Ensuring equity of access to primary health care in rural and remote Australia - what core services should be locally available?
BACKGROUND
Australians in rural and remote areas experience poorer health status compared with many metropolitan residents, due partly to inequitable access to primary health care (PHC) services. Building on recent research that identified PHC services which all Australians should be able to access regardless of where they live, this paper aims to define the population thresholds governing which PHC services would be best provided by a resident health worker, and to outline attendant implementation issues.


METHODS
A Delphi method comprising panellists with expertise in rural, remote and/or Indigenous PHC was used. Five population thresholds reflecting Australia's diverse rural and remote geography were devised. Panellists participated in two electronic surveys. Using a Likert scale, they were asked at what population threshold each PHC service should be provided by a resident health worker. A follow-up focus group identified important underlying principles which guided the consensus process.


RESULTS
Response rates were high. The population thresholds for core PHC services provided by a resident worker were less in remote communities compared with rural communities. For example, the population threshold for 'care of the sick and injured,' was ≤100 for remote compared with 101-500 for rural communities. For 'mental health', 'maternal/child health', 'sexual health' and 'public health' services in remote communities the population threshold was 101-500, compared to 501-1000 for rural communities. Principles underpinning implementation included the fundamental importance of equity; consideration of social determinants of health; flexibility, effective expenditure of resources, tailoring services to ensure consumer acceptability, prioritising services according to need, and providing services as close to home as possible.


CONCLUSIONS
This research can assist policy makers and service planners to determine the population thresholds at which PHC services should be delivered by a resident health worker, to allocate resources and provide services more equitably, and inform consumers about PHC services they can reasonably expect to access in their community. This framework assists in developing a systematic approach to strategies seeking to address existing rural-urban health workforce maldistribution, including the training of generalists as opposed to specialists, and providing necessary infrastructure in communities most in need.
Centre for Remote Health, Flinders University and Charles Darwin University, Alice Springs, Australia. s.thomas@flinders.edu.au.|Centre of Research Excellence in Rural and Remote Primary Health Care, Bendigo, Australia. s.thomas@flinders.edu.au.|Flinders University, Alice Springs, NT, Australia. s.thomas@flinders.edu.au.
Susan L
SL
Thomas
Centre of Research Excellence in Rural and Remote Primary Health Care, Bendigo, Australia. john.wakerman@flinders.edu.au.|Flinders Northern Territory, Darwin, Australia. john.wakerman@flinders.edu.au.
John
J
Wakerman
Centre of Research Excellence in Rural and Remote Primary Health Care, Bendigo, Australia. John.humphreys@monash.edu.|School of Rural Health, Monash University, Bendigo, Australia. John.humphreys@monash.edu.
John S
JS
Humphreys
D001315:Australia; D018672:Community Health Planning; D005843:Geography / Q000379:methods; D006297:Health Services Accessibility / Q000592:standards* / Q000706:statistics & numerical data; D006801:Humans; D011320:Primary Health Care; D012424:Rural Population; D011795:Surveys and Questionnaires; D000078329:Workforce