The collaborative potential of the rural health and student equity fields in higher education

There have been multiple government and community initiatives over the last 20 years to strengthen Australia's rural health workforce. At a national level, the Australian Government's Rural Health and Multidisciplinary Training (RHMT) Program is one of numerous Commonwealth rural health workforce programs aiming to address the maldistribution of the rural health workforce and comprises a network of Rural Clinical Schools (RCS) and University Departments of Rural Health (UDRHs). Demand for rural health professionals in regional, rural and remote Australia continues to outstrip supply; a trend that extends to other sectors, as illustrated by the Towards a Regional, Rural and Remote Jobs and Skills Roadmap Interim Report, https://www.jobsandskills.gov.au/publications/regional-rural-and-remote-australia-jobs-and-skills-roadmap.

A recent national review of Australian higher education, known as the Australian Universities Accord, https://www.education.gov.au/australian-universities-accord/resources/final-report, has recommended a range of higher education initiatives to address student inequities, including the expansion of higher education infrastructure in rural areas, most notably through the Regional University Study Hub (RUSH) program around the nation. UDRHs and RUSHs are funded by different Australian government departments (the Department of Health and Aged Care and the Department of Education respectively) and have different objectives, although they share broader overlapping aims of building higher education attainment for people living in rural communities and fostering the workforce across in-demand industries, including health. We believe there is potential unrealised synergy between RUSHs and UDRHs—noting that most RUSHs are relatively new compared with the UDRH network, which was established in the mid-1990s. We suggest that developing and harnessing collaborations and initiatives between the rural health and student equity in higher education fields could result in greater benefits for rural communities. We build on previous editorials in this Journal and call on our readership to consider how they can be better aligned with other rural higher education initiatives to strengthen the rural health workforce and improve the health of our rural communities.

For decades, policymakers in the field of higher education have focused on improving the access, participation and attainment of students from ‘equity groups’, including students from ‘regional and remote’ areas, which may include those from lower socio-economic areas, relative to their metropolitan counterparts. Australia has a long history of providing learning opportunities for regional, rural, remote and isolated students. Correspondence courses were first offered early last century, followed by learning over distance via School of the Air. Online learning has been provided by Open Universities and by universities that have prioritised distance learning and online delivery. Place-based on-campus learning has been provided by universities headquartered in regional centres as well as universities headquartered in metropolitan settings with regional campuses. The recent Australian Universities Accord Final Report, https://www.education.gov.au/australian-universities-accord/resources/final-report, stressed the importance of lifelong learning and creating higher education opportunities for rural people, with the aim of lifting the regional, rural and remote student participation rates from 19.8 per cent to 24 per cent. Initiatives to reach this target include a range of non-place specific actions. These include, for example, creating more flexible and connected university processes to allow students to navigate systems and ‘stacking’ prior learning to gain credit and awards. Such initiatives might support rural people to engage in higher education, although there is also a need for place-based initiatives that incentivise and support rural people to undertake higher education courses in their communities. This includes recognising the important role that regional universities have had and should continue to have, in Australian higher education. The RUSH program, https://www.education.gov.au/regional-university-study-hubs, is also a key Accord-related place-based initiative tasked with supporting the process.

At the time of writing, there were 46 community-driven RUSHs in inner regional to very remote areas, with more to be announced. The RUSH program, formerly called the Regional University Centres (RUCs) program, began in 2018, with models and guidance drawing on existing study hubs, notably the Geraldton Universities Centre (https://guc.edu.au/history/) and what was previously called the Cooma Universities Centre (https://www.cucsnowymonaro.edu.au/our-story/). While no two RUSHs are the same, they are all community-driven, physical study hubs that aim to improve access to and successful participation in tertiary education in regional, rural and remote areas. Students in these areas can study a course online at any Australian university and frequent their local RUSH to use computers, study spaces and internet, and receive learning, practical and emotional support from local RUSH staff. Some RUSHs offer end-to-end courses in partnerships with universities. The expansion of this program, particularly into more remote locations, suggests that they may contribute to strengthening the rural health workforce. However, RUSHs are not typically designed to provide specialist expertise, which is critical in health education.

The RHMT program, which offers a range of higher education health, educational and professional development opportunities, plays a key role in the efforts to strengthen the rural health workforce. Importantly, the RHMT program has established critical infrastructure in regional, rural and remote locations for rural health workforce development, including the creation of UDRHs across Australia. Similar to RUSHs, the 19 UDRHs meet local need for higher education in health in ways that are unique to the rural communities that they serve. UDRHs oversee the work involved in facilitating rural student placements and conduct research. Some also provide end-to-end courses, while others are co-located in areas where end-to-end training is available. In part due to the geographical expanse of Australia, the number and range of end-to-end health course offerings in rural contexts is limited, and in reality, delivering end-to-end courses may be out of the scope of current UDRH objectives within the existing budget envelope.

In recent years, higher education academics have collaborated on research relating to both rural health and student equity in higher education, including explorations of study supports for rural mature-aged students and the role of place in rural health workforce education and practice.^{1, 2} We suggest that these collaborations are a good start, but more is needed to address the common ground between rural health and student equity in higher education, especially considering that key initiatives of both are geographically interconnected. Mapping by the Centre for Australian Research into Access (CARA, https://experience.arcgis.com/experience/2e76de924ab546cba6d6fc7ce836c493/) illustrates the national view of access from each Australian address to university campus locations, compared with 46 RUSHs, which at the time of geo-coding included 60 locations (n = 60 from https://regionaluniversitystudyhubsnetwork.edu.au/locations, accessed on 25 September 2024). The list of RUSHs has since been updated (see https://www.education.gov.au/regional-university-study-hubs/list-regional-university-study-hubs). Figure 1 illustrates the areas served by the RUSH network beyond the existing network of traditional university campuses and highlights the potential penetration of tertiary offerings into under-served communities, being mindful that RUSHs shouldn't be viewed as a replacement.

Figure 2 highlights the regional centre of Geraldton, Western Australia, where the first established RUSH, the Geraldton Universities Centre, is located. This mapping illustrates how the existence of a RUSH can reduce travel time for students to access facilities and supports for their learning.

The summary statistics at a local government area illustrated in Figure 2 quantify this improved access to tertiary education, although it provides no detail on what course offerings are available. The application of address-level intelligence as the spatial unit would allow summary statistics to be produced at any existing administrative unit to assist policymakers to better understand the impact of location, both for existing infrastructure and strategic planning of future investment (e.g. deciding where future RUSHs may be located to optimise reach for priority communities).

To leverage the opportunities presented by recent higher education reforms for the benefit of regional, rural and remote communities, it is essential to enhance collaborations between rural health and student equity initiatives in higher education. However, given their different program objectives and the unique communities they serve, it cannot be assumed that RUSHs and UDRHs are primed for collaboration. RUSHs have historically been community-driven, with varying levels of engagement with universities. Additionally, some colleagues on regional campuses are concerned about the current funding and policy focus on RUSHs, fearing that regional universities may be neglected. Careful relationship development between the two fields is necessary to foster future collaborative activities. This groundwork could be established through place-based research partnerships and other localised efforts.

Once relationships are established, rural health and student equity in higher education collaborations could be strengthened at a local level through the establishment of referral models. For example, UDRHs could encourage and refer students to use RUSH resources in their local communities, and RUSHs could refer students to use local UDRH resources (e.g. existing student areas with access to internet and other infrastructure). UDRHs could work more closely with RUSHs to support students on placement, particularly to support social network development. Collaborative partnerships between RUSHs and UDRHs could also foster curriculum innovation drawing on local place-based professional practice knowledge to overcome the divide between students' rural knowledge and often de-contextualised university knowledge. At a national level, stronger partnerships between relevant bodies could support collaborative research to better understand suitable methods for supporting regional, rural and remote student cohorts. This could develop rural practice knowledge into rural workforce initiatives and identify health course delivery models that harness the infrastructures provided by UDRHs, RUSHs and other local infrastructure (including regional university campuses, libraries, community/neighbourhood houses and learning centres, vocational and further education spaces, and schools, as suggested by Crawford and McKenzie³).

Awareness raising of potential opportunities between government departments, including between the Australian Government Department of Health and Aged Care and the Australian Government Department of Education, and between universities and rural health peak bodies is further needed to minimise duplication of effort and support the concerns of individual rural communities. Improving alignment would require the various government departments to work more collaboratively to maximise return on investment and ensure the funding is targeted towards the most pressing needs for each rural community or region, resulting in better utilisation and strengthening of existing community resources. Furthermore, local ownership of initiatives to support students, as previously demonstrated by UDRHs, is needed. Rural health services also have a vital role in this community-building work, as suggested by Duckett (2024) in his editorial.⁴ Health services can continue to support rural students on placement and employ them in assistant roles while they are studying, so they earn as they learn. For these collaborations to occur, enhanced cross-sector research funding to capture and evaluate cross-disciplinary initiatives benefitting both the education and health of rural Australians would be advantageous. Improved spatial intelligence about course availability, access to RUSHs and university campuses, will further our understanding of priority communities. The aggregate travel time statistics used in this paper are intermediate in nature and are actively being developed as part of the ARC LIEF grant (LE220100028).

Rural communities are already leading efforts towards better health. To make the most of this pivotal moment in higher education reforms, collaboration between rural health and student equity fields in higher education is essential.

Claire Quilliam, Mollie Dollinger, Nicole Crawford, Carol McKinstry and Vincent Versace discussed initial ideas and structure for the piece. Claire Quilliam wrote the first draft. Centre for Australian Research into Access (CARA) developed the geographical output. All authors contributed to and revised drafts.

No ethics approval necessary.