Witnessing the surge in transmission of COVID-19 across large swathes of the country and hearing updates day by day of the virus encroaching into rural, regional and remote communities is extremely concerning from a rural health perspective.
The national response to COVID-19 includes the emergency preparedness done by the rural health system. Responding swiftly to reported cases and potential outbreaks has been well executed, as we’ve seen in various towns and regions in Queensland, New South Wales and Victoria.
Health services in rural Australia are renowned for providing community-based, patient-centred care, and everyone working in health has done an incredible job of getting public health information out into communities, ramping up testing and tracing, and overcoming the logistics and challenges of getting our rural population of seven million people vaccinated.
As the peak body supporting rural health, the Alliance includes Aboriginal and Torres Strait Islander health organisations and services, as well as rural doctors, nurses and pharmacists.
These organisations are at the frontline of the COVID-19 response, and as an Alliance we are part of the broad national infrastructure that is managing the COVID-19 disease.
Equity concerns
As we move slowly through the phases of the pandemic, we have three major concerns for rural health.
First is equity, with people not being able to access services in an already sparse rural health system which is being diverted to emergency response.
Second is the state of the rural health workforce, with increasing pressure and fatigue being experienced by the rural practitioners and health professionals.
Third, and most importantly, are high risk groups, with more vulnerable people living in rural and remote areas.
Rural health is a complex public health issue. Rural Australians don’t access Medicare or the Pharmaceutical Benefits Scheme at the same rate as metropolitan Australians. This means there is a deficit in health expenditure in rural Australia, which the Alliance estimates to be around $4 billion per annum.
Issues around health equity have only deepened through COVID-19.
Even before the pandemic it was much harder to access health services in country areas; the more rural and remote you live the scarcer the medical and health services available.
This translates to people living outside metropolitan areas experiencing poorer health outcomes. They have shorter lives and higher levels of disease and injury.
This situation also puts them at risk for serious health complications associated with the COVID-19 virus and long-COVID, notwithstanding the protection of greater natural isolation which is key a factor in reducing the likelihood of significant outbreaks in rural and remote areas.
In this together
In spite of the incredible efforts of the RFDS, Aboriginal Community Controlled Health Organisations (ACCHOs), government in-reach services, the Primary Health Networks and private medical practices and pharmacies, the vaccination program rollout in rural areas is also mirroring this trend of health inequality.
The Australian Government’s recently-released data shows lower vaccination rates in rural areas, with the exception of Victoria.
With this knowledge of a lag in rural and remote vaccination rates it is concerning that we saw the NSW Government diverting some of their rural vaccination supplies to Sydney hotspots.
This is indicative of overall supply issues, and never more so than now is the slogan true that we are ‘all in this together’.
The Alliance is a member of the Australian Government’s COVID-19 Primary Care Response Taskforce, which has weekly briefings and discussions with health and community stakeholders. We have also been working closely with the federal Department of Health and the Consumers Health Forum to disseminate information to rural health professionals and communities about the vaccination program.
Through regular feedback sessions with frontline health organisations, we know that a key problem emerging is the physical and mental fatigue that is building in our already under-resourced workforce.
This is a serious development. There are many barriers to attracting and retaining rural health professionals.
These include professional barriers such as isolation, limited supervision, clinical experiences, peer support and work–life balance. There are also financial barriers such as private practice financial viability, complex funding sources and administrative burdens. Additional to these are the personal challenges around building social and professional networks, work opportunities for partners, and childcare and education.
No two rural communities are the same and the circumstances and needs of each community are unique; therefore, each jurisdiction has their own model of rural service delivery.
But equitable health means having access to multidisciplinary services and teams, including general practitioners, nurses and midwives, and allied health professionals such as physiotherapists, podiatrists, and psychologists.
This is a legacy problem that the Alliance and its member organisations are avidly working through with a new proposed model of care addressing the key barriers to attracting a rural workforce.
In a similar approach to the ACCHOs, the proposed model of care has nominally been called Rural Area Community Controlled Health Organisations, or RACCHOs.
Stakeholders are providing considerable valuable feedback on the model, which has now been included in the draft recommendations from the Primary Health Reform Steering Group for the Government’s Primary Health Care 10-Year Plan.