title: Critical health infrastructure for refugee resettlement in rural Australia: case study of four rural towns.
abstract: OBJECTIVE
  To explore the reported impact of regional resettlement of refugees on rural health services, and identify critical health infrastructure for refugee resettlement.
  
  
  METHODS
  Comparative case study, using interviews and situational analysis.
  
  
  METHODS
  Four rural communities in New South Wales, which had been the focus of regional resettlement of refugees since 1999.
  
  
  METHODS
  Refugees, general practitioners, practice managers and volunteer support workers in each town (n = 24).
  
  
  RESULTS
  The capacity of health care workers to provide comprehensive care is threatened by low numbers of practitioners, and high levels of turnover of health care staff, which results in attrition of specialised knowledge among health care workers treating refugees. Critical health infrastructure includes general practices with interest and surge capacity, subsidised dental services, mental health support services; clinical support services for rural practitioners; care coordination in the early settlement period; and a supported volunteer network. The need for intensive medical support is greatest in the early resettlement period for 'catch-up' primary health care.
  
  
  CONCLUSIONS
  The difficulties experienced by rural Australia in securing equitable access to health services are amplified for refugees. While there are economic arguments about resettlement of refugees in regional Australia, the fragility of health services in regional Australia should also be factored into considerations about which towns are best suited to regional resettlement.
authors.affiliation: Medical School, Australian National University, Canberra, Australian Capital Territory, Australia.
authors.forename: Scott
authors.initials: S
authors.lastname: Sypek
authors.forename: Gregory
authors.initials: G
authors.lastname: Clugston
authors.forename: Christine
authors.initials: C
authors.lastname: Phillips
mesh_terms: D005260:Female; D006297:Health Services Accessibility; D006301:Health Services Needs and Demand; D054625:Healthcare Disparities; D006801:Humans; D007802:Language; D008297:Male; D009517:New South Wales; D019982:Organizational Case Studies; D010563:Personnel Turnover; D010821:Physicians, Family / Q000600:supply & distribution*; D011320:Primary Health Care; D011365:Professional Practice Location; D012036:Refugees / Q000706:statistics & numerical data*; D012040:Regional Health Planning; D012111:Residence Characteristics; D055500:Resilience, Psychological; D019035:Rural Health Services / Q000600:supply & distribution; D012424:Rural Population / Q000706:statistics & numerical data*; D012935:Social Justice; D012944:Social Support; D000078329:Workforce