The National Strategic Framework for Rural and Remote Health promotes a national approach to policy, planning, design and delivery of health services in rural and remote communities.
The Framework has been developed through the Australian Health Ministers’ Advisory Council’s (AHMAC) Rural Health Standing Committee (RHSC) with the valued input of the National Rural Health Alliance and a wide range of other rural health stakeholders.
The Framework is directed at decision and policy makers at the national, state and territory levels. It emphasizes the need for health and prevention services, programs, workforce and supporting infrastructure designed to meet the unique characteristics, needs, strengths and challenges experienced in rural and remote parts of the country.
By providing this direction and identifying the systemic issues that most require attention, the Framework aims to improve health outcomes and return on investment for rural and remote Australians.
While primarily a tool for government, the Framework may also be useful to communities, local health service providers and community groups to help identify and develop new and innovative ways to address specific needs or unique characteristics of their local area or region.
The Framework is designed to encompass the full range of health-related services provided in rural and remote settings. This includes prevention and screening, early intervention, treatment and aged care services, and the delivery of specific health services including primary health care, hospital and emergency care, mental health, dental health, maternity health and preventative health.
It also recognises the needs of specific population groups, including older people, babies and children, Aboriginal and Torres Strait Islander people, people with chronic disease, refugees and people from culturally and linguistically diverse backgrounds.
Why a Framework for Rural and Remote Health?
In January 2009 the Australian Health Ministers’ Advisory Council (AHMAC) tasked the Rural Health Standing Committee (RHSC) to develop a National Strategic Framework for Rural and Remote Health that would:
define an agreed vision and direction for rural health
define an agreed set of national rural health priorities, reflecting common issues and challenges across jurisdictions
align with the timetable and directions of the national health reform agenda and process
align with state and territory initiatives in rural and remote health.
This new strategic approach builds on the previous framework document, Healthy Horizons: a Framework for Improving the Health of Rural and Remote Australians. Outlook 2003 2007 (‘Healthy Horizons 2003-2007’).
The focus is set with a broad policy perspective, identifying the key priority issues that commonly face rural and remote health services and service delivery. It allows the Commonwealth, states and territories to continue to develop and implement health and other related policies and plans, yet highlights the need for governments to consider the potential implications and application of these policies and plans in rural and remote settings.
By promoting a concerted effort across several fronts targeting the design, delivery and structure of health services, enhancing health technologies and infrastructure, supporting the health workforce and community capacity, the Framework will help this nation move towards its overall health goals, and reduce the inequalities in health outcomes and service delivery that are currently experienced by rural and remote Australians.
The National Strategic Framework for Rural and Remote Health
People in rural and remote Australia are as healthy as other Australians.
To achieve this Vision, the Framework sets the following goals:
Rural and remote communities will have:
1.Improved access to appropriate and comprehensive health care
2.Effective, appropriate and sustainable health care service delivery
3.An appropriate, skilled and well-supported health workforce
4.Collaborative health service planning and policy development
5.Strong leadership, governance, transparency and accountability.
The Framework addresses each goal under five outcome areas. These are:
Outcome area 1: Access
Outcome area 2: Service models and models of care
Outcome area 3: Health workforce
Outcome area 4: Collaborative partnerships and planning at the local level
Outcome area 5: Strong leadership, governance, transparency and performance.
Under each outcome area, the Framework sets out the objectives and strategies that have been developed to help achieve each goal.
The rural context
For the purpose of this Framework, the term ‘rural and remote’ is used to encompass all areas outside Australia’s major cities. This includes areas that are classified as inner and outer regional (RA2 and RA3) and remote or very remote (RA4 and RA5) under the Australian Standard Geographical Classification System (see Box 1).
In terms of total land area, the largest remoteness category is ‘very remote’ or RA5. This category covers over 5.5 million km 2 (72.5%) of Australia, with ‘remote’ (RA4) the second largest at 1.02 million km2 (13.2%). The ‘outer regional’ (RA3) and ‘inner regional’ (RA2) categories respectively cover 10.8% and 3.2% of Australia’s land area. A map of Australia’s remoteness areas is provided in Figure 1.
Major urban centres within inner and outer regional areas are considered to be within the context of this Framework. These centres have a key role in providing a hub for health care for rural and remote communities, including preventative healthcare, specialist outreach and emergency retrieval services, infrastructure and training centres.
It is widely accepted that remote and very remote communities experience particular issues and challenges associated with their geographic isolation and so the Framework acknowledges the need to differentiate between remote and rural (or regional) Australia.