Promoting rural academic and community partnerships in the independent state of rural Australia.

Abstract

A fundamental feature of rural communities in Australia is the interconnected relationships of the people in them and how these are harnessed for the benefit of the community. This is never more evident than in times of difficulty or crisis; many have noted the prevailing resilience and stoicism of rural communities. However, even the most determined communities can be challenged by accessing health services. As a General Practitioner and a Mental Health Nurse, the difficulties rural Australians have in accessing evidenced-based mental health services is particularly concerning. Obtaining psychological therapies in rural Australian communities can be almost impossible due to the lack, and availability, of trained healthcare professionals. Rates of suicide are 30% higher in the bush, unacceptable for one of the wealthiest countries in the world. The Rural Health Multidisciplinary Training Programme (RHMTP) has built a quality rural training programme which promotes rural academics and communities working together. It is a uniquely Australian approach to generate sustainable workforce solutions in partnership with rural communities. It works with rural communities to provide quality clinical training experiences for the future health workforce, a feature pivotal to the RHMT programme for 20 years. In addition to supporting to health students, in South Australia, we provide professional development for the existing rural health workforce, employ rural clinicians as academics, build rural academic capacity and conduct rural health research of meaning to rural communities. All of this helps to strengthen rural networks and enables rural communities to grow and develop. Our experience as Directors of two RHMTPs is that rural communities are energetic, accepting and receptive to innovative solutions to workforce recruitment and retention to address professional shortfalls in rural communities. In South Australia, to help us attract the next generation of health professionals, we have utilised the expertise of health students to engage rural school communities showcasing the benefits of pursuing a health career. We have worked with our communities to grow unique rural placement experiences that build the social capital of rural communities. We welcome the contribution of the newly appointed Rural Health Commissioner Professor Paul Worley. This appointment presents an exciting opportunity to revisit and think broadly about how to provide the future workforce with alternative clinical training and research experiences and encourage them to ‘go bush’. This might include rural academics and health providers co-locating, to establish joint academic and health service centres. These centres could offer world-class rural clinical training experiences, provide career development, and conduct high-quality rural research built around the needs of rural communities. Co-location of academics with health care providers will provide opportunities for people living in rural Australia to participate in clinical trials and formulate NHMRC partnership grants with academics and rural health partners. The integration of rural academics into rural health centres brings strength in conducting, translating and implementing research. It would also enable rural academics to work with community partners in research capacity building, such as completing ethics application, writing peer review papers and grant writing. As a community of practice, communities would train and guide academics in community engagement activity. This in turn would drive rural student training programmes and rural workforce development. We would ask our Rural Health Commissioner to consider local government involvement in the training experience and working with the private sector to attract investment, and purposeful involvement with rural communities to help ensure community needs fit with broader government strategy. An example would be provision of housing for students with a genuine commitment to return and work in that community. We are reflecting that perhaps two important next steps to for the RMTP progarmme are to focus our attention on supporting rural origin students and showcase the distinctiveness of the rural immersion learning experiences which rural Australia has to offer. Rural origin students are most likely to remain or return to rural Australia. The most challenging work is to bring three different groups together – health service providers, education institutions, and non-health facilities (government and nongovernment) – to work with local communities and develop local contextual solutions. The RHMTP and the leadership role the universities have in ensuring their successful implementation is an exemplar to the global community and helps address the unacceptable health inequalities between metropolitan and rural Australia. We encourage State and Commonwealth providers to place a higher value on community-led solutions, however innovative, as likely to succeed where traditional interventions have not. Communities with a sense of isolation will continue to advocate for conventional answers if they believe this is the only way forward. We should be talking to communities about how to enhance the social capital they invest in our future health workforce. Activity such as this builds the social capital of rural communities and deepens the clinical training experience.