title: How do small rural primary health care services sustain themselves in a constantly changing health system environment?
abstract: BACKGROUND
  The ability to sustain comprehensive primary health care (PHC) services in the face of change is crucial to the health of rural communities. This paper illustrates how one service has proactively managed change to remain sustainable.
  
  
  METHODS
  A 6-year longitudinal evaluation of the Elmore Primary Health Service (EPHS) located in rural Victoria, Australia, is currently underway, examining the performance, quality and sustainability of the service. Threats to, and enablers of, sustainability have been identified from evaluation data (audit of service indicators, community surveys, key stakeholder interviews and focus groups) and our own observations. These are mapped against an overarching framework of service sustainability requirements: workforce organisation and supply; funding; governance, management and leadership; service linkages; and infrastructure.
  
  
  RESULTS
  Four years into the evaluation, the evidence indicates EPHS has responded effectively to external and internal changes to ensure viability. The specific steps taken by the service to address risks and capitalise on opportunities are identified.
  
  
  CONCLUSIONS
  This evaluation highlights lessons for health service providers, policymakers, consumers and researchers about the importance of ongoing monitoring of sentinel service indicators; being attentive to changes that have an impact on sustainability; maintaining community involvement; and succession planning.
authors.affiliation: Monash University School of Rural Health, PO Box 666, Bendigo, VIC 3552, Australia. penny.buykx@monash.edu
authors.forename: Penny
authors.initials: P
authors.lastname: Buykx
authors.forename: John S
authors.initials: JS
authors.lastname: Humphreys
authors.forename: Rachel
authors.initials: R
authors.lastname: Tham
authors.forename: Leigh
authors.initials: L
authors.lastname: Kinsman
authors.forename: John
authors.initials: J
authors.lastname: Wakerman
authors.forename: Adel
authors.initials: A
authors.lastname: Asaid
authors.forename: Kathy
authors.initials: K
authors.lastname: Tuohey
mesh_terms: D057191:Capacity Building; D003159:Community-Institutional Relations; D003191:Comprehensive Health Care; D019033:Delivery of Health Care, Integrated; D017598:Efficiency, Organizational; D006801:Humans; D007857:Leadership; D008137:Longitudinal Studies; D017146:Models, Organizational; D033262:Narration; D009313:National Health Programs / Q000458:organization & administration; D009936:Organizational Innovation; D009937:Organizational Objectives; D011320:Primary Health Care / Q000191:economics / Q000941:ethics / Q000592:standards; D011785:Quality Assurance, Health Care / Q000379:methods*; D019035:Rural Health Services / Q000458:organization & administration*; D014739:Victoria; D000078329:Workforce