The National Rural Health Alliance, the peak non-government rural and remote health organisation notes that:

1. Healthy Horizons¹ has a goal of maintaining a skilled and responsive health workforce. Strategies to achieve this goal include:
   • tailor training programs to the needs of health professionals and the communities in which they work; and
   • provide opportunities and support for rural regional and remote health professionals to maintain and advance skills, develop capacity for sole practice and encourage personal initiative.

2. Given the individual nature of communities and the barriers faced by rural and remote area health professionals in accessing education and training programs, flexibility in education and training is important if these strategies are to be implemented.

3. The reality facing health professionals, both actual and intending, in accessing appropriate education and training programs is far from ideal. For example a 2000 CRANA Members' Survey² found that 53% of remote area nurses saw education and training as the most important professional issues affecting them in the workplace.

   Further, for all health professionals working in rural and remote areas the opportunities to access education and training programs in major centres to maintain and update their skills and qualifications are limited by difficulties of access, the time and costs involved, excessive work related demands, shift work and problems in securing relief/locum cover for their absence.

4. Education and training emerged as major issues in the 6th National Rural Health Conference (March 2001). Delegates stressed that the maintenance of a high quality health service in rural and remote Australia is contingent upon the continuing development of flexible education and training programs that are locally, culturally and socially appropriate.

5. Among the recommendations from the 6th National Rural Health Conference³ were those that called for:
   • undergraduate curricula for all health disciplines include health promotion, primary health care, population health and cultural safety⁴ components. This will help to ensure the provision of high quality health services that meet the needs of people in rural and remote areas;
   • universities and the Federal Government to work collaboratively to achieve an increase in the total content of Aboriginal and Torres Strait Islander health taught in ALL undergraduate Health Science courses to meet a minimum national standard;
   • a distance education program on cultural awareness be developed for non- Aboriginal health workers;
   • State and Territory Health Services to become involved in supporting distance education students in remote areas and Indigenous students;
   • additional funds for universities to allow all health students to go on rural practicums and that there is adequate preparation of students in cultural awareness, knowledge of history and the context of placement;
   • specific funding for the essential clinical component of nurse education programs;
   • education and training should focus on the needs of clinicians. It should use a variety of models based on collaborative input to curriculum design, delivery and evaluation. The delivery should utilise teleconferencing and videoconferencing, but only as an adjunct to, not as a replacement for, face-to-face delivery;
   • graduate nurse programs which reflect the diversity of nursing contexts, including rural and remote area nursing;
   • more flexible post graduate medical education programs developed and offered on a regional basis; and
   • more flexible training and retraining packages for female GPs moving into or returning to rural and remote practice. Such packages need to include part-time training options and the provision of childcare.

6. The need for flexibility in education and training as a tool to improve the recruitment and retention of health professionals in rural and remote areas does not over-ride the importance of ensuring that all undergraduate curricula for all health professionals provide the competencies for graduates to work effectively in a health system based on a primary health care approach.

7. Evidence suggests that health professionals who originate from rural and remote areas are more likely to practise in such areas than their more urban orientated colleagues . Yet opportunities for students from rural and remote areas to gain health science qualifications are limited.

   The shift of pre-service nurse education from hospitals to universities, while bringing many benefits, might have contributed to reduced opportunities for rural and remote areas residents to obtain professional nursing qualifications.

   Medical schools are generally located in the major cities. What about other health science course beyond medicine and nursing - where are they located?

8. There have been many positive developments in recent years to enhance education and training opportunities in regional, rural and remote areas for health professionals including:
   • establishing a network of rural health training units across the States and Territories, each being based at a regional centre;
   • creating a new Medical School at Townsville and Rural Clinical Schools at Cairns, Tamworth, Lismore, Wagga Wagga and Warnambool;
   • funding University Departments of Rural Health in ten regional centres;
   • programs offered though rural Divisions of General Practice;
   • innovative use of technology to encourage distance education;
   • increased use of student placements for practicums in rural and remote areas, supported in some instances by scholarships to help students with the extra costs of such placements; and
   • innovative approaches in undergraduate nursing programs to enable students from rural and remote backgrounds to undertake their studies locally.

9. Having maximum flexibility in education is an important factor in efforts to ensure that sufficient numbers of appropriately skilled health professionals are available in rural and remote areas. Flexibility should be a parameter applying to access, delivery and curricula/content It is also relevant to all types of education and training, whether it be pre-service, continuing professional development or formal post graduate studies.

10. Currently there is limited flexibility, so that opportunities are lost to encourage young people from rural and remote areas to enter a health science career. This limited flexibility also creates barriers for health professionals practising in rural and remote areas wishing to access ongoing professional development and formal post-graduate study.

11. Many education and training initiatives in recent years have contributed to increased flexibility in education and training and provide a solid foundation on which future initiatives can be built.

12. Support implementation of recommendations from the 6th National Rural Health Conference proposing increased flexibility in education and training programs for rural and remote area health professionals.

13. Encourage Governments and education and training bodies to build on the foundation of recent initiatives which facilitate greater flexibility in education and training programs for health professionals in rural and remote areas.

14. Support the continued expansion of scholarships for rural and remote people to undertake undergraduate, postgraduate and ? development funding in nursing and other health services.

15. Focus in particular on the unmet need for support for the education and training of allied health professionals for rural and remote areas.

1. National Rural Health Policy Forum and National Rural Health Alliance, (1999), Healthy Horizons-A Framework for Improving the Health of Rural, Regional and Remote Australians, Canberra
2. Council For Remote Area Nurses (2001), GET EXACT REFERENCE
3. National Rural Health Alliance (2001) 6th National Rural Health Conference Proceedings, Canberra
4. Cultural safety' is about all practitioners having a minimum level of competence and knowledge of Indigenous and multicultural communities to enable them to practise with those patients effectively, safely and with due diligence.