Showing papers on "Rural area published in 1995"

Poverty and policy

Abstract: In this analysis of public policy to reduce poverty, the authors point out, among other things, that typically the highest incidence and severity of poverty are still found in rural areas, especially if ill-watered. For many of the rural poor, the only immediate route out of poverty is by migration to towns, to face a higher expected income, although often a more uncertain one. This may or may not reduce aggregate poverty. We can be more confident that growth in agricultural output -- fueled by investment in human and physical infrastructure -- is pro-poor, though not because the poor own much land. The policies pursued by most developing countries up to the mid-1980s -- and by many still -- have been biased against the rural sector in various ways. The same is true -- although different policies are involved -- of the other major sectoral concentration of poor, namely, the urban informal sector. There are clear prospects for reducing poverty by removing these biases. Looking ahead (far ahead, in some cases), it is less clear how much further gain to the poor can be expected from introducing a bias in the opposite direction. Neutrality should be the aim. We need good data and measurement to identify which public actions are effective in fighting poverty. There have been a number of advances in household data and analytic capabilities for poverty analysis over the last ten years. We are in a better position than ever to devise well-informed policies. The authors identify two important roles for public action. One is to foster the conditions for pro-poor growth, particularly by providing wide access to the necessary physical and human assets, including public infrastructure. The other is to help those who cannot participate fully in the benefits of such growth, or who do so with continued exposure to unacceptable risks. Here there is an important role for aiming interventions by various means to improve the distribution of the benefits of public spending on social ser(This abstract was borrowed from another version of this item.)

The Contribution of People's Participation: Evidence from 121 Rural Water Supply Projects

Abstract: The study is based on systematic quantitative and qualitative analysis of 121 rural water supply funded by many different water supply agencies in countries throughout the developing world. The analysis consistently shows that beneficiary participation was more significant than any other factor in achieving functional water systems and in building local capacity. The results of this study have profound implications for the way the World Bank supports its partners in planning and implementing development programs. Among the lessons learned from the study are these : obtaining local participation in decision making about development is sound business practice, and special measures are needed to ensure that the marginalized are reached in the participatory process. Even is participation is assured in planning, agencies must listen and learn as project are implemented. These principles are clear, and their implications reach well beyond rural water supply projects. The challenge is to act on these principles and to place people at the center of development.

Determinants of maternal care in a region of South India

Abstract: A cross-sectional survey was conducted during 1993 in urban and rural areas of Karnataka State, India. The survey included 3595 currently married women aged under 35, who had at least one child under five. Nine out of ten women had at least one antenatal consultation during their most recent fertile pregnancies. Most consultations were with doctors and there was minimal use of the services provided by paramedical staff of the primary health care system. Of all respondents, 38 per cent (57% urban and 29% rural) delivered in a hospital, and a majority of institutional deliveries were in private hospitals. Surgical interventions were made in more than one-third of hospital deliveries. There was a marked imbalance between antenatal and postnatal care as fewer than one-fifth of the mothers had a postnatal checkup. The educational level, economic status and religion of the mother are significant predictors of use of maternal health services. The relationship of problems during pregnancy and delivery with subsequent health-related behaviour is also examined. One of the dominant themes of the International Conference on Population and Development held in Cairo in September 1994 was reproductive health. This has been defined as a state in which People have the ability to reproduce and regulate their fertility; women are able to go through pregnancy and childbirth safely; the outcome of pregnancy is successful in terms of maternal and infant survival and well being; and couples are free to have sexual relations free of the fear of pregnancy and of contracting disease (Fathalla 1988). Maternal health services have a potentially critical role to play in the improvement of reproductive health. There is little doubt that access to skilled assistance and well equipped health institutions during delivery can reduce maternal mortality and morbidity and improve pregnancy outcomes. The effectiveness of routine antenatal and postnatal care is less certain. However, a few hospital based studies (Melrose 1984; Boes 1987a, b) and some community * The Ford Foundation provided financial support for the study, which is gratefully acknowledged. We would also like to record the hard and diligent work of Dr N.S.N. Rao in the organization and supervision of field work and the able assistance provided by Mr N.S. Sanath Kumar and Mr S. Ramaswamy in data processing. The interviewers, who collected data under rigorous field conditions, deserve our appreciation and commendation. Thanks are also due to the Karnataka health and ICDS officials for their full support and co-operation in the conduct of this study.

The impact of formal finance on the rural economy of India

Abstract: India has systematically pursued a supply-led approach to increasing agricultural credit. Its objectives have been to replace moneylenders, to relieve farmers of indebtedness, and to achieve higher levels of agricultural credit, investment, and output. India's success in replacing moneylenders has been outstanding. Between 1951 and 1971 their share of rural credit appears to have dropped from more than 80 percent to 36 percent. (It may have dropped to as low as 16 percent by 1981, but that estimate is disputed). Still, institutional credit is far from reaching all farmers. Only about a quarter of cultivators borrow, and no more than 2 percent take out long-term loans. Most small farmers have little access to credit, and long-term credit goes mostly to large farmers. Overall, farm debt has probably not increased sharply in real terms, as formal credit has primarily substituted for credit from other sources. Moreover, with the rapid growth of commercial banks in the 1970s, the system mobilized more deposits than it lent in rural areas in 1981. Of course, enhanced deposit services are a useful service of the rural population, but one must ask what has been the impact of heavy rural credit and better financial services on agricultural investment, production, and rural incomes. The authors' econometric results suggest that the rapid expansion of commercial banks in rural areas has had a substantially positive effect on rural nonfarm employment and output. The availability of better banking facilities appears to have overcome one of the obstacles to locating nonfarm activities in rural areas. Expanded rural finance has had less of an effect on output and employment in agriculture than in the nonfarm sector. The effect on crop output has not been great, despite the fact that credit to agricluture has greatly increased the use of fertilizer and private investment in machines and livestock. There has been more impact on inputs than on output, so the additional capital investment has been more important in substituting for agriclutural labor than in increasing crop output. But overall, rural credit and expansion of the rural financial system have had a positive effect on rural wages. Creating nonfarm jobs has apparently added more to total employment than the substitution of capital for labor has subtracted it in agriculture. So, wages have risen even for agricultural workers, albeit modestly. The supply-led approach to agricultural credit that has been pursued for three decades has clearly benefited current borrowers and farm households formerly indebted to moneylenders. It has also spurred fertilizer use and investment in agriculture. It has been less successful in generating viable institutions - and has failed to generate agricultural employment. The policy's costs to India's government have been high as portfolio losses associated with poor repayment ultimately have to be borne by the government or one of its institutions under optimistic assumptions. The benefits of the agricultural income are at best no more than 13 percent higher than the cost to the government of the extra agricultural credit. If assumptions about the cost of supplying the credit and about repayment rates are less optimistic, the social costs - and the costs to the government of providing the credit - would have exceeded the benefits in agricultural income. The expansion of commercial banks to rural areas paid off in nonfarm growth, employment, and rural wages. The question is: Could these benefits have been achieved without imposing agricultural credit targets on the commercial banks and credit cooperatives? Or did the commercial banks expand only because they were forced to lend to agriculture? The authors could not answer these questions with the data at hand.

Orphan prevalence and extended family care in a peri-urban community in Zimbabwe

Abstract: An orphan enumeration survey was conducted in 570 households in and around Mutare, Zimbabwe in 1992; 18.3% (95% CI 15.1-21.5%) of households included orphans. 12.8% (95% CI 11.2-14.3%) of children under 15 years old had a father or mother who had died; 5% of orphans had lost both parents. Orphan prevalence was highest in a peri-urban rural area (17.2%) and lowest in a middle income medium density urban suburb (4.3%). Recent increases in parental deaths were noted; 50% of parental deaths since 1987 could be ascribed to AIDS. Orphan household heads were likely to be older and less well-educated than non-orphan household heads. The majority of orphaned children were being cared for satisfactorily within extended families, often under difficult circumstances. Caregiving by maternal relatives represents a departure from the traditional practice of caring for orphans within the paternal extended family and an adaptation of community-coping mechanisms. There was little evidence of discrimination or exploitation of orphaned children by extended family caregivers. The fact that community coping mechanisms are changing does not imply that extended family methods of caring are about to break down. However, the emergence of orphan households headed by siblings is an indication that the extended family is under stress. Emphasis needs to be placed upon supporting extended families by utilizing existing community-based organizations. Orphan support programmes may need to be established initially in high risk communities such as low-income urban areas and peri-urban rural areas.

Shall we go home? Increasing urban poverty in African cities and migration processes.

Abstract: The impact of economic decline in the 1980s as well as that of IMF structural adjustment programs on urban incomes in Africa is explored. The author notes that in addition to devastating the real income of a large proportion of the urban population "the gap between real rural incomes and real urban incomes has often narrowed considerably. It appears that the rate of urban growth in some African countries has slowed considerably and there is also some evidence that new forms of `reverse migration from urban to rural areas have occurred. An attempt will be made to assess this evidence drawing on examples from different countries including Zambia Uganda and Tanzania." (EXCERPT)

Migration and HIV-1 seroprevalence in a rural Ugandan population.

Abstract: OBJECTIVE: To study the association between change of residence and HIV-1 serostatus in a rural Ugandan population. DESIGN: A longitudinal cohort study. METHODS: As part of the annual surveillance of a population cohort of approximately 10,000 individuals in a rural subcounty of southwest Uganda, information has been collected for all adults on change of residence over a 3-year period and its association with HIV-1 serostatus. Sera were collected by a medical team during home visits. Antibody testing was performed at the Uganda Virus Research Institute using two independent enzyme immunoassay systems and Western blot when appropriate. RESULTS: At the fourth survey-round, age and sex-standardized seroprevalence rates were 7.9% overall; the rate was 5.5% for 2,129 adults who had not changed address since the first survey, 8.2% for 336 who moved within the village, 12.4% for 128 who moved to a neighbouring village, 11.5% for 1,130 who had left the area and 16.3% for 541 who had joined the study area during the previous 3 years (P < 0.001, 4 degrees of freedom). We also observed an inverse relationship between years lived at the present house at the time of the first survey and both seroprevalence and subsequent seroincidence rates. The reported numbers of lifetime sexual partners were higher in those who changed residence. CONCLUSION: Change of residence is strongly associated with an increased risk of HIV-1 infection in this rural population and is likely to be the result of more risky sexual behaviour among those who move. These findings have important implications for the design of AIDS control programmes and intervention studies.

Democracy, Development, and the Countryside: Urban-Rural Struggles in India

Abstract: Preface Introduction 1. Town-Country struggles in development 2. Nehru's agricultural policy: a Reconstruction 3. Policy change in the mid-1960s 4. Rise of Agrarian power in the 1970s 5. Organizing the countryside in the 1980s 6. Has rural India lost out? 7. Paradoxes of power and the intracacies of economic policy 8. Conclusion: democracy and the countryside Endnotes.

Home, Family, and Community: Ingredients in the Rural Education Equation.

Abstract: Rural communities have precisely the qualities for which the critics of american schools are now looking, Ms. Herzog and Mr. Pittman point out. As educators, we need to recognize these strengths, take advantage of them, and build the preparation of rural educators around them. JONATHAN KOZOL spoke to an audience of education students at our rural university while Savage Inequalities was being passionately debated around the country.(1) He was exciting and inspiring and appealed to the ideals of our students. One graduate student, referring to the rural schools she had experienced both as a student and as a teacher, said with some relief, "I'm glad our schools aren't that bad. We don't have any of those problems." Her comment reflected a commonly held belief that rural schools are in good condition, especially in contrast to schools in urban areas where racism, violence, financial problems, and general decay are prevalent images. But is she correct? Are rural schools really in good condition? Like their urban counterparts, schools in rural areas face financial inequalities, but they also have problems that are uniquely rural. A comprehensive report on rural schools found high rates of poverty and low levels of educational attainment. It found that rural schools were staffed by younger, less well-educated faculty members and administrators who earn lower salaries and benefits than their metropolitan counterparts. The report documents persistent problems related to rural school finance, teacher compensation and quality, facilities, curriculum, and student achievement.(2) Rural communities are said to be suffering from a "bitter harvest," with the well-educated emigrating to metropolitan areas for better jobs.(3) Rural schools have image problems that stem from long-standing negative attitudes toward "country people." These problems stand in stark contrast to our student's naive reaction to Kozol. However, she was correct in some respects. Rural schools and communities have strengths that should be part of the prescription for remedying problems and directing changes in rural education. In order to develop an image of the shape of reform in rural education, it is necessary to understand the problems as well as the strengths of rural social and educational communities. The Problems What is rural? One problem facing rural education is the lack of a definitive understanding of the meaning of rural.(4) The word is often defined from an outsider's and urban perspective, in much the same way that the dominant culture has traditionally spoken for minority groups. The U.S. government's term for a rural area is non-metropolitan. What does nonmetropolitan mean? An area without skyscrapers and interstate junctions? The Census Bureau defines rural areas as communities with fewer than 2,500 inhabitants or fewer than 1,000 inhabitants per square mile. Imagine the silliness of placing New York City or Chicago in a category defined as "nonrural areas with more than 2,500 people" or as "areas without barns." The pervasiveness of the urban perspective seems to have contributed to a weak identity among our students: they often appear apologetic for being from the country. Attitudes toward ruralness. Another basic problem that students of rural education must face is the preponderance of negative attitudes toward rural people and places. As Toni Haas argues, modern American society does not value ruralness, prejudices against rural people and places are strong.(5) Our students seem to have internalized those prejudices, and they exhibit an inferiority complex about their origins. Although the term rural conjures up rich images, many of those images are based on negative stereotypes. Consider one rural image with roots in antiquity, the "country bumpkin" - the healthy, naive, slow-witted, unsophisticated, ignorant, ultraconservative, penniless soul from beyond the outer fringes of the interstate. …

Finding solutions to the rural doctor shortage : the roles of selection versus undergraduate medical education at Newcastle

Abstract: Background : Australia has a rural doctor shortage. Proposed solutions have included both increasing the medical student admissions from rural areas and modifying the curriculum content of rural medicine. Aim : To examine the differences between doctors who chose to practise in rural areas and those who chose urban areas after graduation from the University of Newcastle medical school. Methods : A cross-sectional survey of 331 graduates who had completed at least their intern year was undertaken in 1990, using a mailed self-report questionnaire. Results : A 75% response rate was achieved from those completing their degree before 1987 (N = 217). Twenty-two per cent ofrespondents were employed in a rural area and the great majority of these doctors were in general practice. Those from earlier graduating years, those from rural backgrounds (relative risk [RR] 2.5, 95% confidence interval [CI] : 1.4-4.4), and those who chose an undergraduate rural general practice attachment in their final year (RR = 3.0, 95% CI : 1.3-7.3) were more likely to become rural doctors. However, there was a tendency for those who chose an undergraduate rural rotation in year 3 not to be more likely to become rural doctors (RR = 0.7, 95% CI : 0.4-1.2). The most frequent reasons given for working in rural areas related to lifestyle, whereas work related reasons were given more often for those who chose urban practices. Conclusion : Our data suggest that the rural doctor shortage would be improved by medical school admission policies favouring students from rural areas, and by encouraging rural placements towards the end of undergraduate training.

Rural Development in the United States: Connecting Theory, Practice, and Possibilities.

Abstract: "Rural Development in the United States" presents a comprehensive evaluation of the economic, environmental, and political implications of past rural development and a thorough consideration of the directions in which future development efforts should go. The authors have assembled the best of what is being thought and done with regard to rural development in the United States, and place it in a broad theoretical, historical, and geographical context. The book provides: a summary of the key findings in rural development research of the past twenty years an integration of development theory and practical experience a bridge between the related but often isolated disciplines that inform rural development a catalyst for new thinking in the area of rural development analysis of the key economic sectors in rural areas: natural resources, the service sector, elderly services, telecommunications, manufacturing, tourism, and high-technology It includes important information about how national and international trends affect rural communities and development strategies and will help guide rural economic development policy in the United States during the 1990s and beyond.

Gender and family businesses in rural China

Abstract: The authors investigate the roles played by women and men in the emerging private sector in rural China Specifically the authors explore gender and the allocation of labor in household-run businesses in the rural areas of eight provinces Data collected in the China Health and Nutrition Survey (1989) indicate that households with a large pool of female labor are at no advantage in starting and running a small business; rather business involvement depends on the male labor pool especially the presence of older men Furthermore if a household runs a business men are more likely than women to work in it Men apparently have led the development and expansion of household business in rural China; while women increasingly specialize in agricultural activities Possible reasons for these findings are discussed (authors)

Urbanization in China.

Abstract: This paper discusses the growth and structure of urbanization in major cities and in rural areas in China. The definition of urban area in China is complex and unique in distinguishing between cities with and without an urban status. The designation of "urban" to a city has important implications for social welfare of the urban population. Urban cities grant registration to citizens which entitles them to food an occupation and housing. Since 1949 "city" changed definition in 1955 1963 and 1984. Urban and rural districts are thus separated administratively. Government statistics are based on five designations of urban population: officially designated cities and towns areas under municipal jurisdiction urban population urban population with an urban registry and city district population. There are city-administered counties also in a three-tiered structure of government: provincial government city administration and county administration. Population statistics are based on population censuses or city registries and do not account for migration. Commune populations are people who have quit agriculture but are counted as rural population unless they are registered in officially designated towns. Commune populations are people working in village and township enterprises. World Bank statistics indicate an increase in urbanization rates from 1965 to 1989 from 18% to 53% but most of the growth occurred during the 1980s. It is argued that Chinas population statistics must not be accepted uncritically. The author offers a reconstructed set of Chinese urbanization figures that would be compatible with other countries. Urbanization was estimated to be 21% in 1961 16% in 1971 18.7% in 1981 and 29.7% in 1991. Seven major conclusions are drawn. For instance it is concluded that urban population growth was 5% or more during the 1980s in nine provinces having populations of 380 million or more. Three provinces had rates of 4-5%. The 1990s are expected to show urban growth in areas with over 600 million people.

Socio-economic risk factors for malaria in a peri-urban area of the Gambia.

Abstract: Successful control of malaria depends upon a detailed knowledge of its epidemiology, including knowledge of the social and economic factors that influence its prevalence. Little is known about the socio-economic factors that influence the prevalence of malaria in tropical Africa. Therefore, we undertook such a study in over 350 Gambian children with malaria resident in a peri-urban area with seasonal transmission, using the case-control approach. Malaria was associated with poor quality housing and crowding and with travel to rural areas, where the level of malaria transmission is higher than in urban centres. No association was found between the risk of malaria and the overall education level of parents or guardians of study children. However, the knowledge of malaria possessed by mothers of cases of malaria was less than that of controls, suggesting that further education of the study community on the causation of malaria and on ways of preventing it could be of value.

De Facto Mental Health Services in the Rural South

Abstract: Health care reform efforts highlighted the continuing scarcity of mental health services for the rural poor. Most mental health services are provided in the general medical sector, a concept first described by Regier and colleagues in 1978 as the de facto mental health service system, rather than through formal mental health specialist services. The de facto system combines specialty mental health services with general medical services such as primary care and nursing home care, ministers and counselors, self-help groups, families, and friends. The nature of the de facto system in rural areas with large minority populations remains largely unknown due to minimal available data. This article examines the availability, accessibility, and use of mental health services in the rural South and the applicability of the de facto model to rural areas. The critical need for data necessary to inform changes in health care relative to rural mental health service delivery is emphasized.

China's Household Registration System under Reform

Abstract: The household registration system in China which was formalized in 1959 in order to limit rural to urban migration changed during the 1980s. Records are maintained by the Public Security Bureau and household booklets are maintained by individuals. Permanent residents are legally bound to be registered in one locality. Migration is permitted only with a migration certificate. Temporary residence involves registration within 3 days and no later than 3 months of a visit. Children inherit the residence status of their mothers. Special procedures are required if a move involves communities of a higher rank or a status change from agricultural to urban. Residence registration is required for obtaining food and commodity ration coupons. During early industrialization registration became lax and the nonagricultural population increased from 14.42% in 1952 to 21% in 1960. The decline in 1963 to 17% reflected more effective government controls and the return of rural migrants to rural areas. Reforms after 1978 contributed to the numbers of "floating population" in cities (10% of permanent population or over 50 million people). Census counts indicated that by 1990 temporary residents amounted to 22 million or a tripling over an eight year period. During the 1980s the floating population became an accepted practice for fulfilling labor needs. Only the jobless homeless or beggars became outlaws. Business and industry found ways to circumvent government requirements through contract labor. In 1985 new regulations on temporary residence were instituted which differentiated those with work from other temporary residents. Rural towns began to record temporary residents. Urban registration was granted to peasants with nonagricultural jobs in small towns who supplied their own housing and grain and relinquished their rural land. Many commuted from their nearby homes and continued to grow their own grain. By 1988 4.6 million peasants received a new status as urban residents. The practice of purchasing registration status occurred during the 1980s. Registration varied for military personnel minors technicians and married couples who were separated. The registration system functioned as part of a social development strategy as an instrument for regulating labor flows and as an instrument of state control.

Risk Factors For Motor Vehicle Crashes Among Older Drivers in a Rural Community

Abstract: OBJECTIVE: To estimate the motor vehicle crash rate in a cohort of older drivers from a rural community and to identify health-related conditions that increase their risk for crash involvement. DESIGN: Cohort study with 5 years of crash-record surveillance. SETTING: The Iowa 65+ Rural Health Study, one of four Established Populations for Epidemiologic Studies of the Elderly (EPESE). PARTICIPANTS: A total of 1791 drivers aged 68 years and older. MAIN MEASURES: Exposure measures of physical, mental, and sensory well-being from a health interview survey; outcome measure of police-reported crashes maintained by the Iowa Department of Motor Vehicles. RESULTS: Between 1985 and 1989, 206 drivers were involved in 245 state-recorded crashes. The estimated annual crash involvement rate for these rural older drivers (28 per 1000 driving-years) was about 20% less than the national average for drivers aged 65 years and over (36 per 1,000). An increased risk for motor vehicle crashes was associated with episodes of back pain (Relative Risk = 1.4, P Language: en

Patterns of Development on the Metropolitan Fringe: Urban Fringe Expansion in Bangkok, Jakarta, and Santiago

Abstract: This paper revisits the question of how best to characterize settlements on the metropolitan fringe of developing countries. We examine the socioeconomic composition and structure of such urban fringe settlements, using three sets of household surveys undertaken in Bangkok (Thailand), Jakarta (Indonesia), and Santiago (Chile) during June-August 1990. The findings reveal the metropolitan fringe areas to be populated mainly by middle- and lower-middle-income households formally employed in service occupations. Informal economic activity exists, but is not significant. Micro-enterprises are the exception. Most fringe residents had moved from other neighborhoods within the capital city rather than from rural settlements. Linkages to rural areas and to agriculture are largely absent; the fringe is spatially and functionally well-integrated into the metropolitan economy. The paper recommends that foreign-assistance program officers and local planners resist global “common themes” or approaches to devel...

Born in the Country: A History of Rural America

Abstract: Born in the Country was the first-and is still the only-general history of rural America published. Ranging from pre-Columbian times to the enormous changes of the twentieth century, Born in the Country masterfully integrates agricultural, technological, and economic themes with new questions social historians have raised about the American experience-including the different experiences of whites and blacks, men and women, natives and new immigrants. In this second edition, David B. Danbom expands and deepens his coverage of the late twentieth and early twenty-first centuries, focusing on the changes in agriculture and rural life since 1945. He discusses the alarming decline of agriculture as a productive enterprise and the parallel disintegration of farm families into demographic insignificance. In a new and provocative afterword, Danbom reflects on whether a distinctive style of rural life exists any longer. Combining mastery of existing scholarship with a fresh approach to new material, Born in the Country continues to define the field of American rural history.

Photovoltaic Applications in Rural Areas of the Developing World

Abstract: The cost of photovoltaic (PV) systems continues to fall. At the same time, experience is being rapidly gained in their practical use in the developing world. It is now clear they are going to play an increasing part in the provision of electrificationcal services in the rural and peri-urban areas of many developing countries. This report examines the rural energy context within which PV programs must fit. The first chapter reviews the present position of PV technology and briefly describes the kits and systems commercially available for use in the rural areas of the developing world. The second chapter examines the rural energy background, describing how people manage to meet their energy needs across the huge areas of the developing world that remain untouched by conventional rural electrificationfication programs. The third chpater looks at conventional rural electrification programs, their methods and their inevitably limited scope. The fourth chapter looks at the potential niches for PVs, and how they compare in cost and level of service with their competition. A brief review of PV experience to date and the lessons learned is given in the fifth chapter, and the final chapter looks at the role of governments and funding agencies.

Realities of Rural School Reform

Abstract: The Idea of making high fliers out of students who are low academic achievers living in places that are considered educationally and culturally deprived - such as rural Appalachia - warms the hearts of those who see education as the road to economic well-being for the nation. However, the education reform rhetoric that sounds so good from afar must be sold from the local court-house steps and in the school auditorium to rural residents who distrust outsiders with big plans for making "deprived" people want to be "middle-class." Changing schools means changing the community and its culture. Change is not new in rural Appalachia, but the road to education reform is bumpy and curved. All 55 counties in West Virginia are Appalachian counties. It is the second most rural state in the nation, with almost 64% of its population residing in rural areas. Uncharacteristic of the traditional stereo-type that equates rural with farming, no county in the states relies on agriculture as its primary industry.[1] The state is rebounding from the economic realities of the 1980s when it lost 8% of its total population and more than 20% of its population aged 18 and younger. Tourism replaced coal mining as the state's largest industry, as the economy made a transition to more service-oriented jobs. High unemployment and the need to make local communities competitive in a global economy have driven major education reforms. The state's population has begun to increase. And many native residents who left in the 1980s now return to communities that have changed noticeably. School Consolidation and Education Reform School consolidation has been the most visible and controversial educational change in Braxton County, West Virginia. In the fall of 1950, when Kenna Seal entered first grade at a two-room school in Cedar Creek, there were more than 100 schools situated throughout the county. Forty-five years later, only eight schools remain to serve the 2,700 students who live in Braxton County, all of whose 12,998 residents are classified as rural by the 1990 Census. Braxton County is one of 24 of the 55 county school districts in West Virginia that have only one high school. The new county high school was a result of consolidation efforts E years ago. And those efforts continue. In many economically depressed communities of the state, equal access to educational opportunities often translates in to school consolidation. Declining student enrollment, coupled with a dwindling tax base, provides the fiscal incentive to close or merge schools. School leaders, who are held accountable for financing as well as for educational access and outcomes, are expected to endorse and lead reform efforts forts to build larger schools with more course offerings. School consolidation in West Virginia received a major push in 1982 from a court case that became known as the "Recht decision." In his opinion stating that West Virginia's method of financing all aspects of public education was unconstitutional, Judge Arthur Recht strongly suggested that consolidation could prevent the state from wasting money on an outdated school system. Recht wrote that every consideration about education flows from a common denominator - money.[2] In the spring of 1988 the West Virginia legislature passed 20 education-related bills, including a 173-page omnibus education reform bill enacted to upgrade the quality of education in the state. While welcoming the increased attention to education, several county school superintendents argued that statewide reform must considered the uniqueness of the state's sparse, rural school districts. Leaders in the legislature maintained that all of West Virginia was rural and that all districts shared the same problems. County superintendents, however, insisted that major differences existed among the school districts, even if West Virginia was perceived as a "rural" state. Several of the superintendents, concerns were supported by a 1988 study, prepared for the Appalachian Regional Commission, that was the first major report in the nation to assess the consequences of school reform in small, rural schools. …

Health care seeking behaviour in developing countries: an annotated bibliography and literature review.

Abstract: This monograph reviews the recent (1984-94) literature on household health care seeking behavior and its determinants in rural areas of sub-Saharan Africa south Asia and southeast Asia and presents an annotated bibliography of this literature. Emphasis is placed on studies that locate health care seeking behavior in the socio-cultural context in which such decisions are made and in relation to available health care options (e.g. private and public services primary health care hospitals traditional healers commercial drug outlets). The literature suggests that the following determinants are especially salient: educational level maternal occupation marital status economic status age and sex health care costs womens status type and severity of illness distance and physical access and perceived quality of service provision. Also included is a discussion of the importance of quality of care assessments that incorporate both user and provider perspectives.