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This article describes the development of rural health networks in Florida, which has adopted formal policies to support these networks. First, the history and content of the relevant legislation are described. The current networks are identified and their development to date summarized. Finally, a detailed case study is employed to outline the steps taken to establish one network.
Trachomatous low vision can be prevented by treating or preventing infection or through surgery to treat trichiasis. Resource allocation to prevent trachomatous low vision should be directed to those interventions that are the most cost-effective. In order to assess which of many potential interventions are the more cost-effective, data on the epidemiology of the disease, the effectiveness of community- and facility-based interventions, and the cost of the interventions are required. This paper provides a stylized model of the path from risk of infection through disease to trachomatous low vision or blindness that delineates the points at which interventions may occur and for which data are required. The literature reveals a considerable amount of data regarding the epidemiology of the trachoma and its sequelae but little on the effectiveness of community-based interventions and only one study that measured costs directly. More data are needed to assist policy makers and international program partners who seek to make efficient resource allocation decisions in an effort to eliminate trachoma as a cause of incident blindness in the developing countries in which trachomatous blindness remains prevalent.
Rural residents experience significant disparities in health status and access to care. These disparities and access barriers are particularly prevalent in rural communities in the South. The Southern Rural Access Program, a national program of the Robert Wood Johnson Foundation, was designed as a long-term effort to improve access to basic health care in 8 of the most underserved states in the country. The program was launched in 1998 with 3 goals: (1) to increase the supply of providers in underserved areas, (2) to strengthen the health care infrastructure, and (3) to build capacity at the state and community level to solve problems. The first 3-year phase of the program made $13.8 million available to communities in the 8 target states, and a January 2002 reauthorization of the program will make an additional $18.9 million available in the next 4 years. This article will provide an overview of the Southern Rural Access Program, focusing on the development and evolution of the program during its first 3-year phase. The article will also highlight some of the refinements that the foundation has made during the 2002-2006 second phase of the program.
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Reducing population growth through programs is a high priority for many developing countries. Why particularly in the rural regions of these countries, do these initiatives fail? Using a case study of a recent initiative in rural Nepal between 1998 and 2002 as an example, this opinion piece discusses possible reasons for such failure and recommends that a broader strategic approach is necessary, particularly in relation to empowering women in these communities. Banke district, Nepal, is mainly rural, consisting of 47 villages. Scarcity of family planning provisions is a dominant problem in most parts of the district. District Public Health Office (DPHO), the major family service provider lacks resources and technical capabilities. In recent years, non-government organizations (NGOs) have been collaborating and coordinating their efforts with DPHO in order to cover the larger section of the district population. A local NGO called Banke Mahila Arthick Swawlamban Sangathan (BMASS) provided family planning services in 5 of the 47 villages of Banke district, Nepal, from 1998 through 2002. Outreach activities and clinical services were the two major components of BMASS family planning program. Outreach activities included door-to-door/mass counseling, street drama, and condom distribution. Clinical services that included counseling, testing, temporary sterilization, and referrals for permanent sterilization were provided through a centrally located static clinic and mobile clinics. BMASS family planning program had almost no impact in the target villages. There was no significant increase in contraceptive use, people's motivation to limit fertility, and number of people preferring a smaller family size. The contraceptive prevalence rate increased by less than 2% after 2 years of family planning program intervention. More than 80% of the family planning clients were reported to have discontinued contraceptive use within six months. The mean age of women at the time of first child delivery (16.2 years), total fertility rate (six children per woman), and the birth intervals (13-18 months) were reported to be the same for both periods: before and two years after family planning program intervention. Further assessment of the local factors revealed that women's lack of control over fertility and higher number of desired children could have hindered the community's response to BMASS family planning program. In the target villages a woman's fertility is dependent upon the preference of husbands and in-laws. The women in general are not empowered to voice their opinion with regards to delaying fertility, spacing child-births, and limiting the number of children to be born to them. Higher number of desired children in the target villages is the outcome of low cost of child rearing and high benefits from the children. Children not only contribute significantly in household economy and provide old age security to their parents, but also consume less. To be effective, family planning programs need to be integrated into broader societal reforms that address rural economic development and the role of women in society.
A HIV seroprevalence among 312 antenatal mothers at their first visit to the Idjwi isle's hospital, in Zaïre, near Rwanda, and among 61 other patients, was made with the HIV1 Immunocomb of PBS Orgenics during one year: 1989. The seroprevalence is 0.32%, in this rural area, as was confirmed by Western-Blot. A panel of this 51 "false and true positive" and 13 negative african sera was tested with one other ELISA and two new rapid tests used in France, HIV CHEK 1 + 2 and TEST PACK HIV1/HIV2 to evaluate efficacy under conditions in which transfusions are normally given. These were performed within 15 mn of receipt of blood from a donor in Zaïre.
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PURPOSE: The Agency for Healthcare Research and Quality and the federal Office of Rural Health Policy collaborated to convene an expert group to address issues of quality improvement in the rural health care environment. OUTCOMES: The group identified issues, barriers, and opportunities related to bringing rural health care into the mainstream of the national quality "revolution." A framework for rural quality and specific action steps was proposed. Recommendations were made in the areas of workforce, organizational performance, measurement, dissemination of innovation, and external factors impacting quality. Specific recommendations included fostering development of rural consortia, relevant quality measures for the rural environment, technical assistance capacity, appropriate financial incentives, leadership capacity, and databases.
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"This paper provides a review of the theoretical literature on rural-urban migration in contemporary LDCs [less developed countries]. The paper begins with a brief discussion of the Lewis model before going on to discuss the Todaro and the Harris-Todaro models and the large literature which these models have spawned. The question of job search in the context of migration and the role of family members in migration decisions are considered next. The paper then takes a closer look at the Informal sector and also sets out alternative migration functions to the ones usually employed in the literature."
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