MODELS FOR PRACTICE
FOCUS AREA: ACCESS
(PRIMARY CARE)
Program Name:
Location:
Healthy People 2010 Objective: 1
Web Address: http://wvrhep.org
The
West Virginia Rural Health Education Partnerships (RHEP) was created to train
health professionals in rural, underserved communities. State law enables rural,
community-based facilities to provide this training in underserved, rural areas
of the state. The higher education system requires a three-month rotation and
service learning for degree completion for 10 disciplines of health
professional students in a state-supported program. Students spend 20 percent
of their time in the community on prevention and health education service
projects. Local boards, site coordinators, and field faculty help the students
choose projects that meet the community needs. The program is state funded and
consists of 13 regional partnerships and over 47 rural counties in the largely
rural
Blueprint: The program was first developed in 1992 and fully
implemented in 1996 with the purpose of addressing three problems: recruitment
and retention of the health care workforce in rural, underserved areas; access
to primary health care for the underserved population; and rural health
leadership and service learning for health professionals. It is a statewide partnership
of local rural communities, higher education (19 state and private health professional schools and programs),
and state government.
The
program consists of 13 regional partnerships, each with its own board, and
covers 47 rural, underserved counties in
The program employs an executive and associate
director, administrative secretary, director of research and evaluation, and 17
site coordinators and secretaries. Moreover, the program receives volunteer
services from over half of the faculty preceptors and all 200 community member
partners. It is funded by appropriations from the state legislature through a
direct line item in the higher education budget.
The
recruitment/retention program is critical to the state since West Virginia is
the second most rural state in the country, with 64 percent of the population
living in communities with under 2,500 people and spread over 24,000 square
miles. The program covers 47 counties, or 85 percent of all counties in the
state. The rural population of these counties represents 1,117,133 of the
state’s 1.7 million people. Eighteen of these counties are 100 percent rural,
and all others are more than 50 percent rural. The state is very mountainous
with many secondary two-lane highways and roads. In 1999,
Making a
Difference:
The Rural Health Education Partnerships program primarily focuses on providing
prevention and education services to predominantly rural, low-income
populations of all ages. In 2001,
216,127 community service contacts were made, and of these 148,593 were
prevention and education to the general public; 16,808 were prevention and
education for adults, and 50,726 were prevention and education for children.
These services are provided by approximately 120 health profession students per
month and represent 10 disciplines; 1,402 student rotations were completed in
2001 for a total of 6,822 weeks of training. The program trains and recruits
rural physicians in addition to supplying manpower to rural health care
facilities through the use of students. An online tracking system called
TRACKER© is used to evaluate the program, schedule rotations, and
track the practice location following training. This helps the program identify
how successful it is in recruiting and retaining health care professionals in
rural areas.
Beginnings: In 1990-1991, the West Virginia state legislature examined the issue of the number of rural,
underserved areas and the retention rate of state health professional school
graduates. They also investigated the expenditures of state dollars to public
higher education. This debate sparked community and school interest in
developing a statewide system for community-based training as a strategy to
improve recruitment and retention of state-trained graduates in the health
professions. RHEP was actually created by this legislation and is a program of the higher education system of the state. All health
professional students in a state-supported program are required to complete
three months of training and service in underserved, rural areas of the state. The
partnership began as two programs¾the Community Partnership
Initiative funded by the W.K. Kellogg Foundation from 1991 to 1996, and the
Rural Health Initiative funded by the state’s Rural Health Act of 1991. These
programs were merged into the West Virginia Rural Health Education Partnerships
in 1995, and the legislature increased the appropriations from $6 million to
$7.5 million to cover the Kellogg funding levels. The merger expanded the
program into more underserved counties in the state, bringing it to its present
level of 47 counties and 13 consortia. Since 1992, the program has been solely
funded with state dollars, but many federal and private foundation grants have
been received by the partners on the strength of the partnership and the
expansiveness of the statewide training network. These have included Health
Resources and Services Administration (HRSA) grants for interdisciplinary
training in rural areas, research grants, resident training grants, and
demonstration and model replication grants.
Challenges
and Solutions: Some
of the initial challenges included extending the training in rural, underserved communities as a degree requirement;
working with lead agencies and some partners in building a partnership that was
not a traditional hierarchical organization; devising a decision-making model
that was equally shared among all partners; and developing full trust within
the partnerships to share resources.
These challenges were overcome by developing a clear,
open, and concise system of communication; involving all partners in defining
vision, values, mission, strategies, outcomes, and policies regarding
operations; and spending time to develop trust. This was facilitated by
encouraging partnership interaction and consistently engaging community members
and students in the process as the focal point of the partnerships’ outcomes.
Keeping the focus on the community and the role of the community members as the
stewards of the partnership helped to facilitate shared power in decision
making.
The program is marketed through local newspapers,
websites, and personal advertisements by practitioners. Presentations are also
made at civic clubs, churches, social events, and special annual events. The
program has been featured in a number of professional publications and is the
recipient of numerous awards, including recognition by the U.S. Surgeon
General. Examples include receipt of a Community-Campus Partnership, Inc. Award
for Leadership, a spotlight in the New York
Times, and a publication in the Journal
of the American Medical Association.
PROGRAM CONTACT INFORMATION
Hilda Heady, MSW
Office of Rural Health
Phone: (304) 293-6753
Fax: (304) 293-3005