful papers on the Filipino experience by Caroline Theoharides https://bit.ly/2JHChlh , https://bit.ly/2JnuZTe ). Satish Chand made this point most eloquently at the 2019 Pacific Update last Friday, drawing partly from his excellent paper with Michael Clemens on Fiji’s historical experience (https://bit.ly/2S22Hlf ). Finally, on the ballooning numbers you mention, a crude look at the national aggregates from the WDI suggests that nurses per capita in several (read: all that I looked at) Pacific countries are rising. For example, Fiji went from 1.9/1000 in 1999 to 2.9 in 2015 while Kiribati went from 2.3 (1998) to 4.6 (2013). These are of course denominated by population, which grew much slower: 806,000 to 869,000, and 81,000 to 108,000 for the same country-years. I am not sure if the numbers in the Australian and Pacific censuses include those temporarily away, but we should be able to assume these aggregate numbers from the World Bank are broadly consistent with them. My third point is thus that when thinking about sending country human capital stocks the current evidence does not let us rule out that the actual levels remaining and working in the Pacific would not be lower in the absence of exit options, an effect the recent careful studies I’ve linked to above all point towards. All this is but to say that (a) I would caution readers against starting from a “drain” prior, as the most careful prior work does not point to this, and (b) we really need more careful, systematic quantitative evidence on the benefits and costs for the diversity of participating countries in 2019. We are working on this at the moment, and welcome more to do the same!

We educate bulk of our population on Climate Change Please.

Has not been fully removed in Australia. Has only South Australia and Queensland to go.

Hi Richard, As a victim of this from 1986, I was whipped for simply smiling at a class clown, teacher was removed from school permanently and now they can't find her in QLD Government archives. I'm now an advocate for permanent removal in Queensland. Would like to speak via e-mail if possible?

Thanks Sinclair and Grant for this discussion Policing in PNG serves two purposes; (i) protecting lives and properties and (ii) bring those lawbreakers to face justice. Security in PNG serves one purpose; protect property is the foremost and lives to a lesser extent. In PNG we have security firm operating mostly in towns and cities where more commercial activities goes on and nil or no need for security presence in the villages or settlements. Police stations can be found in towns and cities as well as in the villages and settlements as they have a statutory obligation. In practice-security firms and personnel compliments manpower shortage in the Police force routine in policing work, especially in towns and cities-it works naturally in PNG, no formal agreement in place between the two entities. In the future, it is something that needs to be looked at to align; compliment and share policing work in PNG between security firms and Police force. However, policemen and women have sworn to serve the state under the constitution and security firms cannot exist under the same principle. To understand your hypothesis better, you could draw similar comparisons from other countries where Police and security firms work complement each other. In other countries where real guns are used and terrorism are a daily occurrence, would you recommend Police force and security firms to work together if it is going to be the case for PNG.