Progress made on access to rural health care in Canada

Rural Road Map for Action.⁴

Responding to the disparities faced by rural populations, the RRM (Figure 1) was developed by Advancing Rural Family Medicine: The Canadian Collaborative Taskforce⁵ and released in February 2017. The RRM provides a guiding framework for a pan-Canadian approach to physician rural work force planning as well as improved access to rural health care. Its premise is that all stakeholders from different components of the health care and education systems must work collaboratively and collectively. While the RRM focuses on the health work force, it recognizes that all stakeholders play an important role in delivering health care in rural Canada.

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Figure 1.

Rural Road Map for Action

The Rural Road Map for Action is a series of 20 recommendations for a renewed approach to rural physician work force planning. The 20 recommendations fall under 4 directions that provide a pathway toward developing a comprehensive rural framework for strengthening the rural Canadian physician work force. Within the context of team-based environments, it is expected that health care providers will have the competencies and skills to provide high-quality and culturally safe care in rural Canada. The recommendations call for collective action with outcomes that are measurable, sustainable, and impactful.

The RRM uses a social accountability approach to sharing solutions, and those targeted for action are stakeholders identified as “Pentagram Partners” (Figure 2).⁶ Each of the partners has a role to play in the implementation of the RRM. By understanding who is responsible for what, the RRM aims to provide a pathway to help support a pan-Canadian, coordinated approach to enhancing rural access to health care.

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Figure 2.

Social accountability framework: The Pentagram Partners involved in implementing the Rural Road Map for Action.

Adapted with permission from Boelen.⁶

The RRM addresses Indigenous health needs by generating a multistakeholder rural health care strategy that includes the participation of Indigenous people to benefit these communities in rural Canada. Increasing the number of Indigenous health care professionals trained in Canada, improving the retention of health care professionals within rural Indigenous communities, and providing cultural safety training for all health care professionals are ways to achieve success. The RRM aligns with the commitment to renew relationships with Indigenous peoples through respect, cooperation, and partnership.

Rural Road Map Implementation Committee as catalyst

Rural populations still do not have equitable access to health care services. Rural communities continue to face challenges in recruiting and retaining family physicians and other health care professionals. Several provincial programs have attempted to address these issues, but a comprehensive and cohesive pan-Canadian long-term strategy to support rural physician recruitment and retention is not yet in place. It became clear that a catalyst was necessary to push for the needed changes identified in the RRM.

The RRMIC strongly feels that collaboration is important to the successful implementation of the RRM. Stakeholders, including government leaders, have an essential role to play in identifying opportunities to share information about progress made and in providing advice to advance education, policy, practice, and research activities related to rural health care in Canada. As a result, relationships can be strengthened between rural family physicians, other specialists, and other health care providers and rural communities through the creation of networks of care that improve access and positively influence physician retention.

The RRMIC’s goal is to enhance access to care for people living in rural Canada. It proposes a pan-Canadian strategy through the RRM for provinces and territories, educators, administrative leaders, policy makers, health care professionals, all levels of government, and communities to use to enable equitable access to health care.

Progress to date

Since its work began, the RRMIC has made considerable progress raising awareness across Canada about the need for improved access to rural health care close to home, as highlighted in the following key priorities.

Rural patient transfer and repatriation (RRM Action 11): A national advisory group was established in July 2019 representing the Health Standards Organization, Accreditation Canada, HealthCareCAN, the Royal College of Physicians and Surgeons of Canada, the Canadian Institute for Health Information, the CFPC, and the Society of Rural Physicians of Canada. The group’s focus is developing an approach to improving rural patient transfers and repatriation between rural and urban centres through enhanced hospital standards and better transport coordination among facilities and across jurisdictions.

Rural and Indigenous health competencies (RRM Action 3, Action 5): In July 2018 the CFPC disseminated its approved rural competencies to advance rural education to support the development of family physicians ready to practise in rural Canada.⁷ This resource is a guide to inform rural family medicine curricula and assessment. In April 2019 an invitational symposium was held in Niagara Falls, Ont, with Indigenous health leaders and educators across medical schools and from the CFPC, the Royal College, the Association of Faculties of Medicine of Canada, and the Indigenous Physicians Association of Canada. The goal of the symposium was to develop an action plan for a collaborative approach to competencies to enhance Indigenous health in response to the Truth and Reconciliation Commission of Canada. Following the symposium, Indigenous health physician leaders convened in the fall of 2019 to develop a work plan and business case based on the symposium report.

Rural health research (RRM Direction 4): In August 2018 a pre-budget submission⁸ was made to the federal government to enable rural and remote communities to carry out rural health research through the use of infrastructure funding. In June 2019 the Canadian Institutes of Health Research announced that it is undertaking a strategic planning consultation with input from stakeholders across Canada. As a participant in the consultation process, the RRMIC has corresponded with rural health researchers across Canada encouraging their participation in the Canadian Institutes of Health Research consultation and has advocated for rural health research funding in order to reflect the realities of rural health care.

The RRMIC members are also working on individual activities with key stakeholders on actions that are highlighted in Table 1, which contains a scorecard that describes each of the RRM actions and their implementation status as of the summer of 2019.

Collaborative efforts have also been made with the RRMIC and various organizations, such as the following:

• the Federation of Medical Regulatory Authorities of Canada to explore ways to reduce barriers to licensure for physicians to practise in rural communities where needed;

• the Canadian Medical Association, the CFPC, and the Royal College to form a virtual health care task force in March 2019 to identify the regulatory and administrative changes needed to support virtual care in Canada and to have a set of recommendations ready to present in early 2020; and

• the CFPC, the Royal College, and specialty organizations to promote the acquisition of enhanced surgical skills and anesthesia for rural communities.

While we have made important strides, much work still needs to be done not only by the RRMIC but by leaders, health care providers, administrators of health care institutions, rural communities, and those who work and live with and provide care for rural and Indigenous populations.

Moving ahead

Despite the universality and accessibility principles of the Canada Health Act,⁹ people who live in rural and remote communities do not have equitable access to health care services. A recent Ipsos poll, commissioned by the CFPC, revealed that health care topped the list of issues for last year’s federal election, with 50% of Canadians ranking it among their top 3 issues.¹⁰ Currently, there is no comprehensive national (or even provincial) rural health care strategy to address the needs of rural populations. While some rural health research is conducted in Canada, it is limited, poorly funded, and not well coordinated, and it often fails to be used in informing health policy. As there are gaps in knowledge about how to improve rural health care access and patient outcomes, how to enhance rural health work force recruitment and retention, and how to gather relevant information to influence rural health care delivery, rural health research is needed. Engagement is needed through a set of federally, provincially, and regionally supported networks that would encourage collaboration across rural Canada between rural practitioners; researchers; policy makers; federal, provincial, and territorial leaders; rural and Indigenous communities; and the rural population. Partnerships that can coalesce, in a focused way, around solving problems together are needed now.¹¹

The RRMIC has been actively engaged in federal government advocacy activities by meeting with senior government leaders and policy makers about the importance of making access to health care in rural Canada a priority. The RRMIC will continue its efforts to engage stakeholders in conversations and a series of consultations about RRM collaborative initiatives and it will explore opportunities for sustaining momentum following the conclusion of its mandate in 2020 with a final report.