Roles and activities of the Commonwealth Government University Departments of Rural Health

ABSTRACT: Since 1996, University Departments of Rural Health (UDRH) have been established at Broken Hill, Mount Isa, Shepparton, Launceston, Whyalla, Alice Springs and Geraldton. Each UDRH is underpinned by Commonwealth funding for an initial period of 5 years. The role of the UDRHs is to contribute to an increase in the rural and remote health workforce through education and training programs, as well as a reduction in the health differentials between rural and urban people and between indigenous and non-indigenous peoples. A strong population health focus involving partnerships between existing health providers in a targeted region and the university sector underpins their operation. While UDRHs have been established as a means of addressing a national workforce problem, their organisational arrangements with universities and local service providers vary widely, as does the program mix of activities in education, research service development, facilitation and advocacy. This article outlines some of the activities and progress of the UDRHs to date.     

Value adding through regional coordination of rural placements for all health disciplines: The Broken Hill experience

OBJECTIVE: To describe the experience of the University of Sydney's Broken Hill Department of Rural Health (BHUDRH) delivering a regional program in far western NSW. DESIGN: Case Study Setting: The Australian Government's University Departments of Rural Health Program, established in 1997, has been responsible for setting up regionally coordinated rural placement programs for students from all health disciplines in each state and territory. RESULTS: Over nine years the BHUDRH has harnessed both academic and administrative resources to achieve greater efficiency in program delivery, increased support for students during their placement, and enhanced educational opportunities that draw on regional issues. The Broken Hill program accepts students from 22 Australian universities and places more students in the region, for longer periods than previously (271 students in 2005 compared with 140 students in 1998). CONCLUSION: Regional coordination, linked to investments in rural-based infrastructure and support systems can provide a sustainable platform from which to provide quality rural placements for students from all health disciplines, while at the same time increasing regional capacity to take students.     

Increasing rural activity and curriculum content in the Adelaide University Medical School

This study aimed to document the level of rural activity and curriculum content in the Adelaide University Medical School. A questionnaire was distributed to all heads of departments within the Medical School and additional information was obtained from reports and discussions with key personnel. There has been an increase in the proportion of students with a rural background enrolled from 9% in 1994 to 22% in 2000. There has also been an increase in the number of weeks available for rural placements from 12 (mostly optional) to 29 weeks (some mandatory), and an increase in the number of departments offering rural placements. There has also been improved academic support to rural practitioners and many departments directly provide services in rural communities. A new combined University Department of Rural Health (UDRH)/Rural Clinical School associated with the Adelaide University Medical School aims to provide at least half of all clinical training to 25% of all medical students of Australian origin.     

Delivery of the clinical components of the Newcastle University medical course in a multidisciplinary academic unit in Tamworth

The University Department of Rural Health (UDRH), northern New South Wales, Australia, was established in late 2001 by the University of Newcastle in Tamworth, New South Wales (NSW). The UDRH is part of the Commonwealth Department of Health and Ageing's Health Workforce Undergraduate Initiative and was the eighth UDRH to be established in Australia. The UDRH northern NSW delivers medical education as part of a multidisciplinary academic unit. At the end of 2003, six medical students graduated having completed all of their clinical training based in Tamworth. Over 60% of the local medical community were teachers in the program. These students studied with final year dietetic, occupational therapy and radiography students co-located in Tamworth during 2002 and 2003. In 2004, ten new graduates from the program have chosen to commence employment in the New England Area Health Service, including two medical students completing their internship in 2004. This represents the first time that the full clinical curriculum of an Australian medical school has been delivered entirely in a single rural setting. It demonstrates a new way of funding medical education which embraces local clinicians as 'faculty' and provides a way for regional centres to develop their own future medical workforce.     

A database to record, track and report health student rural placements

The Spencer Gulf Rural Health School (SGRHS), South Australia, is funded by the Australian Commonwealth Government to deliver health education in the rural setting. The SGRHS required a database to record, track and report on student rural placements to satisfy Commonwealth reporting requirements, and for internal academic and administration staff use. Staff in widely separate rural locations needed to be able to access the database. A web-based relational database was created using Microsoft Access. The student rural placement database has been successfully utilised as the primary tool to record and track student placements in the SGRHS for 2 years, and has generated data for eight Commonwealth reports in this time. Future database developments include student accessible sections. With few alterations the database could be utilised by other Australian Rural Clinical Schools and University Departments of Rural Health.     

Approach to sustainable primary health care service delivery for rural and remote South Australia

ABSTRACT: We describe the operation of four University Teaching Practices established by the South Australian Centre for Rural and Remote Health (SACRRH) and the Adelaide University Department of General Practice. These practices were established in response to the acknowledged difficulty in recruiting and retaining GPs in rural South Australia. The practices are co-located with a hospital or accident and emergency service and community based nurses and allied health professionals. They provide integrated health care and multidisciplinary health care student placements in a learning environment where students experience rural multidisciplinary practice and country life. The study found that although the sites differed in significant ways, they all provided integrated care and effective placements for students. This style of health care delivery is flexible and broadly applicable. Sustainability is achieved through financially viability, attracting and retaining health care professionals and the development of electronic information systems, to support integrated practice.     

Loss of income and levels of scholarship support for students on rural clinical placements: A survey of medical, nursing and allied health students

Objective:  To quantify the financial impact of rural clinical placements on medical, nursing and allied health students in rural Australia.
Design:  The Careers in Health Tracking Survey provided data on whether students were employed, usual weekly hours of employment and a range of covariates, such as age, sex, course of study, marital status, dependants and rural or urban origin.
Participants:  A total of 121 students from a range of health professions completed the Careers in Health Tracking Survey while on rural placement at the Northern Rivers University Department of Rural Health.
Outcome measures:  Survey data.
Results:  Forty-one per cent of respondents were working immediately before their clinical placements. Nursing students worked the longest hours by far and were significantly more financially disadvantaged than both medical and allied health students ( P <  0.01). Scholarship support was unevenly distributed, with nursing and allied health students being relatively under-supported in relation to lost earnings.
Conclusion:  Recruitment of students can be an effective strategy to address the rural health workforce shortage throughout Australia. However, there are a number of financial disincentives for students to undertake rural clinical placements. Additional support for some disciplines is needed to provide equitable distribution of scholarship support to offset this financial burden. Establishing an employment scheme for students on rural clinical placements and a scholarship for income replacement where employment is not available would also alleviate income loss.     

Undergraduate nursing students' experiences in a rural clinical placement

Objective: This paper draws on questionnaire findings and analysis of students' comments to demonstrate the aspects of rural placements that were effective in engaging students in the learning process. It also examined how a primary health care clinical placement in Aboriginal communities can provide nursing students with a rich and varied learning experience and an insight into the complex aspects of rural life including Aboriginal health. Design: A cohort of eight second‐year nursing students from the Australian Catholic University, North Sydney, in partnership with the Broken Hill University Department of Rural Health (BHUDRH), participated in a 4 weeks' rural placement in far western New South Wales. A pre‐test/post‐test questionnaire was used to capture their experiences with the students completing the questionnaires before and after their clinical placements. Such placements offer students opportunities to deepen their understanding of issues related to rural health in clinical, professional, social and community contexts. Results: The results suggest that clinical experience in rural areas can positively influence attitudes, preparedness for practice and engage students on many levels, deepened their understanding of rural communities and issues related to rural health. Conclusion: This group of undergraduate nursing students indicated they all had a positive learning experience in their rural clinical placement. The value of rural placements as a method for increasing nursing student's practical experience should be promoted.     

The National Rural Health Unit: The Consultation and Planning Phase

ABSTRACT: The National Rural Health Unit is Australia's peak body for rural and remote area health research. It has been established as a national network by a consortium led by the Monash University Centre for Rural Health in Moe, Victoria. During the consultation and planning phase, the Unit has sought input from interested individuals and organisations through a questionnaire survey and a national consultation and planning workshop. Priority issues identified by the survey were: rural health service policy and delivery; rural health workforce recruitment and retention: rural health workforce continuing education and professional development and Aboriginal health. The workshop brought together key opinion leaders with broad representation of the various health disciplines, geographic locations, health authorities, professional organisations and rural health research centres. From the workshop emerged recommendations for five-year and one-year goals of the Unit.     

中国农村基本卫生保健工作发展与思考

目的：了解我国农村地区基本卫生保健工作的现状,以及在新世纪第一个十年中取得的成绩和存在的问题,为进一步推进农村基本卫生保健工作提出有针对性的政策建议。方法：按照分层抽样的方法,在全国选择400个县级行政单位,收集当地农村基本卫生保健工作的相关数据。结果与发现：（1）农村基本卫生保健工作得到政府重视,但财政保障仍不足;（2）乡村两级医疗卫生服务体系建设仍需不断完善;（3）基本公共卫生服务在医改政策推动下进展明显,后续要加大力度推进;（4）新型农村合作医疗制度不断完善;（5）基本药物制度实施使基层医疗卫生机构面临发展困境。     

A conceptual model for recruitment and retention: allied health workforce enhancement in Western Victoria, Australia

Attracting and retaining allied health professionals in rural areas is a recognised problem in both Australia and overseas. Predicted increases in health needs will require strategic actions to enhance the rural workforce and its ability to deliver the required services. A range of factors in different domains has been associated with recruitment and retention in the allied health workforce. For example, factors can be related to the nature of the work, the personal needs, or the way an organisation is led. Some factors cannot be changed (eg geographical location of extended family) whereas others can be influenced (eg education, support, management styles). Recruitment and retention of allied health professionals is a challenging problem that deserves attention in all domains and preparedness to actively change established work practices, both individually as well as collectively, in order to cater for current and predicted health needs. Changes to enhance workforce outcomes can be implemented and evaluated using a cyclic model. The Allied Health Workforce Enhancement Project of the Greater Green Triangle University Department of Rural Health (GGT UDRH) is working towards increasing the number of allied health professionals in the south west of Victoria. Based on themes identified in the literature, an interactive model is being developed that addresses recruitment and retention factors in three domains: (1) personal or individual; (2) organisation; and (3) community.     

NATIONAL RURAL HEALTH POLICY AND THE ROLE OF THE NATIONAL RURAL HEALTH CONFERENCES

ABSTRACT: The biennial National Rural Health Conference has become an essential feature on the calendar of events for rural and remote health professionals, researchers, public servants and consumers. Since the first conference held in 1991, attendance has grown significantly, factors hindering the achievement of optimal health for all rural and remote Australia have been clearly identified, and recommendations for action have been endorsed by the broad rural health constituency. These recommendations have provided valuable input to the National Rural Health Strategy and many programs and policies of Commonwealth and State departments of health. Significantly, too, the first four conferences have facilitated greater collaboration among rural and remote health professionals and provided a major catalyst in fostering cooperation between consumers, health workers, service providers and governments.     

A Rural Health Education, Training and Research Network for Queensland

ABSTRACT: The purpose of the Rural Health Education, Training and Research Network is to support the education and training of rural health practitioners and research in rural health through the optimum use of appropriate information and communication technologies to link and inform all individuals and organisation involved in the teaching, planning and delivery of health care in rural and remote Queensland. The health care of people in rural areas has the potential to be enhanced, through providing the rural and remote health professionals in Queensland with the same access to educational and training opportunities as their metropolitan colleagues. This consultative, coordinated approach should be cost-effective through both increasing awareness and utilisation of existing and developing networks, and through more efficient and rational use of both the basic and sophisticated technologies which support them. Technological hardware, expertise and infrastructure are already in place in Queensland to support a Rural Health Education, Training and Research Network, but are not being used to their potential, more often due to a lack of awareness of their existence and utility than to their perceived costs. Development of the network has commenced through seeding funds provided by Queensland Health. Future expansion will ensure access by health professionals to existing networks within Queensland. This paper explores the issues and implications of a network for rural health professionals in Queensland and potentially throughout Australia, with a specific focus on the implications for rural and isolated health professional.     

Rural health around the world: challenges and solutions

Despite the huge differences between developing and developed countries, access is the major issue in rural health around the world. Even in the countries where the majority of the population lives in rural areas, the resources are concentrated in the cities. All countries have difficulties with transport and communication, and they all face the challenge of shortages of doctors and other health professionals in rural and remote areas. Many rural people are caught in the poverty- ill health-low productivity downward spiral, particularly in developing countries. Since 1992, WONCA, the World Organization of Family Doctors, has developed a specific focus on rural health through the WONCA Working Party on Rural Practice. This Working Party has drawn national and international attention to major rural health issues through World Rural Health Conferences and WONCA Rural Policies. The World Health Organization (WHO) has broadened its focus beyond public health to partnership with family practice, initially through a landmark WHO-WONCA Invitational Conference in Canada. From this has developed the Memorandum of Agreement between WONCA and WHO which emphasizes the important role of family practitioners in primary health care and also includes the Rural Health Initiative. In April 2002, WHO and WONCA held a major WHO-WONCA Invitational Conference on Rural Health. This conference addressed the immense challenges for improving the health of people of rural and remote areas of the world and initiated a specific action plan: The Global Initiative on Rural Health. The "Health for All" vision for rural people is more likely to be achieved through joint concerted efforts of international and national bodies working together with doctors, nurses and other health workers in rural areas around the world.     

Challenges in Evaluating Rural Health Programs

Complex community-based prevention programs are being held to scientific evidence of their effectiveness and rural public health departments that implement such programs often are not equipped to evaluate them. Rural public health departments are fettered by small budgets, small staffs, and less access to evaluation experts and similar resources. Community-based health promotion programs can include complex designs that may work differently in rural areas and evaluation of rural programs can be hampered by lack of control groups and the instability of results from small populations. The University of Kentucky has entered into a contract with the state Department for Public Health to implement an internal, participatory model of evaluation. In this model, the university evaluation expert trains local public health department staff in technical skills for program evaluation and acts as mentor and technical consultant to local public health departments on an ongoing basis. Through training and site visits, this model is one approach to addressing the challenges of evaluating rural health promotion programs.     

The University of Sydney Rural Careers Project

ABSTRACT: This article describes the activities of the University of Sydney Rural Careers Project, which was established to increase the opportunities for undergraduate students in the health professions to learn more about what it is like to live and work within a rural community. After 18 months of operation, the project has attracted wide support among students and staff, and could be seen as a model worth replicating in other universities. Stimulating interest in rural practice may increase the numbers of health professionals interested in entering rural careers after graduation.     

Rural Health Care in Bolivia*

ABSTRACT: Eighty percent of Bolivians live in rural areas. However, because of a lack of resources and an urban / curative health sector orientation, rural primary health care services are woefully inadequate. Consequently, Bolivia has the worst health conditions of any of the Latin American countries. The broader factors which underlie Bolivia's poor health conditions, such as the low standard of living and impediments to socioeconomic development, are reviewed. Rural primary health programs are hampered by a lack of local support, overdependence on central and distant Ministry of Health supervisory staff, a lack of strong national political support for rural primary health care programs, the absence of public sector support for social programs, and a lack of appropriately trained health providers who are comfortable in the rural sociocultural mileu of community-oriented primary health care. The experience of Andean Rural Health Care is briefly described, and the potential contribution of private organizations working with local communities and with the Ministry of Health is addressed. The most viable option for improving rural primary health care in Bolivia is the census-based community-oriented approach.     

Framework for the strategic and business planning of the Centre – School of Public Health, Belgrade

The science and practice of the New Public Health have a key role in the promotion of people’s health and in the reform of the health system. Serbia experienced many social and economic threats to public health during the 1990s when the health infrastructure both for curative and preventive services gradually deteriorated. Existing skills and knowledge of public health professionals are insufficient in virtually all fields of public health activities. The foundation of the Centre – School of Public Health, within the Medical School of Belgrade University has been a precondition for the improvement of professional training in public health. The objectives are described as (1) education of capable experts in the field of public health, (2) improvement of knowledge in the health sciences, (3) health promotion in cooperation with local communities, (4) training of competent researchers in the field of public health and (5) improvement of the process of decision making and policy formulation. The training programme covers five key areas of education in the domain of public health: (1) public health in Europe, (2) epidemiology and biostatistics, (3) health policy and management, (4) health promotion, health education and social sciences and (5) environment and health. In the first year, 27 students were admitted for the Master of Public Health programme and more than 350 participants attended various short courses for continuing education in public health and health management based on applied learning approach. The next developmental steps focus on sustainability of the programmes for continuing education and research and a wider national and international partnership.     

建立农村突发公共卫生事件应急机制的对策

SARS提醒我们，建立农村突发公共卫生事件应急机制是当前迫切需要解决的问题。尽快出台一部完善的《公共卫生法》，把农村突发公共卫生事件处理的相关环节纳入法制轨道；建立健全农村三级医疗卫生服务体系，形成县、乡、村三级应急机制；加大农村公共卫生投入，完善农村公共卫生体系；建立农村公共卫生资源储备制度，为突发事件的应急处理迅速提供必要的支持；加强健康教育宣传力度，探索适合农村社会、农民心理的救助机制。