History and Organization of the Center

The Alaska Center for Rural Health (ACRH) was created in 1987 by rural health care providers, educators, and administrators. Its mission is to help strengthen systems to deliver comprehensive and culturally relevant health care to rural Alaskans. It serves all aspects of Alaska’s rural health system: Native and non-Native, physical and behavioral, within all disciplines as they struggle to address our state’s health delivery problems.

The Center is housed within the School of Nursing, College of Health and Social Welfare, at the University of Alaska Anchorage and is governed by a Board of Directors. Through this statewide board, there exists a “window” to the broader Alaska community. That access to the community usefully assists the University in its efforts to improve the health system, especially the workforce that will serve that system.

ACRH secured an Area Health Education Center Program in 2005. Alaska has the first AHEC program in the country housed in a School of Nursing. All others are housed in Schools of Medicine. This federal funding enables ACRH to create a statewide university-industry partnership focused on strengthening Alaska’s health workforce.

ACRH achieves its mission by working in three key areas: a) health workforce development; b) research and evaluation; and c) policy and communications. They can be accessed on this web site via the Projects and Publications button.

Rural/Frontier Alaska’s Health System

The health system is a major economic “driver” in Alaska. Providence Health System Alaska is the state’s largest private employer, and 22 health and social assistance agencies are in the top 100 private Alaskan employers. In 2003, the health care industry grew by an astounding 8%, adding 1,200 jobs. According to the AK Dept of Labor, Alaska employment in health related occupations, across all industries, is expected to increase 78 percent (2000-2010).

Underserved Rural Alaska :

Juxtaposed against the staggering size of the health care and social assistance industry, the vast majority of Alaska is a federally designated Health Professions Shortage Area (HPSA). This statistic reflects the challenge that rural, frontier and underserved Alaska faces in delivering adequate health care and prevention services.

Lack of Rural Alaskans and Alaska Natives in Health Professions :

Rural facility administrators have emphasized that staffing difficulties are related to “burnout” and poor acclimatization to different geography and cultures encountered by newcomers to the state. Aside from the Community Health Aides and Practitioners (CHA/Ps) and village-based behavioral health providers, most rural Alaska health care providers are non-native and often non-Alaskan. In a study commissioned by the State of Alaska for 2004 and again in 2006, the Alaska Center for Rural Health documented the strategies employed and costs associated with recruiting 16 provider types (oral health, behavioral health, physical health) in urban, rural and frontier Alaska. The full report may be downloaded HERE. The study compared the cost of recruiting primary care providers in rural/frontier Alaska against recruitment expenditures in the “Lower 48”, documenting that rural/frontier Alaska expends approximately four times what urban/rural facilities in the “Lower 48” do in this arena during a fiscal year. The study did not include turnover, which is widely believed to be higher than other states, further augmenting rural and frontier Alaska’s expenditures on recruitment.

With funding from the University of Alaska and the Alaska Mental Health Trust Authority, the Alaska Center for Rural Health conducted a Vacancy Study for over 119 occupations in 2007. Download the final report HERE.

Lack of Educational Coordination Efforts :

Rural Alaskan health programs, facilities and educators often develop clinical sites, internships and career presentations on a short term, ad-hoc and transient basis. While some individuals and facilities become overloaded with students’ and schools’ requests over the years, others receive none. Coordination can reduce duplication and provide a means of feedback that is crucial for continuous improvement of the sites.

In response, the Alaska Center for Rural Health, in partnership with select regional health care agencies, applied for and secured an Area Health Education Center (AHEC) Program Cooperative Agreement from HRSA in 2005. Key partners include the: Yukon-Kuskokwim Health Corporation, Alaska Family Practice Residency Program, and Fairbanks Memorial Hospital,. Core activities include: continuing education, clinical rotations, and programs to encourage youth into health careers.

Stability and Sustainability of Remote Clinics :

One of the most pressing health care issues in rural/frontier Alaska is the issue of non-reimbursed extended stay primary care. Because of unavoidable terrain, weather and transportation issues, many primary care clinics provide extended services to patients who under “normal” clinic circumstances would be transferred to a tertiary care provider. Without recognition as a provider type that is permitted to offer extended stay services, many Alaska clinics are not adequately compensated for these necessary services. Consequently, they frequently care for patients without needed staff or well-defined quality standards.

In response, Alaska received funds to examine the effectiveness and appropriateness of a new type of provider, the Frontier Extended Stay Clinic (FESC), in providing health care services in remote locations in Alaska. The Alaska FESC Consortium is demonstrating the viability and sustainability of the FESC provider type and service in Alaska. Specifically, this project enables partners within the Alaska health system to develop and test protocols to ensure provision of high quality health care in rural and frontier settings.