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Catalysing improvements in rural health

G. Gregory

The Australian Journal of Rural Health © Volume 3 Number 3, August 1995

Aust. J. Rural Health (1995) 3, 132-142

National Rural Health Alliance

CATALYSINGIMPROVEMENTSIN RURALHEALTH

National Rural Health Alliance, De&in, Australian Capital Territory, Australia

ABSTRACT: The National Rural Health Alliance is the peak non-government body working to

improve rural health and health services. It has been fully operational since August 1993 and has

produced submissions to government on a number ojrural health issues. Through its work it has

increased the public profile of rural health policy in Australia, without endangering the autonomy

oj’the 15 national bodies which constitute the Alliance. Given the prolijeration ojindividual bodies

concerned with various aspects of rural health, and the complex und c1zangin.g policy situation, the

Alliance ha,s a crucial role to pla,y in helping to manage the interface between governments,

consumers and rural health providers. The mission oj the Alliance is informed by a strong

philosophy oj increased consumer involvement in the design, management and evaluation of local

health services. The Alliance rejlects the aspirations oj rural and remote people for high quality

and accessible health services. The chances of this mission being accomplished will be increased to

the extent that individual professional bodies and local groups work in partnership with central

organisa,tions like the Alliance.

KEY WORDS: community involvement, National Rural Health Alliance, policy development,

rural health.

Initially established in 1992, the National Rural

Health Alliance (NRHA) has been fully opera-

tional since August 1993. It is the peak non-

government body for rural health providers and

consumers. The NRHA is now comprised of 15

national bodies (Table 1).

The NRHA works to find common ground

between all of these member bodies in order to

improve the health of people in rural areas and

the health services available to them. The

NRHA’s Mission Statement is ‘to promote the pro-

vision of high quality, accessible and appropriate

Correspondence: G. Gregory, National Rural Health

Alliance, 42 Thesiger Court, ACT 2600, Australia.

AcceptedJbr publication April 1995.

health care in rural areas through partnerships

between health consumers, providers and

managers’.

Given its composition, the NRHA is in a

unique position to provide information to those

who plan and manage rural health services. It

also acts as a lobbyist on rural and remote health

issues and is increasingly being heard by policy

makers because of its wmidely representative

membership.

All of the funds that enable the NRHA to

operate have been provided by the Common-

wealth Department of Human Services and

Health, mainly through the RHSET program.

Despite government funding, the NRHA is

expected and able to take positions of advocacy

NATIONAL RUR.\L HE.iLTH ALLIANCE: G. GREGORI- 139

TABLE 1: \utional Rural Health Alliance: 1.5

national bodies

AARN

ACHA

ACHSE

ANF

ARRAHT

ATSIC

CRANA

CWA

FRM

NACCHO

NARHTU

RDAA

RFDS

RPA

RRCHN

rlssociation for Australian Rural Nurses Inc

Rural Interest Group of the Australian

Community Health Association

.1lustralian College of Health Service

ExecutiT-es (rural members)

Australian Kursing Federation (rural

members)

Australian Rural and Remote Allied Health

Taskforce

.%original and Tortes Strait Islander

Commission

Council of Remote Area lUurses of -Australia

IIlC

County Women’s Association of .%uatralia

Facult!- of Rural Medicine of the Ro!-al

.ktstralian College of General Practitioners

National ilboriginal Controlled Communit!-

Health Organisation

Kational .ksociation of Rural Health

Training Units

Rural Doctors’ lssociation of -Australia

-Australian Council of the Ro!-al PI! ing

Doctor %rl-ice of Australia

Rural Pharmacists -Australia

Rural and Remote Consumer Heallh

Net\\~ork

for rural health consumers. This sometimes

means that it makes demands on. or critical con-

ments of; Commonrrealth, State and Territolr

health policies. It is to the credit of the politicians

and health public sel?-ants invol\med that a pl-ofes-

sional relationship has cle~~eloped &ch enables

the NRHA to fulfil this task \\-ithout endangering

its limited resource base.

The NRHA non has a full-time Executive

Director? Gordon Gregon-: based in Canberra. The

members of its Council hold a teleconference

once a month and meet face-to-face twice a \-ear.

Moves are being adopted to hold these face-to-

face meetings at the same time and at the same

place as meetings of the Forum of Rural Health

Policy Units. This would enable the two groups to

meet, thereby strengthening the links bet\\-een the

State, Territory and Commonwealth Rural Health

Policy Units and the NRHA. The Forum of Rural

Health Policy Units comprises the heads of the

Rural Policy Units from the States: the Northern

Territory and the Commonrrealth.

Much of the profile of the I\RHA. as distinct

from that of its member organieations: comes from

the existence of its Canberra office and the work

of its executive. This has been achier-ed by the

expression of a corporate I\RH-1 approach to gov-

ernments, oppositions and health policy makers

and managers.

The NRHA played an important role in the

review- of the National Rural Health Strategy in

early 19942. It has pro\-ided ad!-ice to a number of

government committees concerned T\-ith rural

health issues, and early and ke!i support for the

establishment of the Australian Rural Health

Research Institute. It has also produced submis-

sions to the Commonwealth Government on spe-

cific issues, including the National Aboriginal

Health Strategy, the evaluation of the Rural

Incentives Program and the ReT-ielr of Profes-

sional Indemnity Arrangements. It has also pro-

duced a number of papers. articles. press releases

and other materials that ha\-e increased the pub-

lic profile of rural and remote health issues in

Australia.

While undertaking these actKties the NRHA

is careful not to interfere J\-ith the internal opera-

tions of its member bodies. It is important that all

member bodies maintain their autonom!~ so that

they are able to promote their o~\-ii interests,

which from time to time 7\-ill be narrow\-er than

those of the KRH_&. m-here there is agreement

betlreen all of its member boclies the NRHA is

able to add comiclerahle I-alue to the I\-ork of its

individual members. The beneficial impact of the

NRH.1 has been particularl!m strong for those

members J\-hose parent bodies are national health

associations: for them, membership of the KRHA

has stimulated and strengthened their rural inter-

est and their rural \-oice.

It is argued that the success of the NRHA

provides a good model for interprofessional and

140

intersectoral work on rural health which should

be adopted regionally. The Central Australian

Rural Practitioners’ Association (CARPA) is one

‘alliance’ which pre-dates the NRHA and which

adds strength to this argument.

THE PROCESS OF RURAL HEALTH

POLICY FORMULATION

At the Second Rural Health Scientific Conference

in Toowoomba in August 1994, one of the more

cynical or conference-hardened delegates com-

mented on w-hat he described as the ‘burgeoning

rural health Mafia’. His remark reflected the fact

that there are now far more formal bodies

involved with rural health policy than was the

case in 1991. This is part of the reason why, as

pointed out in an earlier edition of this journal by

John Humphreys, ‘the rural health community is

better organised than it was a decade ago’.l

There are a number of reasons for the prolifer-

ation of bodies concerned with rural health. One

reason may be the desire of specific groups to be

represented. Health professionals, as well as con-

sumers and those concerned with specific issues

in rural health (e.g. women’s health, sexually

transmitted diseases, mental health), see them-

selves as requiring an organisation that can rep-

resent their own particular vested interests. This

is a functional development but one that brings

with it the sorts of complications alluded to by the

reference to ‘the Mafia’. There is the real danger

that, in focusing on their own narrow vested inter-

ests, a particular group may lose sight of the big

picture of rural health issues as described in the

National Rural Health Strategy. Problems may

arise if these separate groups fail to communicate

well with each other.

Prevention or reduction of these problems is

one of the most important functions for the

NRHA. It provides a forum for the major

providers and consumers to keep in close touch

with each other and, given the bottom line for the

NRHA (the improvement of rural health out-

comes), a forum in which all aspects of health will

be considered. These considerations have led to

AUSTRALIAN JOURNAL OF RURAL HEALTIH

TABLE 2: Issues idenkjied by NRHA as having the

highest priority”

Mental health

Rural Health Training Units

Domestic violence

Aboriginal and Torres Strait Islander health

Women’s health

Community access to health care

Rural access to government programs

Personal support for health professionals working in

remote areas

Personal support for health professionals who are

isolated

Early discharge from hospitals and its effects on

continuity of care

Rural suicide

Education and training

Recruitment and reten Lion

Provision of specialist services

The rural incentives program

Purchaser/Provider separation models

Intersectoral collaboration and primary health care

Matters relating to the Australian Rural Health

Research Institute

An Office of Rural Health

Community consullalion

R d’ t ‘b t’o e is x-1 u i n 0 iesources f

Transport

Men’s health

Ageing

Health consumers and a charter of rights

* Not in order of priority

the NRHA’s identification of 25 issues w-hich it

regards as being of the highest priority for its

attention (see Table 2).

The process of rural health policy develop-

ment in Australia is complex. This reflects our

nation’s Federal system, the division of responsi-

bility for various determinants of health and well-

being between three levels of government, the

size of the country, the inherent difficulty of

addressing problems of ill-health in rural and

remote areas, and the proliferation of interested

bodies referred in Table 1. An analysis of the

process of rural health policy development from

NATIONAL RURAL HEALTH ALLI-1NCE: G.GREGORI- 141

the NRHA’s point of view will appear in a later-

edition of this journal.

One of the most important concerns of the

NRHA is to emphasise that; given its unique

make-up and capacities. it sees itself as a facili-

tator or catall-st for linking the concerns of con-

sumers and coalface health workers with the

development of appropriate rural health policies

by governments and health authorities. It should

be stressed that the YRHA has no aspiration to

take over the roles in the polic>m making process

of individual rural health organisations. The

importance of this stance of the NRH-4 can be

clearly illustrated I~>- reference to the 3rd

National Rural Health Conference.

3RD NKTION-4L RURAL HEALTH

CONFERENCE

The Conference xas organisecl by the NRHA in

conjunction with the community at Mount Beauty.

However% the NRHA continually emphasised that

it was an open, national and inclusive conference;

anybody with an interest in rural health was wel-

come. The NRHA, for as long as appropriate, will

be happy to organise the national rural health

conferences but will alxal-s 1 stress that these con-

ferences are the ‘propert!-’ of the entire rural and

remote health communitv in Ilustralia. The con

ferences represent a pre-eminent opportunity for

any member of the community- to hax~e a aa>- and

to propose a recommendation that ma!~ end u11 as

a new- policy or program.

The corollary of this is that the ZRH_A will do

whatever it can to halme the recommendations

from the Mount Beauty Conference implemented.

It must be emphasised. hoxel-er. that it also

expects all other rural health indil-icluals and

organisations to pick LIP those recollllllelldatiolls

that the!- may assist their oxn purposes. and to

work to 1laT-e them implemented. The KRH_1 has

already begun its own ITork on this matter. The 1.5

individual member bodies of the NRH.1 hal-e

been asked to endorse and rank the 37 recon-

mendations from the Mount Beauty Conference.

At the end of May the council of the NRH-4 met

in Darwin to select from the 51 recommendations

which the NRHA regard as being most important.

It will then be the NRHrls job. through the inter-

face it has with gol-ernments. consumers and

health care prox~iclers. to seek action on those

recommendations.

It is important for incli~~iclual rural health

organisations to use the Mount BeautIm Confer-

ence recollllllelldatiolls to adT-ante their own

interests. Although the majority of the recommen-

dations are directed at governments, training

institutions and national associations: there are

some principles and ideas in the recommenda-

tions that can be acted upon locall!- b>- bodies

such as a district health ser!-ice. a hospital board

or a multi-purpose serx-ice. For instance. there

are recoiiiiiieliclatioris about horr to impro\-e team-

work in the pro\~ision of health services. and how

to ensure that health professionals are suitably

oriented for xork in a particular region or with a

particular client group. Most importantly: the rec-

ommendations consistentb reflect the value to

health services and health outcomes that will flow

from a greater involvement of local people in the

design; deliver- and ei-aluation of local health

services.

COMMUNITY IXYOLT’EMENT

The Countr?- ‘Komen’s dissociation of Australia,

the Rural and Remote Consumer Health Network,

the National rlssociation of Communit~~ Con-

trolled Health Organisations (N-ACCHO) and

Aboriginal and Torres Strait Islander Commission

(ATSIC) are all member bodies of the National

Rural Health -1lliance. The first txo of these

members ha1-e a clear brief to represent the inter-

ests of consumers. SdCCHO and -1TSIC repre-

sent both the proI-iclers of Aboriginal health

services as xell as their consumers.

More impor-tam than the membership struc-

ture of KRH_1 is the underlying impetus for all of

its acti\-it\-. The XRHX holds the \-iew that both

health outcomes and health serx-ices Jvill be

inipro\-ed if consumers are more liea+ involvecl

in the design and management of these local ser-

142 AUSTRALIAN JOURNAL OF RURAL HEALTH

vices. This view was expressed in a variety of

ways and by the representatives of a variety- of

organisations at the 3rd National Rural Health

Conference. The epitome of this view was clis-

cussed in the context of a ‘charter of rights’ for

health consumers. What was not discussed at

Mount Beauty was how this principle of greater

community participation is to be made a reality.

Work on this principle has great potential for

positive returns. It is also an area that any local

health organisation can choose to work. Local

management committees and boards can be as

open or as closed to local inputs and local

accountability as they choose. It is local initia-

tives of this kind that will help to change the sys-

tem from the bottom up. The NRHA, through its

role as a watchdog over governments and health

providers, can contribute to this process from the

top down.

CONCLUSION

People and organisations concerned with rural

health at all levels face a complex challenge.

There is immense pressure to restrain or even

reduce the resources devoted to rural and remote

health. At the same time as there are increasing

expectations, based on sound principles of social

justice and equity, for all rural and remote people

to have access to high quality and affordable

health care. There are also significant institu-

tional and structural changes underway in the

hospital sector and in the organisation of State

and Territory health administrations. The basis of

these structural changes is the rationalisation of

services, usually a euphemism for service reduc-

tions; that will adversely affect rural areas

because of their small populations.

The NRHA is in a unique position to assist

parties involved in this complex process of

change. The NRHA will continue to represent the

interests of its member bodies and to regard the

improvement in the status of rural health (broadly

defined) as the bottom line for its work. It will

continue to consult with health administrations,

seeking a position as a partner with these admin-

istrations, making demands on their policies

whenever necessary and assisting them with

information and views from rural and remote

areas. It will continue to put health consumers

first and to do everything in its power to fulfil its

mission.

The aspirations of the NRHA reflect those of

the five million or so people who live in rural and

remote areas of Australia. The NRHA wants to be

usecl by all of these people. If these people work

within their own organisations and areas on the

same mission, the chances of this mission being

accomplished will be maximised.

ACKNOWLEDGEMENT

Many thanks to John Humphreys.

REFERENCES

1 Humphreys JS, Nicols A. Rural health policy: The

third national rural health conference. Aus~alian.

Jownal of Rural Heallh 1995; 3: 87-92.