Suchergebnisse

Background: Equity, access, safety and quality are prominent themes in rural health policies at a national level. These policies often contain objectives around improving rural health services and the health status of rural Australians. It is important to consider whether these objectives are being met for rural populations to discern the appropriateness of current policies and the potential need for changes in policy approach. Objective: To understand the influence of policy on provision of, and access to, rural maternity care. Design: Analysis of policy and case studies. Setting: Four north Queensland rural towns. Participants: (a) Rural residents who recently accessed maternity care; and (b) health care professionals involved in the provision of maternity services including midwives, procedural medical practitioners and GPs. Main outcome measures: Identification of predominant themes in government policies that relate to rural maternity care and identification of outcomes for local maternity services. These findings were supplemented by insights to rural citizens' experiences in accessing maternity care and rural clinicians' experience in providing care. Results: The findings indicate a dearth of specific policies to support the development and continuation of rural maternity care services. Conclusions: Without detailed policy support for rural maternity care, services at each of the four case study towns appeared more vulnerable to the effects of other non-specific policies and negative environmental factors.

Aims & Rationale: The Alma-Ata Declaration espouses participation as a right for all citizens and important in the provision of primary health care. Australian health policy discourse encourages citizen engagement, but the extent to which this actually occurs remains unclear. Citizen engagement potentially offers considerable benefits for rural communities – a population with known health disadvantages. Drawing on results of a research project exploring the health policy implications for rural maternity care, this paper aims to (a) discuss the extent of community participation found in four rural north Queensland towns; and (b)consider how policy discourse around citizen engagement may be applied to rural health policies. Methods: Case studies of four rural north Queensland towns were completed. Observational, interview and documentary data were collected and qualitatively analysed via an inductive thematic technique. Findings: The case studies provided little indication of formal mechanisms through which community members could provide input to local health service delivery. Two communities demonstrated rapid mobilisation to rally and apply political pressure when their health services were threatened, but a distinction must be made between community action and true engagement processes. While mindful of the benefits, interviewees at all sites were particularly concerned about the barriers to successful community engagement, including: (i) overcoming community scepticism; (ii) concerns about representativeness; and (iii) community capacity. Benefits to the community: For rural communities, citizen engagement may have particular advantages in enhancing the appropriateness and responsiveness of local health services. Recommendations are made for improving rural communities' input to health policies which affect them.

Aims and rationale: Despite government commitments to improve rural residents' access to health services, 42% of rural maternity units throughout Queensland have closed over the last 10 years. Such closures raise concerns about equity of access and quality of maternity care for rural communities. There is little literature available which discusses the impact of health policies on rural residents' experiences of accessing maternity care, or the experiences of the health professionals who provide these services. The aims of this study are twofold: (a) critically review government health policies relevant to rural maternity care; and (b) investigate the correlation between health policy discourse and the lived experiences of rural communities in providing and accessing maternity services. Approaches: Relevant Commonwealth and Queensland health policies were identified and critically reviewed. A case study approach was then used to explore the lived experiences of both providers (midwives, GP proceduralists, hospital administrators) and users (community members) of maternity care in four rural, north Queensland towns. Data comprised documentary evidence, interviews with service providers and focus groups with community members. Findings: The reduction of rural maternity services was found to have profound, multifaceted effects on local communities. Lived experiences and policy-related outcomes are discussed within four topic areas: workforce; community engagement; quality and safety of care. Benefits to the community: Understanding policy outcomes for rural maternity units should inform the development of future health policies. Recommendations are aimed at enhancing maternity care provision and access in rural communities.