Faculty of Medicine and Health, University of Sydney, Sydney, NSW 2000, Australia
NSW Rural Doctors Network (RDN), PO Box 1111, Mascot, NSW 1460, Australia
Rural Remote Health. 2020 Jul;20(3):5633. doi: 10.22605/RRH5633. Epub 2020 Jul 11.
Rural health services, and the workforces that provide those services, are under unprecedented pressure due to insufficient health workforce numbers and distribution of health workforce weighted to urban areas. This creates health service access issues in rural areas, compounding existing health inequalities between rural and urban people. Many approaches to date have aimed to rectify these issues, with moderate success. In this article we present a call to action to pursue a complementary approach: supporting the capability of the rural health workforce. We hypothesise that further exploring what it means to be a 'capable' rural health professional and what processes or conditions support or erode capability may additionally bolster efforts toward strong rural and remote health systems. The Capability Approach is a theory proposed by Amartya Sen, who was awarded the Nobel Memorial Prize in Economic Sciences in 1998 for this work. Although the Capability Approach inspired, for instance, the UN's Human Development Index, it has not been deeply explored in the context of rural health workforce. While still untested, a focus on capability may assist us in taking a broader view, which encompasses functioning and the freedom to pursue different functioning combinations. The feasible freedom and opportunities are paramount to the concept of capability. We posit that competence is static and the responsibility of the practitioner (and their education), but that capability is fluid and multi-dimensional and the responsibility of the practitioner, community and system. Therefore, we hypothesise that a focus on a Capability Approach, which modulates the relation between the contextual factors and outcomes, may provide us with greater understanding and avenues for action when we aim to improve outcomes such as rural health service sustainability. Developing a list of appropriate capabilities and setting strategies to support capability and its more nuanced domains may present unique opportunities for influence, and these may have positive effects on the rural health workforce. Of course it will need to be determined if improving rural primary health professionals' capability has positive impacts upon quality and access to care, and whether supporting capability is sustainable and worthy of investment.
农村卫生服务以及提供这些服务的劳动力正面临前所未有的压力，原因是卫生劳动力数量不足且分布不均，偏向于城市地区。这导致农村地区的卫生服务可及性出现问题，加剧了城乡居民之间现有的卫生不平等现象。迄今为止，许多方法都旨在纠正这些问题，取得了一定的成效。在本文中，我们呼吁采取一种相辅相成的方法：支持农村卫生劳动力的能力。我们假设，进一步探讨成为一名“有能力”的农村卫生专业人员意味着什么，以及哪些过程或条件支持或削弱能力，可能会进一步加强建设强大的农村和偏远地区卫生系统的努力。能力方法是阿玛蒂亚·森提出的一种理论，他因这项工作于 1998 年获得诺贝尔纪念经济学奖。尽管能力方法为联合国人类发展指数提供了灵感，但它在农村卫生劳动力方面并未得到深入探讨。虽然尚未经过测试，但关注能力可能有助于我们从更广泛的角度看待问题，其中包括功能和追求不同功能组合的自由。可行的自由和机会是能力概念的关键。我们假设，能力是动态的，是从业者的责任（及其教育），而能力是多维度的，是从业者、社区和系统的责任。因此，我们假设，关注能力方法，调节背景因素和结果之间的关系，可能会为我们提供更深入的理解和行动途径，以改善农村卫生服务的可持续性等结果。制定一份适当能力清单，并制定支持能力及其更细微领域的战略，可能会为我们提供独特的影响力机会，这些机会可能会对农村卫生劳动力产生积极影响。当然，需要确定提高农村初级卫生专业人员的能力是否会对护理质量和可及性产生积极影响，以及支持能力是否可持续且值得投资。
