The UDRH Program was established as a result of the 1996-1997 Federal budget after being identifiedn as a key component of the Government's Rural Workforce Strategy (Morey 2000). The establishment of the first six UDRHs in 1997 followed a suite of government initiatives implemented over the previous decade to address health workforce needs in rural and remote regions, including the development of several multidisciplinary rural health training units. These units, established between 1989 and 1996, aimed to provide education and training facilities in order to support and attract health professionals to rural and remote communities.
The UDRH Program shared the education and training focus of rural health training units, but differed in its engagement of universities responsible for mainstream and other health professional education, rather than the development of a system outside the mainstream (Morey 2000). In this way, knowledge and skills could be applied to the health problems of rural and remote Australia in a similar way to those of urban Australia (Humphreys 2000).
In its early years, the principal objective of the UDRH Program was identified as the improvement of access by rural and remote communities to appropriate services through the promotion of professional support, education and training for rural and remote health workers and for city-based health care professionals interested in training and practising their clinical skills in a rural or remote setting (Morey 2000). The Department of Health and Ageing itself states that the UDRH Program "encourages students of medicine, nursing and other health professions to pursue a career in rural practice by providing opportunities for students to practise their clinical skills in a rural environment. It also supports
health professionals currently practising in rural settings."5
The first two UDRHs were established at the remote centre sites of Broken Hill (University of Sydney) and Mount Isa (originally through the University of Queensland, and later through James Cook University). These sites were selected on the basis of their provision of services to the main groups of rural constituents. A model for these initiatives was provided by Monash University, which in 1992 established the first rural health academic unit in Australia (becoming a UDRH in 2006).
In determining the creation of new UDRHs, medical schools were invited to submit proposals according to defined criteria, including a population health focus, a multidisciplinary approach, cooperation with other institutions and a focus on Indigenous health. In the early stages of the Program eleven program objectives were developed. Following the lapsing program evaluation in 2003, the objectives were refined and a set of key result areas were created in consultation with the UDRHs. The current set of UDRH objectives are as follows (emphasis added).
- Increase and improve rural experiences for undergraduate students in the health professions, including training to encourage cultural awareness and sensitivity to Indigenous health issues, for undergraduate students in the health professions;
- Expand educational opportunities relevant to rural and remote practice, in particular in relation to existing rural and remote health professionals and Indigenous students;
- Undertake research into rural and remote health issues, including publication of papers and reports and applying for research grants and consultancies;
- Provide training and support for rural health professionals (including mentors, supervisors and preceptors), consumers and communities, including Indigenous communities;
- Contribute to innovation in education, research and service development through collaborations with universities, health services and professional and community organisations, including Indigenous communities;
- Embrace a strong public or population health focus; and contribute to the development of innovative service delivery models in rural and remote health; and
- Endeavour to progress the rural health agenda within the medical and other health sciences faculties or departments to maximise the efficient use of resources provided for a range of rural health programs. These programs include, but are not limited to, the Rural Undergraduate Support and Coordination Program, the Primary Health Care Research Evaluation Development Program and the Rural Clinical Schools Program.
There are a range of different UDRH models in terms of organisational structure and operational focus: each UDRH has derived its own operational style and programs to suit local opportunities and needs.
Some UDRHs are run by one university only (e.g. Monash University's Department of Rural and Indigenous Health), while others are joint ventures between two or more universities (e.g. the Combined Universities Centre of Rural Health in Western Australia, which is a consortium of Curtin University of Technology, Edith Cowan University, the University of Western Australia, Murdoch University and the University of Notre Dame.) Some have multiple sites such as the Northern Rivers UDRH, based in Lismore with established facilities in Murwillumbah and Grafton. Finally, some are colocated and share facilities with a rural clinical school, such as the Spencer Gulf Rural Health School, and the Northern NSW UDRH.
UDRHs have developed a variety of strategies, appropriate for their local contexts, in order to achieve their objectives. This approach was described by several people as characterised by a philosophy of being 'nationally consistent, locally relevant'. Most UDRHs employed some variation of what appeared to be a common three-part strategy in establishing themselves locally.
- Developing links with local health services, including Indigenous and other community-based services, through offering support and training for health professionals and facilitating what has been called a 'cross-pollination' of ideas and experiences. Most UDRHs have seen themselves becoming a focal point for bringing together people with a common aim of improving health service delivery and population health outcomes.
- Creating partnerships for student placements, working with local clinicians as supervisors and academics and in return offering academic opportunities for ongoing professional support and access to university facilities such as library resources.
- Providing a foundation for a rural research culture, through providing training and capacity building support for clinicians in undertaking applied health research, establishing networks and fora for clinicians and academics to meet and discuss research opportunities and ideas, and facilitating applications for research grant funding.Top of page
The models for UDRH operation are similar across the country, generally with an administrative hub located in a regional centre and often satellite offices in smaller towns, or at the least with links to health practitioners in towns or remote sites away from the regional centre. Student placements can take place anywhere from a regional centre to a small remote settlement, subject to the availability of a health professional as a supervisor and access to information technology (IT) and accommodation for the student. Some UDRHs have taken an interdisciplinary approach to supervising and/or teaching students. For example, nursing, physiotherapy, radiology, occupational therapy and other allied health academics and/or practitioners may teach medical students, while medical academics may have a role in teaching nursing and allied health students. Some UDRHs have an open-door policy to attendance at seminars, skills lab or other sessions and actively encourage a cross-disciplinary learning culture. Advocates of this approach see it as part of the necessary future of health education, given the increasing number of students and shrinking academic workforce.
The broad nature of the Program's objectives is often cited as one of the strengths of the UDRH Program, allowing each UDRH the flexibility to deliver a local response to the objectives and establish its own organisational culture and ethos. However, the breadth of the Program objectives (and subsequent variation between UDRHs) is also perceived by some as a giving UDRHs a [em>]'fuzzy' mandate and a lack of clarity of purpose.
An important component of the local direction of each site has been the influence of the character and management style of the individual leading the organisation. Team culture and inclusive style were cited in several UDRHs as positive components of the organisation to the extent that in some sites a change of leadership or direction has been perceived to negatively impact upon the UDRH's development and progress. In all cases the shape of the UDRH is informed significantly by the leadership of the key individual/s.