Overall, there is clear evidence that the UDRH Program and the RCS Program have achieved their initial aims of establishing a functioning educational infrastructure in rural Australia and of increasing support for and, to some extent, capacity within the current rural health workforce. The earliest sites for the Programs have moved past the establishment phase to become more mature agencies of training and research, and in some places innovative partnerships are developing which are enhancing health service delivery. The annual reports for each site and regular reporting mechanisms demonstrate that the sites are fulfilling their obligations according to the requirements which have been made of them through their Program parameters or objectives.
The UDRH and RCS Programs have been described as part of a 'rural health education revolution' (Wing 2007:344). The result of this 'revolution' has been the creation of a rural health infrastructure where none existed, with resulting opportunities for students, academics, and clinicians to contribute to improving rural health services. The benefits which have accrued can be summarised broadly as the following:
- increased number of health students gaining exposure to rural health services and rural health issues;
- the establishment of educational infrastructure, with facilities which are available to a range of health providers and community groups as well as teachers and students;
- some recent nursing and allied health graduates choosing to take up rural employment as a result of their exposure through a UDRH, and some medical students seeking rural internships or vocational training placements as a result of their exposure through an RCS;
- some clinicians - nursing, allied health, and medical - choosing to remain in rural employment as a result of any of the following: new opportunities to teach or train, ability to undertake research and/or postgraduate studies, perception of increased practical, social or professional support, and/or ability to take an academic appointment while remaining in rural clinical practice;
- some clinicians - nursing, allied health, and medical - choosing to relocate from the city because of the opportunity to accept a joint academic and clinical position;
- enhanced visibility of rural health and its challenges within the university environment;
- increased number of publications with a rural or remote focus;
- new partnerships for innovation in service delivery and health system research; and
- enhanced visibility of the university sector within rural and remote Australia.
However, sufficient anecdotal evidence exists to suggest that there is an impact on rural workforce capacity through recruitment and retention of health professionals, and through influencing health students' perceptions of rural health careers. The objective of increasing the workforce through encouraging students to return to the country has been met, to the extent that without a target goal even one student returning to practise in a rural area could increase the workforce. While it was noted by several respondents that it will be impossible to prove causality across either the RCS or the UDRH Program with regard to increasing the rural health workforce, to the extent that the UDRHs and the RCSs have retained or attracted clinicians through opportunities to take up clinical and teaching appointments, the rural workforce has been sustained or increased. The reported increases through recruitment or retention are unlikely at the current level to be sufficient to compensate for rural workforce decline, but the stories of new graduates seeking rural careers, or of experienced clinicians choosing to remain in the country, do give cause for hope that in time the Programs will contribute significantly to overcoming the current workforce shortage.
Other contributions to a vibrant rural health sector are more amenable to measurement, and such indicators as publications, research projects, or partnerships in health service innovation have been reported by the UDRHs particularly, in their annual reports to the Department as well as in journals, conferences, and other professional fora. There is scope for these activities to increase and every expectation that they will do so as the Programs mature. In order to effectively assess the impact of these Programs longitudinally it will also be important to consider such secondary benefits as:
- improved perceptions of rural health services across the health system through students receiving greater exposure and understanding of the challenges of rural health care, whether or not they return to the country to practice themselves;
- enhanced communication amongst rural and remote practitioners through greater information technology infrastructure, increasing professional and personal support to remote practitioners;
- enhanced clinical and educational opportunities including increased availability of interprofessional education;
- increased number of joint academic and clinical positions, attracting highly qualified and dynamic professionals; and
- overall community benefits such as innovations in health service delivery, increased numbers (or maintenance of stable numbers) of health practitioners, and greater availability of health promotion and population health information and activities.
Table 10 summarises the findings of the evaluation applied to the original hierarchy of outcomes of the evaluation framework. Use of the hierarchy of outcomes may assist in future strategic planning to ensure that progress continues to be made towards ultimate outcomes, and that progress can be monitored.
The remainder of this chapter discusses the key strategic issues emerging from the evaluation and makes recommendations for the future.
Table 10 - Hierarchy of outcomes and achievements to date
Hierarchy of outcomes
|Increased workforce capacity||Contributed - see 4.4.1, 5.4.1, 5.4.2|
|Increased training and support||Yes - see 4.4.2, 5.4.1, 5.4.2|
|Increased rural health research capability and output||Yes - see 4.4.3, 5.4.3|
|Integrated rural health training and support programs||To some extent - see 4.4.2, 5.4.4|
|Increased recruitment and retention of health practitioners in rural and remote areas through the provision of a positive rural health education experience||To some extend - see 4.4.1, 5.4.2|
|RCSs and UDRHs engage with other programs/initiatives within local, State, Territory and Commonwealth Governments||yes - see 4.4.4, 5.4.4|
|There is increased and effective collaboration between UDRHs and RCSs, and also with local educational institutions and health service providers||Yes - see 4.4.3, 4.4.4, 5.4.4|
|Research into rural and remote health issues is taking place||Yes - see 4.4.3, 5.4.3|
|Appropriate and effective support provided to health professionals currently practising in rural and remote settings||To some extent - see 4.4.2, 5.4.2|
|More rural and remote health practitioners are engaged in education and training opportunities||Yes - see 4.4.1, 4.4.2, 5.4.2|
|Rural Clinical Schools Program - targeted education, training and support for medical students in rural and remote health, and development of support infrastructure.||Yes - see section 5|
|UDRH Program - targeted education, training and support to enhance opportunities for medical, nursing and allied health students in rural and remote health, and development of support infrastructure.||Yes - see section 4|