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PubMed1976

Problems in the development of a rural primary care center.

For 18 months between July 1973 and December 1974, the development of a primary care center for a rural Appalacian county engaged the efforts of local community leaders and the Department of Community Medicine of the University of Kentucky College of Medicine. This case study discusses some of the major events and factors contributing to this unsuccessful endeavor. The local cultural and sociomedical circumstances, including economic and political forces, and the errors in institutional relations and communication are analyzed. Many of the community problems encountered, at both the local and regional levels, are common to various rural areas. Considerations discussed in some detail include medical care payment mechanisms, rural economics, and local sociocultural systems. These community health problems, and the broader health policy issues that they represent, must be addressed before any significant changes or advances can be made in health care in rural America.

Community Health Services↗
PubMed1983

Primary health care in rural China: post-1978 development.

Primary Health Care in rural China is examined with particular reference to its development since 1978. The expansion and professionalization of the post-Mao rural health system is described and illustrated with examples from particular communes. The financing of the three-tiered health care system between 1967 and 1978 is described and some of the major problems in implementing current objectives are analyzed.

China↗
PubMed2003

A community development approach to rural recruitment.

Programs designed to empower rural communities for health care provider recruitment have usually focused on the health care sector without aggressively addressing broader community development issues. The Recruitable Community Project (RCP) in West Virginia includes community education on recruiting and also assessments of and recommendations to rural communities on broad-based community development, aiming to enhance communities' recruiting potential. The project provides multidisciplinary university-based planning assistance programs for small communities, involving collaborative community visits. The project also uses a project manager as a "community encourager" who participates in community education and in the formulation of sustained community recruiting efforts. From August 1999 through August 2001, 7 underserved rural communities completed the RCP organizational processes and hosted planning assistance teams. Members of community recruitment boards gave high marks to the RCP process, its planning assistance teams, and its usefulness in establishing community ties to state and academic agencies. Since working with the RCP, the 7 communities have recruited 27 providers, success possibly stimulated by their RCP involvement (data current as of September 2002). This model of community training and development to empower rural communities to better recruit health professionals shows early promise. This model could be broadened to include more collaboration of community development and health science disciplines programs for recruitment and retention efforts.

Community Health Planning↗
PubMed2006

An integrated approach to modeling resource utilization for rural communities in developing countries.

Resource consumption in developing countries has been the focus of a considerable amount of research. What has been understudied however, has been the feedback affects of resource consumption on resource availability to both households and communities. Heavy reliance on natural resources and intensive smallholder agriculture common to many rural communities in developing countries has forced people to fulfill short-term needs to the detriment of long-term ecological and livelihood sustainability. This paper introduces a conceptual framework to examine how individuals and households fulfill daily caloric needs and the aggregate effects on resource availability and consumption. Data were collected from a large number of published case studies of rural land-use dynamics, growth and yield models, and human livelihoods were reviewed from scientific journals, reports published by NGOs, and government reports. Using inputs defined by the user, the model tracks annual fuelwood and agricultural land use based on meeting individual energy demands. A case-study-based analysis was patterned after smallholder agriculturalists at the family and community level. Three scenarios are presented in this paper using data from Uganda to illustrate the application of this model.

Adult↗
PubMed2003

Connecting our resources: Louisiana's approach to community health network development.

Louisiana's rural community health systems are in crisis because of pressures fueled by the rising costs of health care, sustained poor health status, state budget shortfalls and changes in priorities, and a sliding rural economy. The development of community health networks is providing new infrastructure and capacity for communities to reprioritize, formulate innovative partnerships, and leverage new resources. Successful elements of Louisiana's network development experience include community commitment to engage in study and action; the availability of capable and motivated technical assistance; an approach that involves open-engagement, community-driven decision-making; and data-driven problem definition, prioritization, and solutions. Louisiana's experiences illustrate the benefits of developing networks along with, or as a result of, a community health plan. When a community owns its health improvement plan, it is more likely to support the new network as a structure for implementation. Broad-scale participation is also a principle of success. When social service agencies are included along with health agencies, more comprehensive strategies result, and they bring additional resources, resulting in more holistic solutions. The cases of 2 networks are presented as illustrations. One involves the facilitation of a community planning process for an existing network. The plan helped to expand the network's community connections and support and provided the content for a successful application for a Health Resources and Services Administration Community Access Program grant. In the second case, a new network was developed, and it leveraged federal funds from the federal Office of Rural Health Policy's Network Development Grant Program.

Community Health Planning↗
PubMed1975

Nutrition and development of children from poor rural areas. V. Nutrition and behavioral development.

2 groups of 17 mother-child units each were studied longitudinally, 1 with the usual feeding habits which resulted in undernutrition of the child, and the other sufficient with food supplementation. From the 24th week on, the supplemented developed a different pattern of interaction with mother and environment; they slept less, barely used the cradle during the day, played more in the yard, and refused to be carried wrapped up. They moved about 6 times as much as the nonsupplemented and exhibited complex behavior. They were more restless, playful, demanding, and disobedient. It is concluded that better nutrition caused an increased level in the child, which made him more demanding, and in turn this increased interaction with his mother and established a feedback system, which in turn modified his behavior.

Americas↗
PubMed2004

Assessing cognitive outcomes in a rural African population: development of a neuropsychological battery in Kilifi District, Kenya.

The ability to measure neuropsychological outcomes in a comparable manner in different cultural groups is important if studies conducted in geographically diverse regions are to advance knowledge of disease effects and moderating influences. The purpose of this study was to evaluate the application of neuropsychological test procedures developed for use in North America and Europe to children in a rural region of Kenya. Our specific aim was to determine if these methods could be adapted to a non-Western culture in a manner that would preserve test reliability and validity. Procedural modifications yielded reliable tests that were sensitive to both the sequelae of cerebral malaria and to children's social and school backgrounds. Results suggest that adaptations of existing tests can be made in such a way as to preserve their utility in measuring the cross-cultural sequelae of childhood neurological diseases.

Catchment Area, Health↗
PubMed1996

Application of primary health care standards to a developing community health group: a rural case history.

The development of community health groups in rural settings involving private general practitioners and other health care workers has been relatively rare. This case history examines the activities of such a group and the views of its participants over a 12-month period. It considers whether the principles of primary care and the relevant Community Health Accreditation and Standards Program criteria can be applied in such a setting. The centre was able to meet most of the primary care criteria; however, some other important elements that could be helpful to further developments emerged in the research process. These included the sensitivity of a rural community to an individual case or patient focus in a case conference setting and the high level of acceptance of population or healthy-community goals. Other key issues included the strength (in terms of advocacy for health service provision) of an intersectoral group in a rural setting. Positive benefits were perceived to accrue from the increased professional and intersectoral communication. The role of the private general practitioner was focal, but the participants did not believe this necessarily had to be a leadership role. The initiation of such a conference and its leadership could be undertaken by any interested and appropriately skilled member. Organisation, administration, continuity and cost are important practical issues which need to be examined in early stages of development and taken into account in evaluation.

Accreditation↗
PubMed2002

Project to develop family medicine in rural India.

The need to develop Family Medicine in the Mayurbhanj region of India is urgent and extreme. Among the poorest areas of India, the Mayurbhanj, has an under-5 mortality twice that of the rest of India. Family physicians in the region are severely restricted by the absence of a basic infrastructure for family medicine. Supported by a WONCA Foundation Award, this project attempts to address the overwhelming healthcare problems of the region and develop a family practice network appropriate to the needs of the communities. Working with local Indian doctors, specific, achievable goals were set, which included developing a maternity protocol and a childhood immunisation program. Community clinics were set up in the villages of the project area to enable the scattered remote peoples to access medical care. The initiatives of this project are now being continued by local Indian family physicians without further outside support.

Family Practice↗