Rural Health Service Decision Guide

Back to Rural health care in Canada

This guide introduces you to a 5-step process to make objective, evidence-based decisions around sustainably delivering health services to rural populations.

The guide is

  • Helpful for assessing alternatives and facilitating productive discussions with service providers and residents, for whom these decisions can be personal, professional and emotionally charged
  • Useful whether you have hours, days, weeks or months to make your decision
  • Designed for application in rural, remote and northern areas, but the fundamentals of the process are applicable to all settings

Downloadable resources

Complete guide

Download and navigate through the complete decision guide, where each step of the Rural Health Service Decision Process is described with the support of additional context and examples.

View the complete guide (PDF)

Quick reference guide

Download a shorter version of the guide, without the examples.

View the quick reference guide (PDF)


Download a 2-page infographic-like document that includes an illustration of the process and a brief description of each step.

View the infosheet (PDF)

Overview of the Rural Health Service Decision Process

This process includes 5 steps, which we recommend you follow in order. As you work through the process, you may find it helpful to document your thoughts, questions and findings. You can use this process even when time and resources are tight, and you may consider involving key stakeholders in any of the steps.

Rural Health Service Decision Process visualization

This page features a visualization of the 5-step process included in the decision guide.

View the visualization

Step 1: Clearly state the question to be answered

You need to clearly and specifically state the question you’re trying to answer or the decision you’re trying to make ― whether you’re addressing an issue or opportunity ― and the context in which the decision will be made.

Step 2: Quantify the need for services

Gather evidence to better understand the need for a service or service change, and use it to characterize and quantify the current and anticipated future service requirements.

Step 3: Identify potential service options

Once you have a good understanding of the population and the need for services, you can identify potential service options that you could feasibly employ to address the need.

Step 4: Assess viable service options

Once you’ve identified the viable options, the next step is to assess them, as well as the status quo, against 6 themes. The first 3 themes are outcomes you may wish to prioritize. The other 3 themes are inputs related to context and processes.

Themes to prioritize

Outcomes to achieve

  • Quality and safety
  • Patient experience
  • Provider experience

Inputs to consider

  • Internal capacity and context
  • Funding and payment models, costs
  • Engagement

Step 5: Summarize your results

Create a summary you can use to develop internal communications and to host discussions about the decision, as well as to support external communications with stakeholders.

Related resources

Rural health frameworks

Other resources


Members of CIHI’s Sparsely Populated Regions Advisory Group raised the need for this guide. This group of senior leaders from rural regions across Western and Northern Canada asked CIHI to create a comprehensive and systematic approach to support informed decision-making in these situations. The advisory group provided valuable input and helped inform the development of this guide and supporting materials. Rural health system leaders in Central and Eastern Canada provided further validation for the content of this guide. CIHI wishes to thank those who were involved in the development of this content.


CIHI’s Western Office

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