Rural Health Care Settings Research Articles

Implementation of a simulation free palliative Radiation Therapy pathway: An inter-professional collaborative project

The Western New South Wales Local Health District (WNSWLHD) has a significant footprint within the state of New South Wales (NSW). Due to the significant size of the WNSWLHD, patients residing in the local health district face many barriers to receiving Radiation Therapy. The inter-professional collaboration behind the successful implementation and evaluation of a simulation free pathway for palliative Radiation Therapy in WNSWLHD will be explored within this narrative. The process known in WNSWLHD as Medical Imaging Simulated Radiation Therapy (MISRT) removes the need for a computed tomography (CT) simulation and allows for palliative Radiation Therapy to be planned on previously acquired diagnostic CT imaging. The implementation of MISRT has required significant inter-professional collaboration. This also extends to inter-centre partnership, intra-district cooperation with Medical Imaging and inter-discipline teamwork amongst Radiation Oncologists, Radiation Oncology Medical Physicists, Radiation Oncology Nursing and Radiation Therapists. The impact and involvement of the inter-disciplinary teamwork will be explored. The methods of implementing MISRT will be outlined covering changes to standard workflow, educational requirements and inclusion criteria. The evaluation of the implementation will also be covered with two evaluation surveys being conducted. Inter-professional communication, education, teamwork and collaboration is highlighted to demonstrate improving access to quality care in a rural and regional healthcare setting whilst reducing known barriers to accessing Radiation Oncology.

Erector Spinae Plane Block for Providing Labor Analgesia in a Rural Health Care Setting in India: A Case Series.

The practice of labor analgesia is highly variable in India. Parturients are often prescribed mild opioids (tramadol and pethidine). Erector spinae plane blocks can provide widespread analgesia covering multiple dermatomes. After a process evaluation to introduce safe and effective labor analgesia mandated due to poor efficacy of the standard care, erector spinae plane analgesia was offered to nulliparous parturients. The procedure was performed under ultrasound guidance at the lumbar L4 level in 10 patients. Outcomes included pain scores. There was a major reduction in labor pain. Erector spinae plane blocks can be part of a sustainable and effective labor analgesia service.

AI APPLICATIONS IN SCREENING AND DIAGNOSIS OF DIABETIC RETINOPATHY IN RURAL SETTINGS

Diabetic retinopathy (DR) remains a significant cause of vision impairment and blindness, particularly in rural settings where access to specialized healthcare services is limited. The integration of artificial intelligence (AI) holds promise in revolutionizing the screening and diagnosis of DR, offering a scalable solution to bridge the gap in healthcare disparities. This systematic review synthesizes existing literature on AI applications tailored for screening and diagnosing diabetic retinopathy in rural areas. Through a comprehensive search across various databases, including PubMed, IEEE Xplore, and Google Scholar, a total of 88 studies meeting the inclusion criteria were identified. These studies encompassed a range of AI techniques, including deep learning algorithms, machine learning models, and image processing methods, deployed in diverse rural healthcare settings globally. The findings reveal that AI-based systems demonstrate high accuracy, sensitivity, and specificity in detecting diabetic retinopathy from fundus images, thereby enabling early identification and timely intervention. Moreover, the scalability and cost-effectiveness of these AI solutions make them particularly suitable for resource-constrained rural environments. However, several challenges persist, including the need for robust validation studies, integration with existing healthcare infrastructure, and addressing ethical and regulatory concerns. Additionally, considerations regarding data privacy, patient acceptance, and healthcare provider training are crucial for the successful implementation of AI-driven DR screening programs in rural settings. This systematic review underscores the transformative potential of AI technologies in improving access to diabetic retinopathy screening and diagnosis in rural areas. Future research should focus on addressing the identified challenges and optimizing AI systems to enhance their efficacy and accessibility in underserved communities.
 Keywords: AI, Rural, Diagnosis, Diabetic, Retinopathy, Rural, Review.

Enhanced Recovery After Surgery Orthopaedics Program in a Community-Based Health Care System.

Enhanced Recovery After Surgery programs are common among healthcare systems and various surgical disciplines. Although evidence supporting the physiological rationale of multiple nutrition, physical activity, and pain control strategies before, during, and after surgical procedures is accumulating, implementing such strategies may pose a substantial challenge. The purpose of this quality improvement initiative was to outline the development, workflow, and implementation of an Enhanced Recovery After Surgery program for same-day total joint replacement procedures in a rural healthcare setting. This was not just an academic exercise. Our leadership had a strong desire to support our patients by identifying ways to hasten their recovery so that they can return to their preferred activities.

A cross sectional study on serum homocysteine levels in women with unexplained infertility at rural hospital setup and its correlation with ovulation

This cross-sectional study aims to investigate the serum homocysteine levels in women diagnosed with unexplained infertility at a rural hospital setup and its correlation with ovulation patterns. Unexplained infertility is a challenging clinical entity, with a limited understanding of its underlying mechanisms in resource-constrained healthcare settings. The study will include women between 21 and 45 years of age, diagnosed with unexplained infertility, who have not received any prior fertility treatments. Data will be collected through blood samples to measure serum homocysteine levels, and ovulation assessments using hormonal analysis and ultrasound monitoring of the menstrual cycle. Descriptive statistics will summarize participants’ characteristics, while comparison tests will be employed to assess the association between serum homocysteine levels and unexplained infertility. Correlation analysis will explore the relationship between serum homocysteine levels and ovulation parameters. Furthermore, multiple regression analysis will identify independent associations between serum homocysteine levels and ovulation, controlling for potential confounding variables. This study aims to provide valuable insights into the role of serum homocysteine in unexplained infertility and its potential impact on ovulation patterns in women in a rural healthcare setup. The findings may contribute to understanding the pathophysiology of unexplained infertilities and pave the way for targeted therapeutic interventions. Ethical considerations will ensure participant privacy, and all data will be managed with the utmost confidentiality. The study’s results will be reported transparently, adhering to ethical guidelines, to offer evidence-based guidance for managing unexplained infertility in rural healthcare settings.

Closing the Last Mile Gap in Access to Multimodality Imaging in Rural Settings: Design of the Imaging Core of the Risk Underlying Rural Areas Longitudinal Study.

Achieving optimal cardiovascular health in rural populations can be challenging for several reasons including decreased access to care with limited availability of imaging modalities, specialist physicians, and other important health care team members. Therefore, innovative solutions are needed to optimize health care and address cardiovascular health disparities in rural areas. Mobile examination units can bring imaging technology to underserved or remote communities with limited access to health care services. Mobile examination units can be equipped with a wide array of assessment tools and multiple imaging modalities such as computed tomography scanning and echocardiography. The detailed structural assessment of cardiovascular and lung pathology, as well as the detection of extracardiac pathology afforded by computed tomography imaging combined with the functional and hemodynamic assessments acquired by echocardiography, yield deep phenotyping of heart and lung disease for populations historically underrepresented in epidemiological studies. Moreover, by bringing the mobile examination unit to local communities, innovative approaches are now possible including engagement with local professionals to perform these imaging assessments, thereby augmenting local expertise and experience. However, several challenges exist before mobile examination unit-based examinations can be effectively integrated into the rural health care setting including standardizing acquisition protocols, maintaining consistent image quality, and addressing ethical and privacy considerations. Herein, we discuss the potential importance of cardiac multimodality imaging to improve cardiovascular health in rural regions, outline the emerging experience in this field, highlight important current challenges, and offer solutions based on our experience in the RURAL (Risk Underlying Rural Areas Longitudinal) cohort study.

Early impacts of the Pennsylvania Rural Health Model on potentially avoidable utilization.

The Pennsylvania Rural Health Model (PARHM) is a novel alternative payment model for rural hospitals that aims to test whether hospital-based global budgets, coupled with delivery transformation plans, improve the quality of health care and health outcomes in rural communities. Eighteen hospitals joined PARHM in 3 cohorts between 2019 and 2021. This study assessed PARHM's impact on changes in potentially avoidable utilization (PAU)-a measure of admission rates policymakers explicitly targeted for improvement in PARHM. Using a difference-in-differences analysis and all-payer hospital discharge data for Pennsylvania hospitals from 2016 through 2022, we found no significant overall reduction in community-level PAU rates up to 4 years post-PARHM implementation, relative to changes in rural Pennsylvania communities whose hospitals did not join PARHM. However, heterogeneous treatment effects were observed across cohorts that joined PARHM in different years, and between critical access vs prospective payment system hospitals. These findings offer insight into how alternative payment models in rural health care settings may have heterogeneous impacts based on contextual factors and highlight the importance of accounting for these factors in proposed expansions of alternative payment models for rural health systems.

First-contact patients with a community mental health service in rural Greece: A 3-year prospective study of treatment attendance and its co-relations.

Treatment continuation is essential for the optimal management of patients with mental disorders in the community, but treatment and outcome are often undermined by the high rates of service disengagement and treatment non-adherence across all psychiatric diagnoses. The phenomenon may be even more relevant in rural settings. The aim of the present study was to explore attendance to treatment in first-contact patients in a community-based treatment setting in rural Greece and to explore the associations of treatment attendance with demographic and clinical factors. Data were collected prospectively over a 3-year period, with 1-year follow-up interval. All first-contact cases with the Mobile Mental Health Unit of the prefectures of Ioannina and Thesprotia (MMHU I-T), Northwest Greece were considered, but only clinical cases were processed. The sample size consisted of 446 patients, with a mean age 65.4 ± 18.8 years. The rate of 12-month attendance to mental health treatment was 13.5% (60 out of 446 patients). Treatment attendance was found to be correlated with younger age, the diagnosis of schizophrenia-spectrum disorder, and patients' referral by other psychiatric services. First examination over the year 2019 had been significantly inversely associated with treatment engagement. Rates of subsequent attendance after initial assessment in a rural community mental healthcare setting were rather low in the present study. Several variables that have been previously associated with service engagement were found to be related in this study too, whereas other were not. Research on treatment engagement in rural treatment settings should be ongoing to reveal all associated factors.

Survival after docetaxel for metastatic castration-resistant prostate cancer in a rural health care setting

Survival after docetaxel for metastatic castration-resistant prostate cancer in a rural health care setting

Implementing evidence-based practices in rural settings: a scoping review of theories, models, and frameworks.

Rural healthcare has unique characteristics that affect the dissemination and implementation of evidence-based interventions. Numerous theories, models, and frameworks have been developed to guide implementation of healthcare interventions, though not specific to rural healthcare. The present scoping review sought to identify the theories, models, and frameworks most frequently applied to rural health and propose an approach to rural health research that harnesses selected constructs from these theories, models, and frameworks. This resulting synthesis can serve as a guide to researchers, policy makers, and clinicians seeking to employ commonly used theories, models, and frameworks to rural health. We used the Scopus abstract indexing service to identify peer-reviewed literature citing one or more of theories, models, or frameworks used in dissemination and implementation research and including the word "rural" in the Title, Abstract, or Keywords. We screened the remaining titles and abstracts to ensure articles met additional inclusion criteria. We conducted a full review of the resulting 172 articles to ensure they identified one or more discrete theory, model, or framework applied to research or quality improvement projects. We extracted the theories, models, and frameworks and categorized these as process models, determinant frameworks, classic theories, or evaluation frameworks. We retained 61 articles of which 28 used RE-AIM, 11 used Community-Based Participatory Research (CBPR) framework, eight used the Consolidated Framework for Implementation Research (CFIR), and six used the integrated-Promoting Action on Research Implementation in Health Services (iPARIHS). Additional theories, models, and frameworks were cited in three or fewer reports in the literature. The 14 theories, models, and frameworks cited in the literature were categorized as seven process models, four determinant frameworks, one evaluation framework, and one classic theory. The RE-AIM framework was the most frequently cited framework in the rural health literature, followed by CBPR, CFIR, and iPARIHS. A notable advantage of RE-AIM in rural healthcare settings is the focus on reach as a specified outcome, given the challenges of engaging a geographically diffuse and often isolated population. We present a rationale for combining the strengths of these theories, models, and frameworks to guide a research agenda specific to rural healthcare research. https://osf.io/fn2cd/.

An Evaluation of the Efficacy of Flexible Nailing in the Management of Diaphyseal Forearm Fractures: A Prospective Study in Rural India's Healthcare Settings

Introduction: High-speed accidents and trauma are becoming increasingly common and often result in forearm fractures in developing countries and even rural populations are not immune to such injuries. To address this issue, there has been a growing trend towards using flexible intramedullary nailing systems, such as the Titanium Elastic Nailing System (TENS). Methodology: This prospective study conducted at PES Institute of Medical Sciences and Research, Kuppam India, between June 2019 and March 2023 after receiving institutional ethical approval, patients with diaphyseal fractures of the forearm were treated with TENS, after their consent and, then followed up at 1st, 3rd, and 6th months post-operatively using Daruwalla's Clinical criteria. Result: The study involved 300 patients, with a male predominance (60%) and most common age group of 11-20 years old (26.7%) involving right forearm (63.3%), at middle third (76.7%) with transverse (80%) and closed (86.7%) nature. The leading cause was road traffic accidents (50%). At the first month, 86.7% had fair outcomes according to Daruwalla's grading, with 40% showing excellent outcomes by the 6th month. Over time, the proportion of patients with good (46.7%) and excellent (40%) outcomes increased, while fair and poor outcomes decreased (13.3%, 0%) Conclusion: TENS has shown efficacy in treating forearm fractures. Positive trends in clinical grading were seen, with a majority of patients achieving fair to excellent outcomes by the 6th month post-operative follow-up. These results support TENS, even in rural settings with limited resources, as a viable alternative to plate osteosynthesis. Keywords: Intramedullary Nailing, Forearm Injury, Fracture

Exploring Facilitators and Barriers to Delayed Antibiotic Prescribing in Rural Northwest China: A Qualitative Study Using the Theoretical Domains Framework and Behavior Change Wheel.

Antimicrobial resistance, exacerbated by antibiotic misuse, poses a global threat. Though delayed antibiotic prescribing (DAP) can mitigate antibiotic overuse, its adoption in developing nations, such as China, is limited. This study probed barriers and facilitators to DAP in Xinjiang, characterized by extensive rural landscapes and primary care institutions (PCIs). Adopting a qualitative methodology, we conducted key informant interviews with thirty participants across six county hospitals in Xinjiang using VooV Meeting. Employing a two-stage sampling method targeting economically diverse areas, our interviews spanned physicians, pharmacists, patients, and caregivers. We organized the data according to the Theoretical Domains Framework (TDF) and the Behavior Change Wheel (BCW), spotlighting behavioral and policy elements impacting DAP. Our research included thirty interviewees. Twelve physicians contemplated delayed prescriptions, while five adult patients and six caregivers encountered recommendations for delayed antibiotic prescriptions. Six patients sought pharmacists' advice on antibiotic necessity. Prominent TDF domains were memory, attention, and beliefs about consequences. Critical intervention functions included education and environmental restructuring, while vital policy categories encompassed communication/marketing and guidelines. Countering antibiotic misuse and resistance in China necessitates overcoming barriers through strategic resource distribution, comprehensive education, rigorous training, and consistent monitoring, thereby promoting DAP adoption. The adoption of DAP in rural healthcare settings in China has the potential to significantly reduce antibiotic misuse, thereby mitigating the global threat of antimicrobial resistance.

Enhancing the Retention of Healthcare Workers in Rural Areas: A Systematic Review

Introduction: Rural areas globally face significant challenges in retaining healthcare workers, impacting the delivery of essential health services and exacerbating health disparities. This systematic review aimed to evaluate the effectiveness of various strategies implemented over the last 15 years to enhance healthcare worker retention in rural settings, with the goal of identifying evidence-based interventions that can inform policy and practice to improve rural healthcare delivery. Methods: The review focused exclusively on interventional studies and clinical trials published from 2007 to 2022. A comprehensive search of multiple databases, including PubMed, MEDLINE, Embase, CINAHL, and the Cochrane Library, was conducted using specific search terms related to healthcare worker retention in rural areas. Inclusion criteria targeted studies evaluating quantifiable outcomes of retention strategies, with exclusion criteria set to omit non-interventional studies, research focused on urban settings, and non-English publications. The study selection, data extraction, and quality assessment processes were rigorously conducted to ensure the reliability of the findings. Results: Twelve studies met the inclusion criteria, revealing a broad range of interventions from financial incentives and educational programs to supportive workplace interventions and community engagement strategies. Financial incentives demonstrated a notable positive impact on retention, with risk ratios ranging from 1.2 to 1.75, indicating a 20% to 75% increase in retention rates. Supportive workplace interventions also showed effectiveness, with a risk ratio of up to 1.4. However, the results for educational and community engagement strategies were more variable, suggesting the need for tailored approaches. Conclusions: The review highlights the effectiveness of targeted interventions in enhancing the retention of healthcare workers in rural areas, particularly financial incentives and supportive workplace interventions. These findings underscore the importance of implementing multifaceted, evidence-based strategies tailored to the unique challenges of rural healthcare settings to improve workforce stability and healthcare delivery.

The perceived benefits and effectiveness of patient feedback systems in strengthening patient-provider relationships in Rural Tanzania

IntroductionPatient feedback system (PFS) forms an important entry point for the medical personnel and healthcare administrators to identify healthcare service delivery gaps and develop responsive interventions. This may foster patient trust consequently increasing healthcare-seeking, engagement in decision, continuity, and satisfaction. However, research on the PFS in rural primary healthcare settings appears limited.ObjectiveThe paper examines the perceived role and effectiveness of PFS in improving therapeutic relationships building on the recent research on patient-provider relationships in rural Tanzania.MethodsThe paper examines the findings of qualitative descriptive research conducted in the Shinyanga Region which employed a human-centred design (HCD) approach to co-create an intervention package for improving nurse-client relationships between January and September 2022. The study used semi-structured interviews in Swahili to first explore drivers of poor provider-patient relationships with purposefully selected providers, patients, and administrators. The findings guided the co-designing of an intervention package in subsequent HCD steps. Interviews were concurrently translated and transcribed, then systematically coded to facilitate the development of themes using a deductive thematic analysis approach.ResultsPFS emerged as one of the key themes in the deductive analysis when examining factors shaping provider–client relationships. The PFS theme was characterized by three major subthemes, which included perceived benefits, availability and accessibility, and perceived effectiveness. The perceived benefits of PFS cited by most participants included: reducing patients’ confusion around the complaints process, promoting patients’ positivity towards providers and hospitals, and reducing tensions between patients and providers. Suggestion boxes (SBs) were the most frequently cited PFS, but there were widespread concerns and disagreements among participants about their accessibility and effectiveness. Despite the providers (nurses) and administrators describing SBs as widely available, they stated that they had not received feedback or complaints from patients for a very long time. In contrast, most patients stated that SBs were either unavailable or ineffective in many facilities, with concerns about non-user friendliness and lack of responsiveness as the main issues when discussing effectiveness.ConclusionDespite the many benefits of PFS in improving healthcare service quality, their availability, user-friendliness, and responsiveness still pose challenges. A call is made to providers, health administrators and researchers to prioritize the PFS as both a useful entry point to reducing tensions in therapeutic relationships and, a tool for improving patient service uptake, continuity of care and satisfaction.

A systematic and comprehensive review and investigation of intelligent IoT-based healthcare systems in rural societies and governments

Healthcare needs in rural areas differ significantly from those in urban areas. Addressing the healthcare challenges in rural communities is of paramount importance, as these regions often lack access to adequate healthcare facilities. Moreover, technological advancements, particularly in the realm of the Internet of Things (IoT), have brought about significant changes in the healthcare industry. IoT involves connecting real-world objects to digital devices, opening up various possibilities for improving healthcare delivery. One promising application of IoT is its use in monitoring the spread of diseases in remote villages through interconnected sensors and devices. Surprisingly, there has been a noticeable absence of comprehensive research on this topic. Therefore, the primary objective of this study is to conduct a thorough and systematic review of intelligent IoT-based healthcare systems in rural communities and their governance. The analysis covers research papers published until December 2022 to provide valuable insights for future researchers. The selected articles have been categorized into three main groups: monitoring, intelligent services, and body sensor networks. The findings indicate that IoT research has garnered significant attention within the healthcare community. Furthermore, the results illustrate the potential benefits of IoT for governments, especially in rural areas, in improving public health and strengthening economic ties. It is worth noting that establishing a robust security infrastructure is essential for implementing IoT effectively, given its innovative operational principles. In summary, this review enhances scholars' understanding of the current state of IoT research in rural healthcare settings while highlighting areas that warrant further investigation. Additionally, it keeps healthcare professionals informed about the latest advancements and applications of IoT in rural healthcare.

Effect of COVID-19 pandemic on utilization of maternal healthcare services in a rural area of Haryana - A record-based comparative study.

The COVID-19 pandemic posed a challenge for the public health system, as all the health facilities and manpower were diverted for the delivery of COVID-19-related services. This affected the provision of routine health services, including maternal healthcare services. There is a paucity of data from rural and primary healthcare settings, as the earlier studies were either modelling-based or from tertiary care centres. This record-based study was conducted in 12 subcentres in the district Faridabad of Haryana. Data of pregnant women registered during 1 April to 30 September in the years 2017-2020 were retrieved. The utilization of maternal healthcare services among women registered during 1 April 2020 to 30 September 2020 was compared with those registered in the same period during the preceding 3 years (2017-2019). There was a significant decline in utilization of maternal healthcare services. Services like minimum four antenatal visits declined from 67.8% to 48.3% (P < 0.0001), at least 100 iron-folic acid tablets (45.4-20.9%; P < 0.001), and examination at each visit (90.8-72.3%; P < 0.001). The proportion of pregnant women who received full antenatal care decreased from 26.0% to 10.7% (P < 0.001). There was a significant increase in delivery in private health facilities (40.9-49.9%) and delivery by caesarean section (21.6-27.3%; P = 0.002). COVID-19 pandemic had an adverse effect on utilization of maternal healthcare services. Effective planning and coordination between different levels of government health facilities and primary care providers, including family physicians, can ensure uninterrupted provision of essential services during similar emergencies in future.

Research translation mentoring for emerging clinician researchers in rural and regional health settings: a qualitative study

BackgroundBuilding clinician and organisation-level research translation capacity and capability is fundamental for increasing the implementation of research into health practice and policy and improving health outcomes. Research translation capacity and capability building is particularly crucial in rural and regional settings to address complex problems impacting these socially and economically disadvantaged communities. Programs to build clinicians’ research translation capability typically involve training and mentoring. Little is known about the features of and influences on mentorships in the context of training for emerging clinician-researchers working in rural and regional healthcare settings. Research translation mentorships were established as part of the Supporting Translation Research in Rural and Regional settings (STaRR) program developed and delivered in Victoria, Australia from 2020 to 2021. The study sought to address the following research questions: 1) What context-specific types of support do research translation mentors provide to emerging researchers?. 2) How does the mentoring element of a rural research translational training program influence research translation capacity and capability development in rural emerging researchers and mentors, if at all?. 3) How does the mentoring element of the program influence translation capacity and capability at the organisational and regional level, if at all?MethodsWe conducted a qualitative descriptive study. Interviews with individuals involved in the STaRR program took place approximately 12 months after the program and explored participants’ experiences of the mentored training. Interviews were undertaken via telephone, audio-recorded, and transcribed. Data were analysed using a team-based five-stage framework approach.ResultsParticipants included emerging researchers (n = 9), mentors (n = 5), and managers (n = 4), from five health services and two universities. We identified four themes in the interview data: (1) Mentors play an educative role; (2) Mentoring enhanced by a collaborative environment; (3) Organisational challenges can influence mentorships, and (4) Mentorships help develop research networks and collective research and translation capacity.ConclusionsMentorships contributed to the development of research translation capabilities. The capabilities were developed through mentors’ deepened understanding of the rural and regional healthcare contexts in which their emerging researchers worked, the broadening and strengthening of rural and regional research networks, and building and sharing research translation knowledge and skills.

MicroDoc: Developing a guide for managing infections in Zambian rural low-resource health settings

Abstract Lack of access to diagnostic tests and guidelines that are inappropriate for poorly resourced facilities can result in incorrect and excessive prescribing of antimicrobial therapy in rural healthcare settings. On Call Africa (OCA) and Virtual Doctors (VD) are two non-governmental organisations that work in healthcare in Zambia. Volunteers and staff from OCA and VD have collaborated with the Zambian Ministry of Health and local healthcare providers to design a guide to support decisions around management of infections specifically in rural primary healthcare settings in Zambia. Local staff were initially surveyed for their attitudes towards treatment of infections, the content they would like capacity building in, and preferred modes of learning. The team, comprising public health and infectious disease doctors and GPs from Ireland and the UK with experience working in Zambia, have created a guide called MicroDoc which encompasses workshops, PDFs, flowcharts and modules relating to management of infections and antimicrobial prescribing. All the content can be downloaded and accessed offline. The Zambian Standard Treatment Guidelines were consulted for antimicrobial choice, supplemented by NICE and WHO where necessary. Red flags for urgent hospital referral are also incorporated, as well as modules about risks of antimicrobial resistance. Early versions of the guide have been distributed to a range of facilities in Zambia's Southern Province, with promising feedback from healthcare providers. In collaboration with local partners and input from facility staff, MicroDoc will be finalised and rolled out to more health posts and health centres in the region, with a view to eventually expanding to other regions. The OCA team has been conducting clinical audits of prescribing practices in two rural health posts and it is hoped that the MicroDoc guide will contribute to improved antimicrobial stewardship as well as better outcomes for patients. Key messages • Management of infectious presentations is particularly challenging in rural low-resource primary healthcare settings in Sub-Saharan countries such as Zambia. • A team from On Call Africa and Virtual Doctors has created a guide called MicroDoc, in collaboration with Zambian health authorities, to support decision making in managing infections in primary care.

Palliative care in Ethiopia’s rural and regional health care settings: a qualitative study of enabling factors and implementation challenges

BackgroundPalliative care is limited in Ethiopia, particularly in rural areas, where more than 78% of the population live. Current initiatives and research are focused on urban settings and are primarily donor dependent. This study aims to explore the status of palliative care, enabling factors and implementation challenges in Ethiopia’s rural and regional health care settings.MethodsA qualitative regional case study was conducted with health professionals drawn from different health care settings, academic institutions and included health planners and practitioners. Focus groups were conducted with rural community members and face- to face- individual interviews were conducted with health professionals working in numerous roles as well as academic leaders.ResultsParticipants indicated that despite a few leaders being aware of the inclusion of palliative care in the Ethiopia national policies and guidelines, palliative care is not, integrated into the existing health care system. Other participants responded that palliative care is not well integrated into the undergraduate and postgraduate courses except for limited content in the diploma and a few postgraduate courses. Participants described the challenges for palliative care implementation as follows: many lacked awareness about palliative care; and chronically ill patients other than those with HIV received inadequate care, limited to physical care, some pain management, and psychosocial support rather than comprehensive palliative care. In addition, some participants perceived that palliative care was not within the remit of their service, so families and patients were forced to seek alternative or informal care, including from traditional healers.ConclusionsEnablers for the improvement of palliative care access in rural and regional health care were identified, including better integration of palliative care into the national health care plan and guidelines; palliative care content in university and college courses; and use of mobile phone technology to facilitate care. And policy makers and responsible stakeholders could consider the palliative care implementation in rural and regional health care settings through a combination of home, community and facility-based models.

POWERING RURAL HEALTHCARE WITH SUSTAINABLE ENERGY: A GLOBAL REVIEW OF SOLAR SOLUTIONS

Access to reliable healthcare and sustainable energy remains a global challenge, particularly in rural and underserved communities. This review paper explores the integration of solar energy solutions in rural healthcare settings, shedding light on the transformative impact of this innovative approach. This paper also explores the multifaceted benefits, challenges, and future directions of solar-powered healthcare through a comprehensive examination of the literature. Solar energy solutions in rural healthcare provide reliable power for medical equipment, extend operating hours, and improve lighting, leading to enhanced healthcare services and more accurate diagnoses. Moreover, solar-powered vaccine refrigeration ensures the potency and safety of vaccines, contributing to improved public health outcomes. Financial sustainability is bolstered as solar solutions reduce healthcare costs and offer financial independence to facilities. Environmental sustainability is achieved through reduced carbon footprints and responsible resource use. Beyond healthcare services, solar initiatives empower local communities by creating employment opportunities and enhancing resilience in emergencies. Challenges such as initial costs, maintenance, adverse weather conditions, scalability, and policy hurdles are addressed through innovative financing models, capacity building, climate-resilient solutions, standardized monitoring systems, advocacy, and technological advancements. As the world seeks to achieve universal healthcare and sustainable development, solar-powered healthcare exemplifies the potential of renewable energy to drive positive change. This review paper emphasizes that we can improve healthcare access, quality, and sustainability by harnessing the sun's energy, ultimately illuminating the path toward brighter, healthier, and more equitable rural communities.&#x0D; Keywords: Solar Energy, Rural Healthcare, Sustainable Energy, Healthcare Access Renewable Energy, Healthcare Quality, Financial Sustainability, Environmental Sustainability, Future Directions.