DELIVERING QUALITY EDUCATION AND HEALTH CARE TO ALL : preparing regions for democratic change.

Description

Preface Foreword Acknowledgements Abbreviations and acronyms Executive summary Rethink the future of rural schools with networks and digital solutions Address territorial health care gaps by reinforcing primary and integrated care Tackle skill and Internet access gaps to harness digital provision Increase the scale and quality of services with decentralisation 1 Assessment and recommendations Introduction Assessment Education Health care Digital connectivity Governance Recommendations Education Health care Digital connectivity Governance 2 Setting the scene Introduction Megatrends that shape the future of service provision Depopulation is at the doorstep of many rural communities Healthier and longer lives mean more ageing in rural areas The COVID-19 pandemic has revolutionised service provision Rural regions face teacher and care worker shortages even if specialised in services Digital skills and connectivity gaps limit switch to digital provision What are public services and who pays for them? Defining public services How states provide public services and to whom How are rights to public services defined within legal frameworks across the OECD? Who pays for public services? The governance of public service delivery The spatial implications of public spending and public management reforms Fiscal equalisation mechanisms Roles and responsibilities across levels of government New and emerging service provision models Colocation, collaboration and co-production Flexible approaches – Mobile, on-demand and e-services Integrated spatial planning Conclusions References Notes 3 Delivering quality education in rural communities Introduction How is education provided? How is education provided? Education system organisation and governance Education resources and quality Inputs to providing education Education outputs and outcomes What can policymakers do to ensure access to quality education services in rural areas while pursuing cost efficiency? Restructuring rural schools Creating school clusters and establishing co-operations Adapting the definition and distribution of education levels across schools Consolidating schools Comprehensive and digital approaches Information and communication technology (ICT)-based support to education delivery Involve stakeholders and draw on local community support Improve transport provision for students and teachers Extending and combining services provided in a single location Consider rural education provision as part of regional economic development efforts Conclusions References Notes 4 Delivering quality health services in rural communities Introduction Structural trends affecting health systems and their effect in rural areas Structural trends in affecting health systems Lower income and education levels are linked to poorer health outcomes Longer lives can raise health costs Exposure to risk factors increases the risk of chronic conditions Evidence of the effect of broad health system trends in rural areas Geographical dimensions of health systems Objectives and organisation of health systems System organisation and spatial distribution of healthcare within countries Balancing quality, access and cost of health care in rural areas Quality health care in rural areas Life expectancy is lower and mortality is higher in rural areas Survival rates to major causes of death are lower in rural areas Avoidable admissions are higher and disease prevention is lower in rural areas Equitable access to health care in rural areas Higher unmet medical needs in rural areas Lower access to facilities and medical professionals Sustainable health costs in rural areas Health expenditures and the impact of austerity measures on rural health Financial sustainability of rural hospitals Comprehensive measures to save costs and improve performance in rural areas Reinforcing primary care Reducing financial barriers and increasing financial incentives for primary care professionals Patient involvement Shifting responsibilities across health care professionals Increase care co-ordination through integrated care Innovative approaches for sustainable rural health care provision Exploiting the power of networks to expand and co-ordinate rural care Clinical networks Hub-and-spoke model Reorganisation into multi-disciplinary teams Increasing access in rural areas with telemedicine and mobile clinics Overcoming workforce shortages Foreign recruitment Educational reforms Financial incentives Shifting responsibilities Combining strategies Conclusion References Notes 5 Unleashing the potential of digital services in rural communities Introduction Digital provision of education and healthcare Unlocking funding, skills and connectivity barriers to distance learning in rural schools Resources, skills and connectivity gaps limit the potential of distance learning The COVID-19 pandemic stressed the need to overcome barriers to distance learning in rural areas Unleashing the potential of telemedicine to increase access to quality health care in rural areas Evidence of effectiveness of telemedicine More telemedicine uptake in rural areas requires a change in culture, more funding and sounder legislation COVID-19 has uncovered the potential and limitations of telemedicine for rural areas Service provision in low-density rural areas and the digital gap Barriers to higher broadband connectivity in rural areas Technology options to boost provision in low-density rural and remote areas Current approaches to closing connectivity gaps Supporting the business case through demand aggregation models Putting the community in control through locally owned co-operatives Dakota Carrier Network B4RN Simplifying subsidies using vouchers for consumers and businesses Project and auction-based subsidy programmes to drive change at scale Spain United States Canada Driving competition through the creation of publicly owned market entrants SaskTel Reykjavik Fibre Network Sunet and municipal fibre in Finland and Sweden Gaining expertise and sharing risk through public-private partnerships Community Fibre Partnership Westminster, Maryland National Broadband Ireland (NBI) The complex public wholesale monopoly COVID 19 responses Conclusions References Notes 6 The governance of public service delivery across territories Introduction Decentralisation, multi-level governance and service provision Spending and revenue assignments to subnational government Spending assignments: Theory and practice Assigning subnational government revenues: The “finance should follow function” principle Transfer systems to reduce fiscal disparities Addressing the challenges of decentralisation to improve service provision Benefit spill-overs and externalities Lack of scale economies Unbalance between spending and revenue assignments Unfunded or underfunded mandates Insufficient capacity of subnational governments Overlapping responsibilities Intermediary institutions and cross-border services Decentralisation and education services Education is the main spending item of subnational governments In many countries, transfers form a major source of education funding for subnational governments About half of the education decision-making is done at school or subnational government level Effects of decentralisation on student achievement Decentralisation of the health systems Financing of health systems across OECD countries Why do countries decentralise their health care? Healthcare decentralisation in OECD countries The effects of decentralisation on health outcomes Conclusion References Notes