The health systems in remote Australia are broken. Long-term and persistent workforce shortages, non-viable services, and fragmentation of care have been exacerbated by the COVID-19 pandemic. Remote health services’ struggles to keep clinics open are evident, with many clinics forced to close or offer reduced services. Nowhere and at no time is the need for access to an effective comprehensive Primary Health Care (PHC) system more urgent than in remote Australia right now. Residents of remote areas of Australia, characterised by the poorest health status and greatest health needs, many with multiple complex chronic diseases, are bearing the brunt of the current primary health care system crisis and marked decline in access to primary health care. Health care providers and authorities are struggling with excessive levels of staff burnout and turnover, inequitable funding and escalating service costs, and structural barriers resulting from a fragmented health care system.

The new CRE for Strengthening Health Systems in Remote Australia (CRESTRA), led by Menzies School of Health Research, seeks to address the current crisis through leveraging strong partnerships built over many years with Aboriginal Community Controlled Health Services, Aboriginal Medical Services Alliance Northern Territory, NT Health, Health Communities Foundation Australia and NT Primary Health Network/NT Rural Workforce Agency.

Importantly, the program of work is driven by the expressed needs and priorities of partnering remote Aboriginal Community Controlled Health Organisations, which are to tackle 4 fundamental issues: 

  1. Improve workforce retention through multiple evidence-based strategies,
  2. address the current inequitable funding of remote health services,
  3. improve service integration and co-ordination to provide an efficient, seamless pathway to care for remote residents, and 
  4. build remote area research capacity.
Our research focus

Improving access to health services in remote areas requires a whole-of-system approach to service provision. This cutting-edge research program will generate important new knowledge in the following areas:

  • Theme 1 will improve service efficiency and cost-effectiveness by implementing multi-pronged strategies to optimise remote workforce retention, thereby reducing the extent to which scarce resources are spent on expensive locum and agency staff
  • Theme 2 addresses eliminating funding inequities and their consequences for the health of remote communities and the sustainability of PHC services
  • Theme 3 explores the nexus of primary and secondary care, focusing on streamlining co-ordinated service delivery in remote areas
  • Theme 4 is a cross-cutting theme that will not only build local research capacity through training of individual researchers, but also collaboratively build the capacity and capability of health service partners to be able to effectively engage with research. 

The outcomes of the CRESTRA research platform will be informed by an innovative conceptual framework which will take a systems and systematic approach to ensuring quality service provision. This means that instead of addressing a single element of primary health care in isolation, such as workforce, CRESTRA seeks to address a range of inputs (eg. appropriately trained, stable, clinically, and culturally competent workforce, strong linkages, and adequate funding) and enablers (eg. strong governance, public participation and effective leadership and management).


Chief Investigator Professor John Wakerman
Professor of Remote and Rural Health Services Research at Menzies School of Health Research