Rural health workforce policies are often fragmented, driven by short-term priorities and requiring stronger governance, more systemic planning, and better alignment between national and state policy settings, according to a study published recently.
The new National Health Reform Agreement provides an opportunity for governments to commit national strategic workforce planning, improved workforce data, public reporting of workforce trends and forecasts, and to link health workforce reform to broader health system performance, write the study’s authors below.
Stephanie M Topp, Thu Nguyen, Lana Elliott and Karen Johnston write:
Rural health workforce shortages are often described as a numbers problem. Train more doctors. Recruit more nurses. Offer better incentives. Move more health workers to the places where they are needed.
But rural workforce policy is not only about supply. It is also about whether governments can build a coherent system around the workers, services and communities they are trying to support.
That question is newly urgent. Australia’s National Health Reform Agreement (NHRA) Addendum for 2026–2031 gives a more visible place in the national reform agenda to rural and remote health, and workforce issues. It includes commitments on rural and remote health equity, workforce planning, flexible service models, local governance, data and performance reporting.
Those commitments are welcome. Rural and remote communities need more than another round of short-term initiatives. They need health services that can operate across distance, thin labour markets, high turnover, limited infrastructure and long-standing inequities in access.
Yet our recently published study in Australia Journal of Rural Health lays bare the challenges of this task. We mapped current rural health workforce policies across national and Queensland repositories and in those two jurisdictions alone identified 118 current policy documents for rural and remote health workforce, including 67 national and 51 Queensland state-level documents.
National policy is dominated by grants, programs and sub-programs. Queensland policy places greater emphasis on retention, mainly through employment-based incentives such as allowances, leave, professional development and workload management.
So there is no lack of policy attention; and there is plenty of activity. The problem is that policy activity does not always add up to an effective, long-term workforce strategy.
Divided responsibilities
Rural health systems in Australia are shaped by divided responsibilities.
The Commonwealth holds major levers over Medicare, primary care, aged care, training pathways, professional regulation and national workforce programs. States and territories employ large parts of the public workforce, manage hospitals and health services, negotiate industrial conditions and oversee local service delivery.
These roles are legitimate. But they are also hard to align. Rural communities experience the results as one health system, but governments continue to manage the pieces separately and without much reference to each other.
For example, a national recruitment program may help attract workers, but it cannot fix local housing shortages. A training pathway may increase supply, but it will not guarantee supervision, safe workloads or local retention. A retention incentive may help, but it may not address family employment, childcare, schools, professional isolation, cultural safety or community connection.
This is why rural workforce reform cannot rely on a revolving door of new programs alone. Programs can be useful. They can test new approaches, support local innovation and respond quickly to visible shortages. But when programs accumulate without a clear system-wide logic, supported by aligned action at both state and federal levels, they make the policy landscape busier, without having the much-needed long-term impact.
Our study showed that Queensland rural workforce policies were more strongly oriented toward health workforce performance, by comparison to workforce supply or distribution. Yet much of this policy focus on performance relates to individual outcomes such as career progression, with comparatively less on policy addressing broader, system-level workforce outcomes.
In other words, policies may support professional development or employment conditions but still fail to improve stable access to care in rural and remote communities.
Opportunity
The NHRA creates an opportunity to change this. It commits governments to national strategic workforce planning, improved workforce data, more consistent data standards and public reporting of workforce trends and forecasts. It also links health workforce reform to broader health system performance.
That data agenda needs to become practical and rural-specific. Governments should be able to report, by region and profession, where vacancies persist, where turnover is highest, how long positions remain unfilled, which communities lack access to essential services, and whether new funding models improve workforce stability.
Without this kind of visibility, rural workforce policy remains easy to announce and hard to evaluate.
The NHRA also points toward more flexible models of care. That is essential. Rural health equity does not mean copying metropolitan service models into smaller or more isolated settings. It means designing services around geography, community need, cultural context and workforce capability.
Flexibility, however, must not become a softer word for lower expectations. Rural and remote communities should not receive thinner care because governments struggle to coordinate their policy levers. The goal should be stable, culturally safe, multidisciplinary care delivered as close to home as possible.
That requires a broader view of workforce. Doctors, nurses and midwives are essential, but rural services also depend on allied health professionals, pharmacists, paramedics, dentists, Aboriginal and Torres Strait Islander health workers and practitioners, personal care workers, managers, administrative staff and local service leaders.
Workforce policy that focuses too narrowly on a few dominant professions will miss planning for the teams that hold rural care together.
Against this backdrop, the new NHRA is not a solution in and of itself. It is an opening, creating a sequence of deadlines that could become a genuine reform pathway.
By July, for example, agreed Scope of Practice actions are to be translated into rural implementation plans. By September, the National Health Reform Strategy should define shared workforce objectives, responsibilities and indicators. By December, the rural and remote equity paper should identify where pooled funding, joint commissioning, flexible payment models and new employment arrangements will be used; and from 2027–28, Service Model Reform Funding should support reforms that align these levers in practice.
Stewardship critical
But whether this pathway actually strengthens Australia’s rural and remote health outcomes will depend entirely on whether governments and other stakeholders can shift from the current scatter-gun approach that generates a high quantity of workforce programs, to coherent and coordinated health workforce stewardship.
And for this work, our existing intergovernmental forums are insufficient.
Stewardship of Australia’s health workforce policy relies on a series of vertically reporting committees starting at the National Cabinet, down to the Health Ministers Meeting, the Health Chief Executives Forum and the Health Workforce Taskforce. These bodies can and do set direction and authorise decisions. Yet each is comprised of a small number of senior political or jurisdictional representatives with multiple, sometimes conflicting responsibilities.
As has been argued previously in relation to Australia’s federated health system governance, the challenge is not simply to create agreement, but to build the systemic, standing, capacity needed to implement and adapt those programs across a divided system.
Rural health workforce reform desperately needs this kind of standing capacity: a mechanism with mandate, resources, analytic capability, implementation support and public accountability for progress across jurisdictions. Without this, Australia may have a strong reform agreement, but not the stewardship required to turn it into stable, culturally safe, multidisciplinary care for rural and remote communities.
The next phase of reform should be judged by a simple test: are rural and remote communities better able to access stable, culturally safe, multidisciplinary care when they need it?
If the answer is to be yes, governments will need to do more than announce workforce initiatives. They will need to govern for rural workforce change.
Author details
Stephanie M. Topp is a Professor of Global Health and Development at James Cook University and Director of the JCU Centre for Rural Remote and Tropical Health Systems.
Dr Thu Nguyen is a Research Fellow in Health Policy and Systems at James Cook University.
Dr Karen Johnston is a Senior Research Fellow at James Cook University and Deputy Director of the JCU Centre for Rural Remote and Tropical Health Systems.
Dr Lana Elliott is a Senior Lecturer at the School of Public Health and Social Work, Queensland University of Technology.
Previously at Croakey
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See Croakey’s archive of articles on workforce matters
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