Rural/Urban Imbalance

Rural township health centres and urban community health centres play a crucial role in the delivery of primary health care in China. The limited availability and low qualifications of human resources in health are among the main challenges facing lower-level health facilities. This paper aims to analyse the mobility of health workers in township and community health centres. [from abstract]

This study investigates the influence of demographic characteristics, provincial policies, organizational changes and emerging practice challenges on the rural–urban segments of the Canadian nursing workforce in order to describe the nature of nursing work from the perspective of rural nurse executives and frontline nurses. [adapted from introduction]

This paper serves as background documentation for the first expert meeting for developing the evidence-based recommendations for increasing access to health workers in remote and rural areas through improved retention, to be held in Geneva on 2-4 February 2009. It is intended to provide an overview of the issues, challenges and potential solutions to the problem of inequitable access to health workers in remote and rural areas. [from introduction}

This presentation discusses an ineffective incentives effort to retain rural health workers and suggestions for more useful interventions.

This presentation reviews the current state of health worker retention in rural areas, discusses interventions aimed at addressing the problem and describes the challenges and directions for solving it.

This presentation outlines the World Health Organization’s (WHO) efforts to scale up health care delivery in rural areas through health care worker retention programs.

This document discusses China’s long struggle with rural coverage for health care through the barefoot doctors program, which was introduced as a national policy focused on quickly training paramedics to meet rural needs. [adapted from author]

This is the first study to systematically review the available published literature describing innovative models of comprehensive primary health care (PHC) in rural and remote Australia since the development of the first National Rural Health Strategy (1993-2006). The study aimed to describe what health service models were reported to work, where they worked and why. [from abstract]

The two main objectives of this study were to examine aspects of the acculturation of overseas-born and Australian-trained health professionals in the Australian health discourse and identify key coping strategies used by them when in working in the rural context. [from abstract]

This article reports on an initiative in a rural New Zealand community to meet the need for after hours care. First contact for patients is with a community nursing team operating from the local health centre, complemented by on-call advice from GPs and GP clinics twice daily at weekends. The article reports on the demand for after hours services generated by a geographically defined community in New Zealand. [from introduction]

This presentation on health worker retention in rural area was offered during a dialogue hosted by the WHO and OECD.

The so-called brain drain is a complex phenomenon with a web of push-pull factors determining final outcomes. There are no quick fixes. Yet, those on the front lines addressing the critical personnel shortages in South Africa’s public health system - especially in rural areas - have pointed to approaches that could slow the exodus and eventually turn the situation around. [from author]

This presentation was given at the First Forum on Human Resources for Health in Kampala. It covers the imbalance in physician deployment in Ethiopia and the lottery system for ensuring coverage in rural areas.

This presentation was given at the First Forum on Human Resources for Health in Kampala. It discusses the situtation of rural health workers citing Mali and Madagascar as examples.

In rural areas across Australia the recruitment and retention of adequate numbers of medical specialists, including psychiatrists, has been a long outstanding problem. Latrobe Regional Hospital reached a major crisis in 1994, with only one psychiatrist and a large number of vacancies. This led to a focus on the recruitment and retention of psychiatrists in order to improve this essential element of the workforce. [from abstract]

Rural healthcare provision is limited in many areas because of workforce recruitment and retention issues. Pharmacists and social workers are examples of allied health professionals who play vital roles in the provision of rural health care. Personal factors including an individual’s fit with a local community and their professional role were explored to determine the way they affect access to rural health care. [from abstract]

The configuration of rural health services is influenced by geography. Rural health practitioners provide a broader range of services to smaller populations scattered over wider areas or more difficult terrain than their urban counterparts. This has implications for training and quality assurance of outcomes. This exploratory study describes the development of a “clinical peripherality” indicator that has potential application to remote and rural general practice communities for planning and research purposes. [from introduction]

This is a review of the literature on attracting and retaining health workers. The findings suggest that recruitment and retention strategies are usually not comprehensive and often limited to addressing a single or limited number of factors. Because of the complex interaction of factors impacting attraction and retention, there is a strong argument to be made for bundles of interventions which include attention to living situations, working conditions and environments, and professional development opportunities. [adapted from author]

This article reports a project that investigated the way government policies, health and community services, population characteristics and local peculiarities combined for residents in two small rural towns in New South Wales. Interviews and focus groups with policy makers, health and community service workers and community members identified the felt, expressed, normative and comparative needs of residents in the case-study towns. [from abstract]

The overall objective of community-based medical education (CBME) is to produce highly qualified doctors in sufficient numbers to meet the health needs of the nation at community and hospital levels. In the current program, medical students undertake an eight-week residential posting in their final year. The objective of this study was to assess the communities’ awareness, perception and participation in the CBME program. [adapted from introduction]

Rural background and training have previously been found to increase the likelihood of rural practice. However, practitioners of many health professions remain in shortage in rural and remote Australia. This study builds on previous work in that it includes medical, nursing and allied health professions, considers the role of the health professional’s family in employment decisions, and includes a broader array of factors influencing employment preference and the preferred location of practice. The survey also examines when students might work in a rural area. [introduction]

This article presents the result of a literature review examining possible ways to improve healthcare services in rural areas. [from abstract]

Australian remote area nurses (RANs) are specialist advanced practice nurses. They work in unique, challenging and sometimes dangerous environments to provide a diverse range of healthcare services to remote and predominantly Aboriginal communities. There is an emerging skills gap in the remote nursing workforce as experienced and qualified RANs leave this demanding practice. There is a shortage of new nurses interested in working in these areas, and many of those who enter remote practice leave after a short time. Distance management was examined in order to gain a better understanding of its effects on the retention of RANs. Distance management in this context occurs when the health service’s line management team is located geographically distant from the workplace they are managing. [introduction]

Rising health care costs and the need to consolidate expertise in tertiary services have led to the centralisation of services. In the UK, the result has been that many rural maternity units have become midwife-led. A key consideration is that midwives have the skills to competently and confidently provide maternity services in rural areas, which may be geographically isolated and where the midwife may only see a small number of pregnant women each year. Our objective was to compare the views of midwives in rural and urban settings, regarding their competence and confidence with respect to competencies identified as being those which all professionals should have in order to provide effective and safe care for low-risk women.

This Issues in Health Economics presents the main conclusions of an international literature review of policies designed to tackle geographical inequalities in the distribution of health professionals. [author’s description]

The aim of the project was to evaluate the effect of the new rural allowance on the short-term career choices of health professionals in rural areas. A longitudinal cohort study design was used, before and after the introduction of the new allowance.

The health worker crisis is particularly acute in rural and hard to reach areas, where 80% of the population in Africa live. The resultant low capacity at the peripheral level of the health system is a crucial barrier to good health. AMREF believes that developing capable, motivated and supported health workers at all levels of the health system is essential in ensuring the delivery of accessible and effective health care across Africa… This briefing draws on AMREF’s experience to look at three key issues: the importance of appropriate training, task-shifting to lower cadres of worker, and training and supporting community health workers (CHW) in order to bring health care closer to communities.

This paper begins by clarifying the terms shortage and underserviced. Provincial and federal programs for underserviced areas in Ontario are then described and considered in terms of their relevance to nursing. A discussion of the issues associated with policies addressing shortage and underserviced areas follows. The paper concludes with recommendations for change. The importance of making funding decisions based on a clear understanding of relevant concepts and models is emphasized. [introduction]

Understanding the supply and utilization of nurses is critical to maintaining an effective community health system. There has to be sufficient staff and a work environment that builds on the existing strengths of community health nursing to meet emerging needs. This report provides a demographic profile of community health nurses (CHNs) in Ontario and identifies enablers that support optimal practice of their competencies. [from executive summary]

Rural health care is changing. Following restructuring in the 1990s some small hospitals remained independent, while others reorganized as amalgamations and alliances. In 2004, Ontario was divided into 14 Local Health Integration Networks (LHINs) to create accessible, quality health care at a local level. Th is study was designed to gain an understanding of the impact on nursing work and the workforce. [from executive summary]