Since 2000, 24 rural facilities in BC have closed their maternity programs, impacting 140,000+ people across their catchment areas, and disproportionately disadvantaging Indigenous communities. Within the current health system environment of increasing complexity, increasing acuity, and insufficient resources, rural maternity providers struggle to continue providing safe, appropriate maternity care as close to home as possible. Furthermore, rural service closures adversely impact and destabilize referral sites along networks and corridors. When local service closures occur in multiple sites across a geographic area of the province, regional capacities become situationally overwhelmed and providers in these sites face increasing stressors and burnout. 

For the sites with funding to support their surgical programs, sustaining these local surgery programs are an integral part of rural health care infrastructure and are essential to the sustainability of rural acute care programs. They increase the medical capacity of rural communities by supporting enhanced critical care, emergency, and trauma care, and by providing access to surgical first responders and anesthetic staff. In addition, surgical infrastructure enables robust maternity care through access to cesarean section: a key determinant of the proportion of local births the service can support and overall provider sustainability.

The approach of the ROAM program is to engage interprofessional provider teams and provide them with resources to develop a plan for their own community’s specific context, needs and priorities to support the sustainability of maternity and surgical services in their community. Guiding principles of ROAM are to foster “Community Determined Safe Birth Environments” based on holistic risk evaluation and assessment, and to support local team-based approaches that enhance equity, stability, and support sustainability across the broader medical community.  

ROAM funding is available for all rural maternity teams and the smallest surgical teams in rural British Columbia. Examples of what teams do within the ROAM program include coaching, team learning, peer/team/regional network development, Indigenous partnership initiatives, and continuous quality improvement projects. By undertaking these activities, the teams in each community foster team collaboration, strengthen interprofessional relationships and provide high-quality, sustainable maternity and surgical care in their communities. 

ROAM funding has played a valuable role within rural communities, and providers participating in ROAM report strengthened team relationships and cohesion, increased confidence, improved job satisfaction, and enhanced safety and quality of care for patients. Some sites have reported that ROAM has been integral to their ability to maintain ongoing maternity services in their communities.  

Rural maternity and surgical programs are linchpins of a stable full-service community hospital. When these programs are maintained, sites are often better able to recruit and retain all health care providers, are better equipped to sustain their emergency and acute services, and are able to offer a wider scope of services locally so that patients can access care closer to home.