ID-5184 Wonca Abstracts supplement A-K 13-10-23 - Flipbook - Page 190
WONCA 2023 Supplement 1: WONCA 2023 abstracts (A–K)
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Scope of practice: Contrasting developments in rural and
remote healthcare in Bangladesh and Australia
Mrs Pratima Durga1,2, Lisa A Caffery1, Olav T Muurlink1, Andrew W Taylor-Robinson3,4
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Central Queensland University, 2Alphacrucis University College, 3VinUniversity, 4University of
Pennsylvania
Background
Primary healthcare provision in Bangladesh, a developing country, contrasts starkly with Australia, a
G20 nation. This study examines primary healthcare delivery in two contrasting rural settings: Bhola,
a densely populated island in Bangladesh; and the Gemfields, a marginalised, sparsely populated
region in Queensland, Australia. This paper aims to compare and contrast how medical practitioners in
these two environments perceive their scope of practice in response to infrastructural constraints and
very different regulatory frameworks. It also looks at how the COVID-19 outbreak has influenced the
implementation of telehealth in both settings.
Methods
Qualitative interviews were conducted with 51 rural health practitioners: 28 unqualified medical
practitioners and eight formally trained medical professionals on Bhola Island; and 15 health
professionals in the Gemfields.
Results
Bangladesh and Australia face a common problem: a chronic shortage of qualified healthcare
providers in rural areas. This deficit is mainly caused by the reluctance of qualified medical practitioners
to relocate from urban areas. Other shared problems include limited health literacy, inadequate
control regulations and misuse of prescription medicine. In Bhola, residents turn to informal ‘village
doctors’ due to restricted access to government facilities. In contrast, the Gemfields residents cannot
readily access allopathic medicine due to greater regulatory control of healthcare delivery, so eschew
government healthcare because of low trust in authority and governmental services.
Conclusion
COVID-19 has prompted a shift in the scope of practice of healthcare professionals in Australia and
the strengthening of telehealth offerings in remote areas such as the Gemfields. Here, the pandemic
triggered a loosening of the regulatory framework surrounding formal healthcare provision, with faceto-face consultations put on hold and telehealth developing by default in response to emergency
needs. However, the Bangladeshi ‘solution’ to similar rural healthcare challenges, in a much more
laissez-faire regulatory setting, continues to be more locally ‘appropriate’ and clinically risky.
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