Showing papers on "Rural area published in 2009"

A critical review of interventions to redress the inequitable distribution of healthcare professionals to rural and remote areas.

Abstract: Introduction The shortage of healthcare professionals in rural communities is a global problem that poses a serious challenge to equitable healthcare delivery. Both developed and developing countries report geographically skewed distributions of healthcare professionals, favouring urban and wealthy areas, despite the fact that people in rural communities experience more health related problems. This review provides a comprehensive overview of the most important studies addressing the recruitment and retention of doctors to rural and remote areas. Methods A comprehensive search of the English literature was conducted using the National Library of Medicine's (PubMed) database and the keywords '(rural OR remote) AND (recruitment OR retention)' on 3 July 2008. In total, 1261 references were identified and screened; all primary studies that reported the outcome of an actual intervention and all relevant review articles were selected. Due to the paucity of prospective primary intervention studies, retrospective observational studies and questionnaire-driven surveys were included as well. The search was extended by scrutinizing the references of selected articles to identify additional studies that may have been missed. In total, 110 articles were included. Results In order to provide a comprehensive overview in a clear and user-friendly fashion, the available evidence was classified into five intervention categories: Selection, Education, Coercion, Incentives and Support - and the strength of the available evidence was rated as convincing, strong, moderate, weak or absent. The main definitions used to define 'rural and/or remote' in the articles reviewed are summarized, before the evidence in support of each of the five intervention categories is reflected in detail. Conclusion We argue for the formulation of universal definitions to assist study comparison and future collaborative research. Although coercive strategies address short-term recruitment needs, little evidence supports their long-term positive impact. Current evidence only supports the implementation of well-defined selection and education policies, although incentive and support schemes may have value. There remains an urgent need to evaluate the impact of untested interventions in a scientifically rigorous fashion in order to identify winning strategies for guiding future practice and policy.

A deprivation index for health planning in Canada.

Abstract: Administrative databases in the Canadian health sector do not contain socio-economic information. To facilitate the monitoring of social inequalities for health planning, this study proposes a material and social deprivation index for Canada. After explaining the concept of deprivation, we describe the methodological aspects of the index and apply it to the example of premature mortality (i.e. death before the age of 75). We illustrate variations in deprivation and the links between deprivation and mortality nationwide and in different geographic areas including the census metropolitan areas (CMAs) of Toronto, Montreal and Vancouver; other CMAs; average-size cities, referred to as census agglomerations (CAs); small towns and rural communities; and five regions of Canada, namely Atlantic, Quebec, Ontario, the Prairies and British Columbia. Material and social deprivation and their links to mortality vary considerably by geographic area. We comment on the results as well as the limitations of the index and its advantages for health planning.

"Land grabbing" by foreign investors in developing countries: Risks and opportunities

Abstract: "One of the lingering effects of the food price crisis of 2007–08 on the world food system is the proliferating acquisition of farmland in developing countries by other countries seeking to ensure their food supplies. Increased pressures on natural resources, water scarcity, export restrictions imposed by major producers when food prices were high, and growing distrust in the functioning of regional and global markets have pushed countries short in land and water to find alternative means of producing food. These land acquisitions have the potential to inject much-needed investment into agriculture and rural areas in poor developing countries, but they also raise concerns about the impacts on poor local people, who risk losing access to and control over land on which they depend. It is crucial to ensure that these land deals, and the environment within which they take place, are designed in ways that will reduce the threats and facilitate the opportunities for all parties involved." from Author's text

Reducing out-of-pocket expenditures to reduce poverty: a disaggregated analysis at rural-urban and state level in India.

Abstract: Based on Consumer Expenditure Survey (CES) data from the National Sample Survey (NSS), conducted in 1999–2000, the share of households’ expenditure on health services and drugs was calculated. The number of individuals below the state-specific rural and urban poverty line in 17 major states, with and without netting out OOP expenditure, was determined. This also enabled the calculation of the poverty gap or poverty deepening in each region. Estimates show that OOP expenditure is about 5% of total household expenditure (ranging from about 2% in Assam to almost 7% in Kerala) with a higher proportion being recorded in rural areas and affluent states. Purchase of drugs constitutes 70% of the total OOP expenditure. Approximately 32.5 million persons fell below the poverty line in 1999–2000 through OOP payments, implying that the overall poverty increase after accounting for OOP expenditure is 3.2% (as against a rise of 2.2% shown in earlier literature). Also, the poverty headcount increase and poverty deepening is much higher in poorer states and rural areas compared with affluent states and urban areas, except in the case of Maharashtra. High OOP payment share in total health expenditures did not always imply a high poverty headcount; state-specific economic and social factors played a role. The paper argues for better methods of capturing drugs expenditure in household surveys and recommends that special attention be paid to expenditures on drugs, in particular for the poor. Targeted policies in just five poor states to reduce OOP expenditure could help to prevent almost 60% of the poverty headcount increase through OOP payments.

Towards a better conceptual framework for innovation processes in agriculture and rural development: from linear models to systemic approaches

Abstract: The role of farming previously dedicated mainly to food production changed with an increasing recognition of the multifunctionality of agriculture and rural areas. It seems obvious to expect that farmers and rural actors adapt themselves to these new conditions, which are innovative and redefine their job. In many regions farmers can increase their income basis as rural entrepreneurs, developing new services and exploring new markets. Often, however, there is a gap between the need for change and farmers’ willingness to adjust, and the insufficient capacities of innovation agencies and advisory services to effectively support changes. In this contribution we discuss the kinds of gaps between present societal demands, the related farm-level adjustments, and the capacities of innovation agencies and advisory services. We explore a conceptual framework that understands innovation processes as the outcome of collaborative networks where information is exchanged and learning processes happen. We argue...

Factors influencing the intensity of market participation by smallholder farmers: A case study of rural and peri-urban areas of Kenya

Abstract: Participation in commercial agriculture holds considerable potential for unlocking suitable opportunity sets necessary for providing better incomes and sustainable livelihoods for smallscale farmers. This study examined factors that influence the intensity of market participation among smallholder farmers in Kenya. Data was obtained through a rapid rural appraisal and a household survey. A truncated regression model was applied in the analysis. Results showed that farmers in peri-urban areas sold higher proportions of their output than those in rural areas. Distance from farm to point of sale is a major constraint to the intensity of market participation. Better output price and market information are key incentives for increased sales. These findings demonstrate the urgent need to strengthen market information delivery systems, upgrade roads in both rural and peri-urban areas, encourage market integration initiatives, and establish more retail outlets with improved market facilities in the remote rural villages in order to promote production and trade in high value commodities by rural farmers.

Incidence, Types, Risk Factors, and Outcome of Stroke in a Developing Country The Trivandrum Stroke Registry

Abstract: Background and Purpose— Despite increasing burden of stroke in developing countries, population-based data are rare. Through the Trivandrum Stroke Registry, we intend to assess incidence, types, risk factors, and outcome of stroke among urban and rural dwellers of a South Indian community. Methods— We ascertained all first-ever strokes occurring among 741 000 urban and 185 000 rural inhabitants of Trivandrum, Kerala. In addition to Steps 1 and 2 of World Health Organization STEPS Stroke Manual, we used multiple supplementary methods to maximize ascertainment of nonfatal and nonhospitalized fatal stroke events in the community. Results— During a 6-month period, 541 strokes were registered, 431 in the urban and 110 in the rural communities. Stroke occurred at a median age of 67 years; only 3.8% of patients were aged ≤40 years. Adjusted annual incidence rates per 100 000 were 135 (95% confidence interval 123 to 146) for total, 135 (122–148) for urban, and 138 (112–164) for rural populations, and 74.8 (66.3 t...

Rurality, Institutional Disadvantage, and Achievement/Attainment*

Abstract: Students living in rural areas of the United States exhibit lower levels of educational achievement and a higher likelihood of dropping out of high school than do their nonrural counterparts. In this paper we extend the literature by offering a framework in which resources influencing achievement/attainment are viewed as embedded in, and varying across, rural and nonrural places because of differences in structures of local opportunity. We draw from the National Educational Longitudinal Survey and the Common Core of Data, and employ hierarchical linear and hierarchical logistic modeling techniques to test our ideas. Rural adolescents are disadvantaged in regard to those family and school resources which are conducive to educational success. These resources translate into important educational investments at both family and school levels, and explain rural deficits in both attainment and standardized achievement. We discuss the implications of our findings for analyses of rural deprivation and inequality specifically, and for educational processes and the spatial patterning of stratification in general.

Women workers and perceptions of the National Rural Employment Guarantee Act in India

Abstract: The National Rural Employment Guarantee Act, which entitles rural households to 100 days of casual employment on public works at the statutory minimum wage, contains special provisions to ensure full participation of women. This paper, based on fieldwork in six states in 2008, examines the socio-economic consequences of the NREGA for women workers. In spite of the drawbacks in the implementation of the legislation, significant benefits have already started accruing to women through better access to local employment, at minimum wages, with relatively decent and safe work conditions. The paper also discusses barriers to women’s participation.

Community-acquired bacteremia among children admitted to a rural hospital in Mozambique.

Abstract: Background:Although community-acquired bacteremia is an important cause of childhood mortality in Africa, recognition of disease burden and potential impact of bacterial vaccines is limited.Methods:Blood cultures for bacterial pathogens were conducted systematically among children <15 years of age a

Bypassing primary care facilities for childbirth: a population-based study in rural Tanzania

Abstract: In an effort to reduce maternal mortality, developing countries have been investing in village-level primary care facilities to bring skilled delivery services closer to women. We explored the extent to which women in rural western Tanzania bypass their nearest primary care facilities to deliver at more distant health facilities, using a population-representative survey of households (N = 1204). Using a standardized instrument, we asked women who had a delivery within 5 years about the place of their most recent delivery. Information on all functioning health facilities in the area were obtained from the district health office. Women who delivered in a health facility that was not the nearest available facility were considered bypassers. Forty-four per cent (186/423) of women who delivered in a health facility bypassed their nearest facility. In adjusted analysis, women who bypassed were more likely than women who did not bypass to be 35 or older (OR 2.5, P

Conservation Payments, Liquidity Constraints, and Off-Farm Labor: Impact of the Grain-for-Green Program on Rural Households in China

Abstract: This study evaluates the labor response of rural households participating in the Grain for Green program in China, the largest payments for ecosystem services program in the developing world. Using a panel data set that we designed and implemented, we find that the participating households are increasingly shifting their labor endowment from on-farm work to the off-farm labor market. However, the effects vary depending on the initial level of human and physical capital. The results support the view that one reason why the participants are more likely to find off-farm employment is because the program is relaxing households’ liquidity constraints.

Hypertension prevalence, awareness, treatment, and control in mozambique: urban/rural gap during epidemiological transition.

Abstract: The prediction of cardiovascular risk profile trends in low-income countries and timely action to modulate their transitions are among the greatest global health challenges. In 2005 we evaluated a nationally representative sample of the Mozambican population (n=3323; 25 to 64 years old) following the Stepwise Approach to Chronic Disease Risk Factor Surveillance. Prevalence of hypertension (systolic blood pressure > or =140 mm Hg and/or diastolic blood pressure > or =90 mm Hg and/or antihypertensive drug therapy), awareness (having been informed of the hypertensive status by a health professional in the previous year), treatment among the aware (use of antihypertensive medication in the previous fortnight), and control among those treated (blood pressure <140/90 mm Hg) were 33.1% (women: 31.2%; men: 35.7%), 14.8% (women: 18.4%; men: 10.6%), 51.9% (women: 61.1%; men: 33.3%), and 39.9% (women: 42.9%; men: 28.7%), respectively. Urban/rural comparisons are presented as age- and education-adjusted odds ratios (ORs) and 95% CIs. Among women, hypertension (OR: 2.0; 95% CI: 1.2 to 3.0) and awareness (OR: 4.3; 95% CI: 1.9 to 9.5) were more frequent in urban areas. No urban/rural differences were observed in men (hypertension: OR: 1.3, 95% CI: 0.9 to 2.0; awareness: OR: 1.5, 95% CI: 0.5 to 4.7). Treatment prevalence was not significantly different across urban/rural settings (women: OR: 1.4, 95% CI: 0.5 to 4.4; men: OR: 0.3, 95% CI: 0.1 to 1.4). Control was less frequent in urban women (OR: 0.2; 95% CI: 0.0 to 1.0) and more frequent in urban men (OR: 78.1; 95% CI: 2.2 to 2716.6). Our results illustrate the changing paradigms of "diseases of affluence" and the dynamic character of epidemiological transition. The urban/rural differences across sexes support a trend toward smaller differences, emphasizing the need for strategies to improve prevention, correct diagnosis, and access to effective treatment.

Placing the Rural in Regional Development

Abstract: Ward N. and Brown D. L. Placing the rural in regional development, Regional Studies. Urban and regional development studies tend to focus on the urban as driving innovation and growth, with surrounding areas cast in a passive, residual role. As a result, rural and urban development debates are often conducted separately. This paper introduces a special issue on rural development. It sets out current rural development thinking in Organisation for Economic Co-operation and Development (OECD) countries, and explores two trends affecting the place of rural areas in regional development – the differentiation of ruralities in the context of global changes and the changing nature of travel and communications – or mobilities. It then introduces the papers in the special issue. Ward N. et Brown D. L. Introduire l'espace rural dans l'amenagement du territoire, Regional Studies. Les etudes de l'amenagement du territoire ont tendance a focaliser l'espace urbain comme moteur de l'innovation et de la croissance, tandis...