Gordon Gregory, National Rural Health Alliance Inc (NRHA)
 Like everyone else in Australia's health sector, the NRHA has been trying to keep abreast of opportunities provided by the Rudd Government's reform agenda.
In the Alliance's case the apparently simple challenge is to ensure that a rural and remote voice is provided to the various reviews and inquiries in train.
Despite the fact that there are still significant data limitations, particularly where remote areas and Indigenous peoples are concerned, it is widely agreed that the need is to focus not on what the problem is but on the way to bring health status in rural remote areas up to par with the cities.
This is why the next six months will be such a critical period. The work of the National Health and Hospitals Reform Commission (to which the Alliance made two submissions) has the capacity to provide the structural and financing blueprint for an improved health system for Australia. The Preventative Health Taskforce will lead the way to more effective work in health promotion, initially for obesity, smoking and alcohol, but thereafter for other issues like mental health and injury as well.
The Alliance's submission to this Taskforce emphasised the need for health promotion and illness prevention activities to be tailored to meet the characteristics of rural and remote areas.
The development of a National Primary Health Care Strategy has the capacity to make clearer how effective and safe changes can be implemented in the workforce so that the best clinician provides the appropriate service in the right place and at the right cost to health consumers, including those in rural areas.
The review of Medicare will hopefully support moves in this direction. And there should be recommendations on reinvesting in maternity services from the review headed by Chief Nurse Rosemary Bryant.
Whether it be in health promotion or primary health care, people in rural and remote areas will miss out if programs are delivered only through existing health professionals and funding schemes - simply because of the serious shortages in numbers and capacity of the workforce in those areas. This is why specific initiatives are needed and justified for people outside metropolitan areas.
Some 65 of the existing initiatives are being reviewed by the Office of Rural Health and this takes the Alliance to the heart of its core business. In response to what seems to be a plethora of unrelated programs with diverse characteristics, the Minister has apparently indicated a desire for rationalisation and reform. The Alliance is working on input to this review, taking a position in support of rationalisation if it can lead to greater effectiveness but making the point that the quantity of overall support for rural and remote programs needs to be larger, not smaller.
The Alliance hopes to be in a position soon to provide further justification for this position by reference to the size and nature of the overall ‘rural health deficit' - not just from the underspend on Medicare but also through the PBS and the private health insurance rebate.
Many of these issues will be the focus of papers at the 10th National Rural Health Conference in Cairns, 17-20 May. You can register on-line for the conference at: <www.ruralhealth.org.au>
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