“Beyond workforce”: a systemic solution for health service provision in small rural and remote communities

摘要

Successful, "innovative" primary health care (PHC) models exist that have adapted to the specific circumstances of their rural and remote context. A typology of discrete, integrated, comprehensive and outreach rural and remote services exists rather than a "one coat fits all" PHC health service model. Successful models are characterised by macro-scale environmental enablers (supportive health policy, federal-state relations, and community readiness) and five essential service requirements (workforce organisation and supply; funding; governance, management and leadership; linkages; and infrastructure). Service sustainability depends on ensuring that key systemic service requirements are met at the local level in ways that accord with, and are supported by, the broader macro-scale environmental enablers. Based on these principles, these model types are amenable to generalisation and evaluation in other regions.