What Are Some of the Barriers to Overcome in the Rural Health Care System and How Do They Affect the Quality of Physiotherapy Care Available in Rural Australia?

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What are some of the barriers to overcome in the rural health care system and how do they affect the quality of physiotherapy care available in rural Australia?

Introduction
This paper is aimed at examining the barriers in the rural regions that contribute towards a poor physiotherapy care and exploring some strategies to work towards a better physiotherapy care in those regions. With higher mortality rates and lower life expectancy, rural health has been a major concern for the Australian Government and having rural health catch up with the city counterparts is a vision that the government has been working on achieving (Williams et al. 2007, p.380). Physiotherapists are also concerned by this since they contribute to the WHO definition of health by working with people with disabilities through active rehabilitation programs, education, health promotion initiatives, advocacy and strategies to remove barriers, and by fostering increased participation in activities. However, many hurdles stand in the way of this dream coming true and these include cultural, structural, historical and critical factors.

Historical Factors
Australia’s rural economies have always been running on agriculture. For a while now, their economy has been going downhill and this has had consequences on the health care available in these communities. Back in the days, with a stable economy, the inhabitants did not have to travel very far to get a job, earn money and have a respectable living standard. However, events such as globalisation and climate change have had significant consequences on agriculture. There were changes in government subsidies, transport costs, sale of farms, and relocation of farmers off the land (Mahoney et al. 2001, p.107). The income provided by this industry was no longer sufficient enough for the whole area to survive. In addition to that, with the increased use of machines in such industries, inhabitants found themselves unemployed and had to move to the cities for jobs (Hughes 2009, p.200). Hence, this resulted in a series of events leading to downgrading of schools, loss of health care workers, closure of banks, hospitals and loss of services such as water and electricity (Mahoney et al. 2001, p.107). Thus, for those chose to stay back, they did not have adequate health care services and providers to have access to better primary health care such physiotherapy care.

Structural Factors
This section looks at how some specific forms of social organisations affects rural lives and consequently the quality of physiotherapy care available to the rural communities. Mahoney et al. (2001, p.106) found that one of the significant structural changes was the relocation of Home and Community Care (HACC) services to the nearest town, which was one hour away and it lead to having a day-to-day support to the elderly moving to an outside location, the potential loss of a personal service and local knowledge of residents requiring services. With the lack of proper infrastructures available for good health care quality, the health care workers move to other towns and the rural communities are left with just one or two doctors. During his study, Mahoney et al. (2001, p.106) noted that one of the rural communities being studied used to have only one doctor before and he would be on call day and night, seven days a week. If he was away on weekends, inhabitants requiring medical assistance had no other choice than travel long distances to get help. The centralization of local government services away from rural communities leads to the loss of a significant amount of jobs, loss of families, businesses, contributions within the community and the remaining inhabitants felt a bigger burden on their shoulders (Mahoney 2001, p.106). With the loss of all these services, only second rate services were available to the residents, who would stop using them and move to places where better services and standard of living were available (Mahoney...
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