In this latest instalment of a rural health series, Helen Hopkins, Policy Adviser at the National Rural Health Alliance (NRHA) highlights how failing to improve broadband access in remote areas can block access to health care and entrench other disadvantage.
The other instalments, also inspired by the NRHA’s recent CouncilFest, can be read here:
Helen Hopkins writes:
The National Rural Health Alliance (NRHA) has consistently advocated for the provision of high speed broadband, by whatever technical means are best, to communities, health services, businesses and households in more remote areas at the same price that people in major cities have to pay.
Mobile alone is not enough
In July 2014 an OECD report showed that Australia was second only to Finland among the seven OECD countries with more than 100 per cent wireless broadband penetration – more subscribers than people. This increase in broadband internet access is driven largely by the continuing strong demand for tablets and smartphones. During June 2013, 7.5 million Australians used the internet via their mobile phone, an increase of 33 per cent (or ten percentage points) compared to June 2012 and a telling 510 per cent since June 2008 according to the Australian Communications and Media Authority.
Smart phones and tablets are becoming more and more important for people in rural and remote communities to access the internet in some areas with poor access to fixed broadband. Pre-paid mobile plans can provide affordable access to the internet for people who don’t have home computers. But mobile phone coverage is poor in many rural and remote areas. The Government has recently released a database of approximately 6,000 black spot locations in rural, regional and remote Australia which have been nominated as having poor (or zero) mobile coverage.
Even where there is mobile phone coverage, high demand for its use results in competition for bandwidth – which limits its usefulness for health applications. There is not sufficient bandwidth to cover basic administrative services such as maintaining client management systems (which would be taken for granted in city health services and practices) as well as the phone calls and downloads that need to be made in a small, isolated community. Health clinicians and managers in more remote areas need broadband for telehealth consultations for their patients with specialists, to contact their clinical mentor and access continuing professional development, and to have online decision support – as well as for staying connected with friends and family in the city.
So although it is not a panacea for the health sector, the government action underway to improve mobile telephony is warmly welcomed.
Remote area complexities
The situation in the Kimberley Region of WA illustrates the complexity where health services in sparsely populated areas are concerned.
There are a significant number of remote area clinics operated by the publicly-funded health service (WA Country Health Service) or Aboriginal community controlled health services. Some are weekday-only services with 24-hour on-call and some are operated through fly-in fly-out or drive-in drive-out staffing, providing services for specified days of the week. Because of their small size and more isolated location, access to high speed broadband is either prohibitively expensive or not possible. Kalumburu, for example, has no hardwire connection to the Telstra network. Its connection is wireless and given its size and location there is no plan to deliver wire or fibre-optic connection to the community.
In larger communities where the clinics have a fibre connection, administrative and clinical systems can be tested, upgraded and maintained in real-time. But in the absence of sufficient and reliable bandwidth, clinics in remote communities such as some of those in the Kimberley cannot reliably access cloud-based solutions for updates or maintenance. This means that health clinics in those smaller communities depend on inefficient health care record management systems and have only what technical support is available locally. Major technical diagnostics and fixes rely on technicians who travel in, which means additional delay and expense.
Failing to address bandwidth and reliability solutions in these smaller communities can block access to contemporary health care and entrench other disadvantages of remoteness that such communities face.
Getting the ‘Last mile’ infrastructure right
The NRHA supports the range of proposals being canvassed by the Broadband for the Bush Alliance, including through a program focused on ‘Last mile’ solutions. A Last mile program would give priority to connection for premises or communities close to fibre, a fixed wireless base station, or a mobile phone tower. It would also provide affordable products for community connections (as well as individual premises) to a single satellite dish, fibre to a node serving a small settlement, a fixed wireless base station, or community-wide WiFi, where individual premises are unlikely to be able to afford to connect – and may not even have a computer.
The focus should be on getting digital infrastructure right – both through the rational use of existing set-ups and through building new infrastructure. Although it does not yet provide sufficient bandwidth for all purposes, improved mobile phone coverage should be a focus.
The Government is making some headway through reassessment of the balance in the NBN between satellite coverage and fixed wireless which can provide more effective and cost-effective services to smaller remote communities. There is still a long way to go in targeted programs that take the connections that last mile – or even the last 100 metres – to provide broadband for health and connectedness in rural and remote communities.
Where access to broadband is concerned the health sector has particular needs (CPD, mentoring, clinical decision and support, telehealth). And good broadband access is also a prerequisite for personal connections and is something that neither the current nor the next generation of health care workers should be expected to do without.
* The image on this post comes from the Broadband for the Bush Alliance website: http://broadbandforthebush.com.au/
 http://broadbandforthebush.com.au/. The NRHA is grateful to the Broadband for the Bush Alliance for assisting with this summary piece.