COMMUNITY PARTICIPATION IN GOVERNMENT AND PRIVATE SECTOR PLANNING: A CASE STUDY OF HEALTH AND TELECOMMUNICATIONS PLANNING FOR RURAL AND REMOTE WESTERN AUSTRALIA

This study was conducted in the context of health service planning in an environment of changing government strategies for regional, rural and remote area health care and telecommunications infrastructure planning in Western Australia. The study provides an account of the State Government of Western Australia's planning for the implementation of a telecommunications network infrastructure, and specifically the Telehealth Project, conducted between 1998 and 2002. The purpose of this study was to examine influences on community participation in planning within the dynamic political, economic and social forces that impact on the development of regional, rural and remote area health services. Specifically, the study outlines the issues and barriers in providing for significant local participation in projects that are centrally initiated and controlled. It examines the influences in planning for projects that incorporate local community based beliefs and needs, the requirements of collaborating with multiple state and national government departments, and the private sector. This study was situated within the interpretive paradigm, and is conceptualised within Donabedian's (1969) framework for assessing and assuring quality in health care. The methodological approach is bound within a case study and consists of a participatory action research approach. The research method uses the single case to undertake in-depth interviews, observations and a survey to collect data from community, government and industry members as a basis for reflection and action. The findings of the study clearly indicated that there was consensus between all rural, remote and metropolitan area participants that telecommunications did offer the opportunity to provide increased, improved or alternative health services. However, there were a number of obstacles to the success of the planning process, including a lack of local community inclusion in planning committees, poor communication within central government agencies, overuse of external consultants, a bias toward the medical view, a limited scope of invitation to contribute, and local information being overlooked in the final implementation plan. Analysis of planning for the Telehealth Project reveals the implications of organisational and political stakeholders making final decisions about outcomes; and provides a reminder of the importance of engaging communities authentically when planning for health and telecommunications services which involve the public and private sectors. The originality and significance of this study stems from understanding how technology can advance community health; through measures such as the use of community participation strategies, through authentic community based leadership, truly representative participants, decentralised decision making, a focus on community based health needs and change management strategies that include all of these. Consequently, the study advances knowledge of community participation in planning and the evidence suggests implications for practice, education and further research.