Building resilience and mitigating risk in our rural communities calls for long-term risk management, planning and deploying solutions based on our collective experience, emerging science and technology, and latest research. With this in mind, and with an understanding that we need to plan and prepare now while recent disasters and emergencies are still fresh, leaders from the NSW health sector have been coming together to debrief, exchange ideas and work on a common approach. The 2021 Natural Disaster and Emergency Learnings and Recommendations Report (The NDER Report) is the result of these efforts, focusing on the critical role of primary health care.
Why primary health care is key
If there is one thing we've learnt from a succession of natural disasters that began with drought and bushfires and continues today in NSW with COVID-19 and floods, it's that primary health care plays a critical role in any effective response and must be comprehensively integrated into disaster preparedness planning. This requires an understanding of disaster resilience in the NSW rural context, and a commitment to collaboration and coordination that can be embedded within our complex health and disaster response systems.
To achieve this, more than 30 organisations have come together regularly to share their vast experience and current thinking and develop a framework for future action. NSW Rural Doctors Network (RDN) and Australian Medical Association (NSW) had the privilege of facilitating this group.
Why is the role of PHC so critical?
While the underlying causes of emergencies vary, the resulting disruption has significant health consequences. Primary health care can provide essential routine health services, identify and manage emergency cases, prevent disease outbreaks with effective public health measures and play a key role in disease surveillance. It is the foundation for managing health risk and health outcomes in emergencies and therefore must be included in any disaster planning.
Primary health care has pre-existing links with communities and through its proximity and networks is well placed to understand the environmental, social and cultural elements that affect health. It can, therefore, deliver context-appropriate care as well as effective risk communication. In the recovery phase, due to its relationship with community and ongoing presence, primary health care continues to offer support, particularly in mental health.
What is disaster resilience?
Disaster resilience is the ability of individuals, communities, organisations and states to adapt to, and recover from, natural disasters and emergencies. Disaster resilience initiatives help people and organisations recognise how their strengths and capabilities can reduce risks, respond to the challenges and disruption of disasters should they occur, and adapt to the losses and changes associated with natural disasters and emergencies.
What are the challenges for building disaster resilience in rural communities?
Natural emergencies disrupt health care provision. Many rural communities are already chronically under-serviced or under-resourced and natural disasters and emergencies can exacerbate this shortage or the underutilisation of some health professions within the rural health workforce.
Disasters can also compound existing health disparities in local communities, particularly in rural, regional and remote areas. Some vulnerable groups within rural communities are particularly in need of mental health support following natural disasters.
In addition, the structure of our health system can add complications. In NSW, responses to health emergencies are the responsibility of the State health department, Local Health Districts (LHDs) and Primary Health Networks (PHNs) and involve both public and private structures. Strong links between these organisations must be maintained.
What have we learnt about the role of primary health care from recent disaster responses in NSW?
In addition to discussions between members, the Natural Disaster and Emergency (NDE) Group conducted two sector surveys and gathered intelligence to identify successes and missed opportunities in the sector’s response to the 2019-2020 natural disasters and emergencies. This process identified gaps in resources, features of useful resources, examples of strong health and social mobilisation responses and barriers to taking effective action.
The process also enabled the NDE Group to identify the need for better pre-planning at the local level, with strong partnerships and coordination mechanisms; and referral pathways at both local and systems levels alongside specific preparation to address nuanced rural risks, build community resilience and strengthen capability. Fostering a coordinated and supported rural primary health care response is essential to all of these. Details can be reviewed in full in the Report.
What recommendations are we making that would ensure primary health care is fully integrated into a capable, collaborative, response system?
Focusing on these conclusions, the NDER Report makes recommendations that aim to build an enabling environment for better system preparedness going forward.
Firstly, we must secure a seat at the disaster management table. This will facilitate a greater understanding of the role of primary health care in disaster management and support the localised planning and delivery of appropriate primary health care services prior to, during and following a natural disaster.
Secondly, we must take a long-term approach to prioritising and programming support needs and dedicated resources tailored to the unique situations of rural and remote communities. This includes investing in the wellbeing of the primary healthcare workforce and those offering frontline and recovery services. It also requires an investment in the mental health, wellbeing and self-care resourcing during and after a natural disaster or emergency.
Thirdly, we must target those working across the broader emergency management systems to improve their understanding of primary health care and general practice, to maximise their role and to ensure they are embedded in the disaster recovery response.
In essence, we can only hope to build disaster resilience, mitigate disaster risk and prepare for recovery, by coming together in the spirit of cooperation and with a commitment to strengthening the role and resourcing of the primary health care system in NSW.
For natural disaster or emergency support, please refer to COVID-19 Support and #RuralHealthTogether.
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