Kevin Chacko, Research and Policy Officer, AHHA Staff
Healthcare workers are the cornerstone of Australia’s health system, ensuring people receive the right care, in the right place, at the right time. Yet Australia faces a workforce crisis marked not only by undersupply but also by inequitable distribution, particularly in rural, regional, and remote communities. This imbalance limits access to essential services and undermines our ability to deliver care that improves health and wellbeing outcomes .
A range of interconnected factors drive this challenge. Market dynamics and geographic preferences tend to draw healthcare workers toward metropolitan areas, which are perceived to offer greater access to specialised facilities, professional networks, and support services. In contrast, rural and remote regions often present limited opportunities for career progression. Reports such as the Grattan Institute’s Special treatment: Improving Australians’ access to specialist care have highlighted the scarcity of specialised training and advancement pathways outside urban centres.
Beyond professional incentives, social and community factors shape workforce attraction and retention. Limited housing, amenities, and social support can deter workers from rural settings, while climate change compounds the issue by threatening workforce stability. For example, an Australian National University survey of 362 doctors in the Northern Territory found that climate impacts such as extreme heat could lead to health workforce shortages in rural and remote communities.
Recognising these challenges and drawing on extensive engagement with the Australian Healthcare and Hospitals Association (AHHA) members who have shared their experiences in delivering person and community-centred care in rural and remote Australia, the Deeble Institute for Health Policy Research has developed a Perspectives Brief, Policy alignment for place-based solutions for better health outcomes in rural and remote communities. The brief calls for strong national leadership to move away from fragmented, input-focused systems towards coordinated, value-based approaches that measure success not by the number of services delivered, but by improvements in health and wellbeing outcomes for communities.
Value-based health care (VBHC) fundamentally reorients systems from operating around provider needs to those of people and communities. For workforce planning and design, this means moving away from input-focused workforce obligations in contracts, to instead instilling flexibility in policy and funding levers to incentivise workforce supply and distribution.
Through multiple case studies, the brief exemplifies how the current approach to workforce development is rigid and siloed, focused on sector or professional interests, as opposed to what is best for rural and remote populations. For example, a mental health service contract may specify a full-time equivalent requirement for a clinical psychologist. While this may be attainable in urban areas, in regions where there are no clinical psychologists the funds are unable to be redirected to an alternative, innovative model of care (e.g., the use of a virtual service or an alternative professional) that can still support improved outcomes, rather than allowing no care at all.
Another barrier is the under-recognition of enabling roles, such as community connectors, often developed through the Vocational Education and Training (VET) sector. These roles play a critical part in ensuring continuity of care, facilitating service navigation, and supporting scarce health professionals to work to top of scope. Yet their effectiveness in rural setting depends on shared understanding and agreed integration with services across the health, aged care, and disability sectors as there is insufficient population to justify enabling and connector roles in just one portfolio.
The brief outlines opportunities to use value-based principles to build a flexible and sustainable rural health workforce through:
- Using a VBHC framework to identify cost-effective delivery in terms of access and outcomes for local populations rather than outputs or workforce quotas.
- Applying flexible policy levers and associated funding streams at the local level in response to the specific health and workforce needs of communities.
- Developing connected workforce planning processes and vocational education and training (VET) systems responsive to the needs of the service systems in rural and remote Australia.
A VBHC approach recognises that the health workforce is not simply an input to be costed, but a critical enabler of outcomes. Workforce policy levers should shift from incentivising short-term, transactional activity towards long-term investment in people, services, and relationships that deliver measurable improvements in outcomes. Addressing these opportunities through coordinated, cross-sectoral reform will be essential to building a sustainable and flexible health workforce that is capable of delivering equitable, high-quality care and genuine value to all Australians, regardless of where they live.
