Review Article

Health service delivery and workforce in northern Australia: a scoping review


name here
Alexandra Edelman1
MPH, Research Fellow *

John Grundy2 PhD, Adjunct Research Fellow

name here
Sarah Larkins3
MBBS, MPHTM, PhD, Professor of Health Systems Strengthening

name here
Stephanie M Topp4
MIPH, MPhil, PhD, Associate Professor of Global Health and Development

David Atkinson5 MBBS, MPH, Professor and Regional Training Hub Lead

name here
Bhavini Patel6
MSc, Executive Director of Medicines Management: Research, Transformation and Change

name here
Edward Strivens7
MBBS, Adjunct Professor and Clinical Director, Older Persons and Subacute Services

Nishila Moodley8 PhD, Lecturer

name here
Maxine Whittaker9
MBBS, MPH, PhD, Dean


*Ms Alexandra Edelman


1, 2, 4, 8, 9 College of Public Health, Medical and Veterinary Sciences, James Cook University, Douglas, Qld 4811, Australia

3 College of Medicine and Dentistry, James Cook University, Douglas, Qld 4811, Australia

5 Rural Clinical School of Western Australia, University of Western Australia, 12 Napier Terrace, Broome, WA 6725, Australia

6 Top End Health Service, Northern Territory Department of Health, Royal Darwin Hospital, Rocklands Drive, Tiwi, NT 0810, Australia

7 College of Medicine and Dentistry, James Cook University, Douglas, Qld 4811, Australia; and Cairns and Hinterland Hospital and Health Service, PO Box 902, Cairns, Qld 4870, Australia


28 November 2020 Volume 20 Issue 4


RECEIVED: 1 June 2020

REVISED: 27 October 2020

ACCEPTED: 30 October 2020


Edelman A, Grundy J, Larkins S, Topp SM, Atkinson D, Patel B, Strivens E, Moodley N, Whittaker M.  Health service delivery and workforce in northern Australia: a scoping review. Rural and Remote Health 2020; 20: 6168.



As a literature review this work relied on secondary materials and as such did not require ethical review.

This work is licensed under a Creative Commons Attribution 4.0 International Licence


Introduction:  Delivering health services and improving health outcomes of the 1.3 million people residing in northern Australia, a region spanning 3 million km2 across the three jurisdictions of Western Australia, Northern Territory and Queensland, presents specific challenges. This review addresses a need for systems level analysis of the issues influencing the coverage, quality and responsiveness of health services across this region by examining the available published literature and identifying key policy-relevant gaps.
Methods:  A scoping review design was adopted with searches incorporating both peer-reviewed and grey literature (eg strategy documents, annual reports and budgets). Grey literature was predominantly sourced from websites of key organisations in the three northern jurisdictions, with peer-reviewed literature sourced from electronic database searches and reference lists. Key articles and documents were also contributed by health sector experts. Findings were synthesised and reported narratively using the WHO health system ‘building blocks’ to categorise the data.
Results:  From the total of 324 documents and data sources included in the review following screening and eligibility assessment, 197 were peer-reviewed journal articles and 127 were grey literature. Numerous health sector actors across the north – comprising planning bodies, universities and training organisations, peak bodies and providers – deliver primary, secondary and tertiary healthcare and workforce education and training in highly diverse contexts of care. Despite many exemplar health service and workforce models in the north, this synthesis describes a highly fragmented sector with many and disjointed stakeholders and funding sources. While the many strengths of the northern health system include expertise in training and supporting a fit-for-purpose health workforce, health systems in the north are struggling to meet the health needs of highly distributed populations with poorly targeted resources and ill-suited funding models. Ageing of the population and rising rates of chronic disease and mental health issues, underpinned by complex social, cultural and environmental determinants of health, continue to compound these challenges.
Conclusion:  Policy goals about developing northern Australia economically need to build from a foundation of a healthy and productive population. Improving health outcomes in the north requires political commitment, local leadership and targeted investment to improve health service delivery, workforce stability and evidence-based strengthening of community-led comprehensive primary health care. This requires intersectoral collaboration across many organisations and the three jurisdictions, drawing from previous collaborative experiences. Further evaluative research, linking structure to process and outcomes, and responding to changes in the healthcare landscape such as the rapid emergence of digital technologies, is needed across a range of policy areas to support these efforts.


allied health, Australia, health systems, health workforce, medicine, multidisciplinary, nursing.

full article:


Delivering health services and improving the health outcomes of the 1.3 million people residing in northern Australia, a region spanning 3 million km2, presents specific challenges. Northern populations experience poorer health outcomes than their southern counterparts across a range of measures including life expectancy, potentially preventable hospitalisations, avoidable deaths, and risk factors for chronic disease1-3. Many entities, including public, private, community controlled and other non-government organisations, are responsible for planning and delivery of health services across the north. Training and retaining a fit-for-purpose, competent health workforce is also a major focus of the region’s governments, universities, health services and training organisations but, as in rural and remote areas in Australia generally, workforce shortages across the north are widespread4.

With around 40% of the northern Australian population living in townships and communities of less than 8000 people, health service capacity, including workforce, is widely distributed5. Outside of the larger regional centres of Cairns, Darwin, Mackay and Townsville, which offer a full range of primary healthcare, secondary and most tertiary services close to home, patients access visiting or on-site primary care services including Aboriginal community controlled health services (ACCHSs) and referral pathways often involving travel or e-health for specialist and allied health services. Larger towns also offer small public hospitals and clinics. Other subcontexts of health service delivery in the north include discrete Aboriginal, and Torres Strait Islander, communities; and population centres with high numbers of fly-in/fly out or drive-in/drive-out workers, such as mining towns. Around 15% of the northern Australian population identify as Aboriginal and/or Torres Strait Islander, representing 30% of all Aboriginal Australians and Torres Strait Islanders in Australia6.

The 2015 Australian Government’s Northern Australia White Paper articulates an opportunity for northern Australia to ‘become an economic powerhouse’ within Australia, identifying health as a key strategic pillar in developing the north6,7. Northern Australia, as defined in the White Paper, incorporates all of the Northern Territory (NT) and the northern parts of Queensland and Western Australia (WA) above the Tropic of Capricorn6 (Fig1). Across the north, health care and social assistance is the largest employing industry, representing 13% of total employment7. Improving health services, including health workforce, in the north is fundamental to both the wellbeing of people living in the region and broader economic productivity and development.

Health services are the most obvious output of health systems but rely on many other health system components or ‘building blocks’ including financing, governance and leadership, human resources for health (ie health workforce), medical technologies and health information systems8. Although many articles and policy papers address aspects of these different components in northern Australia (as identified in this review), few (if any) take a systems level approach, integrating and analysing the way these various components interact and cumulatively influence the coverage, quality and responsiveness of health services in the region. The aim of this review is therefore to systematically review the available published literature (both peer-reviewed and grey literature) describing health service delivery and health workforce characteristics, trends, challenges and opportunities across northern Australia and to identify key policy-relevant gaps. The review constitutes the first component of a broader project commissioned by the Cooperative Research Centre for Developing Northern Australia to develop a Northern Australia Health Service Delivery Situational Analysis9.

table image Figure 1:  Geographic boundary of northern Australia as defined in the review (all of the Northern Territory, along with Queensland and Western Australia above the Tropic of Capricorn). 



Scoping reviews enable complex and heterogeneous bodies of literature in a field to be summarised and mapped in terms of volume, nature, characteristics, extent and gaps10. This literature review adopted a scoping review design11 utilising systematic methods to comprehensively identify and map the literature relating to health service delivery and workforce in northern Australia. The searching, selection and extraction methods followed the PRISMA Extension for Scoping Reviews Checklist12.

Search strategy

Both peer-reviewed and grey literature were sourced for the review with searches for both types undertaken in parallel by two members of the project team during August 2019.

Grey literature searches:  Given the focus of the review on identifying policy-relevant health systems literature and gaps, grey literature such as strategy documents, annual reports and policy papers were identified as important sources of information. Searches involved website searching, contacting policy experts for advice on key articles and websites, and snowballing from references. Documents were sourced from organisational websites, including government health services and planning bodies, Aboriginal and Torres Strait Islander health organisations, universities and research institutes. Searches for policy and health system strategy documents were conducted by jurisdiction (ie by state and territory) and, where available, across jurisdictions.

Electronic database searches:  Peer-reviewed publications were identified from electronic database searches, reference lists and expert recommendations. An initial list of keywords was developed to reflect the review aim, and searches using these terms were piloted in Scopus and Medline (Ovid). Final search terms were selected to ensure an appropriate balance of breadth and specificity. The final search strategy as used in Medline (Ovid) is shown in Table 1. Final electronic searches were conducted in Scopus, Medline (Ovid), CINAHL, ERIC and Informit (Health and Indigenous suites); these databases were selected for comprehensiveness and likelihood of containing policy-relevant information appropriate to the Australian context. Searches in Medline (Ovid) and CINAHL used medical subject headings (MeSH) and keywords, while searches in the other databases relied on keywords.

Table 1:  Search strategy and keywords in Medline (Ovid)table image

Selection and extraction

Selection and extraction were undertaken in parallel by the two members of the research team who undertook the grey literature and database searches. This process involved frequent meetings between the two researchers to agree on an approach to interpreting the inclusion criteria and determining eligibility, supplemented by regular meetings of the broader review team to discuss the boundaries and address any concerns. Stakeholders involved in the broader Situational Analysis project were also consulted about the approach to searching, selection and extraction in the review. Articles were included if they were published in English and described characteristics, trends, challenges or opportunities relevant to health service delivery and workforce in northern Australia. Although a relatively narrow date range of 2015–2019 was used in the database searches to maximise policy currency of the research-based findings, the search strategy enabled flexibility to include seminal documents and resources published prior to 2015 as identified through snowballing, expert recommendation and grey literature searches. Three jurisdictional advisory groups involving senior health system stakeholders in each jurisdiction, which were convened for the broader Situational Analysis project, were an important source of advice for additional literature. Following screening of title-abstract records from the database searches, full texts of peer-reviewed literature were uploaded to Clarivate EndNote and assessed for eligibility. While there were no uncertainties about inclusion of any grey literature sources, uncertainty about whether 29 peer-reviewed articles met the inclusion criteria was resolved by consensus involving at least three reviewers.

Information from peer-reviewed and grey literature was extracted to a single data extraction template in Microsoft Excel using the following fields: authors/organisation; title; date of publication; study setting/geographic location; study type; study design/type of evidence; focus, aim and rationale of the study; current capacity; developmental trends; key challenges; key opportunities; and gaps. Additional fields were added to enable examination of whether articles mentioned community participation and, if so, how any participatory planning was operationalised; these fields facilitated critical examination of the body of literature using a community engagement lens. A broad interpretation of community engagement was used for this purpose, which allowed the reviewers to identify whether researchers or policymakers had sought to engage end users of the research or policy (whether community members directly, clinicians in a target health service or representative organisations) in the development of the publication, and how such engagement was enacted. Information relating to the social determinants of health was also extracted (either as reported in the article or reflecting analysis by the authors of this review). Finally, records were classified using a health systems framework (described below) to facilitate analysis of the highly diverse body of literature.


Relevant data from the articles included quantitative and qualitative data, and findings were synthesised and reported in narrative form, using a narrative synthesis approach13 to facilitate mapping of the domains covered by the literature. This synthesis focused primarily on identification of key issues and gaps, with quantitative findings extracted where possible to supplement findings relating to health service delivery, and workforce capacity and trends. Consistent with a scoping review approach and the review aim, selected articles were not critically appraised for methodological rigour; however, mapping of the study types enabled the review to report the extent and nature of the empirical body of evidence underpinning the findings.

Findings were analysed and reported against the WHO health system ‘building blocks’8: service delivery, health workforce, health information systems, access to essential medicines and technologies, financing, and leadership and governance. As is sometimes done internationally when using the building blocks, a seventh category – community engagement – was added to capture and describe community-focused issues and gaps. The WHO building blocks are interconnected components that contribute to the functioning of health systems.


From a total of 324 documents and data sources included in the review following screening and eligibility assessment (Fig2), 197 were identified as peer-reviewed journal articles and 127 as policy papers and data sources (grey literature). The grey literature synthesis reflects the strategic efforts of key health service delivery and workforce planning bodies in northern Australia, and includes policy strategies, plans and reports including budgets, health profiles and datasets. The peer-reviewed literature (referred to from here as articles) consists of empirical research (88%), expert opinion (10%) and other literature reviews (2%). Most articles focus on the jurisdictions of Queensland (39%) and the NT (35%), with fewer articles focused on WA (17%) or on cross-jurisdictional issues (10%). Grey literature has roughly equal focus on the NT (31%) and cross-jurisdictional issues (30%), with fewer sources focused on Queensland (23%) or WA (17%). Key findings are presented against the six WHO building blocks and the community engagement addition.

table image Figure 2:  PRISMA flow diagram, showing results of literature searches.

Leadership and governance

The innumerable organisations providing healthcare and workforce education and training across the north have largely separate governance and resourcing structures, with clear distinction between jurisdictions. Though uncommon, there are a few notable examples of cross-northern governance arrangements focusing on coordination and information-sharing relating to health services and workforce planning and delivery. An example of cross-jurisdictional collaboration is the clinical use of remote primary healthcare manuals in the NT and northern WA14. While research initiatives sometimes involve project-specific governance arrangements involving academic, health service and community stakeholders across jurisdictions15,16, the only cross-jurisdictional initiative identified at a broad health policy level is the (now disestablished) Greater Northern Australian Regional Training Network (GNARTN). GNARTN was established in 2013 to address a range of clinical workforce and clinical placement, education and training issues, via an agreement reached between WA, NT and Queensland health departments, supported with Commonwealth funding17. GNARTN aimed to address a lack of ‘governance connectivity’ across the northern jurisdictions, with stated achievements including improvements to health service efficiency and effectiveness, building of new capabilities, reduced duplication and identification of shared opportunities for new initiatives17.

Even within jurisdictions, several articles identify fragmentation of health-related policy and planning as an important governance challenge18-20, with some articles offering specific examples of how policy and planning fragmentation result in service fragmentation, impeding optimal health service delivery. One study found that a key challenge for NT-based health professionals providing postpartum diabetes care to Aboriginal, and Torres Strait Islander, women was disjointed systems and confusion about roles and responsibilities, highlighting a need for improved communication and integration of different health system components21. Another study demonstrated that poor coordination of services inhibited support systems for people travelling to large regional centres from remote far north Queensland to access health care19.

Primary health networks (PHNs), four of which are in northern Australia, were established nationally to address fragmentation resulting from different funding streams and siloed engagement between different organisations22-24. The PHN roles are intended to involve a commissioning cycle of planning, determining need and innovative solutions, procuring services and monitoring and evaluation, drawing from comprehensive needs assessments. However, no northern-focused studies evaluated the PHN model or the establishment of devolved health services districts or networks such as Queensland’s Hospital and Health Services. In general, few articles offer an analysis of the complex governance structures or policy approaches apparent across the north, apart from articles expressing strong support for community governance models in the ACCHS sector (see ‘Community engagement’). Nonetheless, some articles have a macro policy focus; examples include an evaluation of Connecting Healthcare in Communities, a historical initiative in Queensland aimed at establishing formal partnerships in the primary healthcare sector to improve health care and outcomes25, and a study examining the effect of changes in primary health care in the NT over 5 years (2009–2013) on services’ ability to respond to health inequity26. This latter study found that long-term secure funding is needed to support delivery of comprehensive primary health care, which underpins equity performance. Perhaps linked to the relative lack of policy analyses, very few studies addressed issues pertaining to policy leadership, although community leadership was an implicit focus in the literature on ACCHSs (see ‘Community engagement’). Articles for only two studies directly mention leadership in relation to study findings, with one identifying a general need for strengthened Aboriginal leadership as part of health system reform in the NT27, and the other identifying gaps in formal recognition and training of Indigenous health workers as program leaders in Queensland28.

Community engagement

Community engagement in the literature represents a continuum of approaches from passive feedback platforms to active community control of health governance structures. Most strategic plans and policies of northern organisations – including the PHNs, government health services and universities – express an intent to engage with individuals and communities through management mechanisms, governance models, service delivery or ‘consumer’ feedback processes. The grey literature also demonstrates an aspiration for health services to be delivered in a way that values and respects cultural rights, views and values of Aboriginal, and Torres Strait Islander, people across the north22. Jurisdiction-based frameworks, such as the NT Aboriginal Cultural Security Framework 2016–202629, aim to guide the work of government services providing culturally secure health care.

Notwithstanding these aspirational sentiments, the tangible role or mechanisms to engage with community members as agents of health governance is poorly reflected in the grey literature, with the notable exception being the ACCHS sector. The ACCHS model of health service delivery is described as an exemplar in community engagement, adopting a healthcare approach that values culture, spirit, country, family, community and language as critical determinants of physical, social and emotional health and wellbeing of Aboriginal, and Torres Strait Islander, people26,30-33. Community engagement approaches in other organisations sometimes involve partnerships with ACCHSs and ACCHS peak bodies within the jurisdictions. The Western Queensland PHN, for example, has a partnership with the Queensland Aboriginal and Islander Health Council and individual ACCHSs to ‘enable greater quality and capability of services for Aboriginal and Torres Strait Islander people living in the catchment’34.

Numerous articles reviewed highlight the comparative strengths of ACCHSs in responding to population health inequities and in providing a comprehensive model of primary health care26,35-40. Further, ACCHS peak bodies across the three northern jurisdictions were noted to provide a strong voice for Aboriginal, and Torres Strait Islander, people in regional service delivery, research and policy. For example, the Kimberley Aboriginal Medical Services Council and the Kimberley Aboriginal Health Planning Forum lead the longstanding production of the Kimberley Chronic Disease Protocols, the Kimberley Maternal and Child Health Protocols and the Kimberley Standard Drug List41. However, tensions were identified in the literature between cultural preferences and biomedical models of health care in the north, such as in the use of practice manuals relying predominantly on scientific and clinical logic (rather than community choices) to sanction birthplace42, in maternity services policy that effectively ‘silence’ the voices of Aboriginal Australians43, and in community-disengaged policies on end-of-life care for remote-dwelling Aboriginal people44,45.


The grey literature highlights growing cost pressures facing the northern Australian health system regarding the high chronic disease burden, ageing population, and the need to maintain ageing infrastructure and upgrade information and communications technology infrastructure46-51. Reflecting the higher disease burden and costs in the north, data from the Australian Institute of Health and Welfare indicate higher per-capita spending on health in parts of northern Australia compared with national averages: in 2017–2018, the average per-capita spending on health in the NT was A$10,857 per person compared with A$7485 per person nationally52. According to Zhao et al53, in the NT alone the excess costs associated with the Aboriginal health gap were A$16.7 billion over a 5-year period (made up 22% of excess healthcare costs, 35% due to lost productivity and 43% attributable to lost life-years). The high chronic disease burden across the north is reported as a leading driver of escalating costs48,54.

A large body of evidence in the review supports strengthening comprehensive primary health care as one of the most effective strategies for improving health outcomes and containing healthcare costs54-59. An important distinction is made in the literature between fee-for-service ‘walk in/walk out’ models of general practitioner-led primary care (as exemplified by the Medicare Benefits Schedule financing structure), and the strategic intent of resource allocation for population-based ‘comprehensive’ primary healthcare models (as implemented in ACCHS)60. A rationale is also offered for transitioning to models of funding for remote primary healthcare services that include the safety and equity requirements for a ‘minimum viable service’, requiring payment reforms that reward value over volume of services55. In the NT, Wakerman et al55 found that the current funding systems for remote primary healthcare services, including Medicare, do not promote equity in access, warranting establishment of a minimum funding base for primary healthcare services in remote communities, supplemented by a capitation rate. Such reforms may be in the pipeline – the Australian Healthcare and Hospitals Association, in its blueprint for the next 10 years in the health sector, reported developing a mixed funding formula for the health sector whereby 25% of resource allocation is outcomes-based, and is initially trialled for the top four chronic diseases, risk factors or determinants of health61.

Service delivery

A wide range of health services and models in northern Australia are described in the literature. Examples include hospital services58,62; remote primary care clinics57,63; ACCHSs26,35,36,64; rehabilitation, cancer, dialysis and palliative care services65-69; visiting specialty, general practitioner and nurse-led remote area outreach clinics70-72; maternal and child health services73,74; mental health and social services75-77; health promotion services64,78,79; oral health services80-84; and e-health services (see ‘Essential medicines and technologies’). Most articles were about improving access to the various healthcare services outside of larger regional centres and highlight a range of persisting barriers. These barriers include:

  • contextual factors such as small population sizes and remoteness, meaning great distances between communities and services18,85
  • workforce shortages, especially in remote and very remote areas (see ‘Health workforce’)
  • deficiencies in providers’ cultural capability training and/or the ability of service models to deliver their cultural capability goals86.

Most of these articles relate specifically to rural and remote health service delivery, with few addressing health service issues in the larger regional centres. In addition, apart from the articles relating to mental health and social services already cited, mental health issues in the north appear to be under-prioritised and under-explored in both the policy and peer-reviewed literature.

Key enablers of successful health service models and programs include:

  • use of innovative workforce models87-89
  • cross-sectoral collaboration between health services and non-health organisations90
  • community leadership and involvement in program design and implementation36,72,91
  • a focus on complex healthcare needs rather than disease-specific care67,92
  • continuity of care, including services close to home93
  • effective cross-cultural communication16,86,94-99.

Several articles address investment need in primary prevention, with many of the reported studies demonstrating significant health benefits from such investments64,79,96,100-105. For example, McMullen et al106 link environmental risks with health service use in northern WA, finding that around 20% of attendances at primary care facilities are directly attributable to the environment, indicating that investments in environmental factors such as sanitation and hygiene, home condition, land use, air pollution and chemical exposure could substantially reduce healthcare demand. The ability of comprehensive primary healthcare models to combine competent clinical care with population health programs underscore its relevance to rural and remote contexts in improving health care and outcomes38,107, often at reduced costs (see ‘Financing’).

Strategic planning documents of the government services express strong commitments to equitable health outcomes, prevention of poor health and supporting people to lead healthier lives46,48,108-110. However, some of the jurisdictional health budgets and implementation documents analysed in the review indicate limited translation of strategic intent to act on social determinants of health at a strategic planning level into operational capacity and funded action111-113. In WA, a review of the health system recommends reforms involving a cultural shift from acute, reactive, hospital-based systems to systems focused on prevention and equity114. As noted earlier, articles for several studies report the importance of addressing the social, cultural and environmental determinants of health that underpin health outcomes. For example, studies across the north identified a need for increased attention to and investment in nutrition, including food access and affordability115,116; physical activity96,117; adequate hygiene and housing58,118; tobacco control102,119; alcohol policy105,120,121; child literacy101; health literacy122; socioeconomic circumstances including employment and income122,123; and caring for country124.

Health workforce

The literature documents many ongoing challenges across northern Australia in recruitment and retention of health workforce. All three jurisdictions report shortages of health workforce, particularly of medical generalists and specialists, and allied health workforce, in rural and remote areas125-128. Some articles report very high turnover of nurses and allied health professionals in government-funded remote NT clinics and heavy reliance on agency nurses129-131. For example, a study conducted in the Top End region of NT found that only 20% of nurses and allied health professionals remained working at the same remote clinic 12 months after commencing, with half leaving within 4 months129. Low levels of doctor retention have also been documented in WA, with Bailey et al132 finding that the majority of new doctors leave rural practice within 5 years of their posting.

A synthesis of studies on health workforce retention applied to the NT context describes potential savings to the NT health system of around $32 million per annum if staff turnover in remote clinics was halved131. The present study finds considerable evidence about what works in improving health workforce retention but describes a persistent implementation gap in translating empirical research evidence into policy action. Addressing this gap requires political commitment, and coordination and collaboration between different organisations and sectors.

Under-representation of Aboriginal, and Torres Strait Islander, people in the health workforce is also reported; for example, in the WA Country Health Service catchment, 10% of the population identify as Aboriginal or Torres Strait Islander, but only 4.4% of health sector employees identify as such, although a range of strategies are being employed to increase recruitment and retention and to support Indigenous leadership development133. Articles for several studies examine the role and/or training pathways of Aboriginal and Torres Strait Islander Health Workers and Health Practitioners89,123,134,135, finding the roles to be highly effective but potentially hampered by significant unmet training needs. While availability of Aboriginal and Torres Strait Islander Health Workers and Health Practitioners is described as instrumental to culturally safe health service delivery, this cadre of health workforce is seen to be under-recognised, under-supported and under-utilised136.

Training needs are also reported across a wide range of capability areas for different health professional staff, including in provision of culturally safe care among hospital staff in the NT135, health promotion skill development for primary healthcare staff working in Cape York104, and research skills among regional allied health professionals from the northern districts of Queensland Health137. Articles for several studies profile successful models of undergraduate medical and rural generalist training to develop a fit-for-purpose rural medical workforce, which are currently being used in the north138-145. These highlight the importance of exposing undergraduate students to all elements of the rural training pathway, including well-supported rural clinical placements, to build the rural and remote workforce. Apart from a study evaluating allied health assistant roles in the NT88, however, no articles report studies on the development or evaluation of rural generalist training pathways in allied health, nursing or pharmacy. Trainee and staff support and wellbeing, including occupational health and safety, are also important considerations in building and supporting health workforce across the north, particularly for those working remote and very remote locations146-148.

Health information systems

The grey literature indicates increasing uptake of digital information systems in healthcare settings in the north47,49. Improved data sharing is also reported as an opportunity for improving the quality and coordination of patient care23,149. In Queensland, investments totalling more than $1 billion are estimated to be needed to upgrade ageing information and communication infrastructure in the health sector, to deliver a range of priorities including contemporary network and data centre foundations, information interoperability, statewide electronic medical records and secure information-sharing environments49.

Despite the policy attention on digital information systems and infrastructure across the north, few evaluations of health information systems were identified in the literature. One study evaluating an electronic data management system implemented in the delivery of health services to the Fitzroy Valley in WA (Communicare) found the system to be a feasible way to establish population health indices for the remote health service with minimal expenditure150. Another study evaluated the Chronic Conditions Management Model in the NT, involving monthly functional recall lists, quarterly functional traffic light reports of performance and 6-month trends reports151, finding that the model leads to substantial improvements in preventive care for cardiovascular disease in the primary healthcare context. Additionally, another study identifies the lack of connectivity between patient information systems in different services as a key challenge in implementing a diabetes antenatal care and education clinic in the remote NT18. Future evaluative work should explore the benefits and shortcomings of different digital health information systems being rolled out across the north, including implementation experiences.

Essential medicines and technologies

The literature in this building block addresses both access to medicines and the role of technological innovations in improving health care, particularly among rural and remote patients. Several articles report barriers to treatment access, such as low levels of health literacy among patients with poorly controlled diabetes, and difficulties accessing reimbursement for hepatitis B treatment, in the Torres Strait region70,152; and deficits in registration and recall systems for rheumatic heart disease treatment in northern Queensland153. A statewide initiative in Queensland that aims to improve access to medicines and pharmaceutical advice among Aboriginal, and Torres Strait Islander, people is also reported154. Although not examined directly in the literature, nationwide funding mechanisms such as the Pharmaceutical Benefits Scheme also support medicines access in the north.

There is increasing emphasis on the benefits of digital and telehealth models of care in northern jurisdictions47,49, which may be translating into increased use of e-health technologies. Several articles report studies conducted in different service contexts that evaluate telehealth models for treatment, service access or workforce development. Overall, these studies found telehealth to be a feasible and satisfactory delivery method from the perspective of both service providers and patients155-172. One of these studies explored the impact of teleoncology models of care in enabling safe delivery of chemotherapy in a remote area of north west Queensland (Mount Isa)171, finding no significant differences between the Mount Isa and Townsville Cancer Centre patients with regard to demographic characteristics, mean numbers of treatment cycles, dose intensities, proportions of side effects and hospital admissions. The study concludes that it appears safe to administer chemotherapy in rural towns under the supervision of medical oncologists from larger centres via teleoncology, provided that rural healthcare resources and governance arrangements are adequate. Several articles address the efficacy and cost-effectiveness of point-of-care testing for diagnosis and treatment management of a range of conditions173-175. Similar to those for the telehealth studies, these articles highlight the benefits of this technology in bringing treatment closer to home, especially for rurally based patients.

However, some important limitations to the overall effectiveness of digital and telehealth are identified in the literature. These include a need for adequate rural healthcare resources, including local health workforce65; infrastructure, including technical support163,165, training and governance arrangements159; as well as a need for e-health services to complement, rather than replace, community-led comprehensive health service models176. Staffing pressures were a barrier to telehealth use in one study163, and technical issues such as client position and camera angle were identified as a challenge in another165. One article contends that, despite its multiple benefits in providing timely and responsive services to remote clients, video-conferencing was unable to replicate the achievements of actual occupational therapists during community visits167.


This review represents the first comprehensive sector-informed narrative synthesis of published literature on health system issues across northern Australia. A wide range of health sector actors including planning bodies, universities and training organisations, peak bodies and providers exist across the north, delivering primary, secondary and tertiary services and workforce education and training in highly diverse contexts of care. Although a great many exemplar health service and workforce models are apparent in the north, the synthesis presents a picture of a highly fragmented sector with many and disjointed stakeholders and funding sources. Overall, despite the many strengths of the northern health system, including expertise in training and supporting a fit-for-purpose health workforce, health systems in the north are struggling to meet the health needs of highly distributed populations with poorly targeted resources and ill-suited funding models. Ageing of the population and rising rates of chronic disease and mental health issues, underpinned by complex social, cultural and environmental determinants of health, continue to compound these challenges.

The literature overwhelmingly highlights the benefits of comprehensive primary health care, exemplified by ACCHSs, and the potential for significant cost savings to be made from investing in these models. There is convincing evidence of the health-promoting influence of primary health care, including its role in preventing illness and death and in creating more equitable distribution of health in populations177. Primary health care provides continuity of care that has been shown to reduce total hospitalisations, avoidable admissions and emergency department use in a range of settings in Australia and overseas178-180. In the northern Australian context, evidence shows that investing A$1 in primary health care in remote Aboriginal communities can lead to a saving of between A$3.95 and A$11.75 in public hospital expenses, in addition to the health and social benefits for patients181. Mental health, alongside cultural, social and emotional wellbeing, is a critical component of comprehensive primary health care. The overwhelming evidence of the benefits of such comprehensive, health-promoting (rather than disease-focused) models of care, and the gaps identified in this review, suggest important opportunities for strengthening comprehensive primary health care in the north.

The literature also highlights widespread recognition that community preferences, control and participation are essential in healthcare decision-making; but outside of ACCHSs, implementation of community engagement goals into practice is highly variable. A similar gap is identified between stated commitments of services and policymakers to address the social and cultural determinants of health, and policy action and funding. Addressing these gaps should be an urgent policy priority to improve the cultural responsiveness and overall effectiveness of health services in the north. Action in these areas is widely supported in the literature: improving access to and suitability of housing, nutrition and transportation can significantly improve health outcomes and influence healthcare patterns of use118,182. Furthermore, cultural competence of healthcare services and professionals is associated with increased likelihood that Aboriginal people will access services183,184. The findings of this review provide a strong rationale, based on both scientific evidence and widespread policy commitments, for increased efforts to prevent poor health by resourcing programs that target the social, cultural and environmental determinants of health and support co-produced policymaking. Policy-focused, and co-produced, evaluative research should be mobilised to help guide these efforts, with a particular emphasis needed in future research on understanding governance mechanisms that enable cross-sectoral and cross-cultural activity, and community leadership and engagement.

The ongoing health workforce shortages identified in this review highlight the urgency of investing in evaluation and reform of the jurisdiction-based educational pathways and governance structures that act as barriers to timely recruitment, and in adequate resourcing of training and staffing models that support local career pathways, strengthen retention and stabilise the primary care workforce in the north. High staff turnover impacts on health outcomes for people living in remote areas, with increased staff turnover associated with higher hospitalisation rates and higher average hospital costs185. Ensuring a sustainable remote health workforce while preventing excessive turnover requires investments in targeted recruitment; adequate support, including access to good quality housing and information and communication technologies; competitive and realistic remuneration packages and retention incentives; effective and sustainable workplace organisation; a collegiate professional environment; and access to family supports and broader community amenities131. Established evidence also supports continuing investment in rural generalist workforce models, which have been shown to improve workforce retention, improve health outcomes and reduce costs in rural areas186-188. The gaps in the literature pertaining to rural generalist training pathways outside of medicine highlight important opportunities for future research to further test and evaluate multidisciplinary models of rural health workforce development in northern Australia. Specific and urgent investment is also needed to develop Aboriginal, and Torres Strait Islander, health workforce career pathways, including leadership development189.

Strengths and limitations

This scoping review is the first attempt to comprehensively synthesise and describe the published literature on health system issues across northern Australia. Strengths of the study include its use of a health system (rather than solely health service) framework and its focus on both peer-reviewed and grey literature. This approach enabled examination of several inter-related structures and processes that combine to determine key health system strengths and weaknesses, and comparison of policy approaches and intent with research evidence. The use of several search strategies, including database and website searches as well as stakeholder recommendation, increased the likelihood that the findings are representative of the key service and workforce issues in the north.

A key limitation, which reflected the breadth of the review, was the narrow window of eligibility for peer-reviewed articles (notwithstanding the inclusion of seminal articles outside of the 2015–2019 date range), which likely resulted in the omission of research findings relevant to the review aim. Future syntheses might address this limitation by undertaking more of a deep dive into some of the specific issues and gaps identified in this broad review, such as those relating to community co-produced policymaking and research, data interoperability in and between northern Australian health services, and cross-sectoral and cross-jurisdictional governance arrangements for service and workforce planning. 


Policy goals about developing northern Australia economically need to build from a foundation of a healthy and productive population. Improving health outcomes in the north requires political commitment, local leadership and targeted investment to improve health service delivery and workforce stability, building from the evidence to direct resources towards strengthening community-led comprehensive primary health care. This requires coordinated efforts across many organisations and the three jurisdictions, drawing from past collaboration experiences. Further evaluative research, linking structure to process and outcomes, and responding to changes in the healthcare landscape such as the rapid emergence of digital technologies, is needed across a range of policy areas to support these efforts.


The authors acknowledge the advice and feedback provided from a range of stakeholders from across the north, especially individuals involved in the jurisdictional advisory groups established for the broader Situational Analysis project. The authors also thank and acknowledge the Cooperative Research Centre for Developing Northern Australia for supporting the review.


1 Australian Institute of Health and Welfare. Potentially preventable hospitalisations 2015–16. Canberra: Australian Institute of Health and Welfare, 2018.
2 Australian Institute of Health and Welfare. Life expectancy and potentially avoidable deaths in 2014–2016. Canberra: Australian Institute of Health and Welfare, 2018.
3 Australian Institute of Health and Welfare. Health community indicators 2018. Canberra: Australian Institute of Health and Welfare, 2018.
4 Australian Institute of Health and Welfare. Medical practitioner workforce 2015. Canberra: Australian Institute of Health and Welfare, 2016.
5 Australian Bureau of Statistics. Regional population growth, Australia, 2017–2018, Cat. No. 3218.0. Canberra: Australian Bureau of Statistics, 2019.
6 Commonwealth of Australia. Our north, our future: white paper on developing northern Australia. Canberra: Department of Industry, Science, Energy and Resources, 2015.
7 Commonwealth of Australia. Our north, our future: 2018 implementation report. Canberra: Department of Industry, Science, Energy and Resources, 2018.
8 World Health Organization. Monitoring the building blocks of health systems: a handbook of indicators and their measurement strategies. Geneva: World Health Organization, 2010.
9 Edelman A, Grundy J, Moodley N, Larkins S, Topp SM, Atkinson D, et al. Northern Australia Health Service Delivery Situational Analysis. Townsville: Cooperative Research Centre for Developing Northern Australia, 2020.
10 Pham MT, Rajic A, Greig JD, Sargeant JM, Papadopoulos A, McEwen SA. A scoping review of scoping reviews: advancing the approach and enhancing the consistency. Research Synthesis Methods 2014; 5(4): 371-385. DOI link, PMid:26052958
11 Arksey H, O'Malley L. Scoping studies: towards a methodological framework. International Journal of Social Research Methodology 2005; 8(1): 19-32. DOI link
12 Tricco AC, Lillie E, Zarin W, O'Brien KK, Colquhoun H, Levac D, et al. PRISMA extension for scoping reviews (PRISMA-ScR): checklist and explanation. Annals of Internal Medicine 2018; 169(7): 467-473. DOI link, PMid:30178033
13 Tricco AC, Soobiah C, Antony J, Cogo E, MacDonald H, Lillie E, et al. A scoping review identifies multiple emerging knowledge synthesis methods, but few studies operationalize the method. Journal of Clinical Epidemiology 2016; 73: 19-28. DOI link, PMid:26891949
14 Central Australian Rural Practitioners Association. CARPA Standard Treatment Manual 7th Edition. Alice Springs: Centre for Remote Health, 2017.
15 Maple-Brown L, Lee IL, Longmore D, Barzi F, Connors C, Boyle JA, et al. Pregnancy and Neonatal Diabetes Outcomes in Remote Australia: the PANDORA study – an observational birth cohort. International Journal of Epidemiology 2019; 48(1): 307-318. DOI link, PMid:30508095
16 Turner NN, Taylor J, Larkins S, Carlisle K, Thompson S, Carter M, et al. Conceptualizing the association between community participation and CQI in Aboriginal and Torres Strait Islander PHC services. Qualitative Health Research 2019; 29(13): 1904-1915. DOI link, PMid:31014184
17 Greater Northern Australia Regional Training Network, Health Workforce Australia. Submission to the Joint Select Committee on Northern Australia by Greater Northern Australia Regional Training Network (GNARTN) & The Remote Health Project (RPH). Darwin: Greater Northern Australia Regional Training Network, 2014.
18 Kirkham R, Boyle JA, Whitbread C, Dowden M, Connors C, Corpus S, et al. Health service changes to address diabetes in pregnancy in a complex setting: perspectives of health professionals. BMC Health Services Research 2017; 17(1): 524. DOI link, PMid:28774291
19 Wapau H, Jans D, Hapea E, Mein J, Curnow V, McDonald M. Coming to town: reaching agreement on a thorny issue. Australian Journal of Rural Health 2018; 26(6): 416-421. DOI link, PMid:30450678
20 Bailie RS, Wayte KJ. Housing and health in Indigenous communities: key issues for housing and health improvement in remote Aboriginal and Torres Strait Islander communities. Australian Journal of Rural Health 2006; 14(5): 178-183. DOI link, PMid:17032292
21 Kirkham R, MacKay D, Barzi F, Whitbread C, Kirkwood M, Graham S, et al. Improving postpartum screening after diabetes in pregnancy: results of a pilot study in remote Australia. Australian & New Zealand Journal of Obstetrics & Gynaecology 2019; 59(3): 430-435. DOI link, PMid:30276799
22 Western Australia Primary Health Alliance. Commissioning for better health. Perth: Western Australia Primary Health, 2019.
23 Northern Territory Primary Health Network. Strategic plan 2018–2023. Darwin: Northern Territory Primary Health Network, 2018.
24 Northern Queensland Primary Health Network. Strategic plan 2018–2023. Cairns: Northern Queensland Primary Health Network, 2018.
25 Australian Institute for Primary Care & Ageing. Connecting healthcare in communities (CHIC): statewide evaluation final report. Melbourne: Australian Institute for Primary Care & Ageing, La Trobe University, 2011.
26 Freeman T, Baum F, Lawless A, Javanparast S, Jolley G, Labonté R, et al. Revisiting the ability of Australian primary healthcare services to respond to health inequity. Australian Journal of Primary Health 2016; 22(4): 332-338. DOI link, PMid:28442028
27 Kildea S, Gao Y, Rolfe M, Josif CM, Bar-Zeev SJ, Steenkamp M, et al. Remote links: redesigning maternity care for Aboriginal women from remote communities in Northern Australia – a comparative cohort study. Midwifery 2016; 34: 47-57. DOI link, PMid:26971448
28 McCalman J, Searles A, Bainbridge R, Ham R, Mein J, Neville J, et al. Empowering families by engaging and relating Murri way: a grounded theory study of the implementation of the Cape York Baby Basket program. BMC Pregnancy & Childbirth 2015; 15: 119. DOI link, PMid:25994123
29 Northern Territory Government. Northern Territory Aboriginal Cultural Security Framework 2016–2026. Darwin: Northern Territory Health, Northern Territory Government, 2016.
30 Aboriginal Medical Services Alliance Northern Territory. Strategic plan 2019–2023. Darwin: Aboriginal Medical Services Alliance Northern Territory, 2019.
31 Kimberley Aboriginal Health Planning Forum. Strategic plan 2018–2028. Broome: Kimberley Aboriginal Health Planning Forum, 2018.
32 Queensland Aboriginal and Islander Health Council. 2016–2019 Strategic plan. Brisbane: Queensland Aboriginal and Islander Health Council, 2016.
33 Queensland Aboriginal and Islander Health Council. QAIHC Strategic plan 2010–2013. Brisbane, Qld: Queensland Aboriginal and Islander Health Council, 2010.
34 Western Queensland Primary Health Network. 2017–2018 Health NEEDS ASSESSMENT summary. Mount Isa: Western Queensland Primary Health Network, 2017.
35 Carroll V, Reeve CA, Humphreys JS, Wakerman J, Carter M. Re-orienting a remote acute care model towards a primary health care approach: key enablers. Rural and Remote Health 2015; 15(3): 2942. Available: web link (Accessed 24 June 2020).
36 Campbell MA, Hunt J, Scrimgeour DJ, Davey M, Jones V. Contribution of Aboriginal Community-Controlled Health Services to improving Aboriginal health: an evidence review. Australian Health Review 2018; 42(2): 218-226. DOI link, PMid:28263705
37 Ah Chee D. Given this history of strength and success, why do Aboriginal health dollars keep going to NINGOs? 2019. Available: web link (Accessed 17 October 2019).
38 Nattabi B, Girgis S, Matthews V, Bailie R, Ward JE. Clinic predictors of better syphilis testing in Aboriginal primary healthcare: a promising opportunity for primary healthcare service managers. Australian Journal of Primary Health 2018; 24(4): 350-358. DOI link, PMid:30056828
39 Marley JV, Nelson C, O'Donnell V, Atkinson DN. Quality indicators of diabetes care: an example of remote-area Aboriginal primary health care over 10 years. Medical Journal of Australia 2012; 197(7): 404-408. DOI link, PMid:23025738
40 Panaretto KS, Dellit A, Hollins A, Wason G, Sidhom C, Chilcott K, et al. Understanding patient access patterns for primary health-care services for Aboriginal and Islander people in Queensland: a geospatial mapping approach. Australian Journal of Primary Health 2017; 23(1): 37-45. DOI link, PMid:27493153
41 Kimberley Aboriginal Health Planning Forum. KAHPF resources. 2019. Available: web link (Accessed 7 January 2020).
42 Ireland S, Belton S, Saggers S. The logics of planned birthplace for remote Australian Aboriginal women in the Northern Territory: a discourse and content analysis of clinical practice manuals. Midwifery 2015; 31(10): 993-999. DOI link, PMid:26183920
43 Felton-Busch C, Larkins S. Remote dwelling Aboriginal Australian women and birthing: a critical review of literature. Women and Birth 2019; 32(1): 6-15. DOI link, PMid:29887507
44 Waran E, O'Connor N, Zubair MY, May P. 'Finishing up' on country: challenges and compromises. Internal Medicine Journal 2016; 46(9): 1108-1111. DOI link, PMid:27633472
45 Bell D, Lindeman MA, Reid JB. The (mis)matching of resources and assessed need in remote Aboriginal community aged care. Australasian Journal on Ageing 2015; 34(3): 171-176. DOI link, PMid:25482529
46 Northern Territory Government. Northern Territory Health strategic plan 2018–2022. Darwin: Northern Territory Government, 2018.
47 Western Australia Country Health Service. WA Country Health Service digital innovation strategy 2019–2022. Perth: Western Australia Government, 2019.
48 Queensland Government. The Health of Queenslanders 2018: report of the Chief Health Officer Queensland. Brisbane: Department of Health, 2018.
49 Queensland Government. 21st century healthcare: eHealth investment strategy. Brisbane: Queensland Department of Health, 2015.
50 Lowe M, Coffey P. Effect of an ageing population on services for the elderly in the Northern Territory. Australian Health Review 2019; 43(1): 71-77. DOI link, PMid:28965536
51 Tilton E, Thomas D. Core functions of primary health care: a framework for the Northern Territory. Darwin: Northern Territory Aboriginal Health Forum, 2011.
52 Australian Institute of Health and Welfare. Health expenditure Australia 2017–18. Canberra: Australian Institute of Health and Welfare, 2019.
53 Zhao Y, Vemuri SR, Arya D. The economic benefits of eliminating Indigenous health inequality in the Northern Territory. Medical Journal of Australia 2016; 205(6): 266-269. DOI link, PMid:27627937
54 Thomas SL. The cost-effectiveness of primary care for Indigenous Australians with diabetes living in remote Northern Territory communities. Medical Journal of Australia 2014; 201(8): 450. DOI link, PMid:25332028
55 Wakerman J, Sparrow L, Thomas SL, Humphreys JS, Jones M. Equitable resourcing of primary health care in remote communities in Australia's Northern Territory: a pilot study. BMC Family Practice 2017; 18(1): 75. DOI link, PMid:28662639
56 Zhao Y, Connors C, Lee AH, Liang W. Relationship between primary care visits and hospital admissions in remote indigenous patients with diabetes: a multivariate spline regression model. Diabetes Research and Clinical Practice 2015; 108(1): 106-112. DOI link, PMid:25666107
57 Davy C, Cass A, Brady J, DeVries J, Fewquandie B, Ingram S, et al. Facilitating engagement through strong relationships between primary healthcare and Aboriginal and Torres Strait Islander peoples. Australian & New Zealand Journal of Public Health 2016; 40(6): 535-541. DOI link, PMid:27523395
58 Dossetor PJ, Martiniuk ALC, Fitzpatrick JP, Oscar J, Carter M, Watkins R, et al. Pediatric hospital admissions in Indigenous children: a population-based study in remote Australia. BMC Pediatrics 2017; 17(1): 195. DOI link, PMid:29166891
59 Health Workforce Australia. Australia's Future Health Workforce – nurses overview report. Adelaide: Commonwealth of Australia, 2014.
60 Wakerman J, Humphreys JS, Wells R, Kuipers P, Entwistle P, Jones J. Primary health care delivery models in rural and remote Australia: a systematic review. BMC Health Services Research 2008; 8: 276. DOI link, PMid:19114003
61 Australian Healthcare and Hospitals Association. Healthy people, healthy systems: strategies for outcomes-focused and value-based healthcare, a blueprint for a post-2020 National Health Agreement. Canberra: Australian Healthcare and Hospitals Association, 2017.
62 Carroll V, Mansour R, Humphries J, Wakerman J, Carter M, Reeve C. Reducing primary health care outpatient 'did not attends': responding to community preferences. Australian Journal of Rural Health 2017; 25(3): 187-188. DOI link, PMid:27600359
63 Haren MT, Setchell J, John DL, Daniel M. The impacts of withdrawal and replacement of general practitioner services on aeromedical service trends: a 13-year interrupted time-series study in Tennant Creek, Northern Territory. BMC Health Services Research 2015; 15: 456. DOI link, PMid:26438226
64 McFarlane K, Devine S, Judd J, Nichols N, Watt K. Workforce insights on how health promotion is practised in an Aboriginal Community Controlled Health Service. Australian Journal of Primary Health 2017; 23(3): 243-248. DOI link, PMid:28162218
65 Kingston GA, Judd J, Gray MA. The experience of medical and rehabilitation intervention for traumatic hand injuries in rural and remote North Queensland: a qualitative study. Disability & Rehabilitation 2015; 37(5): 423-429. DOI link, PMid:24856789
66 Hamilton S, Mills B, McRae S, Thompson S. Cardiac rehabilitation for Aboriginal and Torres Strait Islander people in Western Australia. BMC Cardiovascular Disorders 2016; 16: 150. DOI link, PMid:27412113
67 Carey TA, Schouten K, Wakerman J, Humphreys JS, Miegel F, Murphy S, et al. Improving the quality of life of palliative and chronic disease patients and carers in remote Australia with the establishment of a day respite facility. BMC Palliative Care 2016; 15: 62. DOI link, PMid:27430257
68 Gupta A, Baxi S, Hoyne C. Assessing feasibility, compliance and toxicity of concomitant chemo-radiotherapy in head and neck cancers in the Northern Territory: initial experience and challenges. Journal of Medical Radiation Sciences 2017; 64(2): 131-137. DOI link, PMid:27741378
69 Gorham G, Majoni SW, Lawton P, Brown S, Dube B, Conlon T, et al. Interesting times -- evolution of dialysis in Australia's Northern Territory (1980-2014). Renal Society of Australasia Journal 2018; 14(3): 108-116.
70 Anderson E, Ellard J, Wallace J. Torres Strait Islanders' understandings of chronic hepatitis B and attitudes to treatment. Australian Journal of Primary Health 2016; 22(4): 316-319. DOI link, PMid:26329779
71 Bonner A, Boyle J. Are women's needs being met by specialist health services managing urinary incontinence in the remote Top End NT? Australian & New Zealand Journal of Obstetrics & Gynaecology 2017; 57(3): 351-357. DOI link, PMid:28397253
72 Reeve C, Banfield S, Thomas A, Reeve D, Davis S. Community outreach midwifery-led model improves antenatal access in a disadvantaged population. Australian Journal of Rural Health 2016; 24(3): 200-206. DOI link, PMid:26390849
73 Josif CM, Kruske S, Kildea SV, Barclay LM. The quality of health services provided to remote dwelling aboriginal infants in the top end of northern Australia following health system changes: a qualitative analysis. BMC Pediatrics 2017; 17(1): 93. DOI link, PMid:28359332
74 Ellem K, Baidawi S, Dowse L, Smith L. Services to young people with complex support needs in rural and regional Australia: Beyond a metro-centric response. Children & Youth Services Review 2019; 99: 97-106. DOI link
75 Johnston K, Harvey C, Matich P, Page P, Jukka C, Hollins J, et al. Increasing access to sexual health care for rural and regional young people: similarities and differences in the views of young people and service providers. Australian Journal of Rural Health 2015; 23(5): 257-264. DOI link, PMid:25809380
76 Kotz J, Munns A, Marriott R, Marley JV. Perinatal depression and screening among Aboriginal Australians in the Kimberley. Contemporary Nurse 2016; 52(1): 42-58. DOI link, PMid:27294330
77 Hinton R, Kavanagh DJ, Barclay L, Chenhall R, Nagel T. Developing a best practice pathway to support improvements in Indigenous Australians' mental health and well-being: a qualitative study. BMJ Open 2015; 5: e007938. DOI link, PMid:26316649
78 Campbell S, McCalman J, Redman-MacLaren M, Canuto K, Vine K, Sewter J, et al. Implementing the Baby One Program: a qualitative evaluation of family-centred child health promotion in remote Australian Aboriginal communities. BMC Pregnancy & Childbirth 2018; 18(1): 73. DOI link, PMid:29573747
79 Lange FD, Jones K, Ritte R, Brown HE, Taylor HR. The impact of health promotion on trachoma knowledge, attitudes and practice (KAP) of staff in three work settings in remote Indigenous communities in the Northern Territory. PLoS Neglected Tropical Diseases 2017; 11(5): e0005503. DOI link, PMid:28542225
80 Carlisle K, Larkins S, Croker F. Disparities in dental health of rural Australians: hospitalisation rates and utilisation of public dental services in three communities in North Queensland. Rural & Remote Health 2017; 17(1): 3807. Available: web link, DOI link, PMid:28092967 (Accessed 24 June 2020).
81 Formosa J, Jenner R, Nguyen-Thi MD, Stephens C, Wilson C, Ariyawardana A. Awareness and knowledge of oral cancer and potentially malignant oral disorders among dental patients in far North Queensland, Australia. Asian Pacific Journal of Cancer Prevention 2015; 16(10): 4429-4434. DOI link, PMid:26028109
82 De Silva AM, Martin-Kerry J, Geale A, Cole D. Flying blind: trying to find solutions to Indigenous oral health. Australian Health Review 2016; 40(5): 570-583. DOI link, PMid:26691689
83 Patel J, Hearn L, Slack-Smith LM. Oral health care in remote Kimberley Aboriginal communities: the characteristics and perceptions of dental volunteers. Australian Dental Journal 2015; 60(3): 328-335. DOI link, PMid:25328989
84 Stuart J, Ha H, Crocombe L, Barnett T. Relationships between dental personnel and non-dental primary health care providers in rural and remote Queensland, Australia: dental perspectives. BMC Oral Health 2017; 17: 1-10. DOI link, PMid:28629349
85 Hafeez U, Joshi A, Bhatt M, Kelly J, Sabesan S, Vangaveti V. Clinical profile and treatment outcomes of advanced neuroendocrine tumours in rural and regional patients: a retrospective study from a regional cancer centre in North Queensland, . Internal Medicine Journal 2017; 47(3): 284-290. DOI link, PMid:27860085
86 Smith K, Fatima Y, Knight S. Are primary healthcare services culturally appropriate for Aboriginal people? Findings from a remote community. Australian Journal of Primary Health 2017; 23(3): 236-242. DOI link, PMid:28403914
87 Kruske S, Schultz T, Eales S, Kildea S. A retrospective, descriptive study of maternal and neonatal transfers, and clinical outcomes of a Primary Maternity Unit in rural Queensland, 2009-2011. Women & Birth 2015; 28(1): 30-39. DOI link, PMid:25458610
88 Kuipers P, Hurwood A, McBride LJ. Audit of allied health assistant roles: suggestions for improving quality in rural settings. Australian Journal of Rural Health 2015; 23(3): 185-188. DOI link, PMid:25946572
89 McDermott RA, Schmidt B, Preece C, Owens V, Taylor S, Li M, et al. Community health workers improve diabetes care in remote Australian Indigenous communities: results of a pragmatic cluster randomized controlled trial. BMC Health Services Research 2015; 15: 68. DOI link, PMid:25884300
90 Quilty S, Wood L, Gazey A. Katherine Individual Support Program (KISP): first evaluation report. Katherine: School of Population and Global Health, University of Western Australia, 2019.
91 Rheumatic Heart Disease Australia. Champions4Change Program. 2019. Available: web link (Accessed 20 January 2020).
92 Barker RN, Sealey CJ, Polley ML, Mervin MC, Comans T. Impact of a person-centred community rehabilitation service on outcomes for individuals with a neurological condition. Disability & Rehabilitation 2017; 39(11): 1136-1142. DOI link, PMid:27281692
93 Lack BM, Smith RM, Arundell MJ, Homer CS. Narrowing the gap? Describing women's outcomes in Midwifery Group Practice in remote Australia. Women & Birth 2016; 29(5): 465-470. DOI link, PMid:27050200
94 Rumbold AR, Wild KJ, Lawurrpa Maypilama E, Kildea SV, Barclay L, Wallace EM, et al. Challenges to providing fetal anomaly testing in a cross-cultural environment: experiences of practitioners caring for Aboriginal women. Birth: Issues in Perinatal Care 2015; 42(4): 362-368. Available: web link, DOI link, PMid:26256095
95 Ralph AP, Lowell A, Murphy J, Dias T, Butler D, Spain B, et al. Low uptake of Aboriginal interpreters in healthcare: exploration of current use in Australia's Northern Territory. BMC Health Services Research 2017; 17(1): 733. DOI link, PMid:29141623
96 Mihrshahi S, Vaughan L, Fa'avale N, De Silva Weliange S, Manu-Sione I, Schubert L. Evaluation of the Good Start Program: a healthy eating and physical activity intervention for Maori and Pacific Islander children living in Queensland, Australia. BMC Public Health 2017; 17(1): 77. DOI link, PMid:28086843
97 Canuto K, Brown A, Harfield S, Wittert G. 'I feel more comfortable speaking to a male': Aboriginal and Torres Strait Islander men's discourse on utilizing primary health care services. International Journal for Equity in Health 2018; 17(1): 185. DOI link, PMid:30558619
98 Klein J, Boyle JA, Kirkham R, Connors C, Whitbread C, Oats J, et al. Preconception care for women with type 2 diabetes mellitus: a mixed-methods study of provider knowledge and practice. Diabetes Research and Clinical Practice 2017; 129: 105-115. DOI link, PMid:28521194
99 McKay CC, Chang AB, Versteegh LA, McCallum GB. Culturally appropriate flipcharts improve the knowledge of common respiratory conditions among Northern Territory Indigenous families. Health Promotion Journal of Australia 2015; 26(2): 150-153. DOI link, PMid:25917372
100 Jainullabudeen TA, Lively A, Singleton M, Shakeshaft A, Tsey K, McCalman J, et al. The impact of a community-based risky drinking intervention (Beat da Binge) on Indigenous young people. BMC Public Health 2015; 15: 1319. DOI link, PMid:26715449
101 Jones C, Sharma M, Harkus S, McMahon C, Taumoepeau M, Demuth K, et al. A program to respond to otitis media in remote Australian Aboriginal communities: a qualitative investigation of parent perspectives. BMC Pediatrics 2018; 18(1): 99. DOI link, PMid:29510680
102 Li M, McDermott R. Smoking, poor nutrition, and sexually transmitted infections associated with pelvic inflammatory disease in remote North Queensland Indigenous communities, 1998-2005. BMC Women's Health 2015; 15(31). DOI link, PMid:25887145
103 Matthews V, Burgess CP, Connors C, Moore E, Peiris D, Scrimgeour D, et al. Integrated clinical decision support systems promote absolute cardiovascular risk assessment: an important primary prevention measure in Aboriginal and Torres Strait Islander primary health care. Frontiers in Public Health 2017; 5(233). DOI link, PMid:28929097
104 McFarlane KA, Judd JA, Wapau H, Nichols N, Watt K, Devine S. How primary health care staff working in rural and remote areas access skill development and expertise to support health promotion practice. Rural & Remote Health 2018; 18(2): 23-29. DOI link, PMid:29771570
105 Ramamoorthi R, Jayaraj R. Epidemiology, etiology, and motivation of alcohol misuse among Australian Aboriginal and Torres Strait Islanders of the Northern Territory: a descriptive review. Journal of Ethnicity in Substance Abuse 2015; 14(1): 4413. Available: web link, DOI link, PMid:25629929 (Accessed 3 March 2020).
106 McMullen C, Eastwood A, Ward J. Environmental attributable fractions in remote Australia: the potential of a new approach for local public health action. Australian and New Zealand Journal of Public Health 2016; 40(2): 174-180. DOI link, PMid:26259550
107 Reeve C, Humphreys J, Wakerman J, Carter M, Carroll V, Reeve D. Strengthening primary health care: achieving health gains in a remote region of Australia. Medical Journal of Australia 2015; 202(9): 483-488. DOI link, PMid:25971572
108 Queensland Department of Health. Annual report 2017–18. Brisbane: Queensland Health, 2018.
109 Northern Territory Government. Northern Territory Chronic Conditions Prevention and Management Strategy 2010–2020. Darwin: Department of Health and Families, 2009.
110 Government of Western Australia. WA Health strategic intent 2015–2020. Perth: Government of Western Australia, 2015.
111 Government of Western Australia. 2019–20 budget agency details: annual budget for Department of Health. Perth: Government of Western Australia, 2019.
112 Queensland Government. Queensland Budget 2019–2020. Brisbane: Queensland Treasury, 2019.
113 Government of Western Australia Country Health Service. Health service annual report 2017–18. Perth: Government of Western Australia, 2018.
114 Government of Western Australia. Sustainable health review: final report to the Western Australian Government. Perth: Department of Health, 2019.
115 Colles SL, Belton S, Brimblecombe J. Insights into nutritionists' practices and experiences in remote Australian Aboriginal communities. Australian & New Zealand Journal of Public Health 2016; 40(Suppl1): S7-S13. DOI link, PMid:25903118
116 Georges N, Guthridge SL, Li SQ, Condon JR, Barnes T, Zhao Y. Progress in closing the gap in life expectancy at birth for Aboriginal people in the Northern Territory, 1967–2012. Medical Journal of Australia 2017; 207(1): 25-30. DOI link, PMid:28659111
117 Sushames A, Engelberg T, Gebel K. Perceived barriers and enablers to participation in a community-tailored physical activity program with Indigenous Australians in a regional and rural setting: a qualitative study. International Journal for Equity in Health 2017; 16(1): 172. DOI link, PMid:28923069
118 Bailie R. Housing. In: B Carson, T Dunbar, RD Chenhall, R Bailie (Eds). Social determinants of Indigenous health. Sydney: Allen & Unwin. chapter 10.
119 Passey ME, Sanson-Fisher RW. Provision of antenatal smoking cessation support: a survey with pregnant Aboriginal and Torres Strait Islander women. Nicotine and Tobacco Research 2015; 17(6): 746-749. DOI link, PMid:25634937
120 Clough AR, Margolis SA, Miller A, Shakeshaft A, Doran CM, McDermott R, et al. Alcohol control policies in Indigenous communities: a qualitative study of the perceptions of their effectiveness among service providers, stakeholders and community leaders in Queensland (Australia). International Journal of Drug Policy 2016; 36: 67-75. DOI link, PMid:27518836
121 Clough AR, Margolis SA, Miller A, Shakeshaft A, Doran CM, McDermott R, et al. Alcohol management plans in Aboriginal and Torres Strait Islander (Indigenous) Australian communities in Queensland: community residents have experienced favourable impacts but also suffered unfavourable ones. BMC Public Health 2017; 17(1): 55. DOI link, PMid:28068977
122 Seear KH, Lelievre MP, Atkinson DN, Marley JV. 'It's important to make changes.' Insights about motivators and enablers of healthy lifestyle modification from young Aboriginal men in Western Australia. International Journal of Environmental Research & Public Health 2019; 16(6): 24. DOI link, PMid:30909655
123 Segal L, Nguyen H, Schmidt B, Wenitong M, McDermott RA. Economic evaluation of Indigenous health worker management of poorly controlled type 2 diabetes in north Queensland. Medical Journal of Australia 2016; 204(5): e1961-e1969. DOI link, PMid:26985851
124 Burgess CP, Johnston FH, Berry HL, McDonnell J, Yibarbuk D, Gunabarra C, et al. Healthy country, healthy people: the relationship between Indigenous health status and 'caring for country'. Medical Journal of Australia 2009; 190(10): 567-572. DOI link, PMid:19450204
125 Health Workforce Queensland. 2019 health workforce needs assessment. Brisbane: Queensland Government, 2019.
126 Northern Territory Primary Health Network. Northern Territory primary health care workforce needs analysis: priority areas. Darwin: Northern Territory Primary Health Network, 2018.
127 Western Australia Country Health Service. Kimberley health profile. Perth: Government of Western Australia, 2018.
128 Western Australia Country Health Service. Pilbara health profile. Perth: Government of Western Australia, 2018.
129 Russell DJ, Yuejen Z, Guthridge S, Ramjan M, Jones MP, Humphreys JS, et al. Patterns of resident health workforce turnover and retention in remote communities of the Northern Territory of Australia, 2013-2015. Human Resources for Health 2017; 15: 1-12. DOI link, PMid:28810919
130 Zhao Y, Russell DJ, Guthridge S, Ramjan M, Jones MP, Humphreys JS, et al. Long-term trends in supply and sustainability of the health workforce in remote Aboriginal communities in the Northern Territory of Australia. BMC Health Services Research 2017; 17(1): 836. DOI link, PMid:29258521
131 Wakerman J, Humphreys J, Russell D, Guthridge S, Bourke L, Dunbar T, et al. Remote health workforce turnover and retention: what are the policy and practice priorities? Human Resources for Health 2019; 17(1): 99. DOI link, PMid:31842946
132 Bailey BES, Wharton RG, Holman CDAJ. Glass half full: survival analysis of new rural doctor retention in Western Australia. Australian Journal of Rural Health 2016; 24(4): 258-264. DOI link, PMid:26692500
133 Western Australia Country Health Service. Annual report 2017–18. Perth: Government of Western Australia, 2018.
134 Hill K, Harvey N, Felton-Busch C, Hoskins J, Rasalam R, Malouf P, et al. The road to registration: Aboriginal and Torres Strait Islander health practitioner training in north Queensland. Rural & Remote Health 2018; 18(1): 3899. DOI link, PMid:29334752
135 Kelly J, Dowling A, McBride K, Keech W, Brown A. 'We get so task orientated at times that we forget the people': staff communication experiences when caring for Aboriginal cardiac patients. Australian Health Review 2018; 44. DOI link, PMid:30466504
136 Briscoe K. Unrecognised potential of Indigenous health workers and practitioners. MJA InSight 2019; 25(1 July).
137 Pain T, Plummer D, Pighills A, Harvey D. Comparison of research experience and support needs of rural versus regional allied health professionals. Australian Journal of Rural Health 2015; 23(5): 277-285. DOI link, PMid:26381792
138 McGrail MR, Russell DJ, O'Sullivan BG, Reeve C, Gasser L, Campbell D. Demonstrating a new approach to planning and monitoring rural medical training distribution to meet population need in North West Queensland. BMC Health Services Research 2018; 18(1): 993. DOI link, PMid:30577775
139 Orda U, Orda S, Sen Gupta T, Knight S. Building a sustainable workforce in a rural and remote health service: a comprehensive and innovative Rural Generalist training approach. Australian Journal of Rural Health 2017; 25(2): 116-119. DOI link, PMid:27385104
140 Ray RA, Young L, Lindsay DB. The influences of background on beginning medical students' perceptions of rural medical practice. BMC Medical Education 2015; 15: 58. DOI link, PMid:25889114
141 Rikard-Bell C, Woolley T. Aligning an undergraduate psychological medicine subject with the mental health needs of the local region. BMC Medical Education 2018; 18(1): 118. DOI link, PMid:29855301
142 Playford D, Ngo H, Gupta S, Puddey IB. Opting for rural practice: the influence of medical student origin, intention and immersion experience. Medical Journal of Australia 2017; 207(4): 154-158. DOI link, PMid:28814216
143 Playford DE, Nicholson A, Riley GJ, Puddey IB. Longitudinal rural clerkships: increased likelihood of more remote rural medical practice following graduation. BMC Medical Education 2015; 15: 55. DOI link, PMid:25879715
144 Woolley T, Larkins S, Gupta TS. Career choices of the first seven cohorts of JCU MBBS graduates: producing generalists for regional, rural and remote northern Australia. Rural & Remote Health 2019; 19(2): 4438. Available: web link (Accessed 17 May 2020). DOI link, PMid:30943751
145 Woolley T, Sen Gupta T, Larkins S. Work settings of the first seven cohorts of James Cook University Bachelor of Medicine, Bachelor of Surgery graduates: meeting a social accountability mandate through contribution to the public sector and Indigenous health services. Australian Journal of Rural Health 2018; 26(4): 258-264. DOI link, PMid:29799145
146 Hegney D, Eley R, Osseiran-Moisson R, Francis K. Work and personal well-being of nurses in Queensland: does rurality make a difference? Australian Journal of Rural Health 2015; 23(6): 359-365. DOI link, PMid:26683719
147 Onnis LL. An examination of supportive management practices promoting health workforce stability in remote northern Australia. Australasian Psychiatry 2015; 23(6): 679-682. DOI link, PMid:26438652
148 Lenthall S, Wakerman J, Dollard MF, Dunn S, Knight S, Opie T, et al. Reducing occupational stress among registered nurses in very remote Australia: a participatory action research approach. Collegian 2018; 25(2): 181-191. DOI link
149 North West Hospital and Health Service. Strategic plan 2017–2021. Mount Isa: Queensland Health, 2019.
150 Davis S, Reeve C, Humphreys JS. How good are routinely collected primary healthcare data for evaluating the effectiveness of health service provision in a remote Aboriginal community? Rural & Remote Health 2015; 15(4): 2804. Available: web link (Accessed 25 June 2020).
151 Burgess CP, Sinclair G, Ramjan M, Coffey PJ, Connors CM, Katekar LV. Strengthening cardiovascular disease prevention in remote Indigenous communities in Australia's Northern Territory. Heart Lung and Circulation 2015; 24(5): 450-457. DOI link, PMid:25541229
152 Taylor S, Thompson F, McDermott R. Barriers to insulin treatment among Australian Torres Strait Islanders with poorly controlled diabetes. Australian Journal of Rural Health 2016; 24(6): 363-370. DOI link, PMid:27605456
153 Chamberlain-Salaun J, Mills J, Kevat PM, Rémond MGW, Maguire GP. Sharing success – understanding barriers and enablers to secondary prophylaxis delivery for rheumatic fever and rheumatic heart disease. BMC Cardiovascular Disorders 2016; 16(1): 166. DOI link, PMid:27581750
154 National Aboriginal Community Controlled Health Organisation. Quality use of Medicines Maximised for Aboriginal and Torres Strait Islander People (QUMAX). 2019. Available: web link (Accessed 11 October 2019).
155 Edirippulige S, Reyno J, Armfield NR, Bambling M, Lloyd O, McNevin E. Availability, spatial accessibility, utilisation and the role of telehealth for multi-disciplinary paediatric cerebral palsy services in Queensland. Journal of Telemedicine & Telecare 2016; 22(7): 391-396. DOI link, PMid:26519377
156 Fatehi F, Martin-Khan M, Smith AC, Russell AW, Gray LC. Patient satisfaction with video teleconsultation in a virtual diabetes outreach clinic. Diabetes Technology & Therapeutics 2015; 17(1): 43-48. DOI link, PMid:25296189
157 Host BK, Turner AW, Muir J. Real-time teleophthalmology video consultation: an analysis of patient satisfaction in rural Western Australia. Clinical & Experimental Optometry 2018; 101(1): 129-134. DOI link, PMid:28436157
158 Johnson KA, Meyer J, Yazar S, Turner AW. Real-time teleophthalmology in rural Western Australia. Australian Journal of Rural Health 2015; 23(3): 142-149. DOI link, PMid:25851959
159 O'Day R, Smith C, Muir J, Turner A. Optometric use of a teleophthalmology service in rural Western Australia: comparison of two prospective audits. Clinical & Experimental Optometry 2016; 99(2): 163-167. DOI link, PMid:26956453
160 Jhaveri D, Larkins S, Kelly J, Sabesan S. Remote chemotherapy supervision model for rural cancer care: perspectives of health professionals. European Journal of Cancer Care 2016; 25(1): 93-98. DOI link, PMid:25871852
161 Sabesan S, Larkins S, Evans R, Varma S, Andrews A, Beuttner P, et al. Telemedicine for rural cancer care in North Queensland: bringing cancer care home. Australian Journal of Rural Health 2012; 20(5): 259-264. DOI link, PMid:22998200
162 Keogh K, Clark P, Valery PC, McPhail SM, Bradshaw C, Day M, et al. Use of telehealth to treat and manage chronic viral hepatitis in regional Queensland. Journal of Telemedicine & Telecare 2016; 22(8): 459-464. DOI link, PMid:27799448
163 McFarland R. Telepharmacy for remote hospital inpatients in north-west Queensland. Journal of Telemedicine & Telecare 2017; 23(10): 861-865. DOI link, PMid:29081271
164 McWilliams T, Hendricks J, Twigg D, Wood F, Giles M. Telehealth for paediatric burn patients in rural areas: a retrospective audit of activity and cost savings. Burns 2016; 42(7): 1487-1493. DOI link, PMid:27575678
165 O'Hara R, Jackson S. Integrating telehealth services into a remote allied health service: a pilot study. Australian Journal of Rural Health 2017; 25(1): 53-57. DOI link, PMid:25823551
166 Poulsen KA, Millen CM, Lakshman UI, Buttner PG, Roberts LJ. Satisfaction with rural rheumatology telemedicine service. International Journal of Rheumatic Diseases 2015; 18(3): 304-314. DOI link, PMid:25530007
167 Pidgeon FM. Use of telehealth videoconferencing as a supplement to visiting allied health services. Australian Journal of Rural Health 2017; 25(1): 58-59. DOI link, PMid:26153238
168 Conlan L, Thompson J, Fary R. An exploration of the efficacy of telehealth in the assessment and management of stress urinary incontinence among women in rural locations. Australian & New Zealand Continence Journal 2016; 22(3): 58-64.
169 Roberts S, Spain B, Hicks C, London J, Tay S. Telemedicine in the Northern Territory: an assessment of patient perceptions in the preoperative anaesthetic clinic. Australian Journal of Rural Health 2015; 23(3): 136-141. DOI link, PMid:25615954
170 Robinson R. The evolution of perioperative telehealth in Katherine, Northern Territory, Australia. ACORN: The Journal of Perioperative Nursing in Australia 2018; 31(3): 47-50.
171 Chan BA, Larkins SL, Evans R, Watt K, Sabesan S. Do teleoncology models of care enable safe delivery of chemotherapy in rural towns? Medical Journal of Australia 2015; 203(10): 406. DOI link, PMid:26561905
172 Burns CL, Kularatna S, Ward EC, Hill AJ, Byrnes J, Kenny LM. Cost analysis of a speech pathology synchronous telepractice service for patients with head and neck cancer. Head & Neck 2017; 39(12): 2470-2480. DOI link, PMid:28963804
173 Guy RJ, Ward J, Causer LM, Natoli L, Badman SG, Tangey A, et al. Molecular point-of-care testing for chlamydia and gonorrhoea in Indigenous Australians attending remote primary health services (TTANGO): a cluster-randomised, controlled, crossover trial. The Lancet Infectious Diseases 2018; 18(10): 1117-1126. DOI link
174 Spaeth B, Shephard M. Clinical and operational benefits of international normalized ratio point-of-care testing in remote Indigenous communities in Australia's Northern Territory. Journal of Near-Patient Testing & Technology 2016; 15(1): 30-34. DOI link
175 Spaeth BA, Kaambwa B, Shephard MD, Omond R. Economic evaluation of point-of-care testing in the remote primary health care setting of Australia's Northern Territory. Clinicoeconomics and Outcomes Research 2018; 10: 269-277. DOI link, PMid:29881299
176 Tuttle CSL, Carrington MJ, Stewart S, Brown A. Overcoming the tyranny of distance: an analysis of outreach visits to optimise secondary prevention of cardiovascular disease in high-risk individuals living in Central Australia. Australian Journal of Rural Health 2016; 24(2): 99-105. DOI link, PMid:27087389
177 Starfield B, Shi L, Macinko J. Contribution of primary care to health systems and health. The Milbank Quarterly 2005; 83(3): 457-502. DOI link, PMid:16202000
178 Wolters RJ, Braspenning JCC, Wensing M. Impact of primary care on hospital admission rates for diabetes patients: a systematic review. Diabetes Research and Clinical Practice 2017; 129: 182-196. DOI link, PMid:28544924
179 van Loenen T, van den Berg MJ, Westert GP, Faber MJ. Organizational aspects of primary care related to avoidable hospitalization: a systematic review. Family Practice 2014; 31(5): 502-516. DOI link, PMid:25216664
180 Abel J, Kingston H, Scally A, Hartnoll J, Hannam G, Thomson-Moore A, et al. Reducing emergency hospital admissions: a population health complex intervention of an enhanced model of primary care and compassionate communities. British Journal of General Practice 2018; 68(676): e803-e810. DOI link, PMid:30297434
181 Zhao Y, Thomas SL, Guthridge SL, Wakerman J. Better health outcomes at lower costs: the benefits of primary care utilisation for chronic disease management in remote Indigenous communities in Australia's Northern Territory. BMC Health Services Research 2014; 14: 463. DOI link, PMid:25281064
182 Nichols LM, Taylor LA. Social determinants as public goods: a new approach to financing key investments in healthy communities. Health Affairs 2018; 37(8): 1223-1230. DOI link, PMid:30080474
183 Nguyen HT, Gardiner A. Indigenous community members as teachers of Indigenous health. Australian Family Physician 2008; 37(12): 1019-1021.
184 Queensland Productivity Commission. Service delivery in remote and discrete Aboriginal and Torres Strait Islander communities: final report. Brisbane: Queensland Productivity Commission, 2017.
185 Zhao Y, Russell DJ, Guthridge S, Ramjan M, Jones MP, Humphreys JS, et al. Cost impact of high staff turnover on primary care in remote Australia. Australian Health Review 2019; 43(6): 689-695. DOI link, PMid:30158049
186 Sen Gupta T, Manahan D, Lennox D, Taylor N, Stewart R, Bond D. Queensland rural generalist pathway: impacts on rural medical workforce. Darwin: 13th National Rural Health Conference, 2015.
187 Services for Australian Rural and Remote Allied Health. Allied health rural generalist training positions: an overview. Canberra, ACT: Services for Australian Rural and Remote Allied Health, 2015.
188 Ernst & Young. Evaluation and investigative study of the Queensland rural generalist program. Brisbane: Queensland Health Office of Rural and Remote Health, 2013.
189 Bailey J, Blignault I, Carriage C, Demasi K, Joseph T, Kelleher K, et al. We are working for our people: growing and strengthening the Aboriginal and Torres Strait Islander health workforce. Melbourne: The Lowitja Institute, 2020.