Rural Health Care Services Research Articles

An analysis offactors influencing technical efficiency ofhealth expenditures inChina.

China's primary healthcare (PHC) system, together with rural healthcare services, remains the Achilles' heel in the national healthcare system. Healthcare workers, specifically village doctors, are an integral part of the healthcare system. Using the two-stage data envelopment analysis (DEA) and Tobit regression analysis, this study aims to investigate the efficiency of healthcare expenditures on medical resources and services in China, as well as determine how different types of healthcare work influence efficiency. Compared with other types of healthcare workers, village doctors exerted a prominent impact on provincial and rural efficiency at all stages and played a key role in augmenting the efficiency of healthcare expenditures on health outcomes. Besides, township health centers (THCs) and village clinics (VCs) faced administrative overstaffing, mainly involving pharmacists, other nonmedical technologists, and health administrators, which adversely affected the efficiency of healthcare expenditures. This study suggests that the higher the proportion of these non-village doctor positions (e.g., pharmacists, health administrators, and nonmedical technologists) in THCs and VCs, the lower the efficiency of China's PHC system. Overall, the priority should be enhancing the training and remuneration of village doctors and other healthcare workers in rural areas to further enhance their performance and increase the overall efficiency of China's healthcare system.

Perception And Attitude Of Undergraduate Medical Students Towards Rural Health Services – A Cross Sectional Study

Introduction: Medical students are under immense pressure and competition to advance in their career. 65% of Indian population resides in rural area and their health care needs are to taken care of. Understanding perception and attitude of undergraduate medical students towards rural health service will help in better provision of rural healthcare services. Objectives: 1) To assess the perception and attitude of medical students towards rural health services 2) To understand the factors influencing willingness and unwillingness of medical students towards serving in rural areas Material and methods: A cross-sectional study was conducted among 600 students of first, second and final MBBS studying in a private medical college in Andhra Pradesh. A predesigned semi-structured, self-administered questionnaire was used for data collection and the data was analyzed in Epi Info 7 Results: A total of 467 completed questionnaires were returned with participation rate of 78% out of which 67.9% were females and 32.1% were males. 44.3% of the respondents had a family member working in rural area. 81.4% of respondents believed that rural services should be made compulsory for doctors. 79.9% of respondents expressed willingness to work in rural areas. The commonest reason for willingness to work in rural areas was to gain experience (62.2%) while the commonest reason for unwillingness to work in rural areas was limited infrastructure (57.5%).Conclusions: Rural health services can be improved by employing young medical graduates.

Rural community-centred co-planning for sustainable rural health systems.

Sustaining rural healthcare services is challenging because of numerous systemic factors. Rural communities can inform the design of sustainable rural health models; however, further evidence of effective co-design is needed to guide implementation. The study aim was to co-design a series of place-based and evidence-informed rural health models, to improve local health system sustainability. A rural region (categorised as Modified Monash Model 5) defined by three adjoining Shires in Central and Northwest Victoria, Australia. A health executive co-planning network led the co-design, with input and oversight from a broader cross-sector group. Healthcare professionals (n = 44) and consumers and carers (n = 21) participated in interviews, and an online survey was completed by healthcare professionals (n = 11) and consumers and carers (n = 7) to provide feedback on the preliminary results. Community-based participatory action research was applied incorporating co-design methods and systems thinking. Data were collected through qualitative interviews followed by an online feedback survey. Mixed method data analysis (QUAL-quant) was conducted with qualitative directed content analysis of interview transcripts and quantitative descriptive analyses of survey responses to aid prioritisation. Healthcare priorities, strengths and challenges, and proposed rural health models are described. A rural health system sustainability strategy was developed with three integrated pillars: 1. Workforce strengthening, 2. Integrated health services and 3. Innovative models of care. Community-centred co-design with rural health stakeholders was effective for generating locally tailored ideas and potential health models that emulate community strengths and resources, and provide a foundation for further planning, implementation and evaluation.

Strengthening rural healthcare outcomes through digital health: qualitative multi-site case study

BackgroundRural populations experience ongoing health inequities with disproportionately high morbidity and mortality rates, but digital health in rural settings is poorly studied. Our research question was: How does digital health influence healthcare outcomes in rural settings? The objective was to identify how digital health capability enables the delivery of outcomes in rural settings according to the quadruple aims of healthcare: population health, patient experience, healthcare costs and provider experience.MethodsA multi-site qualitative case study was conducted with interviews and focus groups performed with healthcare staff (n = 93) employed in rural healthcare systems (n = 10) in the state of Queensland, Australia. An evidence-based digital health capability framework and the quadruple aims of healthcare served as classification frameworks for deductive analysis. Theoretical analysis identified the interrelationships among the capability dimensions, and relationships between the capability dimensions and healthcare outcomes.ResultsSeven highly interrelated digital health capability dimensions were identified from the interviews: governance and management; information technology capability; people, skills, and behaviours; interoperability; strategy; data analytics; consumer centred care. Outcomes were directly influenced by all dimensions except strategy. The interrelationship analysis demonstrated the influence of strategy on all digital health capability dimensions apart from data analytics, where the outcomes of data analytics shaped ongoing strategic efforts.ConclusionsThe study indicates the need to coordinate improvement efforts targeted across the dimensions of digital capability, optimise data analytics in rural settings to further support strategic decision making, and consider how consumer-centred care could influence digital health capability in rural healthcare services. Digital transformation in rural healthcare settings is likely to contribute to the achievement of the quadruple aims of healthcare if transformation efforts are supported by a clear, resourced digital strategy that is fit-for-purpose to the nuances of rural healthcare delivery.

Rural physician recruitment program in Thailand: factors associated with medical student enrollment and post-graduation intentions

Objectives: Thailand’s Collaborative Project to Increase Production of Rural Doctor (CPIRD) recruits students with a rural background and provides clinical year training in provincial teaching hospitals. We studied the main reasons for students attending this rural recruitment project and their intention to work in rural areas. Methods: In 2018, 2,870 4th–6th year medical students from 34 teaching hospitals under the CPIRD were sent a questionnaire surveying the following factors: their gender; year of study; size of the teaching hospital in which they were training; a domicile of origin and the province where they attended a high school; parent’s occupation; family income and main reasons for choosing to attend the CPIRD rural medical schools, as well as their attitudes towards rural job placement. Factors associated with a student's intention to work in rural areas were also examined, using multiple logistic regression. Results: 1,349 (47%) students responded. 809 (60%) were female, 914 (68%) had adequate family income, 519 (38%) had a domicile of origin in rural areas, 247 (18%) had either a mother or father being health professionals. The top three main reasons for choosing to attend the rural medical schools were: intention to return to work in their hometown(32%); student recruitment being less competitive (18.5%); and pre-specified job placement in their home districts (15%). Medical students who had a domicile of origin in rural areas, CPIRD recruitment track, and trained in medium and small-sized teaching hospitals had higher intention to work in rural areas, with Odds ratio of 1.51 (95% confidence interval (CI) 1.06-2.15), 4.39 (95%CI 3.02-6.39), 1.54 (95% CI 1.09-2.17) and1.74 (95% CI 1.14-2.65), respectively. 1,283 (95%) medical students had a favorable attitude towards rural placement after their graduation. Conclusion: Students´ rural background and training in provincial teaching hospitals may enhance their intention to start and remain working in rural healthcare services.

A Postcolonial Feminist Perspective on Traditional Birth Attendants and Management of Pregnancy Complications Among Indigenous Women in Rural Nigeria

The work of Traditional Birth Attendants (TBAs) in the Global South continues to be pivotal to the operations of rural healthcare services, especially as formal healthcare services often malfunction in rural communities, as in rural Nigeria, where TBAs preponderantly conduct deliveries among Indigenous women. This study examines TBAs’ management of delivery complications in rural Nigeria among Indigenous women using a sample of TBAs and TBAs’ service users. The study adopts a qualitative methodology involving focus groups of TBAs’ service users and interviews of TBAs to determine TBAs’ effectiveness in managing obstetric complications, considering their differentiation in terms of service competence. The study apprehends the phenomenon through a postcolonial feminist theoretical lens. The results show that TBAs have differential capabilities in the management of cases and their perception and interpretation of problems determined whether physical or metaphysical strategies were employed in their work. While some TBAs competently managed the presented cases, others invited either TBA colleagues or traditional resource persons to assist in such dire moments. Even though the TBAs—victims of patriarchy and colonial subjugation—continue to be marginalized and subjugated by male-dominated colonial and neocolonial power structures, they have significantly transformed their values to create a model for rural social work that provides social and emotional support to Indigenous women in rural spaces. The study therefore identifies a social policy and social work imperative for ideas sharing between different forms of Westernized healthcare practitioners and TBAs to engender the best health outcomes for rural Indigenous women.

Drivers of access to cardiovascular health care for rural Indigenous Peoples: a scoping review.

Māori (the Indigenous Peoples of Aotearoa New Zealand) are disproportionately represented in cardiovascular disease (CVD) prevalence, morbidity and mortality rates, and are less likely to receive evidence-based CVD health care. Rural Māori experience additional barriers to treatment access, poorer health outcomes and a greater burden of CVD risk factors compared to Non-Māori and Māori living in urban areas. Importantly, these inequities are similarly experienced by Indigenous Peoples in other nations impacted by colonisation. Given the scarcity of available literature, a systematic scoping review was conducted on literature exploring barriers and facilitators in accessing CVD health care for rural Māori and other Indigenous Peoples in nations impacted by colonisation. The review was underpinned by Kaupapa Māori Research methodology and was conducted utilising Arksey and O'Malley's (2005) methodological framework. A database search of MEDLINE (OVID), PubMed, Embase, SCOPUS, CINAHL Plus, Australia/New Zealand Reference Centre and NZResearch.org was used to explore empirical research literature. A grey literature search was also conducted. Literature based in any healthcare setting providing care to adults for CVD was included. Rural or remote Indigenous Peoples from New Zealand, Australia, Canada, and the US were included. Literature was included if it addressed cardiovascular conditions and reported barriers and facilitators to healthcare access in any care setting. A total of 363 articles were identified from the database search. An additional 19 reports were identified in the grey literature search. Following screening, 16 articles were included from the database search and 5 articles from the grey literature search. The literature was summarised using the Te Tiriti o Waitangi (Treaty of Waitangi) Framework principles: tino rangatiratanga (self-determination), partnership, active protection, equity and options. Themes elucidated from the literature were described as key drivers of CVD healthcare access for rural Indigenous Peoples. Key driver themes included input from rural Indigenous Peoples on healthcare service design and delivery, adequate resourcing and support of indigenous and rural healthcare services, addressing systemic racism and historical trauma, providing culturally appropriate health care, rural Indigenous Peoples' access to family and wellbeing support, rural Indigenous Peoples' differential access to the wider social determinants of health, effective interservice linkages and communication, and equity-driven and congruent data systems. The findings are consistent with other literature exploring access to health care for rural Indigenous Peoples. This review offers a novel approach to summarising literature by situating the themes within the context of equity and rights for Indigenous Peoples. This review also highlighted the need for further research in this area to be conducted in the context of Aotearoa New Zealand.

Assessment of Primary Laboratory Facilities for Rural Health Care Preparedness in Osmanabad District, India

Government of India has provided Indian Public Health Standards to improve rural health care services and health status, but still rural laboratory is a cause of concern. This study is performed to understand the laboratory facility-level gaps that need to be addressed to improve the public primary health centres (PHCs) present in rural areas. The laboratory assessment is performed for governance, financing, resources and services, and results are validated with the PHC laboratory performance. The current assessment shows critical gaps in the facilities regarding governance, services, resources and financing required for the laboratory services at the rural primary health care level. Governance and services need to be strengthened the most, followed with sustained availability of resources and financing. Poor health status in rural areas necessitates public health response based on health systems. Therefore, health system preparedness in the form of laboratory services is essential in primary health care facilities.

Integrating Spatial and Non-Spatial Dimensions to Evaluate Access to Rural Primary Healthcare Service: A Case Study of Songzi, China

Access to rural primary healthcare services has been broadly studied in the past few decades. However, most earlier studies that focused on examining access to rural healthcare services have conventionally treated spatial and non-spatial access as separate factors. This research aims to measure access to primary healthcare services in rural areas with the consideration of both spatial and non-spatial dimensions. The methodology of study is threefold. First, the Gaussian two-step floating catchment area (G-2SFCA) method was adopted to measure spatial access to primary healthcare services. Then, a questionnaire survey was conducted to investigate non-spatial access factors, including demographic condition, patient’s household income, healthcare insurance, education level, and patient satisfaction level with the services. After that, a comprehensive evaluation index system was employed to integrate both spatial and non-spatial access. The empirical study showed a remarkable disparity in spatial access to primary healthcare services. In total, 78 villages with 185,137 local people had a “low” or “very low” level of spatial access to both clinics and hospitals. For the non-spatial dimension, the results depicted that Songzi had significant inequalities in socioeconomic status (e.g., income, education) and patient satisfaction level for medical service. When integrating both spatial and non-spatial factors, the disadvantaged areas were mainly located in the eastern and middle parts. In addition, this study found that comprehensively considering the spatial and non-spatial access had a significant impact on results in healthcare access. In conclusion, this study calls for policymakers to pay more attention to primary healthcare inequalities within rural areas. The spatial and non-spatial access should be considered comprehensively when the long-term rural medical support policy is designated.

A qualitative study of leaders’ experiences of handling challenges and changes induced by the COVID-19 pandemic in rural nursing homes and homecare services

BackgroundThe COVID-19 pandemic had a major impact on healthcare services globally. In care settings such as small rural nursing homes and homes care services leaders were forced to confront, and adapt to, both new and ongoing challenges to protect their employees and patients and maintain their organization's operation. The aim of this study was to assess how healthcare leaders, working in rural primary healthcare services, led nursing homes and homecare services during the COVID-19 pandemic. Moreover, the study sought to explore how adaptations to changes and challenges induced by the pandemic were handled by leaders in rural nursing homes and homecare services.MethodsThe study employed a qualitative explorative design with individual interviews. Nine leaders at different levels, working in small, rural nursing homes and homecare services in western Norway were included.ResultsThree main themes emerged from the thematic analysis: “Navigating the role of a leader during the pandemic,” “The aftermath – management of COVID-19 in rural primary healthcare services”, and “The benefits and drawbacks of being small and rural during the pandemic.”ConclusionsLeaders in rural nursing homes and homecare services handled a multitude of immediate challenges and used a variety of adaptive strategies during the COVID-19 pandemic. While handling their own uncertainty and rapidly changing roles, they also coped with organizational challenges and adopted strategies to maintain good working conditions for their employees, as well as maintain sound healthcare management. The study results establish the intricate nature of resilient leadership, encompassing individual resilience, personality, governance, resource availability, and the capability to adjust to organizational and employee requirements, and how the rural context may affect these aspects.

Comparative Study on the Satisfaction of Healthcare Service Providers with the Synergistic Development of Rural Healthcare Systems in China: Medical Alliance Counties vs. Non-Medical Alliance Counties.

This study aimed to explore whether the establishment of county medical alliances can improve satisfaction with the vertical integration of healthcare systems among rural medical and healthcare service provider managers and service providers. Our study also sought to provide recommendations for the sustainable development of vertical integration in healthcare systems. A semi-structured interview with 30 healthcare service providers was employed in this research, and Nvivo software was utilized to analyze factors that influence vertical integration. From April to July 2021, a multi-stage random sampling method was used to select participants. The sample included two leading hospitals in medical consortia, 15 member units (healthcare service providers and medical staff), two county-level hospitals, and 15 township health centers/community healthcare service centers from non-medical consortia. Questionnaire surveys were conducted with these groups. Factor analysis was used to calculate satisfaction scores for healthcare service providers with the cross-institutional synergistic development of healthcare systems in both medical and non-medical consortia (denoted as M(IQR)). Propensity score matching was employed to reduce confounding factors between groups. The Mann-Whitney U test was used to compare satisfaction differences between groups. The overall satisfaction scores for lead-county hospital managers, member institution managers, medical staff at the lead-county hospital, and medical staff at member institutions were 4.80 (1.00), 4.17 (1.17), 4.00 (1.38), and 4.00 (1.12), respectively. Lead-county hospital managers' satisfaction with cross-institutional collaboration, development capacity enhancement, and structure and resource integration in the Medical Alliance group showed higher satisfaction than the Non-Medical Alliance. Similarly, lead-county hospital medical staff in the Medical Alliance group reported greater satisfaction with collaboration efforts, supportive environment, and development capacity enhancement. Notably, while the Medical Alliance group's satisfaction scores were higher, the differences between the two groups were not statistically significant for lead-county hospital managers and medical staff. The Medical Alliance group did show statistically significant differences in member institution managers' satisfaction with collaboration, development capacity enhancement, and structure and resource integration. Additionally, medical staff of member institutions in the Medical Alliance group reported statistically significant higher satisfaction with collaboration, supportive environment, development capacity enhancement, healthcare service integration, and human resource development. To facilitate the establishment of county medical alliances, managers of leading county-level hospitals should adopt a healthcare system integration strategy. This strategy involves evolution from being a member of a single institution to a coordinator of cross-institutional vertical integration of medical and healthcare services. Additionally, revamping remuneration and appraisal systems for members of county medical alliances is necessary. This will encourage cooperation among healthcare institutions within the three-tiered system and their medical staff, ultimately facilitating the provision of integrated services.

Bridging the Gap: A Comparative Analysis of Healthcare Quality Perceptions Between the Older People and Healthcare Providers.

In our study aimed at improving the healthcare system for the aging population, we compared healthcare quality evaluations between 96 older individuals and 30 healthcare providers in Split-Dalmatia County (Croatia). Using nonparametric analyses such as the Mann-Whitney and Wilcoxon tests on Likert scale questionnaire scores, we found most participants highlighted challenges such as healthcare affordability, long wait times, reliance on private care, poor public transportation, and insufficient rural healthcare services. Healthcare providers rated these quality indicators even more negatively. Both groups rated healthcare for dementia patients notably lower, while emergency response, treatment quality, and hospitalization ease were generally rated positively. The heightened awareness among healthcare providers raises the question: why is there a significant delay between recognizing these problems and implementing effective solutions to address them?

Health poverty alleviation in China from the perspective of historical institutionalism: policy changes and driving factors.

Health poverty alleviation is an effective tool for improving the living quality and developmental conditions of impoverished populations. Since 1978, China has been actively implementing health poverty alleviation projects, resulting in a more robust rural healthcare service network and increased convenience for the local population to access medical treatment. However, it is crucial to acknowledge that China still faces a complex situation with the simultaneous existence of multiple disease threats and the interweaving of various health influencing factors. Ongoing risks of emerging infectious diseases persist, and some previously controlled or eliminated infectious diseases are at risk of resurgence. The incidence of chronic diseases is on the rise and exhibits a trend toward affecting younger populations. Therefore, examining the successful experiences of China's health poverty alleviation over the past 40 years becomes a critically important issue. The study focuses on China's health poverty alleviation policies, employing historical institutionalism as a theoretical perspective to analyze the historical changes and evolutionary logic of health poverty alleviation policies. A historical institutionalist analytical framework for health poverty alleviation policies is constructed. The research findings reveal that China's health poverty alleviation policy has undergone three distinct periods since 1978: the initial phase (1978-2000), the exploratory phase (2000-2012), and the stable development phase (2013-present). At the macro level, the political, economic, and social contexts of different periods have influenced the evolution of health poverty alleviation policies. On the meso level, coordination effects and adaptive expectations have had an impact on China's health poverty alleviation policy. At the micro level, various actors, including the central government, local governments at different levels, social forces, and impoverished communities, interact during the evolution of health poverty alleviation policies. This paper summarizes the theoretical aspects of China's health poverty alleviation policy experience. The research conclusions, viewed through the lens of historical institutionalism, offer practical insights into the evolution of government policies. This provides directional guidance for enhancing health poverty alleviation projects.

Accessibility of Rural Healthcare Services for Women in Developing Countries: A Systematic Review

Accessibility of Rural Healthcare Services for Women in Developing Countries: A Systematic Review

Through the big top: An exploratory study of circus-based artistic knowledge translation in rural healthcare services, Québec, Canada.

The conventional methods and strategies used for knowledge translation (KT) in academic research often fall short in effectively reaching stakeholders, such as citizens, practitioners, and decision makers, especially concerning complex healthcare issues. In response, a growing number of scholars have been embracing arts-based knowledge translation (ABKT) to target a more diverse audience with varying backgrounds and expectations. Despite the increased interest, utilization, and literature on arts-based knowledge translation over the past three decades, no studies have directly compared traditional knowledge translation with arts-based knowledge translation methods. Thus, our study aimed to evaluate and compare the impact of an arts-based knowledge translation intervention-a circus show-with two traditional knowledge translation interventions (webinar and research report) in terms of awareness, accessibility, engagement, advocacy/policy influence, and enjoyment. To conduct this exploratory convergent mixed method study, we randomly assigned 162 participants to one of the three interventions. All three knowledge translation methods were used to translate the same research project: "Rural Emergency 360: Mobilization of decision-makers, healthcare professionals, patients, and citizens to improve healthcare and services in Quebec's rural emergency departments (UR360)." The findings revealed that the circus show outperformed the webinar and research report in terms of accessibility and enjoyment, while being equally effective in raising awareness, increasing engagement, and influencing advocacy/policy. Each intervention strategy demonstrates its unique array of strengths and weaknesses, with the circus show catering to a diverse audience, while the webinar and research report target more informed participants. These outcomes underscore the innovative and inclusive attributes of Arts-Based Knowledge translation, showcasing its capacity to facilitate researchers' engagement with a wider array of stakeholders across diverse contexts. As a relevant first step and a complementary asset, arts-based knowledge translation holds immense potential in increasing awareness and mobilization around crucial health issues.

Sustainable Tourism in the World Heritage Town Luang Prabang, Lao PDR

This paper discusses the role of local institutions in promoting sustainable tourism in Luang Prabang, Laos, with a focus on SDG 11: Sustainable Cities and Communities. The study uses qualitative research methods to gather from stakeholders and examines the synergies and trade-offs among various SDGs, the strategies for balancing different priorities, the importance of positive stakeholder relationships and consultations, and the future challenges facing the tourism industry in Luang Prabang. The socio-economic development plan for Luang Prabang Province prioritizes political stability, protection of cultural and natural heritage, sustainable agriculture, education and healthcare, hydroelectric power, and commercial and financial development. Despite challenges, Luang Prabang Province has made significant progress in implementing its socio-economic development plan over the past two years. However, several challenges still need to be addressed, including economic growth lacking rationality, income and development disparities between urban and rural regions, inadequate educational and healthcare services, preservation of cultural heritage and effective management of tourism resources, inadequate labor skills development and land management, budgetary constraints, deficiencies in policies and mechanisms for private investment, and the impact of social deprivation on progress and development. The province aims to address these challenges by enhancing political education and training, prioritizing rural development and employee welfare, eliminating poverty and uplifting living standards, seeking input from diverse ethnic backgrounds, addressing political resistance and limitations, and cultivating the province to attain prosperity and resilience.

Recruiting students to rural longitudinal integrated clerkships: a qualitative study of medical educationists’ experiences across continents

IntroductionMany health systems struggle in the provision of a sustainable and an efficient rural health workforce. There is evidence to suggest that Longitudinal Integrated Clerkships (LIC) placing student learners in rural community settings have positively impacted the provision of rural health care services The recruitment and engagement of students in rural LIC have significant challenges. This study explored best practice methods of recruiting and supporting the transition of medical students into rural LIC.MethodsThe study took place during the 2021 Consortium of Longitudinal Integrated Clerkships Conference, a virtual event hosted by Stellenbosch University, South Africa. Participants consisted of delegates attending the Personally Arranged Learning Session (PeArLS) themed ‘Secrets to success’. The session was recorded with the participants’ consent and the recordings were transcribed verbatim. Data was uploaded to NVivo software and coded and analyzed using constant comparative analysis. Salient themes and patterns were identified.ResultsThirteen attendees participated in the PeArLS representing a range of countries and institutions. Strategically marketing the LIC brand, improving the LIC program profile within institutions by bridging logistics, and the need to scaffold the transition to the rural LIC learning environment emerged as key themes for success. The attendees highlighted their experiences of using peer groups, early exposure to rural LIC sites, and student allocation strategies for promotion. Unique learning styles adopted in LIC models, student anxiety and the importance of fostering supportive relationships with stakeholders to support students in their transition to the LIC environment were discussed.DiscussionThis PeArLS highlighted successful systems and processes implemented in rural settings across different countries to recruit and manage the transition of medical students to rural LIC. The process proved to be a quick and efficient way to elicit rich information and may be of benefit to educationists seeking to establish similar programs or improve existing rural LIC.

A resilience perspective on healthcare personnels’ experiences of managing the COVID-19 pandemic: a qualitative study in Norwegian nursing homes and home care services

BackgroundThe COVID-19 pandemic led to new and unfamiliar changes in healthcare services globally. Most COVID-19 patients were cared for in primary healthcare services, demanding major adjustments and adaptations in care delivery. Research addressing how rural primary healthcare services coped during the COVID-19 pandemic, and the possible learning potential originating from the pandemic is limited. The aim of this study was to assess how primary healthcare personnel (PHCP) working in rural areas experienced the work situation during the COVID-19 outbreak, and how adaptations to changes induced by the pandemic were handled in nursing homes and home care services.MethodThis study was conducted as an explorative qualitative study. Four municipalities with affiliated nursing homes and homecare services were included in the study. We conducted focus group interviews with primary healthcare personnel working in rural nursing homes and homecare services in western Norway. The included PHCP were 16 nurses, 7 assistant nurses and 2 assistants. Interviews were audio recorded, transcribed and analyzed using thematic analysis.ResultsThe analysis resulted in three main themes and 16 subthemes describing PHCP experience of the work situation during the COVID-19 pandemic, and how they adapted to the changes and challenges induced by the pandemic. The main themes were: “PHCP demonstrated high adaptive capacity while being put to the test”, “Adapting to organizational measures, with varying degree of success” and “Safeguarding the patient’s safety and quality of care, but at certain costs”.ConclusionThis study demonstrated PHCPs major adaptive capacity in response to the challenges and changes induced by the covid-19 pandemic, while working under varying organizational conditions. Many adaptations where long-term solutions improving healthcare delivery, others where short-term solutions forced by inadequate management, governance, or a lack of leadership. Overall, the findings demonstrated the need for all parts of the system to engage in building resilient healthcare services. More research investigating this learning potential, particularly in primary healthcare services, is needed.

Rural Healthcare Services in India: Challenges and Remedies

Health is of paramount importance in an individual's life, and it has far-reaching implications for personal well-being, societal development, and overall quality of life. Good health is essential for enjoying a high quality of life. Healthy individuals are more productive in their personal and professional lives. Health is not merely the absence of illness but a state of physical, mental, and social well-being. It affects every aspect of an individual's life and has implications for communities and societies at large. Prioritizing health through preventive measures, healthcare access, and lifestyle choices is fundamental to personal and societal development. So that, present study focus on Rural and urban healthcare services, availability, infrastructure, technology, and affordability. Addressing the disparities between rural and urban healthcare is a significant challenge, and policymakers often focus on initiatives to improve rural healthcare access, such as telemedicine, mobile clinics, and incentives for healthcare professionals to work in rural areas.

Measuring Performance of Rural Mental Healthcare Services in Saudi Arabia.

Recently, the Saudi government has proposed several initiatives to promote mental health, including the national program named Wazen. The objective of this study was to observe the performance of mental hospitals using a balanced scorecard through this federal program. Secondary quantitative analysis was implemented utilizing the Wazen report program data in 2022. The report adopted a balanced scorecard (BSC) concept. The study focused on 19 mental health facilities (Eraddah Hospitals) in the Ministry of Health (MOH) regions. The MOH's annual statistical report for 2018 and 2022 was reviewed to explore more about beds, staff, and the number of new mental disorder cases. Data were analyzed using Microsoft Excel 365 and the Statistical Package for Social Sciences (SPSS Version 25) software. Mental health hospitals were classified into three categories. Most rural hospitals had lower performance in the yellow threshold value that might need improvement. The data shows that the mean of all hospital performance in some domains ranged, yielding 70% staff engagement and 77% continued educational activity, indicating unsatisfactory performance across public mental health services. The means score of access to care was 97.0% and 94.7%, marking the better mental health services provided. Between 2018 and 2022, there was a significant rise in the prevalence of mental disorders, as evidenced by the number of new patients and outpatients indicated by specific mental diseases, including conditions of psychological development (F80-F98). The high quality of mental healthcare is manifested by therapeutic ethos with a high degree of interaction between professional careers and service users. The former is enhanced by highly educated, competent, compassionate, self-aware, and specialized healthcare professionals in mental health. When assessing mental healthcare services, we recommend considering providers' and professionals' conditions for successful implementation in alignment with patient experience.