Sustained lobbying for equity raises profile of rural health

The results of years of persistent lobbying from the rural sector are becoming apparent following the inclusion of rural in the Pae Ora bill and with the creation of a rural-health focused Chief Advisor role at the Ministry of Health.

The lobbying and advocacy work kicked off in the early 1990s with the Canterbury Action Group of rural GPs which then, over time, morphed into the NZ Rural GP Network. Other affiliated interest groups lobbying for changes to improve rural health then formed the Rural Health Alliance of Aotearoa NZ (RHAANZ) and adopted a concept which originated in Australia – RuralFest.

Encompassing two days at Parliament with a focus on lobbying across the party divide, New Zealand’s version of RuralFest is more than five years old. With an over-arching aim of achieving equity of access to healthcare services for rural New Zealanders, the advocacy work continues today under the auspices of the newly formed Hauora Taiwhenua.

“RuralFest has been immensely important in getting the rural priorities articulated in a way that we can present to rural caucus – I would like to think that some of that work is the reason we are seeing these changes to include rural in health reforms now,” says Northland-based Clinical Director Rural Hospitals, Dr Sarah Clarke.

Dr Clarke is now splitting her time between her Rural Hospitals role and a newly created position at the Manatū Hauora Ministry of Health – Clinical Chief Advisor, Rural Health.  The inclusion of rural health in an advisory position aims to reduce issues around urban-based policies being applied to rural areas.

“Historically, rural health professionals have been told how we need to do something even though in a rural setting, it might be completely impractical,” says Dr Clarke.

“Finding a workaround could involve having to potentially breach policies or encounter professional risk – technically, you may not be following the rules but only because those rules aren’t fit for purpose in a rural environment.  My focus with this new role is to use a rural lens to ensure the rules are fit for purpose.”

The newly created role sits in a Directorate called System Performance & Monitoring and is part of a model where the Ministry of Health takes a kaitiaki role – acting as a steward for the health system and monitoring the performance of the system via an equity lens. This monitoring is influenced heavily by the results of a 2.5-year project carried out by a team of doctors and researchers to develop an agreed definition of rural to be used in health research and policy.

“That work has put an entirely new lens on how we look at health data and how we determine what is being measured.  Our work now is to monitor progress, make sure that new lens is applied and to ensure we are improving inequalities – especially in our priority populations of Māori and Rural.”

With her appointment to the new Chief Advisor role, Dr Clarke is excited for the opportunity to help shape the health system to see meaningful improvement for access to rural people, particularly doubly disadvantage groups like rural Māori.

“In my career, this is the first time I’ve felt like rural is becoming a priority – it really is a cause for celebration. Rural communities are the powerhouse of the agricultural economy so ensuring their wellbeing should be a ‘no-brainer’. Sustained lobbying from a group of passionate people has helped it become a ‘no-brainer’ to our nation’s policymakers too.”