Rural community development in China and the industrial shift of the rural population: summary of an international symposium.
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BACKGROUND AND OBJECTIVES: This article describes the process used by the University of Wisconsin-Madison Family Practice Residency Program to establish its first rural training track (RTT) in Baraboo, Wis. The process includes 1) establishing a core planning group to develop rural site selection criteria with specifications on distance traveled, faculty composition, teaching commitment, rural hospital capabilities, and availability of subspecialty teaching, 2) involvement of the state Area Health Education Center, 3) budget planning, 4) telecommunications plans, including e-mail, library search, and Internet connectivity, 5) creation of a residency curriculum in collaboration with the rural site's faculty and staff, 6) preparing an accreditation document to submit to the Residency Review Committee, and 7) faculty development programs for rural faculty. The program then participates in the National Residency Matching Program with an independent Match number.
"This paper analyses the impact of three credit programmes--the Bangladesh Rural Advancement Committee (BRAC), the Bangladesh Rural Development Board's Rural Development-12 (BRDB RD-12), and the Grameen Bank (GB), on current rate of contraception. These programmes are targeted to alleviate poverty by providing group-based credit to the rural poor in creating self employment opportunities. With small credits, these programmes combine family planning activities in terms of consciousness raising, awareness building and motivation. Sample survey data are used to analyse the problem of impact evaluation. The analyses show that the BRAC and the GB programmes have [a] significantly positive impact on the current rate of contraception, while the BRDB RD-12 programme does not have any such impact. It is also found that education, both of female[s] and male[s] separately, and child survivorship have independently positive impact[s] on current contraception."
OBJECTIVE: To develop a transparent, needs-based mental health resource allocation framework to guide area level service planning in rural and remote settings. METHODS: Using the Central Australian mental health service region as a case study, a five-step approach was used to analyse and gather relevant data as follows: (i) mapping a regional sociodemographic profile; (ii) estimating the expected level of mental illness within the regional population; (iii) estimating the expected level of specialist mental health service usage; (iv) estimating the expected categories of specialist mental health care required for the regional population; (v) making adjustments to the costs of providing specialist mental health care on the basis of demographic features of the region. These data were then matched with the availability, access and cost of specialist mental health care currently provided at the regional level. RESULTS: The capacity of specialist mental health care in Central Australia was below the expected benchmark for the population residing in this region. The region required approximately double the existing funding allocation to provide an adequate and equitable level of care that meets the needs of the diverse population groups. Children and adolescents were the group most in need, as were adult Aboriginal people living in remote settings. CONCLUSION: The framework described provides the beginnings of more open and transparent evidence-based decision-making regarding mental health resource allocation and service development for rural and remote residents.
Leadership is the capacity to help transform a vision of the future into reality. Individuals who can and will exercise leadership are like a river's current--a part past where we now stand, a part yet to come. We have an ongoing need to remember and to look toward the next "generation." A key responsibility of those here now, is to mentor and to create structures for mentoring, in order to maximize the flow and effectiveness of tomorrow's leaders. When recruiting organizational leaders, the recruitment and interview process must seek individuals who in addition to technical competence, also have demonstrated leadership in their prior work and activities. To exercise effective leadership, we must work to know who we are, how we relate to others, and the environment around us. "Servant leadership" is a perspective held by many throughout the rural health community and offers a key set attributes of leadership useful to rural health. To implement the Institute of Medicine's recommendations in Through Collaboration: the Future of Rural Health, we must develop leaders skilled in collaboration, both internal to their organization and across organizations. The National Advisory Committee on Rural Health and Human Services had it right when they said to the Secretary and to the rest of us, "the best way to honor Jim is to consciously work to help develop the next generation of rural health leaders." There are, of course, a multitude of leadership institutes, programs, and courses throughout America; this is not a call for yet another separate entity. But it is a call to each of us in rural health to assure that we are deliberate in how we identify "emerging leaders from and for rural communities and provide them with the training and resources to play a lead role in ensuring access to quality healthcare in their states and communities." Let's get started.
Today most foreign aid donors are genuinely committed to the idea that development in Third World countries should start with rural development. Therefore, a sizable proportion of their development funds are invested in rural projects. However, donors channel these funds through local governments (most often representing local bourgeois interests) that are not as committed to the principle of rural development. These governments are often also embarked in policies that are actually--directly or indirectly--expropriating the surpluses generated by agriculture and investing them in the other sectors of the economy. The peasants are therefore footing most of the bill of overall national development. This paper contends that, because of this state of affairs, foreign aid directed toward rural development is actually filling the investment gap left by an internal system of unequal returns to production in agriculture. In so doing, foreign aid is indirectly financing the development of the other sectors of the economy, even if this result is unintended. This perpetrates maldevelopment without redressing the basic exploitation process of peasants which lies at the core of underdevelopment. Evidence to support this hypothesis is presented using data from a primarily agricultural exporting country: the United Republic of Cameroon.
Both rural communities and urban communities experience problems associated with drug use and drug dependence. However, existing treatment interventions are not tailored for rural settings. This article describes a project which will modify an existing social skills behavioral therapy for rural populations, refine the therapy, develop a manual, train and supervise therapists, and pilot test the structured behavioral outpatient rural therapy to treat rural drug users and drug dependents as Stage I Research for NIDA's Behavioral Therapies Development Program.
The Population and Community Development Association (PDA), a non-governmental organisation, has designed and implemented a new model of rural economic development in which health is considered to be the cornerstone of all development strategies. By attacking migration as the root cause of current threats to the population's health, PDA's Thai Business Initiative in Rural Development program provides economic opportunities to villagers in the poorest areas of the country. This structural approach to health enhancement includes specific components to address primary health care, family planning, and HIV/AIDS prevention, education and care.
Community development efforts in economically depressed rural areas are often hampered by poor access to health care. One barrier to rural provider availability is the difficulty of obtaining capital for rural health care infrastructure development. Commercial lending institutions are limited in their ability to respond to these needs due to traditional lending criteria--creditworthiness, equity, experience, management ability, and profits or cash flow. This paper describes a rural health care revolving loan fund crafted to address these needs for capital while addressing the goal of improving health care access in rural Arkansas. The Arkansas Rural Health Revolving Loan Fund is a model for other states interested in two processes that work synergistically: (1) increasing access to capital to strengthen the rural primary health care infrastructure and (2) making health care more economically viable by integrating the fund's efforts with those of other community development initiatives.
There was considerable support in most major health reform bills considered by the 103rd Congress for the development of rural integrated service networks. The demise of comprehensive health reform, together with the pace of current market-driven changes in the health care system, suggests the need to assess the impact of specific policy strategies considered in the last Congress on rural integrated service network development. Toward this end, this article evaluates the rural health policy strategies of the major bills in relation to three essential preconditions for the development of rural integrated service networks: (1) the need for a more stable financial base for rural providers; (2) the need for administrative, service and clinical capacity to mount a successful network; and finally, (3) the need for appropriate market areas to ensure fair competition among networks and plans. Key policy strategies for supporting rural network development include reform of insurance and payment policies, expansion of targeted support and technical assistance to the underserved, limited-capacity rural areas, and policies governing purchasing groups or alliances that will ensure appropriate treatment of rural providers and networks.
"This paper addresses five key questions related to migration dynamics and development in rural South Africa: (1) Which individual and household level factors are particularly important in understanding migration patterns? (2) Taken together, are sociodemographic or socioeconomic factors more influential? (3) Do present patterns of migration and remittance flows reflect strategies that connote survival, or do they represent household efforts to advance their well-being and their position in society? (4) Which segments of the population appear to gain or lose from contemporary patterns of migration and remittance flows? and (5) How might remittances shape trends in local level development and equality, or inequality?... The data source is the nationwide representative sample survey ¿Project for Statistics on Living Standards and Development' undertaken in the latter part of 1993."
In this paper, human resource development problems facing rural health care facilities are identified and it is recognised that, particularly in the face of escalating demands for training arising from environmental pressures such as implementation of the structural efficiency principle, a coordinated approach to meet these problems is desirable. Such coordination is often sought via a regional staff development service. Accordingly, using the organisational life cycle as a conceptual framework, staff development services in five NSW health regions are examined. Ranging from a cafeteria style to a results-orientation, a diversity of strategic approaches to staff development is reflected.
"The article analyses the population growth in rural counties of the U.S.A. for 1970-80 and 1980-86. The growth rates are examined on different levels of aggregation (individual counties, subregions and regions) and in relation to several possible determinants of growth. The main objective of the study is to examine whether the growth patterns in the eighties support the hypothesis of a turnaround in the population development of rural areas.... The results reveal a diversity of growth patterns and significant regional differences. Rural counties within the daily urban system of a metropolitan area have significantly higher growth rates than peripheral rural counties. The results do not support the notion of a turnaround of long established trends. The trends in the eighties bear more resemblance to traditional growth patterns of rural areas." (SUMMARY IN ENG)
The disease in cattle, called nagana in Zululand, was linked with trypanosomal parasitaemia and tsetse flies. Nagana occurs in livestock throughout the tsetse belts of Africa. Wild animals are tolerant of trypanosomal infections. Nagana affects individual animals, herds and socio-economic development. In susceptible animals nagana may be acute, but chronic infections are more common. The host-parasite interaction produces extensive pathology and severe anaemia. Clinically affected animals lose condition and become weak and unproductive. Nagana is often fatal and, at herd level, its impact is wide ranging. All aspects of production are depressed: fertility is impaired; milk yields, growth and work output are reduced; and the mortality rate may reduce herd size. Africa has to feed its rapidly growing human population, and animal products are a vital dietary component. However, in most tsetse areas, there is not enough meat and milk. Furthermore, animal draft power is often not available, which limits cultivation and local transport. These factors lower household incomes and retard socio-economic development. Sustainable rural development requires that nagana be controlled. This in turn needs considerable resources, whichever control strategy is adopted.
INTRODUCTION: The Rural Undergraduate Support and Coordination program funds medical schools to provide all medical students some time in rural Australia throughout their course. The University of Adelaide has developed a rural week program for both first and second year students to fulfill part of this objective. METHODS: First year students' rural week is an introduction to a range of rural health issues, Indigenous culture and rural lifestyle issues. Second year students choose either a clinical rural week with a general practitioner or a week of Indigenous cultural learning with the Adnyamathanha people in the Flinders ranges, South Australia. Evaluation data were collected from students, practitioners and university staff during rural weeks in 2003 and 2004 using quantitative and qualitative methods. RESULTS: First year students increased their knowledge of and interest in rural medicine and enjoyed their (limited) clinical interaction with patients. Second year students appreciated the clinical experience and valued the welcome they received from doctors and practice staff. Those who chose Indigenous cultural programs appreciated the opportunity to interact with and learn from Indigenous people. General practitioners valued contributing to student knowledge and skills and the opportunity to promote rural practice. Volunteer community members were very enthusiastic about meeting the students and their generosity had a significant impact on the students' ideas about rural lifestyle. University academic and administrative staff found rural week very intensive work but experience and thorough preparation now ensures that few problems occur. CONCLUSION: Rural weeks are now an established part of the first year and second year curriculum at the University of Adelaide Medical School. The ability to provide small groups of students with an intense introduction to rural practice and/or Indigenous culture results in a positive change in opinion about this aspect of medical education. Students now have first-hand experience to positively influence their choice of rural education or Indigenous health options in the medical course. Problems do occur with students being away from the traditional classroom, and protocols have been put in place for behaviour of all parties. Despite the rural weeks program being very demanding on staff energy, financial resources, general practices and rural communities, we feel that this program is valuable and sustainable. Further experience will determine if rural weeks function effectively as a recruitment strategy for the long rural placements offered by the Rural Clinical School.
Many health care needs of rural dwellers cannot be adequately met through the use of existing nursing models alone but require unique approaches emphasizing the special needs of this population. The development of an integrated theory base for rural nursing is necessary. A retroductive approach, building upon both qualitative and quantitative research data, is being used to develop a theory of rural nursing. Key concepts identified are: work beliefs and health beliefs; isolation and distance; self-reliance; lack of anonymity; outsider/insider; and old-timer/newcomer. Implications for practice include the importance of relating health care to work practices and the need to intervene indirectly through established informal systems.
Community-based participatory development empowers villagers to develop community cohesion and confidence, increase their ability to identify, analyze, and priorize their own needs, and organize the resources to meet these needs. An important first step in the process involves establishing a cohesive and functional community group. The authors believe that this is best accomplished through villagers' critical examination of their experiences with development including their understanding of reasons for success or failure, and the gradual emergence of a model of working together that acknowledges and builds on participation and collective expertise. This approach to development is demonstrating encouraging results in a rural area of western Nepal in a university affiliated Canadian/Nepali Health Development Project. This paper describes two mini-projects to illustrate the evolution of group formation through reflection, analysis, and action, and identifies outcomes that could serve as indicators of community empowerment. The paper also presents a generic model of empowerment, and offers lessons learned by the project through the application of the empowerment process to sustainable health development.
Skeletal development and other related indicators were measured in 1680 children aged 7-18 in urban areas of Harbin and rural areas of Hailun County in 1990-1992, and comparisons were made. The results showed that the skeletal age of urban children aged 7-17 was higher than that of rural children in both sexes, and this difference was significant in the early puberty stage. The difference in mean values of cortical thickness of the metacarpals between urban and rural children showed similar tendency. Sesamoid ossification in urban children occurred one year earlier than that in rural children in both sexes. In primary school-age children, skeletal age was highly correlated with body height and weight. The development of secondary sex characteristics in both sexes and the age at menarche in girls in urban areas were earlier than those in rural areas, and the onset of puberty occurred one year earlier in urban than that in rural children.