Olga Anikeeva, Research Associate, Primary Health Care Research & Information Service (PHCRIS) describes how a small rural health service has remained sustainable in a constantly changing health system environment…
Small rural communities that are characterised by dispersed populations and chronic shortages of health professionals frequently experience difficulties in maintaining quality primary health care services. There are numerous threats to rural health service sustainability, including small population sizes, socioeconomically disadvantaged populations, inadequate workforce, poor management structures and geographical isolation.
The article by Buykx et al focuses on the Elmore Primary Health Service (EPHS) located in rural Victoria and describes how it is adapting to ongoing political, health system and workforce changes to ensure its sustainability. Currently, EPHS employs eight general practitioners, three nurses, three allied health professionals and nine administrative staff and provides services to a catchment population of 2760 patients from the Elmore township and its hinterland.
The authors identified four key factors that have contributed to the successful operation of this service. The first of these was community engagement, which resulted in the local community being actively involved in the early development and ongoing growth of EPHS. Community members formed the Elmore Working Group, which worked to regain community control other health services, recruit and retain doctors and develop an integrated model of health care.
The second factor was strong leadership and committed champions with a vision. The small group of champions worked together with the community and neighbouring health services in order to develop an integrated primary health care organisation. This contributed to gaining community ownership and participation. Strategic relationship building was the third factor. The Elmore Working Group worked with the Department of Human Services and developed a strategic approach to optimise the use of scarce health professionals, while maximising community access to a comprehensive range of health services.
The final factor was the establishment of health service linkages. This enabled EPHS to provide a comprehensive range of primary health care services including after-hours emergency care, community nursing, health promotion, disease prevention and allied health services. Overall, the authors reported a high level of community satisfaction with the Elmore Primary Health Service. The service has contributed positively to local employment and encouraged other related businesses, such as pharmacies, to be established in the area. The organisation has pro-actively taken opportunities to strengthen the service and implemented practical responses to threats.
This highlights a number of important lessons for health service providers, policy makers and researchers, such as the importance of ongoing evaluation and monitoring; being attentive to changes that could have an impact on service sustainability; maintaining active community engagement; and succession planning.
This article, which can be accessed at http://www.biomedcentral.com/1472-6963/12/81/, features in the 5 July 2012 edition of PHC RIS eBulletin, available at http://www.phcris.org.au/publications/ebulletin/index.php.