Deerain (2026) recently published insights on the National Health Reform Agreement 2026-2031. Australian health reform has an action-gap.

Whenever I read journals about the critical need for innovation, action or ongoing investment in rural health, I can’t help but think of my daily work.

Delivering equitable training pathways, through the Rural Psychiatry Roadmap 2021-2031, is the most fulfilling and rewarding role in my 25-year career. It’s not just a job. It’s purpose and social impact in one. Our tiny but mighty team is working on 45 deliverables across 5 strategic domains.

A mid-term review is underway and one issue we face is not a mathematical equation, it’s the action-gap. The Roadmap spans a 10-year timeframe, and we’re funded to December 2026. There’s a five-year shortfall that needs to be addressed for our meaningful work to continue.

We’ve achieved a lot in five years. Almost 50% of the deliverables are complete. The remaining 50% are scoped, awaiting completion of other Roadmap items or will continue for the life of the initiative.

We know the psychiatry workforce is struggling in rural areas. That’s why our team, and the Roadmap, exists. We’re driving bold reform for change, in a system that is not able to support all change. And yet, our tiny team is unsure if we will have continuity into the future.

There’s three points in Deerain’s journal that struck a chord:

• We need a National Rural Health Strategy. After working for a specialist medical college, delivering reform for training and practising psychiatry in a rural location, I believe we do need one, bold, action-oriented overarching strategy for all health touch-points in rural Australia. Perhaps policy needs to be human-centred, and co-designed with lived and living experience consumers, in order for meaningful systemic change? A blueprint that links into the myriad of policies, plans and strategies across multiple systems and organisations. A strategy that drives compelling change. Future generations are depending on change.
• The lead up to the December 2026 Health Minister’s Meeting, where a paper “that examines options to support better health equity in rural and remote areas” is a critical advocacy opportunity. Australia needs action and investment in health, not more discussion. The recent review of the National Health Reform Agreement, and inclusion of ‘Schedule F: Better Health Equity for Rural and Remote Communities‘, was a good starting point for rural communities. How long, however, will it take for meaningful action to filter through into systemic reform? Rural Australia doesn’t have the gift of time. We’ve already waited a decade for action, as past governments failed to deliver.
• ‘recognition is not reform…this work must be framed as an implementation plan, not a policy exercise,’ (Gregg, Groth and Woolcock 2026). As Topp et al. (2025) highlights, Australia has 120 health workforce policies and a fragmented system. I think there’s enough pretty documents, full of data, to show the dire need for rural health reform.

The healthcare action-gap is heavily influenced by political and economic cycles. It’s time to stop politicising health, and start transforming the systems that underpin the health workforce and delivery of care.