Across OECD regions, populations are ageing and in some cases beginning to decline. This demographic megatrend presents new development challenges but also opportunities, especially for rural areas. To help policymakers navigate these changes the OECD has launched a new sub-series of work: Preparing Regions for Demographic Change. This report – Delivering Quality Education and Health Careto All – is the first in that sub-series.

The importance of effective delivery of education and health services requires little justification but across OECD countries and indeed within OECD countries, there exist significant gaps in access and quality of these services. Without action, shrinking and ageing populations in many rural communities are likely to see not only fewer hospital beds per head of population, higher rates of morbidity, different skill-levels of, and higher demands on, local teachers and medical staff, but also differences in enabling infrastructures such as transport networks and digital connectivity, among many others. Through its disproportionate impact on senior citizens and in the heightened role that digital tools have played in mitigating the impacts of social distancing and in ensuring service delivery, the COVID-19 pandemic has reinforced the need for action.

The COVID-19 global pandemic has intensified the challenges of delivering public services to all citizens, particularly those living in rural regions. Service facilities in remote and lower-density places often have limited scale and struggle to recruit and retain professionals. These places also face lower fertility rates, rapid ageing and depopulation, which can, in turn, create a vicious circle through further pressures on local finances that have already been stretched because of the pandemic. Ensuring efficient use of public resources and delivering sustainable policy responses in the provision of services has never been more important, especially in those regions that have been hardest hit.

The global pandemic has intensified the challenges of delivering public services across and within OECD countries. Whether seen through a prism of shortages of equipped and staffed hospitals treating disproportionately high numbers of vulnerable people or the difficulties faced by children accessing online learning when schools are closed, COVID-19 has put renewed focus on the importance of addressing longstanding challenges that OECD governments face in delivering critical services, especially in rural communities.

The global COVID-19 pandemic has intensified already existing challenges of delivering public services across and within OECD countries. This chapter sheds light on megatrends shaping the present and future provision of public services in OECD regions, including demographic changes leading to depopulation, digital transition, structural change and, more recently, the COVID-19 pandemic. It provides a working definition of public services and looks at governments’ responsibilities when delivering quality and accessible services. The chapter also outlines public management reforms involving the level of responsibility by levels of government in the delivery of services, highlighting recent trends in spending in public services. Finally, the chapter summarises recent innovative service provision model alternatives offering increased flexibility based on co-location, cooperation and co-production.

Rural schools in OECD countries are facing smaller schools and class sizes as a result of declining student numbers. This chapter offers policy options for the provision of quality education services in rural communities. It analyses differences in resources in schools in rural areas compared to cities and the financial and quality effect of smaller school sizes in rural areas. It then focuses on educational outcomes in rural schools, disentangling the effect of socio-economic and geographical factors on student and teacher performance and motivation. The chapter suggests two main policy areas for dealing with potential issues in rural schooling provision: first, restructuring school networks with an emphasis on rural school clusters; and second, fomenting new forms of provision including digital approaches in order to bring flexibility to school provision in rural and remote areas.

As costs, quality and access to healthcare are all affected by distance and density, reducing inequalities in quality healthcare provision requires a place-based dimension. This chapter compares evidence on structural trends affecting health systems across territories in OECD countries, including income and educational inequalities, exposure to risk factors, and ageing. It also discusses the organization and concentration of health services and the trade-offs between quality, access and cost of healthcare from a spatial point of view. The chapter looks at holistic and people-centred comprehensive strategies, including reinforcement of primary care and new models of care such as service integration, in order to reduce costs while increasing performance of healthcare provision in rural areas. Finally, the chapter examines innovative approaches to healthcare delivery including digital approaches and new forms of hospital and care organisation.

While providing digital services has the potential of overcoming distance barriers, the availability and scope of education and health care digital services is directly affected by lower quality broadband connections in low-density areas. This chapter examines how current digital provision of education and health services can address the challenges of rural areas, while assessing technological and digital barriers to this provision such as the broadband connectivity gaps or the need for digital skills. The chapter also illustrates the advantages and drawbacks of current and emerging broadband technologies. Finally, the chapter sheds light on several strategies deployed by OECD governments in order to improve rural connectivity and expand broadband to low-density rural areas.

The provision of health and education services has become increasingly decentralised in OECD countries, affecting how public services are delivered across territories. This chapter analyses the relationship between decentralisation and the provision of public services, while discussing the challenges of decentralisation and multi-level governance, such as overlapping responsibilities and coordination. It also examines how subnational governments and schools organize the provision of education services and looks at strategies to make this provision more effective through governance solutions. Finally, the chapter assesses the benefits and challenges of decentralising the diverse health systems in OECD countries and the quality of health care according to the degree of decentralisation.