Services In Rural Communities Research Articles

Smart Age-Friendly Villages: Literature Review and Research Agenda

The European concept of Smart Villages encompasses the digital transformation of many activities to revitalise rural areas. Smart Village is based on modern technology such as sensors, robotics, blockchain, artificial intelligence, and machine learning, enabling a direct connection between consumer and producer, sharing machines and services. The application of smart technologies to support mobility, care for the elderly, e-health, tourism, decentralised energy empowers rural areas to develop a system of services that can lead to eco-social or even self-sufficient rural regions. Caring for the elderly is one of the most significant challenges for all of us and an excellent opportunity for the concept of Smart Silver Villages. Older adults want to stay longer independent in their rural community and live their prosperous lives, with minimum possible health risks. However, the literature related to the Smart Villages concept primarily covers energy infrastructure, digital infrastructure, agriculture, and much less the area of social services and care for the older population in rural areas. This paper aims to review the literature of care services in rural communities to encourage scientists to do more research work and develop sophisticated models for this nowadays and future important area of wellbeing for humans.

How Does Sustainable Rural Tourism Cause Rural Community Development?

Rural tourism has been developing vigorously, and rural community functions are becoming diversified in China. Therefore, this paper takes China as an example to explore how sustainable rural tourism affects rural community development in the long and short run over the period 1994–2020. Sustainable rural tourism can be measured using two indicators: total rural tourism revenue and number of rural tourists. Rural community development is measured by the number of rural community service institutions. Then, by incorporating other variables and using the autoregressive distributed lag bounds co-integration technique to perform an empirical analysis, we found that, whether in the long or short run, sustainable rural tourism always plays a positive and significant role in promoting rural community development. In particular, in the long run, rural infrastructure construction, rural ecological environment, agricultural fiscal expenditure, agricultural technological progress, and rural human capital are identified as the major forces behind rural community development. Meanwhile, in the short run, rural infrastructure construction, rural ecological environment, agricultural fiscal expenditure, agricultural technological progress, and rural human capital are also major drivers of rural community development. This paper contributes to the current literature by filling in the existing gaps in several aspects.

An assessment of nursing mothers\u2019 and young people\u2019s access to proprietary and patent medicine vendors\u2019 services in rural communities of south-eastern Nigeria: implication for review of national drug policy

BackgroundPatent and proprietary medicine vendors (PPMVs) form part of the informal healthcare system and are the first point of call for 75% of Nigerians who live in rural and underserved areas where there is limited access to healthcare services. This group of healthcare providers are located close to communities and are easily accessible to the people. This study seeks to determine how PPMVs influence access to medicines among nursing mothers and young people and how this progresses South Eastern Nigeria towards universal health coverage.MethodsA cross-sectional descriptive study was conducted using a purposive sampling technique. Two slightly different pre-tested and validated 5-point Likert scale questionnaires were used to survey the nursing mothers and young people (18–20 years old). The questionnaire for nursing mothers assessed the perception regarding PPMV services and community access to medicines used for the treatment of childhood infections. The questionnaire for young people assessed the services rendered by the PPMVs including family planning, and major enablers/barriers towards to access to medicine.ResultsA total of 159 nursing mothers and 148 youths participated in the study. Up to 60% of both population had a minimum of secondary school qualification. About 90% of the nursing mothers were married and 88% were nursing babies from 1 to 12 months. Results show that the PPMVs were the first point of call for healthcare needs among the respondents and they are easily accessible and sell affordable medicines. The nursing mothers frequently treat their children’s cough with antibiotics with a mean rating (MNR) of 4.7 out of 5 points and most source these antibiotics from PPMV shops. Up to 90% of the nursing mothers reported that the children got well after the treatment. The drugs mostly purchased by the youths from the PPMVs included antimalarials (95%), analgesics (87.7%) and antibiotics (81.3%). Only 25.5% of the respondents purchased family planning commodities. Most of the respondents sought health care from PPMVs with a MNR of 3.4. Patronage of PPMVs for and usage of family planning products by the respondents had MNRs ranging from 1.4 to 1.8.ConclusionPPMVs are bridging the gap in healthcare delivery in the rural and underserved areas. Training of this group of practitioners and appropriate monitoring will go a long way in ensuring that the services they render are efficient, effective and improve the health indices in a low-income setting.

Responding to rural allied health workforce challenges in the public health system: Evaluation of the Allied Health Rural Generalist Pathway pilot in western New South Wales.

The Allied Health Rural Generalist Pathway pilot aimed to improve consistent access to physiotherapy services in rural communities using the "grow own" workforce strategy and existing resources. A summative evaluation of the quality improvement project used to implement the Allied Health Rural Generalist Pathway was completed. A mixed method design was used and included focus groups and a framework analysis. The temporary redesign of specific workforce resources created "development" positions. A shared same-discipline supervisor resource supported five early-career physiotherapists, the participants. The project was undertaken in rural New South Wales in the public health system. The main outcome measures included a number of chronically vacant physiotherapy positions and stakeholder satisfaction. Targeted vacancies were filled, services sustained with minimal service gaps and mean retention rate of 2.9years. A statistically significant increase in service activity to patients in rural locations occurred as a result of the intervention (R-squared 29%, P<.05). Four out of five early career physiotherapists fulfilled terms of their contract and secured senior positions within the region. Whilst participants developed professionally, they did not complete the tertiary education component. The Allied Health Rural Generalist multi-factorial approach supported recruitment, retention and capacity building within the targeted discipline of the allied health workforce. Patient need was met. The rural pipeline capacity was developed. The pathway was complementary of existing NSW Health systems. Systemic change is needed to overcome inefficiencies experienced during implementation and to ensure sustainability. Further research to develop discipline-specific clinical training guidance through the stages of a rural allied health professionals' career may be helpful.

A qualitative study of perspectives on access to tuberculosis health services in Xigaze, China

BackgroundTuberculosis (TB) is a major global health threat and the leading infectious disease cause of death worldwide. Access to and retention in TB care remains a challenge for patients, particularly those living in rural and remote settings. This qualitative study explored barriers and facilitators to accessing and maintaining contact with TB care services in communities in Xigaze (Shigatse) prefecture, Xizang Autonomous Region (Tibet Autonomous Region), China from the perspective of persons impacted by TB.MethodsWe conduced in-depth interviews with 23 participants impacted by TB in four rural districts in Xigaze prefecture, Xizang Autonomous Region, China between April 2019 and November 2020. Interviews were conducted in Tibetan and Mandarin, transcribed in Mandarin and translated into English. Transcripts were checked against recordings by native Tibetan and Mandarin speakers. QSR NVivo12 software was used for framework analysis guided by an access to care conceptual framework by Levesque et al.ResultsOverall patients reported low awareness of and an indifferent attitude towards TB, although all reported understanding the need to adhere to treatment. Participants reported complex pathways to care, often requiring visits to multiple healthcare facilities. Some participants reported visiting traditional Tibetan medicine (TTM) providers. Participants reported various barriers to accessing care including challenges physically reaching care, out-of-pocket payments for tests, diagnostics and transport. Barriers to maintaining care included medication side effects and worry about treatment effectiveness. Enablers to accessing care identified included knowledge or past experience with TB, integrated models of TTM and western care, supportive village doctors who conducted home visits, free TB treatment and other subsidies, as well as having family support with care and social support as barriers and facilitators to maintaining treatment.ConclusionsWe identified barriers and facilitators to accessing services in rural communities in Xigaze from the perspective of persons impacted by TB. Challenges include complex pathways to care, travel distances, wait times and low awareness. Tuberculosis care in the region could be strengthened by ongoing culturally tailored educational campaigns to increase awareness, partnerships with TTM providers, providing comprehensive treatment subsidies and strengthening the role of family members in comprehensive TB care.Graphic abstract

Contributions of village animal health workers to foot-and-mouth disease control in Cambodia.

Local animal health services in rural communities in Cambodia are mainly provided by village animal health workers (VAHWs), although the participation and contribution of VAHWs to livestock disease prevention are uncertain. The participation of the VAHWs as identified by their 'dropout rate' was examined in a desktop review in December 2020 of the national data on VAHWs recorded between 2011 and 2020. The contribution and involvement of VAHWs in disease prevention programmes were examined in a survey conducted between February and March 2014, then analyzed in the context of other surveys of VAHW knowledge, attitudes and practices. The survey involved guided group discussion with VAHWs (n=198) from the two Cambodian provinces of Kampong Cham and Pursat. This study identified that VAHWs generated less than 22% of their annual household incomes from animal health services. Less than one-third had vaccinated livestock against foot-and-mouth disease (FMD), with none having vaccinated cattle every 6 months during the study period, and nearly half of the VAHWs having never vaccinated their own cattle against FMD. As no privately provided FMD vaccination services occurred in these communities, with all vaccines delivered through the government-subsidized programme, the findings confirmed that VAHWs only vaccinated animals against FMD when vaccines were made available by the Government. The desktop review found that the number of VAHWs in 2020 declined by more than 24% since 2017, and the proportion of female VAHWs was consistently low, with a mean of 8.26 (±1.019). These findings confirm findings from previous studies that identified considerable weaknesses in the VAHW system in Cambodia, particularly in contributing to FMD control. Cambodian animal health authorities require more effective policies to strengthen the current VAHW system, improving their services delivery; their retention as 'active'; their development of more sustainable roles with lower 'dropout' rates and the prolonged gender inequity. With the limited availability of government-subsidized FMD vaccination currently, extension programmes that engage VAHWs and farmers in seeking privately funded and delivered FMD vaccination that incorporates appropriate multivalent FMD serotype vaccines of high quality, delivered in small dose vials from a robust cold chain, is suggested. This strategy would assist VAHWs to contribute to the provision of private livestock vaccination services that are likely essential for sustainable FMD prevention and control in Cambodia.

An integrated review of the barriers and facilitators for accessing and engaging with mental health in a rural setting.

The review investigated the barriers and facilitators associated with assessing and engaging with mental health in a rural setting. The aim is to describe and synthesize the literature that examines the experiences of adults who access or attempt to access mental health services in rural settings. A systematic search from 2010 to 2020 was conducted using CINAHL, PsycINFO, Web of Science Core Collection, PubMed, Psychology and Behavioural Sciences Collection, Google Scholar, and Scopus. PRISMA protocols located 32 relevant papers from the overall 573 first selected. Braun and Clarke (Qualitative Research in Psychology, 3:77-101, 2006) thematic analysis methodology was applied to the data resulting in two themes: first theme identified help-seeking with subthemes of stigma and locality of health services. The second theme was connectedness, inclusive of subthemes of support systems and personal identity. The review identified gender-related perspectives concerning accessing mental health support, exposing the need for more research to examine the diverse social connections and support networks in rural communities. The findings suggest the need to further explore the impediments that reduce the likelihood of accessing mental health services in rural communities.

Community Banks' Ongoing Role in the U.S. Economy

In recent decades, both the number of community banks and their share of U.S. banking assets have steadily declined, raising questions about the future of community banking. In addition to competitive pressures from larger banking organizations, community banks face growing challenges from broader economic consolidation, changing demographics, and rapidly advancing financial technologies. Matt Hanauer, Brent Lytle, Chris Summers, and Stephanie Ziadeh explore the role of community banks in the U.S. economy, the challenges they face, and their outlook for the future. They find that despite their declining market share, community banks remain crucial financial services providers and are the predominant providers of banking services in rural communities across the country. In addition, they find that community banks are outsized providers of credit to agricultural and commercial borrowers, including during periods of economic stress. The authors argue that community banks will continue to play an important role in their local communities and the broader economy.

Rural Hospitals and Rural Health Challenges: An Analysis of Recent National Health Rankings and Hospital Data

Rural hospitals play a critical role in providing acute care and other essential medical services to rural populations. However, they are increasingly unable to meet the needs for health services in rural communities. This paper utilizes the data from the recent County Health Rankings and Definitive Healthcare to identify the health care challenges in rural counties and evaluate the operating and financial condition of rural hospitals in the context of the health care needs in rural areas and in comparison with urban hospitals. Our data analysis finds that while there are major health challenges and increased needs for hospital service in rural areas, the operating and financial performance of rural hospitals has been worsening in key aspects. We argue that continued policy support as well as health system innovations will be critically important to address the health care needs of rural America.

Post covid-19 agenda: Maximizing human resources for health towards universal health coverage in africa

Aim: To analyse options for maximising the capacity of human resources for health to achieve Universal Health Coverage (UHC) in Africa. Methods: Articles were retrieved from a Pubmed search and additional snowballing was conducted to provide other relevant sources. Further utilizations were made of Campbell's modified framework of the Human Resources for Health (HRH) and Universal Health Coverage with the WHO labour market dynamics framework for Universal Health Coverage. Four sub-themes viz improved HRH performance, Labour Market Factors, Rural Health Workers Retention Factors, and Information Technology Factors were analysed. Results: Labour market factors such as the dynamics of demand and supply of health workers determine the availability of health workers. Supportive supervision enables the health workers to improve in their performance and enhance optimised utilisation of available resources. This supervision can be more effective by complementing it with tools such as information technology that focus on improving the quality of health care, considering the growth in the number of internet and broadband users in the continent. Conclusion: Expanding the training opportunities for health workers and also increasing the funding to human resources for health are useful policy options to consider. Cost-effective approaches such as a focus on community health committees which stimulate the demand for health services in rural communities to tackle the disproportionate distribution of health workers should be considered in the context of the uncertain economic aftermath of the covid-19 outbreak. Sources of Funding Nil Acknowledgement We express profound gratitude to Prof Flavia Senkubuge for providing technical help and writing assistance during the preparation of this manuscript. We also appreciate Dr. Aborisade Adetayo for assisting with editing of the manuscript. Conflicts of Interest The authors declare no conflict of interest. Author Contributions MIA drafted the entire manuscript. ICE provided a critical review and made substantial contributions to the design of the manuscript.

The Essential Role of Family Physicians in Providing Cesarean Sections in Rural Communities.

Of family physicians who perform cesarean sections, more than half do so in rural communities and 38.6% provide cesarean sections in counties without any obstetrician/gynecologists. As policymakers in the United States struggle with a widening landscape of 'obstetrical deserts,' efforts to adequately train a family physician workforce prepared to provide cesarean sections could help maintain access to local obstetric services in rural communities and reduce perinatal morbidity and mortality.

Adopting a Pragmatic Approach to Rural Information Systems and Services Delivery for Sustainable Community Development in Nigeria

The availability and access to rural information systems and services in rural communities in Nigeria and elsewhere have been recognized as an essential public service utility that can rapidly cause unprecedented development of rural communities. This paper attempts to chronicle the state and condition of rural information systems and services provided in rural Nigeria and their connections to community development. The essence of the paper is to provoke discussion on the relevance of rural information services and to offer direction on the essentials of strengthening and enhancing information systems and services in rural communities. It was argued that library and information professionals especially librarians should assume new roles and strategies to strengthen and enhance rural information systems and services through a pragmatic approach. A pragmatic approach will allow every major key player to compliment ideas with actions. The need for government and other major players accept their responsibilities and also appreciate the invaluable place of building well-informed rural communities as a panacea to developmental challenges confronting Nigeria as a nation is advocated.

Implementing integrated community case management during conflict in Yemen.

BackgroundThe conflict in Yemen has devastated the health system, with only 51% of health facilities classified as fully functional and 19.7 million people lacking access to health care. To address the urgent need for primary health care services in rural communities, Save the Children launched an iCCM program in Lahj and Taiz Governorates. A qualitative study was conducted to document the challenges to iCCM service delivery and to aid in developing strategies for overcoming service delivery bottlenecks in conflict-affected rural areas.MethodsQualitative data were collected in Aden City, Lahj Governorate, and Taiz Governorate. Twenty-three IDIs and six FGDs were conducted with iCCM stakeholders at all levels.ResultsKey findings included: 1) Policy, coordination, and funding were challenged by the fact that iCCM was not integrated into the national health system and was implemented as a short-term emergency program. 2) Villages that received services from a CHW who was based in a different community experienced reduced access to services, especially during times of heightened conflict and insecurity, when CHWs could not travel. 3) Supervision, supply chain, and monitoring were all challenges that were exacerbated by difficulties in travel due to the conflict. Potential solutions to these included the use of mobile technology for supervision and data collection and pre-positioning of buffer stocks in locations closer to CHWs. 4) Travel was seen as the primary threat to the safety of CHWs and supervisors. Measures taken to reduce the risk included limiting travel during periods of heightened insecurity, safety training for CHWs, and use of mobile technology for communication.ConclusionsCHWs were able to provide iCCM services in a challenging and insecure context. The challenges in delivery of services were related to both a weak health system and the conflict. Several adaptations to service delivery to overcome the bottlenecks have been identified and should be considered for future community health programs. The closure of the program in Taiz after only 14 months of implementation is a stark illustration of the failure of the current model of short-term humanitarian funding to address long-term needs in protracted emergencies.

The role of internet of things to support health services in rural communities. A case study of Ghana and Sierra Leone

Incidence of preventable diseases in rural parts of Ghana and Sierra Leone is unacceptably high, which calls for innovative solutions to be directed towards addressing this issue. The intention of this research is to examine the potential contributions of internet of things technologies (IoT) towards health improvement in low-resourced settings with emphasis on transforming patients care and improving efficiency in rural Ghana and Sierra Leone. The research project investigates and identifies appropriate mechanisms by which IoTs technologies could be leveraged to mitigate health burdens in poor communities with emphasis on enhancing remote monitoring of patients health, increasing access to health information, training of healthcare professionals and reducing out-of-pocket health expenditure.

A Shared Electronic Health Record in a Rural Setting Maintains Hematological Cancer Services Remotely during the COVID-19 Pandemic

IntroductionThe COVID-19 pandemic has had drastic effects on healthcare provision across Australia and the world. Rural hematology patients who may rely on visiting medical officers from larger cities or long distance travel for reviews are particularly vulnerable to having their treatment affected by the recent changes to healthcare delivery given severe travel restrictions.The Griffith Hematology/Oncology Unit is based in Griffith Base Hospital, a regional hospital in New South Wales, Australia. It is serviced by consultant hematologists from St Vincent's Hospital at the capital city of Sydney, Australia, who visit fortnightly to run hematology outreach clinics and supervise chemotherapy delivery. Griffith is located 575km from Sydney and has an estimated population of over 26,000(1). The COVID-19 pandemic imposed significant travel restrictions, such that visiting haematologists have been unable to travel to continue in-person clinics since April 2020. This has led to the exclusive reliance on telemedicine (telehealth and telephone reviews) and remote chemotherapy delivery supervision. Having an electronic health record (EHR) containing all relevant patient information which is remotely accessible to treating physicians has been integral to the continuity of comprehensive specialist cancer care in this rural setting via telemedicine.MethodsThe previously reported shared EHR between Griffith and St Vincent's Hospital, Sydney was used to review the impact of COVID-19 on service delivery in Griffith(2). All rural patient information was accessible from the metropolitan location including comprehensive documentation of a patient's clinical findings, routine observations, diagnostic pathology and radiology results, and details of treatment at the Griffith site. Remote chemotherapy prescribing and telemedicine notes were documented through the EHR.ResultsThe number of new referrals, follow ups and total patients over the four months prior to the COVID-19 related changes (December 2019 to March 2020) and the four months following (April to July 2020) were compared. From April 2020 onwards, the Griffith clinic patients underwent reviews via telemedicine or telephone with no in-person reviews able to be conducted in Griffith due to the travel restrictions. The number of new referrals, follows up visits and the total number of patients seen following the change to telemedicine had all increased with no reduction in service delivery seen (Table 1). The total number of patient reviews was 167 visits over the four months prior to the change, which increased to 186 reviews after the travel restrictions were applied.Despite the travel restrictions, the hematology outreach services to Griffith were maintained through telemedicine reviews in a similar manner to the metropolitan service. Griffith rural hematology patients continue to undergo regular telemedicine reviews with monitoring of laboratory and imaging results through the EHR, receiving the same level of care as metropolitan patients.Chemotherapy is still able to be prescribed, adjusted and reviewed from the Sydney location for all patients. The total number of chemotherapy treatment cycles delivered in Griffith only slightly decreased despite the changes to service provision, which was attributed to normal variation in patients requiring treatment over 2020 (Table 2). 32 chemotherapy treatment cycles were delivered prior to the change compared to 26 cycles following, for the primary indications of lymphoma and myeloma.ConclusionIn recent months, the centralised EHR has proven critical in minimising clinical service disruptions caused by the COVID-19 pandemic by facilitating telemedicine links and remote patient management. We demonstrate how the shared EHR has been integral to the continuation of complex rural patient management during the COVID-19 pandemic due to the availability of remotely accessible patient information and chemotherapy prescribing. No significant change in clinical service activity was seen following the drastic travel restrictions due to the pandemic. Given these travel restrictions are expected to continue, it is encouraging that the shared EHR will allow rural Griffith patients continued access to appropriate specialist hematology care over the coming months. This work demonstrates how an EHR is fundamental to the sustainability of vital cancer services for rural communities.DisclosuresHamad:Abbvie: Honoraria; Novartis: Honoraria.

Rethinking access for minority segments in rural health: An LGBTQI+ perspective.

This paper nuances the notion of access when considering minority segments and their use of health care services in rural communities. It argues that access needs to be considered as both the availability and the perceived ability to use a service without fear of retribution. By taking such a stance, this paper addresses the inequality in LGBTQI+ care in rural communities. It claims equitable care can only be achieved if the appropriate environment is created where individuals can disclose their identity and seek appropriate treatment. Given the complexity surrounding rural communities, their prevailing culture and perceptions, as well as stigmas and poor health outcome, a multilevel approach is taken to identify implications. It is argued that to address the individual and systemic barriers to equitable health care, a human rights-centred approach to health needs to be adopted considering the individual, the community and the health system.

Staff connectedness in hub-and-spoke community service organisations working across geographically dispersed regional, rural and remote settings

Abstract Over the last few decades in Australia, as part of a larger economic reform agenda, state and federal governments have increasingly outsourced social services to non-government community service organisations. The community service sector has consequently grown significantly with individual organisations increasing staff and volunteer numbers to manage demand. This article reports on a mixed method study that explored staff communication and connectedness in two nonprofit rural community service organisations that manage their operations across vast geographical distances. Study findings suggest four main types of connectedness that can be enhanced to increase staff connectedness, top-down connectedness, team connectedness, cross-organisational connectedness and cultural connectedness. The study found that country organisations where geographical contexts require management across long distances need to create a more networked, values-explicit organisational architecture that encourages the development of staff connections between programs and levels.

A shared risk: volunteer shortages in Australia’s rural bushfire brigades

ABSTRACT In the latter part of 2019 and into 2020, Australia experienced an unprecedented bushfire season, with major bushfires burning more than 18 million hectares. The scale of the fires served to highlight Australia’s heavy reliance on rural volunteer firefighters, bringing into sharp focus the long-term issues that many volunteer bushfire brigades have faced with recruitment and retention. Against the backdrop of long-term government dis-investment into the provision of essential services in rural communities, and with rural volunteer participation at saturation, a deeper understanding of the factors that influence involvement in volunteer bushfire brigades is vital. This review paper examined the factors that have contributed to rural volunteer shortages, particularly in the Australian context. The research revealed that increased time and financial demands on volunteers hampered attraction and retention efforts. The time and financial costs for individuals to volunteer had risen as a result of increased centralised regulation of volunteer provided services. Given the reliance of Australia’s broader population, environment and economy on the work of volunteer firefighters, there is a critical need for new empirical research to investigate how organisational cultures, changes in attitudes to different forms of volunteering and changes in employment practices will impact rural volunteer bushfire services.

Incidence of postpartum and neonatal illnesses and utilization of healthcare services in rural communities in southern Ethiopia: A prospective cohort study.

Although improving postpartum and neonatal health is a key element of the Ethiopian health extension program, the burdens of postpartum and neonatal illnesses and healthcare-seeking in rural communities in Ethiopia are poorly characterized. Therefore, we aimed to assess the incidence and risk factors for these illnesses and measure the utilization of healthcare services. We conducted a prospective cohort study of 784 postpartum women and their 772 neonates in three randomly selected kebeles in rural southern Ethiopia. Eight home follow-up visits were conducted during the first 42 postpartum days, and six neonate follow-ups were conducted at the same home over the first 28 days of life. The Prentice, Williams, and Peterson’s total time Cox-type survival model was used for analysis. We recorded 31 episodes of postpartum illness per 100 women-weeks (95% confidence interval [CI]: 30%, 32%) and 48 episodes of neonatal illness per 100 neonate-weeks (95% CI: 46%, 50%). Anemia occurred in 19% of women (95% CI: 17%, 22%) and low birth weight (<2,500g) in 15% of neonates (95% CI: 13%, 18%). However, only 5% of postpartum women (95% CI: 4%, 7%) and 4% of neonate (95% CI: 3%, 5%) reported utilizing healthcare services. Walking over 60 minutes to access healthcare was a factor of both postpartum illnesses (AHR = 2.61; 95% CI: 1.98, 3.43) and neonatal illnesses (AHR = 2.66; 95% CI: 2.12, 3.35)). Birth weight ≥2500g was identified factor of neonatal illnesses (AHR = 0.39; 95% CI: 0.33, 0.46). Compared with younger mothers, older mothers with sick newborns (AHR = 1.22; 95% CI: 1.00, 1.50) or postpartum illnesses (AHR = 1.40; 95% CI: 1.03, 1.89) were more likely to seek healthcare. Reasons for not utilizing healthcare services included a belief that the illnesses were not serious or would resolve on their own, little confidence in the healthcare institutions, and the inability to afford the cost. The burden of postpartum and neonatal illnesses in rural communities of southern Ethiopia remains high. Unfortunately, few participants utilized healthcare services. We recommend strengthening the health system that enables identifying, managing, treating, and referring maternal and neonatal illnesses and provide reasonable healthcare at the community level.

Health professional perspectives of expanded practice in rural community pharmacy in Australia.

Expanded pharmacy service delivery for rural and remote Australia has potential to address the rural health disparity. Pharmacists practising to their full scope are recognised as being most beneficial in rural and regional communities, where access to health professionals (HPs) is not comparable to those in metropolitan areas. However, research on HP perspectives on expanded pharmacy practice is limited. This study aims to determine rural and remote HP (doctors, nurses, allied health and other HPs) perspectives of expanded services to be delivered through community pharmacy. Australian rural and remote HPs participated in a questionnaire survey which explored views on expanded pharmacy services in their local communities. Potential expanded pharmacy services were provided, and participants were asked to indicate what expanded pharmacy would benefit their local community and their level of support for the services. Analysis of the data included frequency analyses and one-way ANOVA tests with post hoc Tukey's HSD tests using IBM SPSS Statistic 25. Health professionals (N=121) from rural and remote locations participated. Sexually transmitted disease testing, vaccinations, diabetes and asthma management were the most frequently chosen services that HPs agreed would improve the health of people in their community. Doctors chose the least number of services (mean=1 services) compared with all other HPs (mean=>5 services). Sixty-eight per cent of participants agreed/strongly agreed that providing these additional services would improve health, with participants (73%) agreeing/strongly agreeing that they would support the implementation of these additional services, not otherwise available in their community. Comparing professional groups, doctors were only half as supportive of expanded pharmacy services, when compared with all other HPs. This study confirms the importance of a collaborative, local model to deliver expanded pharmacy services for rural communities. Health professionals were found to largely support expanding pharmacy practice, agreeing about the improved access to health care that would be provided for people living in rural and remote Australia.