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PubMed1983

Can people move bureaucratic mountains? Developing primary health care in rural Indonesia.

Banjarnegara, a regency with a population of 678,000 located in a poor, mountainous region of Central Java, has become a focus of attention because of its Primary Health Care (PHC) programme. Since 1972, three-quarters of Banjarnegara's 279 villages have established a wide range of community-based health activities. Yet it is difficult to describe and analyse this programme, which has never had a specific design or master plan. Nor have there been large injections of funds from Indonesian government or international agencies. The programme runs on a modest budget, relying on an element that eludes many carefully planned, heavily funded development efforts--the voluntary participation of large numbers of local people. Some 4000 unpaid volunteers are largely responsible for planning, implementing and evaluating the programme. This article attempts to describe and assess the programme's achievements, limitations and possible wider relevance.

Community Health Services↗
PubMed2001

Developing better casemix education for rural New South Wales.

Casemix is now an important mechanism for the planning, evaluation and funding of health services in Australia. In New South Wales (NSW) it was believed that while staff from most hospitals in metropolitan Sydney had become both literate and vocal about casemix, staff from rural areas were less familiar and much less likely to participate in casemix initiatives. In conjunction with the NSW Casemix Clinical Committee (NCCC), NSW Health considered a special program of casemix education for rural NSW. Before an education program was attempted, NSW Health inquired into the specific needs for casemix education in rural NSW. Qualitative and quantitative methods of analysis were used. Results of the quantitative analysis indicate that the understanding of casemix classifications is highest among managers. Of concern were the relatively low proportion of Allied Health staff who had more than a vague understanding of the Sub- and Non-Acute Patient (SNAP) classification; the lack of any knowledge of the Mental Health Costing And Service Classification (MH-CASC) by nursing staff; and the lack of any knowledge of the emergency department classification: Urgency, Disposition and Age-related Groups (UDAG), either by clinical or nursing staff. The results of the qualitative analysis show that casemix education for rural areas needs to differ from metropolitan education programs. The analysis also highlights the perception of casemix in rural areas and the special circumstances in rural hospitals that place limits on the ability to use casemix more fully.

Attitude of Health Personnel↗
PubMed2004

High-tech rural clinics and hospitals in Japan: a comparison to the Japanese average.

CONTEXT: Japanese medical facilities are noted for being heavily equipped with high-tech equipment compared to other industrialised countries. Rural facilities are anecdotally said to be better equipped than facilities in other areas due to egalitarian health resource diffusion policies by public sectors whose goal is to secure fair access to modern medical technologies among the entire population. OBJECTIVES: To show the technology status of rural practice and compare it to the national level. DESIGN: Nationwide postal survey. SETTING, SUBJECTS & INTERVENTIONS: Questionnaires were sent to the directors of 1362 public hospitals and clinics (of the 1723 municipalities defined as 'rural' by four national laws). Information was collected about the technologies they possessed. The data were compared with figures from a national census of all hospitals and clinics. RESULTS: A total of 766 facilities responded (an effective response rate of 56%). Rural facilities showed higher possession rates in most comparable technologies than the national level. It is noted that almost all rural hospitals had gastroscopes and colonoscopes and their possession rates of bronchoscopes and dialysis equipment were twice as high as the national level. The discrepancy in possession rates between rural and national was even more remarkable in clinics than in hospitals. Rural clinics owned twice as many abdominal ultrasonographs, and three times as many gastroscopes, colonoscopes, defibrillators and computed tomography scanners as the national level. CONCLUSIONS: Rural facilities are equipped with more technology than urban ones. Government-led, tax based, technology diffusion in the entire country seems to have attained its goal. What is already known on this subject: As a general tendency in both developing and developed countries, rural medical facilities are technologically less equipped than their urban counterparts. What does this paper add?: In Japan, rural medical facilities are technologically better equipped than urban facilities.

Ambulatory Care Facilities↗
PubMed1985

Migration, remittances and development: a study of Caribbean cane cutters in Florida.

The results of a 1981 survey of 302 Caribbean sugarcane cutters who were temporary immigrants in Florida are presented. The focus is on remittances to the islands of origin. The results provide "no evidence that seasonal stateside employment expands agricultural output, or enhances the productive capacity of small farmers in the Caribbean."

Agriculture↗
PubMedDate not supplied

[The primary consequences of a large agricultural project (SEMRY II) on the demographic situation in its area of influence].

"This article describes to what extent a rice-growing development project, begun in 1979 in northern Cameroon, modified the demographic and migratory characteristics of the population within the zone of influence. A representative sample and a control group were followed from 1979 to 1981 using a multi-round survey technique. Data from the general population census (1976) were used to study the population's characteristics from 1976 to 1979." The study population is linked to 1976 census data, and various demographic estimates for the population are produced. An examination of migration patterns in the area indicates that "the project had not yet succeeded in attracting the populations living in the more distant zones two years after its installation." (SUMMARY IN ENG)

Africa↗