Features of effective primary health care models in rural and remote Australia: a case-study analysis

John Wakerman, John S Humphreys, Robert Wells, Pim Kuipers, Judith A Jones, Philip Entwistle and Leigh Kinsman
Med J Aust 2009; 191 (2): 88-91.


Objective: To describe the factors and processes that facilitate or inhibit implementation, sustainability and generalisation of effective models of primary health care (PHC) service delivery in rural and remote Australia.

Design: Case-study approach, including review of relevant literature, interviews with key informants, site visits and direct observation. Thematic analysis and template analysis were used with interview transcripts. An expert reference group provided feedback and advice on policy relevance.

Setting and participants: Six PHC services in small communities across rural and remote Australia were selected based on results of a previous systematic review; they reflected diverse rural and remote settings and PHC models, and the multidisciplinary nature of PHC. Sites were visited, and 55 individuals associated with the establishment and operation of these services were interviewed between July 2006 and December 2007.

Results: Independent and template analysis confirmed the usefulness of a conceptual framework, which identified three key “environmental enablers” — supportive policy; federal and state/territory relations; and community readiness — and five essential service requirements — governance, management and leadership; funding; linkages; infrastructure; and workforce supply. Systematically addressing each of these factors improves effectiveness and lessens the threat to service sustainability.

Conclusions: Evidence from existing effective rural and remote PHC services can inform the health care reform agenda, in Australia and other countries. The evidence highlights the need for improved governance, management and community involvement, as well as strong, visionary political leadership to achieve a more responsive and better coordinated health system which could help eliminate existing health status differentials between cities and rural areas. In Australia, establishment of a single national health system, operationalised at a regional level, would obviate much of the current inefficiency and poor coordination.

  • John Wakerman1
  • John S Humphreys2
  • Robert Wells3,4
  • Pim Kuipers1
  • Judith A Jones2
  • Philip Entwistle1
  • Leigh Kinsman2

  • 1 Centre for Remote Health, Flinders University and Charles Darwin University, Alice Springs, NT.
  • 2 School of Rural Health, Monash University, Bendigo, VIC.
  • 3 Menzies Centre for Health Policy, Australian National University, Canberra, ACT.
  • 4 College of Medicine and Health Sciences, Australian National University, Canberra, ACT.


We are grateful to the Australian Primary Health Care Research Institute for its support of this study, and to the members of our reference group: Professor Ray Pong (Centre for Rural and Northern Health Research, Canada), Professor Martha Macleod (University of Northern British Columbia, Canada), Kim Snowball (Department of Health, Western Australia), Alma Quick (Office of Rural Health, Australian Government Department of Health and Ageing [DoHA]), Gordon Gregory (National Rural Health Alliance), Dr Ian Cameron (New South Wales Rural Doctors Network) and Mark Thomann (Office for Aboriginal and Torres Strait Islander Health, DoHA).

Competing interests:

None identified.

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