Review of Australian Government Health Workforce Programs

3.3 Health education scholarships

Page last updated: 24 May 2013

The Government currently provides health workforce education support through a number of scholarship programs. Whilst the eligibility and target groups vary between scholarships, they all have similar objectives such as supporting students to enter the health workforce, supporting existing professionals to maintain or upgrade their skills and qualifications and other forms of continuing professional development.

The majority of these scholarship programs in the Health portfolio are managed within Health Workforce Division, although scholarship programs have also been established in areas including Ageing and Aged Care Division and Pharmaceutical Benefits Division.

The existing programs vary in terms of the target recipients, eligibility and scholarship value. This can include differences in:

  • the target workforce – for example, medical, nursing or allied health professions and/or particular groups within these professions, such as nurse practitioners or diagnostic imaging professionals;
  • the level of training – for example, undergraduate, postgraduate, CPD or clinical placement support; and/or
  • the training location – for example, rural areas or professionals in particular settings such as emergency departments or Aboriginal Medical Services (AMS).

Current Health Workforce Division scholarship programs and those offered by other divisions are outlined in Boxes 3.5 and 3.6 below.

Box 3.5: Current Health Workforce Division scholarships

Nursing and Allied Health Scholarship and Support Scheme (NAHSSS)

  • The Australia College of Nursing administers the nursing component.
  • The Services for Australian Rural and Remote Allied Health (SARRAH) administers the allied health component.
  • 2012-13 $30.2m

The NAHSSS provides scholarships to nursing and allied health students and professionals for undergraduate and postgraduate studies, CPD and clinical placements. The scheme aims to facilitate the entry of nurses and allied health professionals into the health workforce, encourage practice in geographic and other areas of need, and facilitate continuing professional development.

Rural Australia Medical Undergraduate Scholarship (RAMUS) Scheme

  • Administered by the National Rural Health Alliance (NRHA).
  • 2012-13 $4.6m

The RAMUS scheme provides medical scholarships to students from a rural background with a demonstrated financial need and commitment to rural practice. The scheme also supports an Alumnus Program which enables contact and support mechanisms for former RAMUS recipients. The scheme is part of the Government’s strategy to improve the sustainability of the rural health workforce.

Puggy Hunter Memorial Scholarship Scheme (PHMSS)

  • Administered by the Australia College of Nursing.
  • 2012-13 $4.45m

The PHMSS provides scholarships to Aboriginal and Torres Strait Islander people who are undertaking study in a health-related discipline at an undergraduate or Certificate IV level or above. The scheme aims to address the under-representation of Aboriginal and Torres Strait Islander people in health professions and with professional health qualifications.

Australian Rotary Health Indigenous Health Scholarships Program

  • Administered by Australian Rotary Health.
  • 2012-13 $0.48m

The program provides scholarships to Aboriginal and Torres Strait Islander students in all health-related disciplines. Fifty per cent of the scholarship funding is provided by a local Rotary Club with Governments (Commonwealth or state and territory) contributing the remaining funding. Scholarship recipients also receive mentoring and other support by the different Rotary Clubs around Australia.

Diagnostic Imaging – Enhancing the Rural and Remote Workforce Scheme (DI-ERRWS)

  • Administered by the Australian Institute of Radiography.
  • 2012-13 $0.25m

The DI-ERRWS aims to increase the rural diagnostic imaging workforce through the provision of National Professional Development Year scholarships and postgraduate scholarships. The scheme also aims to support the existing rural diagnostic imaging workforce through access to grants.

Medical Rural Bonded Scholarship (MRBS) Scheme

  • Administered by the Australian Government Department of Health and Ageing
  • 2012-13 $13.1m

The MRBS scheme aims to increase the number of doctors practising in rural and remote areas of Australia. The scheme provides 100 additional graduate and undergraduate medical school places each year to Australian medical students. In return for a scholarship while they are studying medicine at university, students agree to work for up to six continuous years in a rural or remote area of Australia once they have qualified and attained fellowship of a specialist college (including general practice).

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Box 3.6: Scholarship programs managed by other divisions

Aged Care Education and Training Initiatives (ACETI)

  • Administered by the Australian Government Department of Human Services.
  • 2012-13 $13.7m

ACETI was designed as a retention and professional development strategy to maintain a skilled and sustainable aged care workforce. Incentive payments are provided to registered and enrolled nurses and personal care workers who undertake eligible certificate, diploma and degree courses.

Aged Care Nursing Scholarships (ACNS)

  • Administered by the Australian College of Nursing.
  • 2012-13 $18.8m

ACNS assists registered and enrolled nurses working in the aged care sector to increase their skill set through undergraduate and postgraduate study as well as continuing professional development activities. Scholarships are also available to students intending to seek employment in the aged care sector following completion of studies.

Rural Pharmacy Scholarship Scheme (RPSS)

  • Administered by the Pharmacy Guild of Australia.
  • 2012-13 $1.2m

RPSS recognises the role of pharmacists in maintaining the health of all Australians, particularly in rural and remote Australia. RPSS provides financial support to encourage and enable students from rural areas to undertake entry level university pharmacy studies.

Aboriginal and Torres Strait Islander Pharmacy Scholarship Scheme (ATSIPSS)

  • Administered by the Pharmacy Guild of Australia.
  • 2012-13 $45,000

ATSIPSS aims to improve access to community pharmacy services by Aboriginal and Torres Strait Islander people by taking account of cultural issues in meeting health needs. The aim is to encourage Aboriginal and Torres Strait Islander students to undertake entry level studies at a university. Scholarships are offered preferentially to students who currently live, or have lived, in a rural or remote community.

Continuing Pharmacy Education/Professional Development Allowance

  • Administered by the Pharmacy Guild of Australia.
  • 2012-13 $0.6m

The Continuing Pharmacy Education/Professional Development allowance provides financial support to assist pharmacists from rural and remote areas to access CPD and professional development activities.

Rural and Remote Placement Allowance Scheme

  • Administered by the Pharmacy Guild of Australia.
  • 2012-13 $0.8m

The Placement Allowance Scheme recognises the role of pharmacists in maintaining the health of all Australians, particularly in rural and remote Australia. The Placement Allowance Scheme provides financial support to encourage and enable undergraduate pharmacy students to undertake clinical placements in rural and remote areas.

Rural Intern Training Allowance (RITA)

  • Administered by the Pharmacy Guild of Australia.
  • 2012-13 $0.3m

RITA complements the Continuing Pharmacy Education/Professional Development allowance. It provides financial support to assist intern pharmacists from rural and remote areas to defray travel and accommodation costs associated with undertaking compulsory intern training workshops, training days and examinations.

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Are scholarships the most effective way to build and support the health workforce?

There appears to be limited evidence to show whether the desired workforce outcomes are actually achieved through scholarship programs. There is insufficient Australian academic literature or research on the issue of whether scholarships affect an individual’s choice to enter and/or to remain in the health workforce.

Stakeholder feedback

A number of stakeholders were consulted regarding scholarships during this review.

There were some common themes raised:

  • Scholarships should support gaps in service planning and align with priority areas. It is important to identify and target these gaps;
  • The effectiveness of scholarships should be evaluated;
  • Scholarships provided by other stakeholders including state and territory governments should be identified to reduce duplication;
  • There is an inequity of funding across disciplines and there should be greater consistency in the value of scholarships;
  • “Oversubscription” of scholarships causes disillusionment; and
  • There is a need for support programs to complement scholarship schemes.

In 2005 the National Nursing and Nursing Education Taskforce wrote a review of Australian scholarship programs for postgraduate study on specialty nursing areas for the Australian Health Ministers’ Advisory Council. Whilst the report and recommendations specifically related to nursing, the report advised that the same principles are relevant to the whole health workforce.

Recommendations of the taskforce included:

  • The facilitation of greater consistency in data collected by government and individual scholarship providers and to enable greater comparison between programs;
  • Scholarship programs should be informed by, and be based on, the best available evidence, including current service need and workforce projections both local and national, and the effectiveness and need for programs reviewed at least annually;
  • Australian, state and territory governments, in collaboration with the nursing profession, employers and education providers, should identify specialty areas to be targeted for scholarship support and develop strategies to ensure that the targeted uptake in those areas is achieved;
  • Scholarship programs should be developed using a policy framework that is responsive to changing environments and service and workforce needs; and
  • The Australian, state and territory governments develop and implement a common evaluation framework for scholarship programs.

Longitudinal evaluation is required in order to determine whether scholarships are effective in influencing individuals to join the workforce or to remain in the workforce. Without such evidence it is arguable that the funding that is currently spent on scholarship programs could be more appropriately spent on other forms of educational support, such as subsidising the cost of course fees or other training activities in areas of identified workforce need.

There is some evidence to suggest that students from rural areas are more likely to practise in rural locations on completion of their training. Targeted rural origin scholarships like RAMUS could therefore play an important distributional role. However it is not known:

  • how long scholarship recipients are remaining in the health workforce or in particular areas of need;
  • how the scholarships assisted in career choices, the education and training of recipients or the broader health workforce in the longer term; or
  • whether the scholarship recipients would have undertaken the education regardless of whether they did/didn’t receive the scholarship.

Available evidence suggests that a large number of nursing graduates leave the workforce within the first few years of practice. This could potentially mean that undergraduate scholarships, of up to $10,000 annually, are not heavily influencing the recipients’ future career choices and that the workforce is not greatly benefiting from this type of investment in terms of retention.

Some administrators, such as SARRAH for NAHSSS (allied health) and NRHA for RAMUS, undertake surveys of current scholarship recipients in terms of their career choices, but this does not extend to retrospective surveys of past scholarship recipients and definitive evidence of where graduates are currently providing health services.

The Medical Schools Outcomes Database (MSOD) project data is beginning to provide information on the locations being chosen by medical graduates and in future years should be able to provide information on RAMUS graduates as they progress through their vocational training.

Monitoring future practice choices of scholarship recipients may become easier with the introduction of student registration numbers under the NRAS. However, there is likely to be an unsuitable lag time in using such data to accurately inform future scholarship decisions. In the meantime, the Department may be able to fund scholarships administrators to undertake a survey of all past scholars to ascertain their current work situation. Such a survey should form part of a broader evaluation of current programs to ensure scholarship efforts are being appropriately targeted, achieving desired outcomes and are being efficiently and effectively administered.

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Options for reform

Redirection of the MRBS scholarships to RAMUS and NAHSSS rural allied health

Critics have questioned the effectiveness of the MRBS and its ability to provide a return on a significant investment. The value of the scholarships is considerably higher (by $16,000) than the standard undergraduate scholarship. It needs to be noted however that this in part is counterbalanced by the not insubstantial return of service obligations (RSO) and penalties faced by MRBS recipients, which do not apply to any other Commonwealth health scholarship.

Many MRBS participants, it is alleged, lack a positive connection to rural service and generally indicate an unwillingness to fully participate in rural life. The bonded element is experienced as stigmatising of rural practice, and requires complicated contractual arrangements which are expensive and administratively onerous, while being of questionable utility. The Department has suggested it is common for participants to make representations seeking a way out of their obligations, which for some may include pursuing employment overseas. This obviously is undesirable in the light of the depth of need in rural and remote areas, and increased administration costs.

DoHA records indicate that to date fewer than 50 MRBS recipients have commenced their RSO period. While this is expected to increase as more students finish their training it does not represent a particularly positive return after more than a decade of investment in well supported scholarships (there are currently over 1,200 participants in the scheme).

It has been suggested that MRBS funds would generate greater value if the program was phased out and support redirected to other more targeted rural scholarship schemes.

The Commonwealth should consider phasing out the Scheme from 2014 and redirecting the funding to support an additional number of RAMUS places (up to 100) as data suggests that this scholarship scheme is both popular among rural communities and rural medical students. As RAMUS scholars, in order to be eligible, must have a significant rural background, available evidence is that they are most likely to return to their own community or a similar rural setting. This scheme lacks the element of stigma and coercion and is more likely to result in a genuine community engagement.

If the MRBS is phased out consideration should be given regarding the substantial penalties that are currently applied to participants, and whether they should continue to be applied to existing participants who will need to fulfil their contractual obligations. In view of the substantial taxpayer investment in their training it is suggested that the RSO requirement should be maintained for these students. However, if current penalties are applied they will include reimbursement of part of the government’s investment, approximately $250,000, together with a 12 year restriction on providing services under Medicare. The companion Bonded Medical Places (BMP) scheme (discussed in detail in Chapter 6), which does not include a scholarship but is limited to the provision of a university medical school place, allows the participant to buy out of their RSO, roughly equivalent to 75% of the government investment in their education, with no equivalent restriction on Medicare.

A portion of the remaining funds from the MRBS should be reallocated to support additional rural NAHSSS allied health scholarships. The current quota of scholarships available under the NAHSSS for allied health is oversubscribed and must cover multiple disciplines. Distribution of allied health professionals both in the public and private sector is limited in rural Australia and in remote areas can be non-existent. This leads to poorer health outcomes. As such, it is proposed that the NAHSSS allied health scholarships are expanded using the existing model of support, based on the principle that rural students are most likely to return to their home community or similar rural location upon completion of their education.

If the MRBS scholarship funds were redirected towards RAMUS and rural NAHSSS allied health scholarships, for every two MRBS scholarships it would be possible to fund two RAMUS scholarships and three allied health scholarships valued at $10,000 per annum. This has the potential to significantly impact on the rural and regional health professional workforce of the future. Any such expansion of scholarships to allied health and dentistry would need to be subject to the same requirements for data and evaluation outlined above. Specifically, there is a need to target support to the professions where shortages have the biggest impact on population health, and where evidence shows that scholarship support is most likely to make a real difference for disadvantaged populations.

Risks

If this course of action were to be adopted, consideration would need to be given to the 100 university places that are currently allocated to the MRBS. If the scholarship is terminated three options will need to be considered. The places could either:

  1. be withdrawn from universities;
  2. convert to standard Commonwealth supported places (CSP); or
  3. convert to places under the BMP, increasing the total number to approximately 800 students per annum, which is 4% of the total number (16,491 in 2011) of medical school places or 6% of CSPs (13,016 in 2011).62

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Potential for further consolidation of the existing scholarship programs

The consolidation of eight existing scholarship measures into the NAHSSS in 2010 produced some administrative savings and program efficiencies. There has been discussion during the review process as to whether further consolidations should occur, given that there are still numerous Commonwealth funded scholarship programs.

This could encompass some or all of the programs managed within Health Workforce Division and might extend to include all scholarship programs managed within the Department, including aged care scholarships and pharmacy scholarships.

Benefits

Further consolidation of the scholarship programs, it has been argued, might:

  • Lead to an overall reduction in administration costs due to economies of scale.
  • Be more accessible to students and easier to promote. Student representatives have indicated that the current variety of scholarship initiatives can be confusing and hard to navigate, with multiple websites to search and a variety of organisations to contact.
  • Enable a re-profiling of some of the current investment in scholarship initiatives to greater flexibility and targeted funding to ensure the most effective outcomes and better alignment with emerging workforce needs, including those identified in the Health Workforce 2025 report.
  • Facilitate consistency in the way that scholarships are administered and reported. Further consolidation would enable the Department to select an administrator with a good history in administration and reporting.
  • Minimise the potential for duplicate funding, for example scholars receiving multiple Commonwealth-funded scholarships concurrently. For example, the terms and conditions of the NAHSSS allied component state that applicants who are in receipt of another scholarship funded through the Department are ineligible to apply for a scholarship under NAHSSS. However, due to privacy rights of the scholarship recipients, the NAHSSS allied component administrator is not able to contact any other scheme’s administrator, such as the PHMSS, to determine if they share any common scholarship recipients.

Risks

However, further consolidation of the scholarship programs could also:

  • Result in the scholarship programs being administered by an organisation that may not have sufficient knowledge or connections required for effective administration across the range of workforces. For example, the NRHA has established networks across the rural medical portfolio that enable them to administer the RAMUS more effectively than an organisation that does not regularly contact the relevant key stakeholders. These resources however, may not extend to the nursing or allied health professions, rendering effective managing of the NAHSSS more complex. The reverse is true for the administrators of NAHSSS.
  • Cause stakeholder dissatisfaction. Several nursing and allied health stakeholders expressed dissatisfaction with the consolidation of the NAHSSS in 2010, because they considered that this removed expertise from the administration of the individual scholarship streams. A further consolidation that combined the larger scholarship programs (such as RAMUS, NAHSSS, MRBS and PHMSS) could generate greater concerns.
  • Potentially result in a more complicated program through which the Commonwealth awarded scholarships, depending on how the consolidation model was implemented. For example, the NAHSSS funds undergraduate, postgraduate, CPD and clinical placement scholarships (four streams). For each stream, there are several sub-streams to accommodate targeted scholarships such as AMS scholarships or emergency department scholarships (total of 23 sub-streams). If the NAHSSS allied, NAHSSS nursing, PHMSS and the RAMUS were consolidated into one scholarship scheme, then there would be around 25 different scholarships sub-streams from which nurses, midwives, allied health and medical professionals and students would need to navigate to determine the correct scholarship to meet their specific needs.

This system may lead to confusion and dissatisfaction from applicants and key stakeholders unless the scheme was streamlined to establish a single program with broad eligibility criteria and identified priority areas.

Further, the potential administrative savings identified to date are likely to be very small. Most organisations receive less than 8% of the total value of the scholarships awarded towards all the administrative costs incurred in delivering the scholarship program. It is unlikely that consolidation of the scholarships will lead to a significant overall reduction in the cost of administration, although the promise of other benefits remains strong. These would include potential for greater consistency in program delivery, easier access to students and the ability to reprioritise the allocation of scholarships.

In particular, unless there is an appetite to merge the current funding streams between the health disciplines and targeted workforce areas (e.g. rural health and aged care) then the benefits of merging Health Workforce Division programs alone remain questionable. It would also be necessary to maintain branding of iconic schemes, like the Puggy Hunter Memorial Scholarships, and this would further complicate the introduction of any consolidated management model.

Any consolidation that involved consolidation of programs managed in other areas of the Department would require careful consideration and consultation with the relevant divisions to determine if it would be an effective and efficient way to support the health workforce and to identify any concerns that would affect a consolidation.

Nevertheless, this review has identified significant overlaps between Health Workforce Division scholarships and similar initiatives in other divisions. In some cases the same workforce group is targeted, particularly in nursing. The Department is also supporting multiple funding agreements with the same stakeholder group, the Australian College of Nursing.

On balance, while there is certainly potential for improved outcomes and administrative efficiencies, further work needs to be undertaken in developing a model which would justify the disruption and stakeholder anxiety likely to result from consolidation of current scholarship schemes.

In the interim, there could be benefits realised from creating a single entry point where potential applicants can gain information on all Commonwealth-funded health workforce scholarships. This gateway could then direct potential applicants to the appropriate websites for each of the individual schemes. It is suggested that the administrators of each scholarship scheme could work together to develop such a portal, which would come together under uniform branding, but allow providers to continue to deliver their particular scholarship element.

The official Australian Government website for advice on study in Australia (www.studyinaustralia.gov.au) has a user friendly scholarships database which could form the basis of the single entry portal for health scholarships described above. Users of the database are able to search based on the type of course (VET sector, University etc), field of education and location (state or territory). A list of potential scholarships with brief descriptions and links to more information including eligibility criteria is then presented. The Study in Australia database contains a health delimiter but it would require a further filter option to sort the scholarships into medical, nursing, allied health and other subcategories i.e. psychology, physiotherapy.

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Inconsistencies between scholarships

There are variations across the schemes in regard to many aspects of the scholarships including:

  • the value of the scholarships;
  • the number and proportion of undergraduate scholarships available to each discipline;
  • criteria for allocating scholarships including financial need; and
  • the funding arrangements for scholarship schemes.

The rationale for the variations is limited and needs to be considered as part of an evaluation to enable greater consistency across each scholarship element.

Value

There are discrepancies in the value of scholarships funded by the Department. For example, the NAHSSS nursing, NAHSSS allied health and the RAMUS all provide $10,000 per year for undergraduate scholarships, whereas the PHMSS provides $15,000 per year. Postgraduate scholarships for the general NAHSSS nursing and NAHSSS allied health are valued up to $30,000 over three years. However, the NAHSSS emergency department postgraduate scholarships, which are considered to be a Government priority area, are only funded at a total of $15,000 for one year. Clinical placement scholarships vary greatly, with some as low as $5,000 each (Tasmania Package for nurses) and others up to $23,000 (emergency department for nurses). CPD scholarships for nurses are valued at up to $1,500 each, but allied health CPD scholarships are valued at up to $3,000 each. The discrepancy in the value of MRBS scholarships was discussed earlier.

Some stakeholders have commented that the Commonwealth scholarships are generous in comparison to the value of scholarships provided by state and territory governments or philanthropic organisations. The majority of non-Commonwealth postgraduate scholarships are valued at $5,000 or less.

It would be beneficial for the value of the scholarships to be reviewed for appropriateness and consistency. Scholarships that are awarded for a similar purpose should have a similar value. CPD scholarships legitimately have a lower value, as the costs experienced by these students are generally less, but scholarships supporting university education should have their grant amounts aligned.

Number and proportion of undergraduate scholarships available to each discipline

Key stakeholders, including the Australian Nursing Federation, have asked the Commonwealth to consider the number of scholarships available to nursing and allied health students in relation to the number of scholarships available to medical students. Allied health stakeholders also raised this issue during review consultations.

Currently, around 8.5% of the total domestic medical student population in Australia receive a Commonwealth funded scholarship (through RAMUS, PHMSS, MRBS or Rotary) compared to only around 1.7% of the total domestic nursing and midwifery student population in Australia (through NAHSSS, PHMSS, or Rotary).63

It has been suggested that the disproportionate share of scholarships is inconsistent with the findings of the Health Workforce 2025 – Doctors, Nurses and Midwives Report, which predict a future shortfall in nurses nationally. However, the counter argument to this claim is that the medical scholarship programs are primarily targeted at improving rural medical workforce distribution, which was raised as the key issue for medical workforce development in the HWA report. Nursing, in particular, is not experiencing similar distribution challenges at present, noting that this situation may change as rural nurses begin to retire.64

Anecdotal evidence also suggests that there is a shortage of allied health professionals across Australia – particularly in rural areas. As discussed elsewhere in this review report there are challenges with the consistency of national allied health data. HWA is currently undertaking work to quantify any shortage in the allied health workforce.

The allocation of broad-based support for undergraduate scholarships needs to be reviewed to ensure this aligns with current evidence about where support is needed most. In some cases current funding at the undergraduate level may be more effective in generating workforce retention and distribution outcomes if it is redirected to support postgraduate training for committed graduates wishing to upskill particularly in light of the move to demand-driven, uncapped funding for CSPs in all professions except medicine under current Government policy. This could apply to either the development of advanced clinical skills or management and leadership abilities.

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Criteria for allocating scholarships including financial need

There are inconsistencies between the criteria under which different scholarships are awarded. It would be beneficial to have some consistency amongst the different schemes, allowing for the necessary differences in the target recipients.

The demand for undergraduate scholarships for all disciplines far exceeds the supply. It would be desirable if the scholarships could be awarded to students with the greatest financial need because they are at most risk of leaving their studies due to insufficient income to meet their living costs whilst studying.

Whilst most of the scholarship schemes that provide undergraduate scholarships use remoteness or income as eligibility or selection criteria, there is an inconsistency in how these are applied across the schemes.

  • RAMUS, NAHSSS allied health and NAHSSS nursing all require the undergraduate applicant to provide details of income earned to assist with the selection process. PHMSS does not require this information, as the selection process is not influenced by the applicant’s financial situation.
  • RAMUS and NAHSSS allied undergraduate scholarships are restricted to rural students, whereas NAHSSS nursing uses remoteness as a weighting mechanism in the selection process. PHMSS does not consider remoteness in the selection process.
  • The administrator of RAMUS reserves a number of scholarships for appeals. There is no appeals process for NAHSSS allied, NAHSSS nursing or PHMSS; however, the administrator of NAHSSS allied reserves a number of scholarships for students who are able to demonstrate exceptional circumstances.

Each year representations are received by the Department and the administrators from unsuccessful applicants who consider that their financial need is greater than other applicants. There are also objections from unsuccessful applicants that financial need should outweigh academic performance as a selection tool. A counter argument is that basing support only on financial need results in a higher than necessary proportion of scholars failing or deferring their course.

Whilst it is not possible to establish a ‘perfect’ selection system, it would be beneficial to introduce a standardised mechanism. This could be similar to that used for the RAMUS Scheme which assesses financial need using a similar method to the Department of Human Services.

Funding arrangements for scholarship schemes

There is an inconsistent approach to the way annual funding allocations for each scholarship program are provided to the administrators. This results in some administrators holding a cash balance of up to $24 million to pay for the future payments for awarded scholarships, whilst other administrators only hold sufficient cash balances to make the scholarships payments due that financial year. In some cases there appears to be an expectation that students will continue to receive scholarships for the duration of their training, regardless of whether the various program guidelines stipulate that funding is provided on an annual basis and is subject to continued government funding in the out-years.

Duplication with state and territory scholarship schemes

In some areas, particularly nursing and midwifery, Commonwealth scholarships are in competition with those offered by the states and territories (see Box 3.6 as an example). This type of duplication may result in students who are not accessing all of the support options available to them. In other cases there may be a duplication of resources and students may be receiving two separate scholarships from different sources for the same area of study or continuing education.

Prior to making any changes to the Commonwealth’s current health workforce scholarship arrangements it would be prudent to undertake a comprehensive survey of the educational scholarships which are available for each health discipline across the states and territories.

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Box 3.7: New South Wales health scholarships

New South Wales has a variety of allied health scholarships mostly targeted at rural areas.

Up to 50 NSW Rural Allied Health Scholarships, valued up to $10,000, are offered each year.

NSW Metropolitan Allied Health Clinical Placement grants of up to $750 are offered each semester. Grants provide financial assistance to allied health students from a rural or remote background studying at rural universities with the travel and accommodation costs of metropolitan clinical placements. Grants are awarded on the basis of the duration of the placement and the cost of travel associated with accessing the placement.

NSW Rural Allied Health postgraduate scholarships are available to permanent full-time or part-time allied health clinicians employed and currently working in a rural located public health service, to assist with educational expenses directly associated with postgraduate study. In 2012 the scholarships were valued at up to $10,000 dependent on the course undertaken.

There are an even broader range of nursing and midwifery scholarships on offer which have more targeted eligibility criteria including Aboriginal Undergraduate Scholarships, Re-entry to Nursing Scholarships, Rural Undergraduate Scholarships etc.

[end of box]

Funding activities to support the scholarship recipients

Whilst the majority of the schemes are limited to the provision of scholarships alone, RAMUS and Rotary are funded for additional activities, such as mentoring, conference placements or Alumni events which complement the schemes.

Mentoring

  • RAMUS is funded to ensure that each scholar has a mentor and for undertaking the administrative work associated with this activity, including payments to the mentor ($175,050 in 2012-13 to support mentors for 587 students). The attachment to a mentor may be an effective means of linking participants with the rural workforce, ensuring they remain mindful of the purpose of the scheme in receiving support.
  • Rotary is funded to cover the travel and accommodation costs of an administrative officer to visit individual Rotary mentors and provide them with support required to be a mentor. The mentors themselves are not paid – it is a voluntary role ($60,000 in 2012 to support mentors for 40 students).

The NAHSSS allied administrator has also asked for permission to implement a mentoring component, but has not been funded to do so to date.

Conference placements

RAMUS is funded to manage the Conference Placement Program to assist RAMUS scholars and alumni to attend selected conferences in Australia. In 2011-12, a total of 69 conference placements were awarded ($79,874.61 funding in 2012-13).

Alumnus scheme

RAMUS is funded to maintain an Alumnus program for graduated RAMUS scholars as well as current and previous RAMUS mentors, including the provision of networking and communication opportunities ($4,500 in 2012-13 for Alumnus program services).

It would be beneficial to evaluate fully the effectiveness of the mentoring, conference placements and the Alumnus activities for their impact on the retention of health professionals and, if effectiveness is demonstrated, these support activities should be rolled out to nursing and allied health students.

This issue is of particular relevance if there is a consolidation of the current scholarship schemes to form a single Commonwealth program.

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Recommendations
Recommendation numberRecommendationAffected programsTimeframe
Recommendation 3.11This review has identified inconsistencies in scholarship funding arrangements (in both administration costs and levels of support to recipients) that need to be rectified to ensure equity and value for money. To progress this issue, If the recommendations of this review are accepted, a detailed mapping of each of the health workforce scholarship schemes across the Department will have to be undertaken. This process should include an analysis of:
  • the administrative costs of existing scholarship activities with a view towards establishing clear benchmarks for application across programs; and
  • the financial and other value of various scholarships for both appropriateness and consistency across the various activities funded.
All scholarships including PHMSS, MRBS, NAHSS, RAMUS, SARRAH scholarships, Aged Care scholarships, Pharmacy scholarships.Short term – review to commence from July 2013.
Recommendation 3.12The Commonwealth should develop a health workforce scholarship internet portal. This should be the main source of information on scholarships funded by the department. It should have directions and links to other pages managed by scholarship administering agencies.All scholarshipsShort term – development to commence as soon as possible.
Recommendation 3.13The Commonwealth needs to develop measurable health workforce objectives for all scholarship schemes and embed agreed outcomes in contracting, program reporting and post-project evaluation. All scholarshipsMedium term – embed outcomes reporting measures in agreements with program management agencies as they expire.
Recommendation 3.14Detailed workforce data analysis needs to be undertaken to determine where scholarship funding may be most efficiently targeted to achieve workforce distribution objectives in future funding rounds. Such analysis needs to include evidence about the effectiveness of financial support for students suffering other disadvantage in choosing to enter and remain in training for particular health professions.All scholarshipsLonger term – informed by better outcomes data and analysis outlined in recommendations above.
Recommendation 3.15As part of the further evaluation work recommended above, the Commonwealth should specifically consider whether continued investment in the Medical Rural Bonded Scholarship (MRBS) Scheme represents value for money in terms of the level of the scholarship in comparison to other programs, and the workforce outcomes desired.
Subject to more detailed data becoming available, this review recommends phasing out new scholarship funding and converting MRBS medical school places to standard Commonwealth funding places.
Scholarship commitments and return of service requirements for existing participants would be maintained under this scenario with the possible option of allowing some flexibility for students to buy their way out of the commitment.
Any funding released from the reconfiguration of MRBS should be redirected towards the Rural Australia Medical Undergraduate Scholarship (RAMUS) Scheme and to the Nursing and Allied Health Scholarship and Support Scheme (NAHSSS) rural scholarships for allied health students.
Given current funding levels, over time this change should substantially increase the number of scholarships that are awarded to support rural workforce outcomes. It would also allow funding to be redirected towards rural students with demonstrated financial need, and allow a greater proportion of funds to be provided to nursing and allied health than is currently the case.
MRBS, RAMUS, NAHSSSMedium to long term.
The award of new MRBS places could be ceased from 2014 and funding could begin to be redirected to other priorities. Existing scholarship commitments will need to be honoured for up to six years, depending on the length of degree of individual participants.
Recommendation 3.16The Commonwealth should undertake further policy analysis of possible models for consolidation of health workforce scholarship schemes within professional groups. The aim should be to reduce administrative costs and streamline reporting arrangements to maximise the number of scholarships available to each health profession. All scholarshipsLonger term
Recommendation 3.17The Commonwealth should consider changing the focus of its nursing scholarship funding towards postgraduate scholarships that are responsive to identified nursing workforce retention needs, informed through HWA workforce data and analysis. In the first instance the priorities should be mental health, aged care and palliative care. This would provide the ability to target those areas identified and would ensure that priority was given to students undertaking studies in nursing courses or specialties identified in the HWA data. Financial need should also be a relevant consideration.NAHSS, Aged Care Nursing Scholarships.Medium term – implementation to commence from the 2014 allocation of new scholarships.
Recommendation 3.18 As part of any implementation of recommendation 3.15, listed above, the Commonwealth should explicitly consider increasing the number of allied health scholarship and support places with a priority given to rural training locations. Allied health scholarships, such as those managed by SARRAH.Longer term – subject to available funding.

62 MTRP, Fifteenth Report, Table 2.4

63 Health Workforce Division data analysis, 2012.

64 HWA, HW2025 – Vol 1