Open Access Open Badges Correspondence

How do small rural primary health care services sustain themselves in a constantly changing health system environment?

Penny Buykx14*, John S Humphreys14, Rachel Tham1, Leigh Kinsman14, John Wakerman24, Adel Asaid3 and Kathy Tuohey3

Author Affiliations

1 Monash University School of Rural Health, PO Box 666, Bendigo, VIC 3552, Australia

2 Centre for Remote Health, A joint Centre of Flinders University & Charles Darwin University, PO Box 4066, Alice Springs, NT 0870, Australia

3 Elmore Primary Health Service, 46-48 Jeffrey Street, Elmore, VIC 3558, Australia

4 Centre of Research Excellence in Rural and Remote Primary Health Care, Bendigo, Australia

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BMC Health Services Research 2012, 12:81  doi:10.1186/1472-6963-12-81

Published: 26 March 2012



The ability to sustain comprehensive primary health care (PHC) services in the face of change is crucial to the health of rural communities. This paper illustrates how one service has proactively managed change to remain sustainable.


A 6-year longitudinal evaluation of the Elmore Primary Health Service (EPHS) located in rural Victoria, Australia, is currently underway, examining the performance, quality and sustainability of the service. Threats to, and enablers of, sustainability have been identified from evaluation data (audit of service indicators, community surveys, key stakeholder interviews and focus groups) and our own observations. These are mapped against an overarching framework of service sustainability requirements: workforce organisation and supply; funding; governance, management and leadership; service linkages; and infrastructure.


Four years into the evaluation, the evidence indicates EPHS has responded effectively to external and internal changes to ensure viability. The specific steps taken by the service to address risks and capitalise on opportunities are identified.


This evaluation highlights lessons for health service providers, policymakers, consumers and researchers about the importance of ongoing monitoring of sentinel service indicators; being attentive to changes that have an impact on sustainability; maintaining community involvement; and succession planning.