Building capacity for rural health : the role of boundary crossers in coalition maturity for partnerships with external agents

The concept of partnership has entered policy rhetoric and is urged as good practice in a variety of domains including health. Rural communities tend to have fewer resources available for the provision of services such as health than their metropolitan counterparts, and so could be expected to benefit from partnerships with external agencies. Indicators of coalition maturity for working in partnership with external agents in order to build stronger communities are distilled from the group development and partnership research literature and considered in the light of the experiences of the University Department of Rural Health in community engagement. The chapter draws on experiences of two rural community coalitions working to plan and negotiate health service provision. The coalitions were analysed against the indicators. A key indicator of maturity and readiness for working in partnership with external agents is related to the behaviour of ‘boundary crossers’. Boundary crossers are defined as people who move freely between two or more domains and who understand the values, cultures and language, and have the trust, of both. Domains can be within a community or be the community and an external sector. Community health professionals, especially those in senior positions, often act as boundary crossers between the community and broader domains such as regional/state health services or policy, although other community members can fill the role. Other key indicators of coalition maturity for working in partnership with external agents include local leadership that empowers the community, a willingness of community coalitions to take risks and mould opportunities to meet their vision, and a culture of critical reflection and evaluation of past actions.

This chapter analyses the impact of boundary crossing behaviour on community readiness and partnerships with external agents that are intended to build rural community capacity to plan and negotiate health service provision. It is argued that the characteristics and modus operandi of boundary crossers who are members of rural community coalitions affect the level of maturity of the coalitions and community readiness to work with external agents. An understanding of the characteristics and modus operandi of boundary crossers provides valuable insights for external agents in designing their approach to partnerships that build rural community capacity for health.

'no through road'? Disadvantage in rural education

Investigates educational disadvantage for students completing their secondary education in rural schools. For these students rural location has contributed reduced exposure to a broad range of literacy practices, and involvement in student cohorts with lower levels of socio-economic status, less extensive cultural knowledge and lower post-school aspirations.

Rural markets and school choice

This thesis examines how families and schools in a rural Victorian setting engage with education markets and policies of school choice. Focusing on federal funding and state conveyancing policies, the study employs policy sociology and social geographies perspectives to examine policy effects on social relations and the implications for equity.

How parental and school responses to choice policies reconfigure a rural education market in Victoria, Australia

Market principles now dominate the education and social policies of many Anglophone countries, including Australia, but articulate differentially within specific contexts. Existing historical legacies, local economic and social conditions, and geographical settings interact with federal and state funding and transport policies to shape the nature of regional education markets and the choices families make in a rural school market in Australia. Through two school case studies, this article explores the effects of policy shifts on parental choice and student movement within a regional Victorian community. Informed by policy sociology, the article views the policy as a dynamic, often ad hoc process with contradictory effects. It indicates how an ensemble of federal and state funding and conveyancing policies enable some schools to develop marketing practices that reconstruct the local education market to their advantage through the introduction of transport and flexi-boarding policies. It demonstrates that education markets are not confined to urban settings and that while choice is not a new phenomenon in this rural area, federal and state funding and transport policies have reconfigured local markets and intensified the market work undertaken by schools and parents with, in this instance, unequal effects on the provision of schooling in a rural region.

Pluralist risk cultures: the sociology of childbirth

Western medical approaches to childbirth typically locate risk in women’s bodies,making it axiomatic that ‘good’ maternity care is associated with medically trainedattendants. This logic has been extrapolated to developing societies, like Vanuatu, anIsland state in the Pacific, struggling to provide good maternity care in line with theWorld Health Organization’s Millennium Development Goals. These goals include thereduction of maternal mortality by two-thirds by 2015, but Vanuatu must overcomechallenging hurdles – medical, social and environmental – to achieve this goal.Vanuatu is a hybridised society: one where the pre-modern and modern coincide inparallel institutions, processes and practices. In 2010, I undertook an inductive study of30 respondents from four main subcultures – women living in outer rural communitieswith limited access to Western-trained health workers; women from inner urbancommunities with ease of access to medical clinics; traditional birth attendants whoare formally untrained but highly specialised and practised mainly in remote communities;and Western-trained medical clinicians (obstetricians and midwives). I invitedall the participants to comment on what constituted a ‘good birth’. In this article, Ishow that participants interpreted this variously according to how they believed theuncertainties of childbirth could be managed. Objectivist approaches that define risk asan objective reality amenable to quantifiable measurement are thus rendered inadequate.Interpretivist approaches better explain the reality that social actors not only findrisk in different sites but gravitate towards different practices, discourses and individualsthey can trust especially those with whom they feel a strong sense of community.Strategies are, therefore, formed less through scientific rationality but according tofeelings and emotions and the lived experience. The concept of risk cultures conveysthis complexity; they are formed around values rather than calculable rationalities. Riskcultures form self-reflexively to manage contingent circumstances.