Article Text

Download PDFPDF

Understanding and responding to the cost and health impact of short-term health staffing in remote and rural Aboriginal and Torres Strait Islander community-controlled health services: a mixed methods study protocol
  1. Michelle S Fitts1,
  2. John Humphreys2,
  3. Terry Dunbar3,
  4. Lisa Bourke4,
  5. Edward Mulholland5,
  6. Steven Guthridge6,
  7. Yuejen Zhao7,
  8. Michael P Jones8,
  9. John Boffa9,
  10. Mark Ramjan10,
  11. Lorna Murakami-Gold11,
  12. Annie Tangey12,
  13. Clarissa Comerford12,
  14. Rosalie Schultz12,
  15. Narelle Campbell13,
  16. Supriya Mathew1,
  17. Zania Liddle1,
  18. Deborah Russell1,
  19. John Wakerman1
  1. 1Menzies School of Health Research, Charles Darwin University, Alice Springs, Northern Territory, Australia
  2. 2School of Rural Health, Monash University, Strathdale, Victoria, Australia
  3. 3Indigenous Social and Wellbeing Centre, School of Population Health Research, Australian National University, Canberra, Australian Capital Territory, Australia
  4. 4Department of Rural Health, The University of Melbourne, Shepparton, Victoria, Australia
  5. 5Miwatj Health Aboriginal Corporation, Nhulunbuy, Northern Territory, Australia
  6. 6Centre for Child Development and Education, Menzies School of Health Research, Casuarina, Northern Territory, Australia
  7. 7Northern Territory Department of Health, Darwin, Northern Territory, Australia
  8. 8Psychology Department, Macquarie University, North Ryde, New South Wales, Australia
  9. 9Central Australian Aboriginal Congress, Alice Springs, Northern Territory, Australia
  10. 10Top End Health Service, Northern Territory Government, Casuarina, Northern Territory, Australia
  11. 11Poche SA + NT, Flinders University, Alice Springs, Northern Territory, Australia
  12. 12Ngaanyatjarra Health Service, Alice Springs, Northern Territory, Australia
  13. 13Flinders Northern Territory, College of Medicine and Public Health, Flinders University, Darwin, Northern Territory, Australia
  1. Correspondence to Professor John Wakerman; john.wakerman{at}


Introduction Access to high-quality primary healthcare is limited for remote residents in Australia. Increasingly, remote health services are reliant on short-term or ‘fly-in, fly-out/drive-in, drive-out’ health workforce to deliver primary healthcare. A key strategy to achieving health service access equity, particularly evident in remote Australia, has been the development of Aboriginal Community Controlled Health Services (ACCHSs). This study aims to generate new knowledge about (1) the impact of short-term staffing in remote and rural ACCHSs on Aboriginal and Torres Strait Islander communities; (2) the potential mitigating effect of community control; and (3) effective, context-specific evidence-based retention strategies.

Methods and analysis This paper describes a 3-year, mixed methods study involving 12 ACCHSs across three states. The methods are situated within an evidence-based programme logic framework for rural and remote primary healthcare services. Quantitative data will be used to describe staffing stability and turnover, with multiple regression analyses to determine associations between independent variables (population size, geographical remoteness, resident staff turnover and socioeconomic status) and dependent variables related to patient care, service cost, quality and effectiveness. Qualitative assessment will include interviews and focus groups with clinical staff, clinic users, regionally-based retrieval staff and representatives of jurisdictional peak bodies for the ACCHS sector, to understand the impact of short-term staff on quality and continuity of patient care, as well as satisfaction and acceptability of services.

Ethics and dissemination The study has ethics approval from the Human Research Ethics Committee of the Northern Territory Department of Health and Menzies School of Health Research (project number DR03171), Central Australian Human Research Ethics Committee (CA-19-3493), Western Australian Aboriginal Health Ethics Committee (WAAHEC-938) and Far North Queensland Human Research Ethics Committee (HREC/2019/QCH/56393). Results will be disseminated through peer-reviewed journals, the project steering committee and community/stakeholder engagement activities to be determined by each ACCHS.

  • primary care
  • health economics
  • health policy
  • quality in health care

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See:

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.


  • Contributors MSF drafted and revised the manuscript. JW conceived the study, contributed to design and reviewed the manuscript. JH contributed to the conceptualisation and design of the study and assisted with drafting the manuscript. LB and TD contributed to the design of the study, particularly the qualitative component, and provided comments on the manuscript. MPJ, SG, YZ and DR contributed to the design of the study, particularly the quantitative component, and provided comments on the manuscript. NC, JB, EM, MR, AT, CC, RS and LM-G contributed to the design of the study. DR, SM and ZL contributed to the drafting of the manuscript. All authors read and approved the final manuscript.

  • Funding The project is supported under the Australian Research Council’s Project Discovery funding scheme (project number DP190100328) and by the Medical Research Future Fund through the NHMRC and Central Australian Academic Health Science Network (N/A). The information and opinions contained in it do not necessarily reflect the views or policy of the Commonwealth of Australia (or the Department of Health).

  • Competing interests None declared.

  • Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.

  • Provenance and peer review Not commissioned; externally peer reviewed.