6.8.1 Broad community impactAt least three levels of community impacts are evident from the two Programs:
- Affirmation of rural Australia (and therefore of rural Australians): 'that [the university, the Government] thinks it's worthwhile investing in rural Australia.' This 'feel-good' factor has a benefit in that it predisposes community members to be more supportive of the Programs and their place in the community.
- Contribution to local services: Some have indicated that the mere presence of students increases the workforce capacity in providing an extra pair of hands: 'The students are actually useful'; medical students help out in surgery at the hospital, take patient histories in the GPs' surgery, test for blood pressure and sugar at the local agricultural show; and
- Contribution to workforce retention through opportunities for clinicians in research and teaching.
While many have seen the growing university infrastructure as an inspiration to rural schoolchildren and as a contribution to the economic, social and health infrastructure of the country, others have sounded a note of caution, and of weariness:
'I would like to see Australian-trained doctors coming out here. We are putting immense resources into this and not getting anything back - I mean the government, taxpayers - I would like to see something coming back… There's no evidence that we're making any impact.' (RCS staff member)
Each RCS is required to establish a Community Advisory Board to facilitate communication with local community representatives in the areas where RCS training sites are located. UDRHs are also required to establish advisory boards. In the establishment phase of the Programs, the Community Advisory Boards have assisted with promoting the Programs to the community, listening and responding to community concerns regarding health services and providing support to students on placements. Stories abound of the ways in which local committees have worked to ensure that medical students were made to feel at home, including providing welcoming parties, amenities such as bicycles and BBQs, and opportunities to get involved with community activities.
Many of the RCSs have now established a two-tier advisory process, with local advisory committees at each training site, who send representatives to the larger, yearly Community Advisory Board meeting. It appears that this local community engagement has been crucial to the RCS and the university being welcomed into the rural environment, particularly during the early years when the university and RCS were trying to introduce themselves and establish working relationships with community members.
While Community Advisory Board members consider community consultation still to be important, the mechanism of a yearly meeting is considered by some informants to be an ineffective mechanism for consultation. It might be useful to consider whether there are alternative ways for the Programs to interact with the community once the initial establishment phases are completed, or whether the advisory boards could be developed further. While the advisory boards are not intended to function as management or governance bodies, some advisory boards are involved in strategic planning and informing direction for the organisation. Others rely on more informal consultation with community members. Without seeking to prescribe a structure for all sites, there might be scope for encouraging RCSs and UDRHs to consider whether new consultation mechanisms could prove more useful than the established structure.
Recommendation 21:That the role of advisory boards for both Programs be assessed by RCSs and UDRHs, in consultation with the Department, to define their purpose and potential.
6.8.2 Indigenous healthIt is difficult to ascertain the impact of either Program on Indigenous health. A number of indicators are present which may result in improved future provision of health services for Indigenous Australians.
These indicators include:
- the number of Indigenous students studying for health careers;
- the number of Indigenous people employed within RCSs or UDRHs;
- the extent and quality of Indigenous cultural training, including training in cultural safety for non- Indigenous students and clinicians;
- the extent of research on topics relevant to Indigenous health and the increase of an evidence-base for health service development; and
- the involvement of UDRH and RCS students and academics in the delivery of health services through AMSs and other facilities.
There were some comments received regarding perceptions that the reciprocity of relationships could be improved between some Program sites and local AMSs. Accordingly, structural mechanisms for ensuring a continuing open dialogue with local Indigenous communities should be embedded within the structures of the organisation, rather than relying on particular individuals or leaders within the RCS or UDRH. Appropriate consultation mechanisms with local Indigenous communities, including identification of existing structures such as COAG structures, need to be identified and formalised by each RCS and UDRH.
The RUSC parameters provide direction to universities in terms of encouraging Indigenous students to take up health careers and providing support to them throughout their training, as well as providing Indigenous cultural awareness training to all medical students. All RCSs and UDRHs have some engagement with the recruitment of Indigenous staff and students, and of supporting existing professionals working in Indigenous health services. It is likely that more could be done to promote rural health careers to Indigenous students, and to support them as they undertake their training. A useful first step would be to analyse the parameters of all the workforce programs, including the RCSs and UDRHs, and to determine whether there is overlap between the RUSC parameters and the funding parameters of other Programs such as the UDRH and RCS.