Shortages In Rural Areas Research Articles

Exposing Nursing Students to Rural Healthcare Practice: Creating a Rural Simulation Experience

Background: Continued nursing shortages in rural areas have prompted the call for nursing education programs to prepare nursing students for rural practice. Including curricular content on rural health issues and placing students in rural health care facilities are methods used by some institutions. An additional strategy for preparation of students for rural practice is simulation. Method: This project involved the use of simulated health care facilities in rural communities, incorporating rural concepts into rural simulation scenarios and developing a twenty-two member family tree of rural residents for use in the simulation scenarios. Nursing students participate in rural simulation scenarios throughout the curriculum in lecture and lab settings. Conclusions: Using simulation with rural health experiences provides nursing students the opportunity to experience caring for patients from rural areas while increasing their understanding of health care issues, challenges associated with rural health care and opportunities for rural practice. DOI: http://dx.doi.org/10.14574/ojrnhc.v14i1.307 Keywords: Simulation, Rural, Scenarios, Nursing Education

Comparison of biogas development from households and medium and large-scale biogas plants in rural China

Abstract As a renewable energy source, biogas not only alleviates energy shortage in rural areas but also effectively reduces the environmental risk associated with agricultural waste management. This study presents a comprehensive overview of development of household bio-digesters and medium and large-scale biogas plants (MLBPs) in China, and discusses the advantages and disadvantages of both biogas systems in terms of environmental performance, role in agriculture, economic benefit, government support, energy efficiency, societal influence, and resident living mode. Both systems have their relative strengths and weaknesses. The operation and maintenance of household bio-digesters are easier, and their environmental and economic performances are superior compared to those of MLBPs. However, MLBPs have higher energy efficiency and better social effect. Thus, the choice of a biogas generation system depends on the local circumstances. Household bio-digesters are suitable for undeveloped regions where the rural residents live far apart from each other, whereas MLBPs are suitable for developed regions where people live close together. The government can play a positive role in preventing the negative impacts of rural social structural change, such as those of urban migration of adults, on household biogas development. Additionally, establishment of scientific and technological support and service systems is recommended for further development of biogas in rural China.

Theory and reality of integrated rice–duck farming in Asian developing countries: A systematic review and SWOT analysis

The integrated rice–duck farming (IRDF), in which ducks feed on insects and weeds in paddies and fertilise rice plants, has been a flagship of Asian sustainable-agriculture movements. Nevertheless, IRDF is not spreading rapidly enough to the extent to which it becomes a successful alternative agriculture. This paper undertakes a systematic review of a collection of experimental IRDF studies in order to derive an insight from the divergent experimental settings and findings. The paper also identifies the strengths and weaknesses of, opportunities for and threats to IRDF from the perspective of IRDF farmers, using the expert elicitation method. Five IRDF expert farmers from each of South Korea, Malaysia and Vietnam were interviewed for this purpose. The experimental studies and the expert farmers concurred that the most recognisable empirical strength of IRDF is the synergy of rice and ducks. It was found that the establishment of organic food certification systems provides an opportunity for IRDF to grow. On the other hand, labour-intensiveness was found the most challengeable weakness of IRDF. In parallel, labour shortage in rural areas was found as a serious threat to IRDF. It appears that the weaknesses and threats are more influential than the strengths and opportunities to shaping the adoption of IRDF. In order to make IRDF economically more feasible, the non-market ecological benefits of IRDF in mitigating land degradation and global warming can and should be internalised through appropriate policy instruments.

Meeting the water and sanitation MDGs: a study of human resource development requirements in Tanzania

In the Tanzanian water and sanitation (WatSan) sector, the human resource (HR) requirements for meeting the Millennium Development Goal (MDG) targets have so far been relatively unknown. This study was therefore conducted with a focus on determining HR requirements in the public sector and parastatal institutions, in the private sector (private consultancy companies, individual contractors, etc.), and in non-governmental organizations and community-based organizations active in the broader water, sanitation and hygiene (WASH) sector. The competences assessed were: design and construction of new infrastructure, operation and maintenance (O&M), community mobilization, sanitation, and hygiene promotion. The study found a greater HR shortage in rural areas than in urban areas. The smallest HR need is for social development professionals (estimated at 320 in the urban areas). In the water supply and sanitation sectors, the average number of water supply engineers that will be required to achieve MDGs is estimated at 3,864, compared to the sanitation sector, which will need 637 engineers. In terms of the demand for competences in the water supply sector, the highest need is for O&M professionals (7,589) and the lowest for mobilization professionals (447). The study recommends increasing the HR supply in the WatSan sector through the following measures: increasing support for training institutions offering relevant courses in WatSan; focusing on skills required for asset management and O&M; and giving specific attention to HR capacity development in small towns and rural areas.

International medical graduates mandated to practise in rural Australia are highly unsatisfied: Results from a national survey of doctors

ObjectivesRural communities worldwide are increasingly reliant on international medical graduates (IMGs) to provide health care access, with many countries utilising health policies which mandate IMGs to practise only in rural designated areas of (medical) workforce shortage for many years. The objective of this study is to analyse the satisfaction of IMGs in their current work location, particularly in relation to the effect of mandating IMGs to small rural communities. MethodsWe used data of 3502 general practitioners (GPs) from Wave 2 of the Medicine in Australia: Balancing Employment and Life (MABEL) longitudinal study of Australian doctors. The main outcome measures were the level of professional and non-professional satisfaction expressed by GPs with respect to various job and social aspects. ResultsWe found that non-professional satisfaction of mandated IMGs was significantly lower across all social aspects, whilst professional satisfaction was also significantly lower for most job aspects relating to their professional autonomy. In contrast, non-mandated IMGs were similarly satisfied compared to Australian trained GPs. ConclusionsMandated IMGs are currently filling a critical shortage in rural areas of Australia. However, long-term success of this policy is problematic unless outstanding issues affecting their significantly reduced professional and non-professional satisfaction can be addressed.

Korean, Chinese, or what? Identity transformations of Chosŏnjok (Korean Chinese) migrant brides in South Korea

Chosŏnjok migrant brides are Korean Chinese women who married South Korean men (hereafter Korean men). The number of Chosŏnjok migrant brides increased rapidly until recently due to the attempts of the central and local governments of Korea to resolve bride shortages in rural areas in the early 1990s and the Koreans' preference for ethnic Korean brides over non-Korean foreign brides. Currently there are more than 26,000 Chosŏnjok migrant brides in Korea. Due to the drastic changes to their post-migration lives in their ethnic homeland of Korea, most Chosŏnjok migrant brides experience changes in their ethno-national identity(ies). This paper investigates this process and the underlying reasons for these post-ethnic return migration identity changes. It also looks at the types of identity changes that occur through in-depth interviews with 22 Chosŏnjok migrant brides in Korea.

Factors relating to doctors' desire to change hospitals in Japan

This study seeks to investigate doctors' desire to change the hospital where they work to sustain higher quality care. Self-administered questionnaires were sent to doctors in Aichi Prefecture, Japan. Data were analyzed using univariate and logistic regression analysis and recursive partitioning. Factors related to doctors' desire to change hospitals, according to logistic regression, were interaction between working hours and satisfaction with the hospital, evaluation, local government hospitals versus private ones, small vs large hospitals, ophthalmology versus internal medicine, desire to continue working as a hospital doctor and age. Additionally, working hours were also found to be related, based on recursive partitioning. The response rate was low and sampling bias was observed--therefore results need careful interpretation. Also, because this was a cross-sectional study, causal relationships could not be identified. Desire to change hospitals, but not actual behavior, was measured. Efforts to prevent doctors from changing hospitals should include considering job satisfaction and workload, doctor evaluation methods, support for career progression and organizational management. As the hospital doctor shortage in rural areas becomes more serious, exploring doctors' desire to leave their current hospital is meaningful for Japanese hospital managers and hospitals worldwide aiming to provide sustainable and higher quality care.

Management of the impact on soil in Republic of Moldova: Problems and solutions

The great impact on soils in Republic of Moldova is represented by the non-ecological exploitation of agricultural land, non-sanitation of rural space, massive negligence of population and local authorities, surveillance and control authorities of land resources. The most common form of impact on soils is erosion. Very rapid increase of the surfaces affected by erosion is conditioned, in particular, by the non-compliance of environmental requirements to allocation and exploitation of agricultural land and by the actual inefficient management of land resources. In the last two decades, there has been a significant reduction of ecological laboratories for soil quality evaluation, conditioned by liquidation of district and regional centres of plant protection. The State Ecological Inspectorate, which has the exclusive function of ecological damage evaluation, has very modest financial and human resources. As a result, despite the frequent cases of infringement of soil and land protection, because of very low evaluation capacity, most environmental damage in this area are not established and subject to compensation, and most land beneficiaries ignore normative of land and soil use and protection. Due to financial shortages in rural areas apply minimum rates of fines, which do not reflect the real impact on the soil cover. The collected sums from the application of fines are significantly lower than the damage caused to the soils. Under the new Offences Code, it was introduced the penalty for burning stubble, substantially increasing the payment discharge and the amounts of fines for unauthorized land use and for destruction of soil fertile layer. However, there is no positive change in penalties for causing erosion, for falsifying and concealing information about the status of land. Most damage compensation actions are brought for burning stubble and for soil contamination, while compensation actions for damage caused by erosion and landslides are a major exception. Despite the existence of adequate methodology for evaluations of soil injury, their practical implementation is very superficially, what conditioned the illicit behaviour of land beneficiaries.

P1-287 Maternal mortality rate in Kurdistan Province Western Iran from 2002 to 2007; an epidemiologic survey

IntroductionNowadays 1500 mothers die due to complications of pregnancy and delivery in the world. This study is aimed to evaluation the frequency of maternal mortality rate and its associated causes...

Attracting and retaining doctors in rural Nepal

In Nepal, a number of private sector medical schools have opened recently; although sufficient numbers of doctors are graduating there continues to be a doctor shortage in rural areas. This article analysed the rural doctor shortage in Nepal and reviewed the international literature for strategies that may be suitable for use in Nepal. Original research articles, reviews, magazine articles and project reports dealing with Nepal and other developing countries during the period 1995 to 2010 were sourced via Google, Google Scholar and Pubmed. Full text access was obtained via WHO's HINARI database. The health workforce in Nepal is unevenly distributed resulting in doctor shortages in rural areas. The recent introduction of mandatory rural service for scholarship students was aimed to reduce the loss of medical graduates to developed nations. High tuition fees in private medical schools and low Government wages prevent recent graduates from taking up rural positions, and those who do face many challenges. Potential corrective strategies include community-based medical education, selecting rural-background medical students, and providing a partial or complete tuition fee waiver for medical students who commit to rural service. Traditional healers and paramedical staff can also be trained for and authorized to provide rural health care. A range of strategies developed elsewhere could be used in Nepal, especially community-oriented medical education that involves rural doctors in training medical students. The reimbursement of tuition fees, assistance with relocation, and provision of opportunities for academic and professional advancement for rural doctors should also be considered. Government investment in improving working conditions in rural Nepal would assist rural communities to attract and retain doctors.

Policy interventions that attract nurses to rural areas: a multicountry discrete choice experiment.

To evaluate the relative effectiveness of different policies in attracting nurses to rural areas in Kenya, South Africa and Thailand using data from a discrete choice experiment (DCE). A labelled DCE was designed to model the relative effectiveness of both financial and non-financial strategies designed to attract nurses to rural areas. Data were collected from over 300 graduating nursing students in each country. Mixed logit models were used for analysis and to predict the uptake of rural posts under different incentive combinations. Nurses' preferences for different human resource policy interventions varied significantly between the three countries. In Kenya and South Africa, better educational opportunities or rural allowances would be most effective in increasing the uptake of rural posts, while in Thailand better health insurance coverage would have the greatest impact. DCEs can be designed to help policy-makers choose more effective interventions to address staff shortages in rural areas. Intervention packages tailored to local conditions are more likely to be effective than standardized global approaches.

Transition of physician distribution (1980-2002) in Japan and factors predicting future rural practice

The geographic maldistribution of physicians (their concentration in urban areas and shortage in rural areas) has long been an important political issue in post-war Japan. The aim of this study was to evaluate long-term transition in the geographic distribution of physicians, and to reveal which rural physician characteristics predict their retention in rural areas after 22 years. A record-linkage study was conducted to extract a physician cohort by merging the 1980 and 2002 Physician Census in which all licensed physicians are legally required to register. Physician characteristics in 1980 that predicted rural practice in 2002 were identified. Data were used from the 93 077 physicians who were recorded in both 1980 and 2002 Physician Censuses. The number of physicians increased by 52% between 1980 and 2002. In both 1980 and 2002, the physician-to-population ratios in rural areas were approximately half that in urban areas, indicating that the physician maldistribution had not improved. In 1980, 82 414 (88.5%) physicians worked in urban areas and 10 663 (11.5%) worked in rural areas. In 2002, 76 435 (92.7%) of the 1980 urban physicians were still practicing in cities, but only 5958 (55.9%) of the 1980 rural physicians had stayed in their rural area. Logistic regression analysis showed that primary-care discipline and rural practice in 1980 positively predicted rural practice in 2002 (OR [95% CI]: 1.28 [1.23-1.35] and 16.18 [15.43-16.95], respectively). However, female sex and age in 1980 were negative predictors for rural practice in 2002 (OR [95% CI]: 0.80 [0.74-0.86] and 0.91 [0.90-0.94], respectively). The rapid increase of physicians between 1980 and 2002 has not substantially affected their geographic distribution. Baseline rural practice, primary care discipline and male sex of physicians were found to be predictors of rural practice after 22 years.

The Integration of a Telemental Health Service into Rural Primary Medical Care

Mental health care shortages in rural areas have resulted in the majority of services being offered through primary medical care settings. The authors argue that a paradigm shift must occur so that those in need of mental health care have reasonable, timely access to these services. Changes proposed include integrating mental health services into primary medical care settings, moving away from the traditional view of mental health care services (one therapist, one hour, and one client), and increasing the consultative role of psychologists and other mental health care providers in primary medical care. Characteristics of mental health providers that facilitate effective integration into primary medical care are presented. The results of a needs assessment survey and an example of a telemental health project are described. This project involved brief consultations with patients and their physicians from a shared care model using a broadband internet telecommunications link between a rural clinic and mental health service providers in an urban area.

New York State Physicians: Characteristics and Distribution in Health Professional Shortage Areas

Along with high numbers of physicians, New York State also has 2.7 million people living in poverty and 3 million without health insurance who are likely to live in areas with few physicians.1,2 Nearly 4 million New Yorkers live in communities that have been designated as health professional shortage areas (HPSAs).3 We conducted a study to examine the physician workforce in New York State and its HPSAs. Data on federally designated primary medical HPSAs were obtained from the Bureau of Health Professions. Physician data obtained from the AMA Physician Masterfile were geocoded and cross-referenced with the HPSA file. A complete description of methods and findings are available in the full study report.4 Of the 47,981 physicians identified as practicing in New York State (NYS), 14.5% were found to practice in HPSAs. Most of these, 13.5% of all NYS physicians, practice in metropolitan HPSAs. Primary care physicians practice in HPSAs at only a slightly higher rate (16 vs. 15%) than non-primary care physicians, and also practice predominantly in metropolitan HPSAs (see Table 1). Table 1 New York State physicians in metropolitan and nonmetropolitan HPSAs, 2000 More than half (53%) of all primary care physicians practicing in NYS metropolitan HPSAs are international medical graduates (IMGs), compared to 33% of those in nonmetropolitan HPSAs and 44% of those practicing outside of HPSAs. Thus, NYS relies heavily on IMGs born outside of the USA to meet the need for physicians in underserved communities, particularly in metropolitan areas. Almost one in three black, non-Hispanic physicians in NYS were found to practice in metropolitan HPSAs, the highest prevalence of any racial/ethnic group. All non-white physicians had higher rates of metropolitan HPSA practice than white, non-Hispanic physicians. Overall, New York State has a small base of underrepresented minority physicians (8% of all physicians) who are disproportionately located in metropolitan HPSAs. The lack of growth in the number of minority students graduating from medical schools in NYS is out of sync with the state’s growing minority population. Thirty-six percent of NYS physicians are graduates of a medical school located in NYS, yet only 29% of physicians in HPSAs are graduates of these schools. Graduates of the four medical schools in the state university system comprise 13% of both the NYS physician workforce and the HPSA workforce. While the heavy concentration of NYS HPSA physicians in metropolitan HPSAs reflects, to a great extent, the distribution of the overall state population, it is disproportionate to the HPSA population which needs to be served. Seventy-eight percent of New York’s HPSA population is located in metropolitan HPSAs, while 94% of the state’s HPSA physicians practice there.5 New York’s nonmetropolitan HPSAs have lower physician to population ratios and higher unmet need. Given that family physicians are more likely to practice in the nation’s rural areas than other primary care physicians,6 the relatively small workforce and training pipeline for family physicians in NYS contributes to shortages in rural areas. Increased family medicine training, recruitment of minority physicians into training, and ensuring the continuing flow of IMGs into NYS are efforts most likely to increase the number of physicians practicing in New York’s HPSAs.

Introduction: Culture and Psychiatry

Introduction: Culture and Psychiatry

Addressing Issues of Maldistribution of Health Care Workers

Introduction: The maldistribution of health care workers is a near-universal problem, particularly in developing countries. Shortages have become most critical over the past 2 decades with both out-migration of health care workers from developing to developed countries, and intra-country disparities between urban centres and rural regions. A variety of solutions have been proposed and tried, but in recent years the problem has become increasingly serious. Programme Description: Over the past 15 years, we have conceptualised and implemented a programme directed at the re-supply of rural physicians to our own state, Illinois, which was recently ranked as low as sixth worse in the US with regard to physician manpower shortages in rural areas. More recently, this programme has been expanded to include other health care workers where there are equivalent shortages in health services accessibility, and the entire programme is now designated as the National Center for Rural Health Professions. Programme Evaluation: Currently, the physician programme enjoys a 65% to 70% success rate in terms of the return of physicians to rural communities; a success largely due to the unique selection process, training, and the close relationship between students and faculty. Here, we describe this programme in detail, in the hope that elements of this somewhat unique programme may be “exportable”.

Experiences of Organization for Economic Cooperation and Development countries with recruiting and retaining physicians in rural areas.

This present study discusses the potential pitfalls in measuring physician shortages in rural areas and presents existing evidence of the effectiveness of policy interventions designed to influence the geographical distribution of physicians. Information on the geographical distribution of physicians was derived from a survey of Organization for Economic Cooperation and Development (OECD) countries and a desk review of the academic literature and policy documents of OECD governments. Whether policies have been effective in recruiting and retaining physicians in rural areas. Existing measures of physician shortages in rural areas may be misleading as they do not account for a number of supply side factors (e.g. physician productivity, mobility of physicians across areas) and demand-side factors (e.g. patient needs for physician services). Increases in the national number of physicians have narrowed, but not eliminated, shortages in rural areas. Some success in increasing physician supply to rural areas has been reported with educational, regulatory and financial policies; whereas countries' experiences with education-related funding policies are mixed. There is some evidence suggesting that the effectiveness of these policies can be enhanced by supporting occupational opportunities for the spouse/partner, education of children and accommodation. Although there has been little evaluation of policy interventions, physician shortages in rural areas may be reduced by supply side policies that focus on the physician in combination with measures to sustain the economic and social viability of rural communities.

Rural mental health: An opportunity

Rural mental health: An opportunity

Creative Strategies for Teaching Caring Leadership

One of the challenges of teaching nursing in a rural area is developing a creative way to define and express leadership abilities. The Art and Nursing departments of Oklahoma Panhandle State University addressed this challenge by pairing a nursing student and art student, who worked together to create a tangible expression of caring. To meet the challenge of mentor shortage in rural areas, the author developed an e-mail mentor program for nursing-leadership students. The art of story as an intervention was used to help students define their leadership roles by interviewing a historic nursing leader in their geographic area. Students were also encouraged to correspond with their legislators and begin a dialogue about nursing and health care.

Rural energy development in China

The development of the rural energy sector in China has been characterized by much more rapid growth than in other sectors, and by the increasing proportion of non-residential use. In the 70s, a growing energy shortage in rural areas was tackled by the promotion of more efficient stoves, planting of firewood forests and the dissemination of bio-digesters. These initiatives developed into major technology thrusts in the development of rural energy, pilot projects for integrated rural energy development, and the program of integrated rural energy development in one hundred counties. The benefits of this program have included energy self-sufficiency, greater protection of the environment, and economic development in rural areas.