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University of Arizona’s Arizona Center for Rural Health has received a five-year, multi-million dollar grant from state and federal sources to continue their mission of providing health care, education, technical assistance, data analyses and more to rural communities throughout the state.

The Arizona Center for Rural Health aims to support the state’s rural and underserved populations by supporting a number of UA-based programs, including the Arizona State Office of Rural Health, the Arizona First Responders Initiative, the Small Rural Hospital Improvement Program and the Rural Hospital Flexibility Program.

Jennifer Peters, associate director and program coordinator for AzSORH who oversees the day-to-day operations of the program at the state and national levels, says that every federal dollar has to be matched with three state dollars.

The funding period began on July 1, 2021, and ends June 30, 2026. The total amount of the federal award including approved cost sharing or matching this project period was $223,410, which was matched by the state with $670,230, resulting in a total of $893,640, set to be dispersed each year.

The majority of these funds on an annual basis are used to support a staff of 15 within the AzSORH office, with positions in program oversight, community outreach, training and education or health systems development, with some some funds allocated for travel.

“A lot of our efforts go around helping collect and disseminate rural health information, education events and training,” said AzCRH director Dr. Daniel Derksen.

One major challenge: An increasing shortage for primary care physicians in rural parts of the state. According to the AzCRH, Arizona meets only 41.7% of its PCP need. While the majority of the primary care doctors in Arizona live in urban metro areas such as Maricopa and Pima counties, they are aging especially in rural and underserved areas. The AzCRH seeks to place and retain physicians in these areas in order to create jobs and improve access to health care as an effort to lower the cost in these low income and underserved communities.

Other factors affect overall rural health outcomes, such as socioeconomics, lack of health insurance coverage and infrastructure. The AzCRH has helped create 15 federally designated critical access hospitals, 24 federally certified rural health clinics, and 160 federal qualified health centers that are part of the state and federally funded “health safety net.”

The center, previously known as the Rural Health Office, has been housed within the University of Arizona Mel and Enid Zuckerman College of Public Health for the past 30 years.

Since 1990, AzCRH has participated in a five-year cycle in which they are required to submit a full application to show that they have conducted a needs assessment and that they have designed a program that has responded to the needs of a rural community. In order to convey these accomplishments, they must ensure that what they propose addresses specific guiding principles.

The AzCRH looks at rural communities that are unique and not homogenous, with a focus on tribal and the US Mexico border populations that will also have their own subsets variations.

“We have to ensure that everything we do addresses those variations and that are sensitive to the different needs, culture, history, the different capacities that are in all of those communities,” said Peters. “We really like to emphasize sort of a holistic view of rural health that integrates not just individual health behaviors, but also the social and structural determinants of health that exist in a community.”

Certain challenges exacerbated by the pandemic have disproportionately affected the more elderly populations in rural areas, such as the Navajo and Apache nations as well as the Santa Cruz, Cochise and Yuma counties. Both Native Americans and Hispanic populations face significant health disparities due to their isolation from in-person health care services.

“Arizona is a very large state, we have most of our population in the Pima and Maricopa counties. One in four live in the other 15 counties in the state, and a lot of our efforts focus on [these] other counties,” said Derksen.

These rural areas were hit hard by the pandemic due to the volume of patients and amount of people reluctant to seek health care. Despite the decreasing rate of outpatient visits, AzCRH was able to assist in the set-up of telehealth for primary care, rather than in person care for these communities.

“A lot of the rates of infection were high, if you only have 25 beds, you can quickly be overwhelmed by an outbreak of COVID-19,” said Derksen.

While rural communities were inordinately affected by the rise in death rates brought on by the pandemic, the AzCRH in collaboration with the AZDHS, was able to set up testing sites, provide vaccinations, and information regarding the pandemic in a “culturally congruent” manner.

The AzCRH will use this funding to continue to monitor and assist the underserved communities throughout the state.