The majority of health professionals live and work in cities, resulting in a global phenomenon of rural health workforce shortages. Compared to Australians living in urban areas, people living rurally have reduced access to health services, which negatively affects health-care equity and health outcomes. A major contributing factor to this inequity and health disparity is rural health workforce shortages and high turnover. The literature identifies the decision of an individual to take-up, stay, or leave a rural health position as a complex interaction between workplace conditions, career building opportunities, and psychosocial and personal factors. Most of the rural health workforce retention studies undertaken have focused on the influence of workplace and career building factors, and have, in the main, ignored the psychosocial determinants. Recently published studies, including my own, have identified the need for a community engagement approach for successfully attracting, recruiting and retaining a rural health workforce. For newcomer health workers, social isolation is a major issue and community engaged solutions are urgently needed, but there are few examples to draw on in Australia.
My Churchill Fellowship visit to Canada and the interviews I conducted strongly confirmed the need for a community engaged approach to support the development of effective rural health workforce strategies. It also highlighted that this is relatively new thinking and there are still few examples of successful approaches to draw on (the notable exception being the recruiter and community connector model being used in Marathon, Ontario). However, over the last decade, rural and remote northern countries have been working in partnership to develop the Recruit & Retain Framework and this is being used to trial community engaged approaches in the development of recruitment and retention strategies. My Fellowship provided many opportunities to build understanding with stakeholders involved in addressing rural health workforce issues, both in Canada and from other northern countries. It also provided opportunities to discuss the similar challenges we face in Australia and to promote the whole-of-person rural retention improvement project and the community engaged approaches being trialled.
Internationally, there is an urgent need to strengthen the evidence base on effective community engaged approaches for recruitment and retention of rural health workforces. I believe this can be best achieved through greater collaboration among rural and remote communities in far northern countries and Australia. In Australia, there is need for strengthened understanding of the importance of community engagement in addressing rural health workforce issues. Government and rural community support to undertake a longitudinal trial and evaluation of Marathon’s recruiter and community connector model is critical.
Keywords: Rural & remote, community engagement, sense of belonging, recruitment & retention, sense of place, social connection