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PubMed2001

Developing a rural community-based disability service: (I) service framework and implementation strategy.

In response to widely recognised dilemmas associated with rehabilitation and disability service provision in remote and rural areas of Australia, a community-based, participatory approach to service development was adapted for a disability service project in central Queensland. The service framework, known as Community Based Rehabilitation (CBR), fosters the involvement of community members in disability service provision. Although this framework has been described previously, few guidelines exist regarding appropriate implementation of such an approach. Consequently, the implementation strategy known as Participatory Rural Appraisal (PRA) was adopted. Participatory Rural Appraisal has been reported to foster the participation and decision-making of community members in community projects. The present article describes the application of this implementation strategy to disability service provision in a relatively under-resourced rural shire. The rationale, framework and process of the pilot are described. A subsequent publication will document the service component, detail evaluation findings and describe the long-term outcomes of this research.

Community Health Planning↗
PubMed1997

UN system machinery for coordinating follow-up to the World Food Summit.

FAO [UN Food and Agriculture Organization] does not stand alone in implementing and monitoring the Summit Plan of Action. Commitments 7.2 and 7.3 give responsibility to the UN's Administrative Committee on Coordination (ACC) for coordinating interagency follow-up and to the Economic and Social Committee (ECOSOC) for receiving progress reports from FAO and other agencies. The UN General Assembly in December 1996 welcomed the outcome of the Summit and received FAO's first report on it at its 1997 session. The ACC has launched interagency follow-up by establishing the ACC Network on Rural Development and Food Security, as proposed jointly by FAO and the International Fund for Agricultural Development (IFAD). More than 16 UN agencies have joined and the UN Secretary-General has welcomed the intention to involve civil society and the emphasis placed on country-level action in the two-tiered network. All FAO country representatives and UN resident coordinators have been asked to help in setting up interagency thematic groups on rural development and food security at the country level. FAO has introduced a website for the network within SD Dimensions (http://www.fao.org/waicent/faoinfo/sustdev). ECOSOC has welcomed the ACC's decision to include follow-up to the World Food Summit within the context of the integrated follow-up process of all major UN conferences and summits. With these decisions, the machinery has been set in motion for early and sustained support from both interagency and intergovernmental bodies to national efforts to implement the Plan of Action.

Agriculture↗
PubMed1995

MSU Rurality Index: development and evaluation. Montana State University.

The construction and validation of a residence-based index of the degree of rurality are reported. The MSU Rurality Index is a locally normal index and assigns a quantitative measure of rurality to each participant in a study. Data required to compute the index are minimal; only two variables need be measured. Statistical analysis effort required to compute the index is somewhat more intensive than usual, but this tradeoff between data collection and data analysis seems sensible. Data collection is generally more expensive than data analysis. The two required variables, county population and distance to emergency care, are optimally transformed to achieve normality and weighted to achieve validity. A measure of departure from normality is automatically obtained while constructing the index. A positive score reflects a rural residence and a negative score reflects an urban residence relative to the group under study. A score of zero reflects average rurality. Reliability and construct validity were examined using two data sets. The MSU Rurality Index has high test-retest reliability, is appropriately related to a set of ordered categories concerning place of residence, and is as or more strongly related to these categories than alternative indices computed from distance or population alone. The validity of the MSU Rurality Index does not appear to be compromised by its parsimony. Even though the MSU Rurality Index is based on only two variables, it was found to be associated with various health care variables as strongly or more strongly than an 11 variable county-based index developed in Texas.

Adult↗
PubMed1977

[Rural health center in Bali].

The rural Health Centre of Mengwi, on the island of Bali, was built and equipped for US $ 15,000 by Project Concern, a non-sectarian, medical relief organization. It has been run so successfully by them since it opened in 1974, that not only has the Centre gained the trust of the local community into which it is now fully integrated, but it is also regarded by the Indonesian Government as a pilot project. Amongst the factors leading to this success, the author underlines the following points: a suitable location for the Centre, easily accessible by the villagers; a local staff recruited from the villages of Mengwi District, well trained and sympathetic to the population; constant retraining of the staff leading to better medical care; the availability of a doctor and nurse around the clock; an adequate supply of drugs. Evaluation of the operation is best done by the acceptance of special programmes such as the Under-Five Clinic, the Family Planning Scheme, Ante-Natal Clinic and vaccinations. The mere success of the general clinic would not mean that the Centre had been integrated into the community and become a factor in rural development. The success of these special clinics, as well as the out-reach programmes, demonstrates that through adequate delivery of medical care, the Health Centre of Mengwi can now fulfil its role of being an important factor in the development of a rural community in the tropics.

Delivery of Health Care↗
PubMedDate not supplied

Enhancing the family medicine curriculum in deliveries and emergency medicine as a way of developing a rural teaching site.

BACKGROUND: The urban family practice residencies of Memphis were not providing sufficient training or encouragement to young physicians for practice in rural communities. METHODS: In 1990, the Department of Family Medicine, in partnership with the State of Tennessee Health Access Act and the Baptist Health Care System, developed a teaching practice in a rural county of western Tennessee. The family practice curriculum included special skills in advanced women's health care and emergency medicine so that uniformly trained physicians could provide around-the-clock coverage in the hospital, including the delivery of babies and first-hour emergency care. RESULTS: After 7 years, the group now includes six full-time board-certified, OB-capable family physicians. In addition, faculty members from the department's urban program in Memphis are required to contribute a "mini locum tenens" of 2-3 days of rural coverage per month. Since 1992, the practice has provided care for more than 54,000 continuity office visits, 81,000 emergency department visits, more than 3,500 hospital admissions, and 621 obstetrical deliveries. Since 1994, residents have been assigned to the site full time, with growth to 12 (4-4-4) residents assigned to this location as of 1997. Several graduates from the initial group of residents have remained in the community after graduation, and three others have established practices in rural areas. Most recently, control of the practice is being transferred from the family medicine department to the university's corporate group practice. This may result in fundamental changes in the practice's operation. CONCLUSIONS: The approach described in this report may be useful for the expansion of urban departments of family medicine into rural and underserved communities.

Curriculum↗
PubMed1980

Nutrition and cognitive development among rural Guatemalan children.

Women and children from four Guatemalan villages participated in a voluntary food supplementation program for seven years. In two of the villages, they received a vitamin and mineral fortified, high-protein calorie supplement. In the other two villages, the vitamin-mineral fortified supplement contained no protein and a relatively small number of calories. Cognitive tests were administered regularly to children ages three to seven, and anthropometric measures obtained. In addition, measures of families' social milieu were collected at several points in time. Using multiple regression analysis, we find that both nutritional and social environmental measures are related to various dimensions of cognitive competence. The results suggest that nutritional intake, independent of social factors, affects cognitive development. There is also some evidence that the children who receive the high-protein calorie supplement (and whose mothers received it during pregnancy and lactation) are more likely to score high in cognitive performance. Our results, while not diminishing social environmental explanations of differences in cognitive function, suggest benefits from nutrition intervention programs in rural areas of lesser-developed countries.

Anthropometry↗
PubMed1977

Model for the development of rural pharmaceutical services.

The Central Pharmacy of Presbyterian Medical Services (PMS) a nonprofit corporation operating a rural comprehensive health care system in New Mexico, is discussed. PMS Central Pharmacy provides pharmaceutical services to a 34-bed acute care hospital and 24 widely scattered clinics for ambulatory patients. The financial base, administration, development of a formulatory, purchasing, prepackaging of medications, and consulting services of the PMS Central Pharmacy are described. Central Pharmacy acts as a drug wholesaler for PMS; the gross margin between acquisition cost and average wholesale price covers 90% of the cost of the pharmacy operation. In addition, the clinics pay a fee and travel expenses for pharmacist consultation. Seven clinics employ drug technicians who are trained and supervised by Central Pharmacy. It is concluded that this system may serve as a model for the development of pharmaceutical services in other rural areas or in poverty-stricken urban areas.

Costs and Cost Analysis↗
PubMed2006

Continuing professional development for rural physicians: an oxymoron or just non-existent?

There is geographic maldistribution of physicians across Australia and their professional isolation, particularly in relation to continuing professional development, is a definite problem. It tends to be worse in smaller centres where there is no critical mass that allows for peer support. Although some academic research has been carried out concerning the needs of rural GP, none has targetted rural specialists. Several activities, including the Commonwealth-funded Support Scheme for Rural Specialists, have been well received and other initiatives, including the rural clinical schools and university departments of rural health, are beginning to provide an infrastructure that will help overcome the professional isolation through the use of innovative technologies such as interactive videoconferencing. This is being used to deliver RACP initiatives such as the basic physician trainee lecture series and the potential for vertical integration of training in rural settings which offer some promise to address the rural workforce shortage in the years to come.

Australia↗