Health Care In Rural Communities Research Articles

It's all about relationships: Developing nurse-led primary health care in rural communities.

The role of nurses in leading the design and delivery of primary health care services to address health inequities is growing in prominence, specifically in rural Australia. However, limited evidence exists to inform nurse-led primary health care in this context. Based on a focus group with nursing executives and semi-structured interviews with registered nurses we describe nurse experiences of leading the design of a primary health care service in rural Australia and nurse transition to and practice in this service. Nurse experiences were analysed using reflexive thematic analysis. The study reveals the centrality of relational integration in service design and nurse acquisition of relational practice as it relates to nurse to care recipient and nurse to nurse relationships. Tensions between primary health care nurses and their peers, and resultant de-valuing of primary health care practice, are described. The acquisition of nurse professional agency draws attention to investments required to position nurses to lead and sustain care innovations external to hospital settings. The authors propose that relational approaches may provide nurses with the opportunity to reframe their leadership and service contributions towards community literate primary health care provision and provide a pathway to professional emancipation from constrained practice expectations.

Qualitative focus group study of interprofessional healthcare providers to inform the development of a virtual psychoeducational training program for the treatment of childhood interpersonal trauma

ABSTRACT The shortage of adequately trained healthcare providers (HCPs) able to treat adults who have experienced childhood interpersonal trauma (CIT) is a pressing concern. This study explored HCPs’ training needs for a trauma-focused psychoeducational group intervention and the potential barriers and facilitators to accessing such training. Three 1-hour focus group sessions were conducted with HCPs (n = 17) from two urban and one rural community healthcare organization serving diverse populations in Ontario, Canada, including under-housed people, women struggling with mental health and addiction, and LGBTQ+ populations. On average, participants had 2.4 years in their current role and 18.1 years of mental health field experience. Thematic analysis revealed key findings: a strong clinical need for trauma services, accessible training programs, and broadly applicable interventions relevant for diverse populations. Notably, participants emphasized the clinical advantages and increased accessibility of a virtual training programs focused on psychoeducational treatment interventions, particularly within community-based healthcare settings. This study highlights the potential of a virtual psychoeducational training programs for HCPs to address this critical gap in healthcare provision for individual with CIT. It also underscores the need to move beyond training program development and focus on implementation and sustainability of interventions in clinical practice.

Chikungunya virus infection and predisposing factors among febrile patients visiting rural community health care centres in Jos, Nigeria

Chikungunya virus infection and predisposing factors among febrile patients visiting rural community health care centres in Jos, Nigeria

Rural Health Disparities during the COVID-19 Pandemic in the United States: A Scoping Review

COVID-19 has proven to be detrimental across the globe, most notably affecting the United States at an alarming rate compared to comparable countries. The pandemic has had multifactorial implications on the way communities in the United States prevent, prepare for, and address the virus; however, the impact of the pandemic on rural health is less well understood. Historically, rural communities have faced a unique set of challenges regarding accessing and receiving adequate healthcare, addressing chronic illness, and eliminating health disparities closely associated with the population’s socioeconomic status; the pandemic has exacerbated these challenges. The objective of the scoping review was to review peer-reviewed literature and identify gaps to evaluate the effect of the COVID-19 pandemic on rural populations both at the individual and community level. Articles for review were included if published between the 1st of January 1998 and to the 30th of December 2022. Keys words and phrases such as “COVID-19”, “Rural”, “Preventative Measures”, “heart disease”, “Diabetes”, “Substance Use”, “Access to Healthcare”, “Telehealth”, “Mental Health” and “Vaccines”. Articles that did not match and/or were published outside of history range were excluded. Databases utilized to generate results included PubMed, Web of Science, Scopus, USDA, Economic Research Service, Johns Hopkins University Center for system Science and Engineering, U.S. Department of Commerce, Bureau of Census, Current Population Survey, and annual American Community Survey estimates. Seventy-six articles or resources were generated between July 2022 and February 2023 and deemed appropriate for reference in this review. Pertinent results and findings were thoroughly discussed within the paper alongside figures. Limitations of evidence within this review were due to a lack of studies conducted on the impact of COVID- 19 in rural America specifically. Key findings were that rural health disparities increased both at the individual and system-wide levels as a direct result of the pandemic. The lack of infectious disease specialists, access to larger medical centers with substantial numbers of ICU beds and ventilators, and an overall lack of preparedness overwhelmed rural communities. Although comorbidities such as diabetes and heart disease were associated with poorer health outcomes for a multitude of reasons, the lack of clinic and physician availability for routine care during the pandemic further exacerbated the clinical link from COVID-19 positivity to comorbidities. Important lessons include that health comorbidities, mental health, substance use, health literacy, access to healthcare, among others can serve as key indicators for evaluating healthcare in rural communities’ Future studies should seek to identify gaps in the availability of rural health resources that can improve the lives of millions of Americans now and during the next pandemic.

Iteration and Communication During the Development of a Smartphone Endoscope Adapter

A smartphone endoscope adapter was developed by students for Health PEI to reduce the impact of the limited access to healthcare in rural communities. The adapter allows doctors to connect their smartphones to endoscopes to record procedures, which can aid practitioners in remote diagnosis, record keeping, and follow-up appointments. This article contains a case study of the eight-month service-learning experience to offer insights from two students and their instructor in the second-year engineering design course. The design process, communication, and iteration are outlined in the case study. Throughout the experience, twelve CAD models and seven physical prototypes were developed, and the students continued to iterate and test the device after the academic year ended, demonstrating their devotion to the project. The involvement of the community partner influenced the quality of the design, the motivation of students, the timeline, and the number of iterations. Also, the students’ desire to positively impact a community by providing access to technology was a motivating factor throughout the project, which aligns with the intentions of a service-learning project. A discussion on the impact of reflection and iteration is offered and recommendations are provided for instructors, students, and community partners to optimize service-learning experiences.

The Impact of Telerehabilitation on Physical Therapy Services in Rural Communities

Telerehabilitation is a transformative approach to physical therapy, revolutionizing the accessibility of healthcare in rural communities through the strategic use of Telecommunications technology. This novel approach has the potential to significantly enhance the efficacy of healthcare delivery, particularly considering the critical challenges posed by geographical isolation and resource scarcity. This paper explores the multifaceted benefits of Telerehabilitation, including increased access to care and reduced costs, alongside the challenges of technological barriers and privacy considerations. It provides a comprehensive overview of Telerehabilitation’s impact on rural healthcare, emphasizing its capacity to optimize patient outcomes and proposing strategies for effective implementation. The findings of this study suggest that the use of technology to deliver telecare is a key means of delivering equitable healthcare to underserved populations, a promising way to improve access to rural physiotherapy services address the challenge of telehealth resources, and promote the long-term sustainability of rural Telerehabilitation practices.

Abstract TP266: Utilization of Survey, Focus Group, and Referral Data to Plan a Targeted Intervention for Rural Stroke Disparities, Prevention, and Care Access

Methods: This project was a collaborative partnership between a healthcare organization, academic institute, and the local Faith Health Network. A 34-question survey (n=54 respondents) collected data on rural community knowledge of stroke risk factors, symptoms, and prevention. Three focus groups (n=40 total participants) were conducted to better understand experiences with stroke and obstacles to accessing wellness and healthcare in rural communities. The focus group questions centered on barriers, stroke impact, and solutions. Thematic summaries were aligned with stroke referral heat maps and demographics to develop a targeted plan for intervention. Results: Survey respondents reported gaps in awareness of stroke risk factors, stroke identification, and emergency response. Lack of motivation, followed by lack of time or energy, stress, lack of access to healthy foods, and community of support were barriers to healthy living. Cost, followed by transportation, access to medications, time, lack of insurance, and language differences were barriers to accessing medical care. Thematic analysis of focus group discussions was conducted for the three initial topics of barriers, stroke impact, and solutions. Dialogue on barriers revealed themes of lifestyle, access, and advocacy. Themes within stroke impact included mental health, access, and advocacy. For solutions, themes emerged as health education, lifestyle, access, and advocacy. Each theme had additional subthemes and direct participant quotes. Survey responses, focus group themes, and referral demographics were synthesized to form a plan to impact stroke prevention and care in these rural areas. Conclusion: A multi-faceted, targeted approach is necessary to increase rural stroke awareness, address disparities in care, and decrease barriers to healthy living and care access.

Addressing health challenges in rural Japan: a thematic analysis of social isolation and community solutions

BackgroundThe establishment of sustainable connections between medical professionals and rural citizens is pivotal for effective community healthcare. Our study focuses on understanding and resolving health problems arising from social isolation, a critical barrier to achieving this goal, especially in the context of the coronavirus disease 2019(COVID-19) pandemic's impact on community dynamics respecting social cognitive theory. This study investigates the link between social isolation and rural community healthcare. We aim to develop methods that improve interaction and collaboration between healthcare providers and rural communities, ultimately enhancing the region's healthcare system.MethodsEmploying thematic analysis based on social cognitive theory, we conducted semi-structured interviews with 57 community workers in rural communities. This qualitative approach enabled us to delve into the nuances of social isolation and its multifaceted impact on health and community well-being.ResultsOur analysis revealed four key themes: the impact of aging on social dynamics, shifts in community relationships, unique aspects of rural community networking, and the role of these networks in driving community health. Notably, we identified specific challenges, such as the erosion of intergenerational interactions and the hesitancy to seek support, exacerbated by social isolation and negatively impacting community health.ConclusionsOur study reveals the complex factors affecting rural community sustainability, particularly social isolation influenced by privacy concerns and changing social dynamics. Emphasizing the importance of social cognitive theory, it highlights the need for adaptable healthcare systems and strong community-medical collaborations. Future research should focus on developing culturally sensitive, practical strategies for enhancing these collaborations, especially involving physicians, to address rural communities' unique challenges.

Access to Healthcare in Rural Communities: A Bibliometric Analysis.

Access to healthcare is defined by being able to receive regular checkups, specialist appointments, immunizations, procedures, and surgeries within a reasonable timeframe and without restrictive barriers. The Web of Science database was used to collect 4,745 articles published relating to the keywords "rural", "access", and "healthcare". These articles then underwent bibliometric cataloging by country, journal, and keyword using VOSviewer 1.6.19. Between the years 2015 and 2022, the United States emerged as the predominant publisher in the field. From 2015 to 2019, the United States accounted for 47 percent of the total articles published. However, in the subsequent years of 2020 to 2022, there was a slight decline of 3 percent in the volume of U.S. publications. Australia secured the second position in terms of publications within the aforementioned timeframe of 2015 to 2022. England had the third most publications during the time between 2015 to 2022. The prevalence of articles containing the keyword "disparity" ranged between 7 percent and 12 percent throughout this period. Plus One exhibited prominence by contributing 5.025381 percent of all publications pertaining to access to rural medicine during the years 2015 to 2019 thereby establishing itself as the leading publisher in this domain. However, in 2020, the International Journal of Environment suppressed Plus One by publishing the highest number of articles related to rural healthcare. Subsequently, the BMC Health Services Research claimed the leading position in the years 2021 to 2022. An exploration of who is contributing to the discussion of access to healthcare in rural communities shows that the field and number of publications is growing, and that a focus on disparities is emerging, creating an environment surrounding rural health focused on researching equitable care.

Knowledge and utilization of Traditional Birth Attendants by Women of Reproductive Age in Alanamu Community Ilorin, Northern Nigeria

INTRODUCTION The lack of access to skilled healthcare services during childbirth remains a major factor for high maternal mortality in developing countries, as traditional birth attendants (TBAs) continue to serve as the predominant providers of maternal health care in rural communities. This study explores the knowledge and utilization of TBAs by women of reproductive age in a rural community of Ilorin, kwara state Nigeria. METHODSThis study is a descriptive cross-sectional study which was conducted using a well-structured interviewer based questionnaire, administered to 212 women of reproductive age-group to collect data on their knowledge and utilization of the services of TBAs. Analysis was done using Statistical Product and Service Solutions (SPSS) software version 20. RESULTS One hundred and fifty three respondents (72.2%) had background knowledge of TBAs, 91 (40.8%) had visited a TBA at least once to carry out their deliveries, of which 73 (80.2%) of them had successful deliveries, while 18 (19.8%) had complications during their deliveries, and 7 (7.7%) were referred to health care facilities for expect management. The study showed statistical significance between the level of education of respondents and their patronage of TBAs with a p-value of 0.041, and showed no statistical significance with their level of income. CONCLUSION This study showed adequate knowledge and utilization of the services of TBAs by members of the community. The practice of TBAs has continued to thrive in rural communities; integrating their services with the standard healthcare system as well as continuous sensitization of rural communities on their roles and limitations would go a long way in reducing maternal morbidity and mortality associated with the use of poorly trained TBAs

173. Staphylococcus Aureus Bacteremia at a Community Hospital in the Southeastern United States June 2021-June 2022

Abstract Background Staphylococcus aureus bacteremia is a common condition with high risk for mortality. Recent COVID-19 infection may influence the incidence and outcome of S. aureus bacteremia. Methods We performed a retrospective chart review of individuals with Staphylococcus aureus bacteremia from June 2021-June 2022 in a rural community health care system in the Southeastern United States. Primary outcome was mortality—variables included methicillin resistance, persistent bacteremia, ID consult, history of injection drug use, cardiac imaging, and COVID-19 infection within the previous 90 days. Results 172 individuals experienced 188 episodes of Staphylococcus aureus bacteremia. 79 were MRSA, 99 were MSSA. 57 individuals were deceased within 6 months of the positive blood culture (33% mortality). 31 individuals had known injection drug use complicating their illness, endocarditis was confirmed in 18 (58%) of these individuals compared to 33 (19%) of the entire population. 116 individuals (67%) had an ID consult. This study occurred during the delta and omicron COVID-19 surges in the region – 18 episodes of S. aureus bacteremia occurred within 90 days of a positive COVID-19 test, and 10 (56%) of those individuals were deceased within 6 months of the positive blood culture. Conclusion S. aureus bacteremia carries a high risk for mortality. Endocarditis was confirmed more frequently in individuals with known injection drug use. Six month mortality in S. aureus bacteremia was higher when bacteremia occurred in the 90 days post COVID-19 infection. Disclosures All Authors: No reported disclosures

Development and evaluation of the Rural and Northern Community Focused Model of COPD Care (RaNCoM)

BackgroundThe prevalence of COPD continues to rise. To address the challenges to provide high quality COPD care in rural and northern communities, leaders in one rural and northern community in Western Canada sought to change the culture of COPD screening and care. Recognizing effective assessment, diagnosis, and treatment for patients with COPD are crucial to improve outcomes, a program was developed between 2012 and 2021 to enhance primary care for COPD patients.MethodsA process evaluation was undertaken to assess program development, implementation, mechanisms of impact, and context of COPD program. Qualitative thematic analysis of stakeholder interviews (n = 11) and a document review (n = 60; ~ 500 pages) of key clinic documents was conducted.ResultsWe describe five phases of the COPD program’s development (Survive; Reorganize and Stabilize; Assess and Respond; Build and Refine; and Sustain and Share), highlighting areas of innovation. Outreach and localizing resources improved access to the program. Acquiring secured physician compensation, capturing quality data, and improving patient and provider self-efficacy built the capacity of the system and stakeholders within it. Finally, relationships were forged through building an integrated facility, collaborative networking, and patient engagement. Key elements of program implementation included the resources (infrastructure, software, operational) required to ensure operation.ConclusionTeam-based care and service integration enhanced care capacity and the health network. Focused use of infrastructure and resources supported the people in the care system. Upholding a shared value of relationship is critical to deliver robust and sustainable rural healthcare. Quality improvement requires investment in rural community healthcare resources.

Examining the Growing Demand for Surgical Care in Rural Communities and Novel Approaches to Achieving a Sustainable Surgical Workforce: A Narrative Review.

Surgery continues to be an increasingly vital component of public health and aspect of patient care in rural communities. An anticipated shortage of surgeons within the next decade in the United States prompts a growing concern for increasing the delivery of essential surgical care to these populations. When considering the existing barriers to surgical healthcare in rural communities, there is a sense of urgency to identify innovative approaches that will promote a sustainable surgeon workforce.A narrative review was conducted to investigate the current state of access to essential surgical care in rural communities. Qualitative and quantitative data were collected to better understand the key issues in rural healthcare and to provide statistical data related to the status of the surgical workforce. With the anticipated shortage of surgeons in both rural and urban areas, this review highlights the importance of enacting immediate measures to address the concern. This review has accomplished the initial objectives of gaining a better understanding of the current state of access to surgical care in rural communities and utilizing this knowledge to provide recommendations to readily attain a sustainable number of rural surgeons. With each approach addressing ways to address the contributory issues to the surgeon shortage, this review reveals a new avenue of integrating valuable aspects from each approach, rather than relying on a single approach. In particular, enhancing the overall pipeline of medical training to attending status may prove to be more beneficial for achieving this goal. Ultimately, this may be accomplished by introducing additional rural surgical mentorship opportunities for medical students, developing a rural surgery fellowship, and incorporating a market-based response that will correspond to attractive incentives that help to retain a sustainable number of surgeons working in rural areas.

Effectiveness of Telepharmacy in Rural Communities in Africa: A Scoping Review.

Objectives: This review examined the effectiveness of telepharmacy in rural communities in Africa to identify the barriers that hinder its implementation and integration as well as highlight the gaps in the existing research on telepharmacy. Data Source: PubMed and Google Scholar search (2008-2023) was conducted using keywords related to telepharmacy, telemedicine, telehealth, and rural communities. Study Selection and Data Extraction: The inclusion criteria for the review include peer-reviewed articles published in English language and studies that focus on the implementation and evaluation of telepharmacy in rural communities. Data Synthesis: In all articles used, access to quality health care in rural communities has been a persistent challenge in Africa. Digital technologies such as telemedicine, telepharmacy, and artificial intelligence were reported to have emerged as promising solutions to improve health care access and outcomes in rural communities. Telepharmacy, in particular, has the potential to provide medication-related services to patients irrespective of one's location. However, the implementation of telepharmacy in Africa has been slow, and there are several barriers affecting its integration and adoption in rural communities that include access to technology, limited infrastructure, and regulatory challenges. Gaps and limitations in the existing research on telepharmacy in rural communities were highlighted from the articles. Conclusion: Telepharmacy can improve health care access and outcomes in rural communities by bridging the gap between pharmacists and patients. However, the lack of infrastructure, inadequate funding, and regulatory challenges pose significant barriers to its implementation. Future research should focus on addressing these challenges and exploring the potential of telepharmacy to improve health care in rural communities in Africa.

Assessing ethno-veterinary practices in Kashmir Himalayas: Traditional knowledge and its role in animal healthcare

This study was aimed at exploring the ethno-veterinary practices in the District of Kupwara in Jammu and Kashmir Union Territory of India, by examining the traditional knowledge and its application in animal healthcare. The study included qualitative methods, such as interviews with local farmers (n=100) and traditional healers, as well as observation of their practices from February to April 2023. The results revealed a rich knowledge base among the local community regarding the use of medicinal plants for treating a range of animal ailments. 32 plants of pharmaceutical value representing 23 families have been assessed, with the Asteraceae family receiving the greatest attention. Eighty-eight percent of these ethnoveterinary medicinal plant species were herbs. Leaves of these plants were used most often (27%), followed by the entire plant (21%), seeds (21%), roots and fruits (9%), bulbs (6%), and stems and rhizomes (3%). Glycine max (0.91) and Allium sativum (UVi = 0.89) had the highest UVi values, whereas Oryza sativa (0.51), Allium sativum (0.49), and Zea mays (0.43) were the most cited and most often mentioned therapeutic plant species. Traditional veterinary practices were found to be deeply embedded in the local culture and were passed down through generations of farmers and traditional healers. These practices are still widely used today, in combination with modern veterinary medicine, to provide comprehensive care to livestock in the region. This study highlights the importance of preserving and promoting ethno-veterinary knowledge and practices as a valuable resource for animal healthcare in rural communities.

Virtual Rural Trauma Team Development Course: Trying to Zoom in on a Solution.

The COVID-19 pandemic prevented centers from providing in-person interactive training programs such as the Rural Trauma Team Development Course. Adapting the course to a virtual platform is an option, yet little is known regarding the feasibility of using this format. This study aimed to evaluate the feasibility of providing a virtual rural trauma development course during COVID-19. This is a descriptive study of emergency medical technicians, nurses, emergency department technicians, and physicians from four rural community health care facilities and local emergency medical services who participated in a virtual Rural Trauma Team Development Course held in November 2021 which was transformed into a virtual platform using live remote interactive lectures, recorded case-based scenarios, and interactive virtual-based questions. The course was evaluated by the changes instituted at the centers based on program recommendations and a participant survey. A total of 41 participants were studied, of whom 31 (75%) returned the emailed postprogram survey. The majority (>75%) of respondents rated the activity as very good, with course objectives met. All four facilities instituted changes following the program, including enhancing policy and procedures, guidelines, advancing performance improvement triggers, and equipment acquisition. Individual-reported participant satisfaction was very high. The Rural Trauma Team Development Course can be provided virtually and is a feasible option for trauma centers to provide initial trauma management in the rural community in a safe pandemic-restrictive atmosphere.

Analysis of Spatial Distribution of Health Care Facilities and its Effects on Access to Primary Healthcare in Rural Communities in Kpandai District, Ghana

Despite collaborative efforts by the government and the private sector in the provision of health facilities in Ghana, a substantial proportion of communities in rural Ghana still have poor access to primary health care. Employing a case study research design, this study presents an overview of the geographic distribution of healthcare facilities in Kpandai District and access to primary health care. Focus group discussions and interviews were conducted with randomly selected households, opinion leaders, healthcare and in-charges of health facilities to ascertain their perception of accessibility to health services. Geographic Information System (GIS) (ArcMap) was used to model the spatial distribution of health facilities. Spatially, 139 communities representing 50.5% of the communities are not accessible health facilities per World Health Organization and Ghana Health Service Survive distance threshold to health centers and Community-based Health Planning and Services (CHPS), and hospitals, respectively. Ideally, this implies that the majority of the population have to travel for more than 5 km to access health care services. This study found that the poor spatial distribution of health facilities has negative implications on access to primary health care in the district. Poor conditions of roads were a major barrier to the household’s accessibility to district hospitals. In addition to this, the availability, affordability, adequacy and acceptability which are major determinants of access to primary health care delivery were found to be fairly good. These findings have implications for the realization of the United Nations’ health-related Sustainable Development Goals.

Understanding Provider Health Crisis Preparedness Levels at the Initiation of COVID-19 in West Virginia Medical Practices

Introduction Rural community healthcare providers and clinics face unique challenges when addressing public health emergencies. The novel 2019 coronavirus disease (COVID-19) has led to new challenges exacerbated by a lack of experience, resources, and support. In West Virginia (WV), the largely elderly and rural population is cause for significant concern to the healthcare community due to decreased access to healthcare and increased risk of complications from COVID-19. Methods At the dawning of the COVID-19 crisis, the WV Practice-Based Research Network evaluated rural healthcare providers' confidence and preparedness in public health emergencies. Results A total of 149 primary care providers (52% physicians and 47% certified registered nurse practitioners, physician's assistants, or registered nurses) anonymously responded to the survey. The majority of respondents (81%) indicated they had not previously experienced a public health emergency before 2020. Sixty-four percent felt they had access to timely information and identified organizational leadership and federal government as the top two trusted sources. Only 13% of respondents personally felt "very confident" in being adequately prepared for public health emergencies, while 30% felt their healthcare site is adequately prepared. Discussion The WV primary care perspective about public health emergencies has been elucidated during the pandemic, along with determining where healthcare workers get their information and their awareness of resources available to them.

Incentivizing community health workers for scaling up mental health care in rural communities in India: A critical look at principles that work.

Given the low availability of trained mental health professionals, there is evidence on task sharing where basic mental healthcare can be provided by trained community health workers (CHWs). A potential way to reduce the mental health care gap in rural and urban areas in India is to utilize the services of community health workers known as Accredited Social Health Activists (ASHAs). There is a paucity of literature that have evaluated incentivizing non-physician health workers (NPHWs) vis-à-vis maintaining a competent and motivated health workforce especially in the Asia and Pacific regions. The principles around what works and does not work in terms of a mix of incentive packages for CHWs, while providing for mental healthcare in rural areas have not been adequately evaluated. Moreover, performance-based incentives which are receiving increasing attention from health systems worldwide, though evidence on the effectiveness of these incentives in Pacific and Asian countries is limited. CHW programs that have shown to be effective rely on an interlinked incentive framework at the individual, community, and health system levels. Drawing learnings from the past eight years in implementing the SMART (systematic medical appraisal, referral and treatment) Mental Health Program in rural India, we critically examine some of the emerging principles in incentivizing ASHAs while scaling up mental healthcare in communities using a systems approach.

Feasibility issues impacting optimal levels of maternity care in rural communities: implementing the Rural Birth Index in British Columbia

IntroductionThe continued attrition of maternity services across rural communities in high resource countries demands a rigorous, systematic approach to determining population level need, including a clear understanding of feasibility issues that may constrain achieving and sustaining recommended levels of services. The Rural Birth Index (RBI) proposes a robust and objective methodology to determine such need along with attention to the feasibility of implementation.BackgroundPredictions of appropriate levels of maternity care in rural communities require consideration of the feasibility of implementation. Although previous work has focused on essential considerations that impact feasibility, there is little research documenting the barriers to implementation from the perspective of rural care providers and administrators.MethodsWe conducted in-depth, qualitative research interviews with rural community health care administrators and providers (n = 14) to understand the challenges of offering maternity care in 10 rural communities across British Columbia (BC).ResultsParticipants articulated three thematic challenges to providing maternity services in their communities: maintaining clinical skills and financial stability in the context of low procedural volume, recruitment and retention of care providers and challenges with patient transport.ConclusionsCurrent models of compensation for maternity care are inadequate and inflexible and underscore many of the challenges to implementing a level of care that is based on population need. Re-thinking provision of care as a social obligation to actualize our system commitment to equity instead of working to achieve economies of scale is the first step to use equitable care. Addressing remuneration will provide the groundwork for solving other barriers to sustainable care.