Remote Australia Online

A case study uncovering the impact of use patterns of electric domestic indoor cook stoves leading to a user centered product design approach towards improving nutrition in Australian Indigenous Communities. This paper describes the research methods used to identify and uncover patterns of electric domestic indoor cook stove use and the resulting stove life expectancy in remote Indigenous communities. It highlights in detail user interactions with the appliances and identifies use, user and design assumptions being made when designing, specifying, ordering and installing mainstream appliances into non-mainstream environments. The level of infrastructure quality and maintenance & repair support play an important role in influencing the performance delivery and lifespan of the product, in at times unexpected ways. The relationship and interplay between use, environment and product performance is presented as a vital, important consideration in the design process. The discrepancy of expected versus actual product performance can in these cases have a direct impact on the users lifestyle and health that might not be apparent in a more conventional urban domestic setting. Currently this results in a 17 year gap in life expectancy between the average Australian and the Indigenous population (Dart 2008). This highlights the important role design can play in the delivery of improved environmental health outcomes, in this case improving nutrition. The more remote the location, the more mission critical the design becomes in supporting a healthy lifestyle.

This is a practice based account of an unobtrusive experiment conducted as part of a federally funded national project from 2006-2011. As Design consultant I was engaged to investigate the short life expectancy of domestic electric cook stoves in Remote Indigenous Communities. The following account describes the putting in place of a follow up study to verify how the implemented design interventions performed in the field. Product performance data and user feedback are, for Industrial Designers, essential and necessary information that inform their design process and future design interventions. But what if we haven’t got any of these avenues available, what if our users are not located within easy reach, what if they are in a setting so remote that it even has no mobile network reception? Then the designer is faced with an uncommon challenge, how to get the users or their things, in this case commercial stoves, to talk from afar? This account highlights the intricacies and complexities of satellite field data logging in remote locations, where designers cross multiple communities of practice while negotiating complex communication issues between electronic components and humans related and unrelated. While technical issues are resolvable it is the social dimension and the strength of social connections that ultimately determine a projects success or failure.

In this paper, four questions of concern to Education Department s and teacher education institutions in Australia are addressed. How do we develop strategies to attract beginning teachers to rural, remote and isolated schools and how do we retain teachers in those schools? What professional development is available that values rural life? What are some of the current pre-service initiatives that prepare teachers entering rural areas? How do we meet professionall development need of teachers and pre-service teachers in rural, remore and isolated areas? This paper will draw on research from a collaborative, ARC funded study Teacher/intern Partnerships in Isolated areas. Partners in the study include, Queensland University of Technology, Education Queensland, the Priority Country Area Program, the Queensland Teachers Union and the Board of Teacher Registration. The project is designed to better prepare inexperienced teachers for the particular demands involved in teaching in rural and isolated areas. The ultimate goal of the project is to improve the quality of teaching and learning in remote and isolated areas. The paper will focus on issues related to developing partnerships between stakeholders which facilitate reflective and interactive teaching practices. A mentor/internship model that promotes in student-interns an understanding of the needs of students and parents in their school and community will be outlined.

Attracting teachers to live and work in rural and remote schools is a continuing challenge in more isolated parts of Australia and internationally. It was this challenge that prompted the Priority Country Area Program (PCAP) to fund the trial of a Community-based Mentoring Model in Queensland to ascertain if a joint approach could make a difference for teachers. Two aims guided the research; 1) to design and implement a Community-based Mentoring Model for enhancing the lives of teachers living and working in rural and remote settings and; 2) to ascertain the effectiveness of the mentoring model by conducting two case studies in different geographic locations. One site was in a medium sized rural setting (population 900) and personnel from two schools and the local community were involved. The second was in a much smaller remote community (population 323) where local community members and school personnel participated.

The main focus of this paper is to select an economically suitable sustainable standalone power supply system for a remote off-grid town in Western Australia. Existing power systems of such remote towns in Australia have adverse environmental impacts and contribute to global warming due to the utilization of fossil fuels, especially diesel and gas. The possible electricity supply systems for such towns can vary from a diesel/gas generator towards a hybrid system composed of a generator, wind turbine, photovoltaic system, and battery energy storage. In order to limit the cost of the system and to propose the most economically feasible solution, various combinations of supply systems are considered. These systems are analyzed in this paper by the help of HOMER software to determine the optimal architecture and the control strategy of the supply system. This study has used real demand data of the town, as well as the prices of different electrical components in the Australian market. The scenario which yields the minimum cost of energy is defined and suggested. Also, a decision-making based technique is proposed to help the local electricity utility in finding the suitable solution in the case of budget limits on the investment and annual operation and maintenance. Another aim of this analysis is to investigate and illustrate the impact of a small annual load growth on the size of the selected components for the selected power system, as well as the total net present cost and the cost of electricity. A sensitivity analysis is also performed to analyze the impact of uncertainties of some of the parameters in the outcome of the study to obtain the optimized cost of the selected system.

To combat social and economic inequity in rural Australia, governments, communities, and policy makers are seeking ways to empower local residents to find local solutions to local problems. Through an exploratory review of the literature and semi-structured interviews conducted in the Mid West of Western Australia, this research examined the role of the arts as a vehicle for increased social and civic participation to build resilience to inequity. For those interviewed, the arts were observed to strengthen sense of place and community identity. The arts were utilised as a means for encouraging and enabling civic participation, as well as providing opportunities for social interaction and networking, which are essential for the health and wellbeing of rural and remote residents. While providing a context for civic and social participation, the arts were viewed by several of those interviewed as a means for facilitating understanding between divisive and disparate groups. Yet, it was noted that the execution and drive for arts activities and events was dependent on the availability of human capital, but also on support from governance and funding authorities to build capacity to sustain these activities. If, as suggested by this exploratory review, the arts are a vehicle for building resilience in rural Australia, then further research is needed to support these claims to enable continued and future support for not just the arts, but the capacity of communities to engage in the arts.

In response to the review questions, IRCA makes the following key recommendations: 1. Governments need to Close the Gap in funding of First Nations led-solutions. 2. Government needs to Close the Gap in engagement of Governments with First Nations peoples through properly funding representative national peaks, representative bodies, and government/sector forums. 3. Government needs to Close the Gap in the inclusion of First Nations leaders in decision making by establishing a First Nations Policy government authority led by First Nations policy makers. 4. Government messaging to be channeled through First Nations broadcasters with local customization of content specific to local needs and issues. 5. First Nations groups be positioned as the key designers, deliverers and evaluators of targets and measures for reduction of systemic barriers to the social inclusion of First Nations peoples. 6. Place based programs should be encouraged; First Nations community organisations, such as First Nations broadcasters to be supported to design and deliver services that strengthen communities across a range of social inclusion measures. 7. Indigenous Digital Inclusion needs to be included in Closing the Gap initiatives. 8. The Australian Government, State and Territory Governments recognise First Nations groups as the best placed, in terms of cultural understanding and engagement, to design, deliver, coordinate and evaluate Closing the Gap initiatives. 9. First Nations broadcasters and media organisations be recognised as key partners in designing and delivering Closing the Gap communications and community engagement. 10. Employment opportunities in First Nations broadcasters and media organisations be expanded through increased funding for positions and training.

The seedbanks of four arid trees from Australia were examined using periodicrecovery of seeds buried in nylon mesh bags in the field. Casuarina pauper did not maintain a soil seedbank. Seeds were not dormant at release and available rainfall will govem the timing of germination events. Three Acacia species have seedbanks of varying longevities. In A. oswaldii, the seedbank was very shortlived with most seeds from any one annual seed-crop having germinated in the first 1–2 years after release. In A. ligulata the seedbank was persistent, although it did vary between different populations. A. loderi had a relatively short-lived seedbank, with only 5% of seeds from an annual seed-crop surviving in the soil for between 3–5 years. Both C. pauper and A. oswaldii must rely on the production of annual seed-crops to maintain a seedbank through time and hence, take advantage of infrequent and irregular rains promoting germination and establishment. For A. ligulata and A. loderi, occasional seed production is all that is required to ensure the presence of a soil seedbank.

The ESSA for an Active Nation campaign is calling on the Australian Government, our stakeholders and the community to commit to building a nation where everyone is supported to be active. The main goals of the campaign are to: 1. promote Access, Fairness and Quality in the development of health policies on exercise services provided by accredited exercise physiologists and exercise scientists 2. propose priority policies that cements physical activity and exercise services as essential in health 3. seek support from the Federal Government to commit more resources in the 2019 Federal Budget to ensure all Australians can access exercise services provided by accredited exercise physiologists and exercise scientists 4. seek support from key stakeholders in the health and sport sectors to facilitate and create opportunities for consumers to better access services and programs that will increase their physical activity level.

Australia’s rural and remote populations have poorer health than their metropolitan counterparts with respect to several health outcomes. They have higher mortality rates and consequently lower life expectancy. They also experience higher hospitalisation rates for some causes of ill health. This report adopts an indicator-based approach to compare the health of rural and remote populations with that of metropolitan Australians. Mortality data, cancer incidence, hospital statistics, ABS 1995 National Health Survey risk factors, medical labour force statistics, and Medicare data have all been analysed using the three zone/seven category Rural, Remote and Metropolitan Area classification (RRMA). This classification was developed in 1994 jointly by the Department of Primary Industries and Energy and the then Department of Human Services and Health. The seven RRMA categories are ‘capital cities’ and ‘other metropolitan centres’ within the metropolitan zone, ‘large rural centres’, ‘small rural centres’ and ‘other rural areas’ within the rural zone, and ‘remote centres’ and ‘other remote areas’ within the remote zone.

This report describes changes in death rates, for a number of causes, in Major Cities, Inner Regional, Outer Regional, Remote and Very Remote areas, between 1992 and 2003. Overall, death rates for males and females in Major Cities declined by 4 points p.a. for males and 3 points p.a. for females. The rate of decline in regional and Remote areas was similar (although slightly lower for males in Inner Regional areas). The rate of decline in Very Remote areas (5 points p.a.) was greater than that in Major Cities. Both the pace and the direction of change in death rates differed between causes. There are several causes of death identified as being the main contributors to higher death rates in regional and remote areas (AIHW 2003). The most numerically important four of these causes (in terms of raising regional and remote death rates) are coronary heart disease, ‘other’ circulatory diseases, chronic obstructive pulmonary disease and motor vehicle traffic accidents. For both sexes, there has been a decrease over time in the rate of death due to these causes (although for women, there has been essentially no change in chronic obstructive pulmonary disease death rates over the period). For diabetes and suicide, there have not been consistent or substantial decreases, and in a number of areas, there have been increases in the rate of death from these causes. For the other causes (‘other’ injuries, and for lung, colorectal and prostate cancers), there have also been decreases in death rates over time. However, for women there was little change in the rate of death from ‘other injuries’ and there was an increase in the rate of lung cancer death.

Indicators, describing the nature and extent of health dimensions across regions and time, provide a systematic set of measures which can inform rural health policy. In 2003, a Rural Health Information Framework was established to aid the understanding of, and to monitor the health of regional and remote populations. Indicators were identified across three areas: health status and outcomes; health determinants; and health system performance. This report is the second in an AIHW series, which reports on indicators of health from a regional and remote perspective. Indicators of health status and determinants of health are published here. A complementary report focusing on indicators of health system performance is scheduled for publication in mid–2008. Key findings: • Rates of self-reported diabetes, cerebrovascular disease, coronary heart disease, depression, and anxiety were generally similar for those living in Major Cities and those living in regional and remote areas. • Compared with those living in Major Cities, the incidence of cancer was slightly higher for those living in regional areas and slightly lower for those living in Very Remote areas in the two years 2001–03. • People in regional and remote areas were more likely than those in Major Cities to report an acute or chronic injury, to drink alcohol in quantities risking harm in the short term, or to be overweight or obese. • Compared with people living in Major Cities, people living in regional and remote areas were less likely to consume low-fat or skim milk or to consume the recommended two serves of fruit per day. However, they were more likely to consume four or more serves of vegetables per day. • Lower birthweights outside Major Cities were particularly marked for teenage mothers (those aged younger than 20 years). • Life expectancy decreases with increasing remoteness. Compared with Major Cities, the life expectancy in regional areas is 1–2 years lower and in remote areas is up to 7 years lower. • Compared with those in Major Cities, people in regional and remote areas were less likely to report very good or excellent health. • Across all geographic areas, the health of Aboriginal and Torres Strait Islander peoples was generally worse than non-Indigenous Australians. The higher proportion of Indigenous Australians in remote area populations contributes to, but does not completely account for, the generally poorer health of people living in remote areas.

In 2003, a Rural Health Information Framework was established to help understand and to monitor the health of regional and remote populations. Indicators were identified across three areas: health status and outcomes; health determinants; and health system performance. This report publishes selected indicators relating to health system performance. A complementary report focusing on indicators of health status and determinants of health was published in March 2008. The indicators presented here illustrate differences between Australia’s health system performance in rural and major urban centres. In regards to effectiveness Compared with Major Cities, participation in breast cancer screening among women in the target age group (50–69 years) was significantly higher in all, except Very Remote, areas. Indigenous Australian women were significantly less likely to participate in breast screening than non-Indigenous women, but rates of Indigenous participation have increased over time. In regards to appropriateness With the exception of dialysis, hospitalisation rates for common procedures were significantly lower for people living in Remote areas than for those living in Major Cities. In particular, separation rates for procedures used in the management of heart disease were significantly lower for people living in Remote areas. This finding is particularly noteworthy as death rates from coronary heart disease were significantly higher in these areas. The provision of aged care places and support packages was above the planning target ratio in all, except Major City and Outer Regional areas. In regards to accessibility The per-person supply of employed medical practitioners and dentists decreased with remoteness. The supply of nurses and general practitioners was more evenly distributed across regions. People living in remote areas had higher rates of hospitalisation than those living in Major Cities. Prescription rates were slightly higher in regional areas and lower in remote areas for the majority of pharmaceutical groups analysed. In 2005–06, people with disability living outside Major Cities were significantly less likely to access disability support services than those living within Major Cities. In regards to capability, safety and sustainability Hospitals outside Major Cities were less likely to be accredited. However, this may partly reflect the varied, and sometimes voluntary, accreditation practices across jurisdictions.

What we know: • How public sector agencies fund Indigenous organisations, known internationally as funding ‘modalities’ (see Terminology for definition), can enhance or corrode the capabilities of Indigenous people to govern themselves. • The modality used to fund Indigenous organisations is only one factor involved in the governance and service delivery performance of an Indigenous organisation. Other factors involved include skills, capabilities, material resources, legislative provisions and the complexity of their operating environment. • The impact that funding modalities have on the governance and performance of Indigenous organisations is under-researched in Australia compared with generically similar international modalities. • The situation for remote Indigenous organisations differs in 3 ways from the international case studies examined in this paper. In Australia: (1) performance indicators are imposed, rather than negotiated; (2) few existing public funding modalities reward performance or provide incentives; and (3) funding arrangements do not generally require receiving organisations to be accountable to their constituents. • Although the rules of public finance management are uniform across the Australian Public Service, Indigenous authorities and organisations are funded through a wide variety of modalities. These range from completely untied general-purpose grants with minimal or no reporting requirements, to tightly prescribed specific-purpose grants with cumbersome reporting requirements. • During the past decade, the 3 lead Commonwealth agencies demonstrated the diverse ways in which financing guidelines can be interpreted. These included contested contractualism; a multitude of small special-purpose grants, and decentralised funding of community-controlled health organisations. • Strong path dependencies and interests exist in some parts the system, influencing how public sector agencies fund Indigenous organisations and constrain innovation. Governments tend to over-emphasise ‘risk and uncertainty’ and respond by measures that reduce local discretion, centralising decision-making authority and accountability. • Due in part to the application of contestability principles, public finances in remote Indigenous contexts have generally become fragmented and unstable, leading at times to considerable duplication and administrative burden. This can divert limited resources and talents available to Indigenous organisations away from delivery of outcomes to their constituency. • There are examples of remote Indigenous organisations that have been funded through a block grant system (see Terminology for definition) for their core functions. There is potential to expand this approach and trial other innovations that have been tested internationally. This paper considers the circumstances under which block funding could be adapted to the unique context of remote Indigenous communities in Australia. • While it is not possible to claim that block funding will necessarily result in organisations becoming more capable and accountable, the international experience is that the block-funding modality can result in heightened public engagement in local politics, including downward accountability, as occurs in democracies generally. • Block funding is no panacea. Given the diversity of context, capabilities and the difficulties of backing innovative grant systems, it is reasonable to expect some failure. But seeing such contexts only through the lens of risk, deficit and chronic governance failure undermines the prospect of local capability or accountability developing. What works: • Public financing of Indigenous organisations has been successful when the organising node is the organisation, rather than the program. Funding can be organised either around the totality of the organisation’s functions, or restricted to its core functions. • Stable, ongoing funding (generally over a 3–5 year timeline) can lead to improved governance capabilities. • Governance capabilities can be enhanced when discretion is devolved locally, including the powers to budget, plan and make operational decisions, allowing the organisation to respond to locally identified priorities. This is particularly effective when the devolved functions are within the general capability of the funded organisation, the rules have been negotiated, and the decisions can be contested by the people they serve. • Where block funding has occurred, organisational-level accountability arrangements have been in place. This includes stipulation of minimum governance standards being in place (for example, budget, plans, key staff) before qualifying for the block grant. • Supporting culturally and contextually appropriate governing structures is likely to have a positive effect on governance capabilities. • Indigenous organisations have tended to benefit from general-purpose and more expansive and flexible funding arrangements in cases where they have a recognisable jurisdictional boundary or a well-defined service delivery catchment area. • Legislating the performance-management framework and reporting requirement into clearly defined jurisdictions can both increase local autonomy and decrease the duplication and quantity of reporting requirements. • Funding arrangements based on citizen entitlements for social security or health care have been successfully adapted to provide core governance funding, partly because they can limit departmental discretion to impose conditions. When different departments are able to pool their funding, even on a modest scale, there can be a reduction in the transaction and reporting costs for Indigenous organisations and government departments. Departmental discretion is however still limited by the different ways that the funds have been appropriated by Parliament. • Single parliamentary appropriations to clearly defined jurisdictions can increase local autonomy and decrease the volume and duplication of reporting requirements. What doesn’t work: • Imposing financing frameworks and performance measures that have not been jointly negotiated. • Expecting capacity to develop and performance to improve in the absence of government support. • Cobbling together funding for core governance from multiple special-purpose grants. • Building performance frameworks around outcome and impact measures that are beyond the influence or capability of the Indigenous organisation. What we don’t know: • Because block funding has not been explicitly trialled in remote Indigenous contexts, evaluations and other evidence are lacking. More research and evaluation is required to explore how different block funding modalities affect capabilities and performance. • It is not yet known if there is government and stakeholder support to trial block funding. It should at least be practically possible to operate a combination of an untied general-purpose grant—that funds the core mandate of the organisation—and tied special-purpose grants to fund additional outcomes desired by governments and agreed upon by local organisations. As governance capacity is demonstrated, it should be possible to roll more of the special-purpose grants into the general-purpose grant, thereby increasing the size of the pool of block funding and decreasing the number of grants and associated administrative burden. • Little has been documented about the realpolitik of actual expenditure behaviours and about the conditions under which innovation occurs in Indigenous organisations. • Earlier attempts at finance reform have generally led to increased fragmentation and reporting. Indigenous participation is likely to be conditional on the reforms leading to longer-term commitments to stable and predictable funding, reduced and more flexible funding conditions, increased local discretion, reduced reporting requirements, and negotiated agreements on outcomes. • It is unclear if Indigenous organisations would be in favour of enhanced performance-management systems and incentive-based funding, though anecdotal evidence suggests that they could be if the systems are built around their actual practice (rather than around the grant) and they can better demonstrate effectiveness to constituents and stakeholders. • Further work is required to develop new accountability frameworks that satisfy 3 different sets of accountability requirements: – upward to the funding agency; – downward to the organisation’s constituents and/or clients; – operationally to the Indigenous organisation’s capabilities. • These frameworks need to be developed around the organisation or project, rather than a multitude of different departmental grants.

This study aimed to evaluate a scale to measure attitudes to child sexual abuse (CSA) in remote Australian Indigenous communities. The scale was developed to gauge attitudes that may be inhibiting the reporting of cases of CSA to police, as well as to evaluate whether interventions that focused on collaborative relationships between community members and police resulted in changes in attitudes. Participants included service providers living outside the community (58%), community members (living within the community; 9%), and service providers who were also community members (33%); 18% of participants identified as Indigenous. Principal components analysis revealed a nonintuitive six-factor solution that did not support the original four concepts. Four intuitive factors emerged from an abridged version of the scale: entrenched issues, personal understanding and knowledge, communication between community and government, and community action. The scale detected significant differences between community status and between Indigenous status groups on some factors.

Australia's airline industry was born on connecting regional communities to major cities, but almost a century later, many regional and remote communities are facing the prospect of losing their air transport services. The focus of this paper is to highlight key issues and concerns surrounding remote, rural and regional airports in Australia using a network governance framework. Contributions are focused towards regional and remote airport managers, decision makers, and policy makers to stimulate further discussion towards retaining regional and remote services to communities.

Water provision for developing countries is a critical issue as a vast number of lives are lost annually due to lack of access to safe drinking water. The presence and fate of inorganic trace contaminants is of particular concern. Trace inorganic contaminants have been found in elevated concentrations in drinking waters supplied directly from brackish groundwaters in developing countries. Desalination and the removal of trace inorganic contaminants from bore water sources from a remote community in Australia using electrodialysis (ED) were investigated. The influence of applied voltage on the removal of the trace contaminants was evaluated. While the results from this study demonstrated that ED is an effectual method for the removal of total dissolved solids and a number of trace inorganic contaminants from brackish groundwaters to below drinking water guideline levels, the deposition of trace contaminants on the membranes (fouling) influenced the ED process in relation to ionic flux and the effectiveness of trace contaminant removal.

Telecommunications access in the rural and remote areas of Australia has come under considerable scrutiny in recent years. In the past decade, various Federal Government reports and inquiries have citied inadequate infrastructure, lack of service provision, the high cost of access and “thin” markets as key impediments. Whilst these difficulties are not restricted to rural and remote Australia, they tend to impact disproportionately on regional communities, notably in education and health service provision. Particularly at risk are the indigenous communities in rural and remote regions of Australia. In this paper telecommunications infrastructure is perceived as the lynch-pin for achieving sustainable economic and social development. It is suggested that without appropriate development of information infrastructure, the disparities already experienced by rural and remote communities will be further exacerbated as the reliance of goods and services over computer-mediated networks increases. The paper offers a new paradigm that will assist in maintaining a competitive telecommunications environment and facilitate the sustainable social and economic development of rural and remote communities.

Objective to explore perceptions and examples of risk related to pregnancy and childbirth in rural and remote Australia and how these influence the planning of maternity services. Design data collection in this qualitative component of a mixed methods study included 88 semi-structured individual and group interviews (n=102), three focus groups (n=22) and one group information session (n=17). Researchers identified two categories of risk for exploration: health services risk (including clinical and corporate risks) and social risk (including cultural, emotional and financial risks). Data were aggregated and thematically analysed to identify perceptions and examples of risk related to each category. Setting fieldwork was conducted in four jurisdictions at nine sites in rural (n=3) and remote (n=6) Australia. Participants 117 health service employees and 24 consumers. Measurements and findings examples and perceptions relating to each category of risk were identified from the data. Most medical practitioners and health service managers perceived clinical risks related to rural birthing services without access to caesarean section. Consumer participants were more likely to emphasise social risks arising from a lack of local birthing services. Key conclusions our analysis demonstrated that the closure of services adds social risk, which exacerbates clinical risk. Analysis also highlighted that perceptions of clinical risk are privileged over social risk in decisions about rural and remote maternity service planning. Implications for practice a comprehensive analysis of risk that identifies how social and other forms of risk contribute to adverse clinical outcomes would benefit rural and remote people and their health services. Formal risk analyses should consider the risks associated with failure to provide birthing services in rural and remote communities as well as the risks of maintaining services.

Objective: there is a significant gap in pregnancy and birth outcomes for Australian Aboriginal and Torres Strait Islander women compared with other Australian women. The provision of appropriate and high quality antenatal care is one way of reducing these disparities. The aim of this study was to assess adherence to antenatal guidelines by clinicians and identify factors affecting the quality of antenatal care delivery to remote dwelling Aboriginal women. Setting and design: a mixed method study drew data from 27 semi-structured interviews with clinicians and a retrospective cohort study of Aboriginal women from two remote communities in Northern Australia, who gave birth from 2004–2006 (n=412). Medical records from remote health centres and the regional hospital were audited. Measurements and findings: the majority of women attended antenatal care and adherence to some routine antenatal screening guidelines was high. There was poor adherence to local guidelines for follow-up of highly prevalent problems including anaemia, smoking, urinary tract infections and sexually transmitted infections. Multiple factors influenced the quality of antenatal care. Key conclusions and implications for practice: the resourcing and organisation of health services and the beliefs, attitudes and practices of clinicians were the major factors affecting the quality of care. There is an urgent need to address the identified issues in order to achieve equity in women's access to high quality antenatal care with the aim of closing the gap in maternal and neonatal health outcomes.

Background The Council for Remote Area Nurses of Australia deliver the MEC course which is the only short-course on maternity emergencies offered to non-midwifery qualified remote area nurses and Aboriginal Health Workers. The aim of the course is to improve the maternity emergency skills and knowledge of health service providers who do not have midwifery qualifications. There has been no long-term evaluation of the course since its inception. Research objective To review the longer-term effectiveness of the maternity emergency care (MEC) course which was developed in consultation with the Australian College of Midwives (ACM) and rural and remote practitioners in 2003. Participants and methods Fifty-seven clinicians who completed the MEC course since 2003 responded to a survey. Seven remote area health managers and two course facilitators were interviewed. Results This study provides an evaluation of the experiences of non-midwives who manage maternity emergencies in the rural and remote setting; their perception of the skills, knowledge and confidence acquired through participation in the MEC program. Conclusions The MEC course is valued by both remote health managers and practitioners. The learning activities, skills and knowledge gained are reported to be very beneficial and used by remote health practitioners.

The aim of this descriptive study, undertaken in 1997, was to examine the professional environment and work practices of physiotherapists, occupational therapists and speech pathologists in public sector positions in Central Australia. All therapists identified in these positions were interviewed. The study indicates that incumbents value specific professional benefits associated with remote area practice, particularly the opportunity to work with Aboriginal people. However these recruiting advantages are diminished by a lack of management support - a key factor in the high turnover of staff. The findings of this study have implications for the development of strategies to improve support, and thereby retention, of allied health professionals and other workers in remote areas.

Publisher Summary This chapter focuses on work examining the role that spatial metaphors and basic spatial representations play in constructing representations of time across languages. One factor that affects the perceived direction of time is writing direction. People who read text arranged from left to right tend to lay out time as proceeding from left to right, and people who read text arranged from right to left arrange time from right to left. Because people tend to recruit spatial representations to think about time, representations of time also differ depending on what spatial representations are most cognitively available to co-opt for time. Cross-cultural differences in thought can be more than a matter of style or preference. Pormpuraawans think about time in ways that other groups cannot. Many Americans simply could not lay out time in absolute coordinates even if they wanted to, because they lack the basic spatial knowledge necessary to do so.

People living in rural and remote areas face challenges in accessing appropriate health services, many of which struggle to recruit and retain staff. While researchers have documented these issues in Australia and internationally, rural health remains reactive to current problems and lacks comprehensive understanding. This paper presents a conceptual framework that can be used to better understand specific rural and remote health situations. The framework consists of six key concepts: geographic isolation, the rural locale, local health responses, broader health systems, social structures and power. Viewed through Giddens' theory of structuration, the framework suggests that rural health is understood as spatial and social relations among local residents as well as the actions of local health professionals/consumers that are both enabled and constrained by broader health systems and social structures. The framework provides a range of stakeholders with a guide to understanding rural and remote health.

Background Food insecurity underlies and compounds many of the development issues faced by remote Indigenous communities in Australia. Multi-sector approaches offer promise to improve food security. We assessed the feasibility of a novel multi-sector approach to enhance community food security in remote Indigenous Australia. Method A longitudinal comparative multi-site case study, the Good Food Systems Good Food for All Project, was conducted (2009–2013) with four Aboriginal communities. Continuous improvement meetings were held in each community. Data from project documents and store sales were used to assess feasibility according to engagement, uptake and sustainability of action, and impact on community diet, as well as identifying conditions facilitating or hindering these. Results Engagement was established where: the community perceived a need for the approach; where trust was developed between the community and facilitators; where there was community stability; and where flexibility was applied in the timing of meetings. The approach enabled stakeholders in each community to collectively appraise the community food system and plan action. Actions that could be directly implemented within available resources resulted from developing collaborative capacity. Actions requiring advocacy, multi-sectoral involvement, commitment or further resources were less frequently used. Positive shifts in community diet were associated with key areas where actions were implemented. Conclusion A multi-sector participatory approach seeking continuous improvement engaged committed Aboriginal and non-Aboriginal stakeholders and was shown to have potential to shift community diet. Provision of clear mechanisms to link this approach with higher level policy and decision-making structures, clarity of roles and responsibilities, and processes to prioritise and communicate actions across sectors should further strengthen capacity for food security improvement. Integrating this approach enabling local decision-making into community governance structures with adequate resourcing is an imperative.