Researching for better health for regional and rural Australians?

Abstract

In November 2019 the Federal Government announced $100 million would be allocated to increase clinical trial participation for rural Australians.1 This is welcome and applauded. At the time of publication, the details of this grant program were not available, but it is pleasing to see the focus on improving facilities and services and increasing rural research capacity. It is also heartening to see this was a joint announcement with the Minister for Regional Services, Decentralisation and Local Government and the Minister of Health. It seems to indicate that they appreciate that rural health and regional development are interwoven. This bodes well for the intended outcomes and for genuine rural input, control and oversight of the process. With limited funding, there is always a need to prioritise. In good programs, a “golden thread” of policy continuity is evident. This thread connects the best international research evidence and expertise with national policy and state policy, and effectively articulates this with the local context. This does, of course, raise the question about the lack of a national rural health strategy.2 Agreed priorities and implementation strategies are an essential part of effective program implementation. Some of our greatest improvements in health status in rural Australia could be addressed through more effective use of the personnel, infrastructure and clinical expertise already in place. Although there are acute shortages in the rural allied health workforce,5 GPs, nurses and pharmacists comprise a highly skilled, workforce widely dispersed across rural Australia. Research focusing on more effective models of care through integration6, 7 and better use of the existing workforce probably represents the best return on investment for this research funding. Apart from developing new medicines and innovative treatments, the health of communities is about control.8 It is about personal and community agency and autonomy. Placed-based planning and priority setting is an important aspect of this.9 Money is power, and for communities, controlling funding and its allocation has a profound impact on community benefit. Time and time again we see rural funding given to “central” organisations for rural service provision, only to see, when things get tight, distal projects are neglected. If we are serious about improving rural research outcomes, the control of the funding must lie with rural communities. The funding might still support metropolitan-based research group, but the vital component is this has been determined as the best option by the local community. Via the local community controlling the funding, and monitoring performance, partnerships between the city and country are forged and strengthened. Another risk is that mainstream grant assessment panels might assume rural communities already have their grant program, therefore be (informally) disqualified from the major grant funding streams. The proportion of the total health research funding to rural communities is already very low.10 This program seeks to address this gap and enhance research capacity in rural communities.11, 12 We must ensure it does not unintentionally result in the gap becoming greater. What we do not want is a process that results in a residue of envy between city and rural research organisations. Good research and policy implementation combines the technical expertise and critical mass available in major metropolitan research institutes, along with the expertise, capacity and the place-based intelligence of rural research institutes.4 In addition to the clinical trial findings, the program should leave a legacy of greater appreciation of the rural health in the city centres and enhanced local capacity in rural communities. Third-generation telehealth models integrating service delivery and connecting the rural workforce with specialist support from capital city hospitals exist13, 14 and have tremendous potential to be applied to process of research implementation. On the other hand, responding to local imperatives runs the risk that projects are so site-specific that the research does not effectively answer the research question or that the results are not generalisable to other rural communities. Thus, it is important that coordination across the rural and regional centres occurs to enable large multi-site trials.2 Again, while this might emerge organically, the lack of a rural health strategy hinders collaboration. This program is very welcome. If we ensure the rural control and alignment with a national rural health research strategy, this research initiative should prove of great benefit to rural communities. Professor Roberts may submit a funding application to this grant program.