State Offices of Rural Health Address Health Equity Through Collaboration

November 11, 2022 | Chikamso Chukwu

State Offices of Rural Health (SORHs) are the voice of rural America at the state, regional, and federal levels and help rural communities build healthcare delivery systems. All 50 states have SORHs, many of which are co-located with the Primary Care Offices (PCOs), but others are based in universities, nonprofits, or outside of the state health department.

SORHs offer technical assistance to public and nonprofit entities to participate in state and federal programs that support the health and wellbeing of their rural community. They may support the collection and interpretation of rural health data, collect and share model programs in the state, align rural health initiatives across a jurisdiction, and support recruitment and retention of rural health professionals, among other topic areas. They may work directly with healthcare delivery systems, local governments, rural hospitals and clinics, emergency medical services providers, academic institutions, social service agencies, and other state offices. Ultimately, SORHs serve as a collaborator, convener, and resource for sustaining rural healthcare and supporting healthy, thriving communities. 

In honor of National Rural Health Day, which celebrates "the power of rural," we sat down with Alisa Druzba, who directs New Hampshire’s Office of Rural Health and Primary Care, to learn about the role and impact of SORH and its intersection with other offices in state government. 

What is the intersection between state PCOs and SORHs? How can SORHs and PCOs work together effectively?

PCOs help identify communities in need of healthcare services and are responsible for shortage designation work, as well as managing workforce programs such as the National Health Service Corps. In many states, the SORH and PCO are located in the same office. In New England, for example, SORH and PCOs have lots of staff crossover, so it is a little bit easier to leverage resources between each office. 

However, you do not have to be co-located to work together effectively to expand access to healthcare workforces and services in underserved areas. For example, if you're a SORH, you have an interest in supporting and sustaining rural health clinics. Rural health clinics can get their own facility level healthcare shortage designations, but they can only do that by becoming a National Health Service Corps site. There's a great opportunity, as a SORH, to connect your PCO with your rural health clinics so that they can assist them with that process and understand the value of the designations.

What are some opportunities you perceive to improve rural health overall in the post-COVID public health emergency era?

Silver linings carried me through the entire pandemic. For one thing, the widespread acceptance of virtual meetings and video conferencing is a tremendous opportunity, not only from a healthcare access standpoint but also for community engagement. Where people have broadband internet access, they can now interact with their healthcare providers, state officials, the legislature, or various workgroups and decision-making panels in a way that they couldn't previously. These are opportunities for consumer voices, which are so critical to our work, to be heard in a way that is accessible. It removes the barrier of people having to figure out a ride or take time off work to have their voice heard. In New Hampshire, we’ve seen a tremendous amount of community engagement due to increased digital accessibility.

Second, the COVID-19 pandemic has been tremendously challenging but has created opportunities for innovation. The wonderful thing about working with rural communities is that they can be such a great incubator. Rural communities are incredibly innovative and passionate and full of skilled people who understand their strengths and are transparent about their gaps. We now have an opportunity to engage a larger audience and work with people that we wouldn't have worked with before because of the traditional separation between rural and non-rural. Rural communities are really open to ideas as long as you respect that they are the experts when it comes to rural and their unique community.

What is unique about working in rural health?

SORHs always have to convince people that volume isn't the be-all and end-all. It is possible to measure work, see progress on health outcomes, and get returns on investment on a smaller scale. Sometimes, that creation of capacity and infrastructure is the win. Just as it's important to measure progress in a different way than by sheer numbers, it is also important to make sure that the measures you're using are rural-appropriate. Where you’re quantifying quality of care and protocols, it needs to make sense for rural areas, and the numbers should be meaningful. 

I always explain to people looking to roll out a project across New Hampshire that in the design process they must account for geography. In non-rural environments, there may be enough existing capacity and organizational partners to pick up a program and launch it easily, whereas there is not going to be the same capacity in rural areas. You have people in a SORH or PCO who are doing the work of three jobs, so you need to design projects in a way that accounts for that bandwidth issue. It means accounting for the fact that you need to give them the money to build capacity, instead of continuing to subdivide one person’s time across various programs. You need to allow some flexibility and longer timelines in funded projects or grants to build that infrastructure. But that capacity and that infusion of skills, that's all progress.

And nobody can stretch a dollar like our rural partners. The return on investment and the multiplier effect of the investments in rural areas are just phenomenal. They have an ability to codify, communicate, and replicate their work across the state that is incredible and shows the power of rural. They don't have time for bureaucracy and red tape. So, they don't design projects that rely on those things.

How would you describe "the power of rural"?

The power of rural is one of the reasons I've worked in this space for as long as I have. There is amazing collaboration and passion from all the partners across the state, but particularly the rural partners. They are so innovative and supportive of each other. There is something about that sense of community that is infectious.