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Background: Staff shortages could harm the provision and quality of health care in Uganda, so staff retention and motivation are crucial. Understanding the impact of HIV/AIDS on staff contributes to designing appropriate retention and motivation strategies. This research aimed 'to identify the influence of HIV/AIDS on staff working in general hospitals at district level in rural areas and to explore support required and offered to deal with HIV/ AIDS in the workplace'. Its results were to inform strategies to mitigate the impact of HIV/AIDS on hospital staff. Methods: A cross-sectional study with qualitative and quantitative components was implemented during two weeks in September 2005. Data were collected in two government and two faith-based private not-for-profit hospitals purposively selected in rural districts in Uganda's Central Region. Researchers interviewed 237 people using a structured questionnaire and held four focus group discussions and 44 in-depth interviews. Results: HIV/AIDS places both physical and, to some extent, emotional demands on health workers. Eighty-six per cent of respondents reported an increased workload, with 48 per cent regularly working overtime, while 83 per cent feared infection at work, and 36 per cent reported suffering an injury in the previous year. HIV-positive staff remained in hiding, and most staff did not want to get tested as they feared stigmatization. Organizational responses were implemented haphazardly and were limited to providing protective materials and the HIV/AIDSrelated services offered to patients. Although most staff felt motivated to work, not being motivated was associated with a lack of daily supervision, a lack of awareness on the availability of HIV/AIDS counselling, using antiretrovirals and working overtime. The specific hospital context influenced staff perceptions and experiences. Conclusion: HIV/AIDS is a crucially important contextual factor, impacting on working conditions in various ways. Therefore, organizational responses should be integrated into responses to other problematic working conditions and adapted to the local context. Opportunities already exist, such as better use of supervision, educational sessions and staff meetings. However, exchanges on interventions to improve staff motivation and address HIV/AIDS in the health sector are urgently required, including information on results and details of the context and implementation process.

Abstract Background Staff shortages could harm the provision and quality of health care in Uganda, so staff retention and motivation are crucial. Understanding the impact of HIV/AIDS on staff contributes to designing appropriate retention and motivation strategies. This research aimed 'to identify the influence of HIV/AIDS on staff working in general hospitals at district level in rural areas and to explore support required and offered to deal with HIV/AIDS in the workplace'. Its results were to inform strategies to mitigate the impact of HIV/AIDS on hospital staff. Methods A cross-sectional study with qualitative and quantitative components was implemented during two weeks in September 2005. Data were collected in two government and two faith-based private not-for-profit hospitals purposively selected in rural districts in Uganda's Central Region. Researchers interviewed 237 people using a structured questionnaire and held four focus group discussions and 44 in-depth interviews. Results HIV/AIDS places both physical and, to some extent, emotional demands on health workers. Eighty-six per cent of respondents reported an increased workload, with 48 per cent regularly working overtime, while 83 per cent feared infection at work, and 36 per cent reported suffering an injury in the previous year. HIV-positive staff remained in hiding, and most staff did not want to get tested as they feared stigmatization. Organizational responses were implemented haphazardly and were limited to providing protective materials and the HIV/AIDS-related services offered to patients. Although most staff felt motivated to work, not being motivated was associated with a lack of daily supervision, a lack of awareness on the availability of HIV/AIDS counselling, using antiretrovirals and working overtime. The specific hospital context influenced staff perceptions and experiences. Conclusion HIV/AIDS is a crucially important contextual factor, impacting on working conditions in various ways. Therefore, organizational responses should be integrated into responses to other problematic working conditions and adapted to the local context. Opportunities already exist, such as better use of supervision, educational sessions and staff meetings. However, exchanges on interventions to improve staff motivation and address HIV/AIDS in the health sector are urgently required, including information on results and details of the context and implementation process.

In the early 1990s Canada was in a recession and the government of Saskatchewan felt the pressure of a growing deficit. In 1992, the provincial government decided to reduce the health care budget by 3.3%. The following year, the government undertook regionalization of health care services through the Health Districts Act, with a focus on promoting preventative health care rather than solely treatment-based care. The budget cuts resulted in the closure of 52 rural hospitals, leading to a public outcry. Evaluations of the reform were not able to show a definite detrimental effect on health outcomes in the corresponding communities. Community members expressed increased caregiver burden, travel costs and travel time to the next nearest hospital, and potential inequalities in access to care. When undertaking reform, it is important that government consider the voices of local communities in the decision-making process. Au début des années 90, le Canada était en récession et, en Saskatchewan, le déficit budgétaire posait un problème pressant au gouvernement provincial. Celui-ci décida de réduire le budget de la santé de 3,3% en 1992. L'année suivante, le gouvernement mit en place une régionalisation des services de santé fondée sur la Loi sur les Districts de Santé, avec comme objectif de favoriser la prévention par rapport aux soins purement curatifs. 52 hôpitaux ruraux durent fermer à cause des coupes budgétaires, entraînant une réaction de rejet de la part du public. Les évaluations de la réforme n'ont pas pu établir avec certitude une détérioration de la santé dans les communautés concernées. Les habitants des communautés concernées ont exprimé une charge accrue pour les aidants, des coûts et temps de transports plus élevés pour se rendre à l'hôpital le plus proche, et d'éventuelles inégalités d'accès aux soins. Les voix des populations concernées devraient être écoutées lors de la prise de décision sur de telles réformes.

The aim of this article is to explain the situation of the Spanish hospital system during the twentieth century and to analyse the reasons why the difficulties that a significant part of the Spanish population, resident in rural areas, had to access hospital services during the Franco dictatorship were perpetuated. The first section uses a conceptual perspective to discuss the repercussions that the new medical significance of the hospital had for the notion of 'rural hospital'. The second section examines the projects for hospital modernisation that appeared before the Spanish Civil War (1936–39) and highlights what impeded the consolidation of these pioneering experiences in the country. The following section analyses the hospital situation in Spain's rural world as well as the profound changes that occurred during the last decades of the dictatorship, just on the threshold of the health reform that was finally implemented in the democratic period ; SI

The aim of this article is to explain the situation of the Spanish hospital system during the twentieth century and to analyse the reasons why the difficulties that a significant part of the Spanish population, resident in rural areas, had to access hospital services during the Franco dictatorship were perpetuated. The first section uses a conceptual perspective to discuss the repercussions that the new medical significance of the hospital had for the notion of 'rural hospital'. The second section examines the projects for hospital modernisation that appeared before the Spanish Civil War (1936–39) and highlights what impeded the consolidation of these pioneering experiences in the country. The following section analyses the hospital situation in Spain's rural world as well as the profound changes that occurred during the last decades of the dictatorship, just on the threshold of the health reform that was finally implemented in the democratic period.

Bill introduced by the Texas House of Representatives relating to the authority of rural hospitals to establish a health care collaborative.

Summary
The aim of this article is to explain the situation of the Spanish hospital system during the twentieth century and to analyse the reasons why the difficulties that a significant part of the Spanish population, resident in rural areas, had to access hospital services during the Franco dictatorship were perpetuated. The first section uses a conceptual perspective to discuss the repercussions that the new medical significance of the hospital had for the notion of 'rural hospital'. The second section examines the projects for hospital modernisation that appeared before the Spanish Civil War (1936–39) and highlights what impeded the consolidation of these pioneering experiences in the country. The following section analyses the hospital situation in Spain's rural world as well as the profound changes that occurred during the last decades of the dictatorship, just on the threshold of the health reform that was finally implemented in the democratic period.

Today's hospitals are becoming increasingly complex and stressful organizations. Few studies have examined the stressors experienced by nurse executives working in this highly stressful environment. None have considered the stressors experienced by nurse executives working in a rural hospital setting. An exploratory descriptive design was used to explore and describe the major stressors that have caused nurse executives in rural Manitoba's community hospitals to experience job-related stress. As well, the relative intensity of the identified stressors was determined. Cooper and Marshall's (1978) Sources of Managerial Stress Model served as the conceptual framework for the study. The Delphi technique, consisting of three successive rounds of mailed questionnaires which incorporated feedback from the previous round, was used for data collection. Data were analysed after each round of questionnaire using both qualitative and quantitative procedures. Fifty-four nurse executives completed all three questionnaires. Forty-four stressor items were identified. Findings of the study generally supported Cooper and Marshall's (1978) intra-organizational stressors. Two additional categories of extra-organizational stressors, namely the governing board and physical-related issues, arose. As well, contextual stressors related to the provincial government's health reform initiatives were also evident. Strategies to prepare rural nurse executives to individually and collectively address the identified stressors are recommended. Ways that employers, the professional nursing association, and educational institutions can help to lessen nurse executives' perceived stress are also suggested. Design and methodological considerations for future research are addressed.

AbstractManagement of solid waste from rural hospitals is among major problems affecting developing countries. This is mostly attributed to inadequate data related to quantity and quality of hospital solid waste. Similarly, information related to rural hospital solid waste characteristics and management is limited in Zimbabwe. However, SDGs complemented by Zimbabwe Vision 2030, NDS 1 advocates for sustainable solid waste management. Hence, enough data related to characteristics of solid waste from rural hospitals are required to attain sustainability. This research focuses on hospital solid waste characteristics and management strategies at STT and HC rural hospitals. Descriptive cross sectional research design which triangulates qualitative and quantitative paradigms was utilized. Interviews, observations, questionnaires were used to collect data. Quantitative data were analyzed using Statistical Package for Social Sciences whereas qualitative data were subjected to content analysis. Solid waste generated at STT encompasses non-hazardous (77.35%), hazardous waste (22.65%). At HC solid waste consists of non-hazardous (79%) and hazardous waste (21%). Respondents at STT (70.4%) and HC (72.7%) noted that solid waste was increasing. Solid waste was increasing due to various factors namely high use of disposable materials at HC (35.1%), STT (42.5%) and increase of patients at HC (30%) and STT (29.7%). Solid waste was indiscriminately stored in various types of containers although pedal operated bins and sharp containers were highly used at STT (72.4%) and HC (69.1%). Waste receptacles were transported to disposal sites using wheelbarrows and manual handling. Open pits and burning were among disposal strategies but incineration was regarded as the golden approach at STT (44.8%) and HC (41.8%). Inappropriate hospital solid waste management was due to shortage of finance at STT (38.1%) and HC (30.9%) and unawareness among health workers. Although it was worsened by lack of all stakeholder participation at STT (79.0%) and HC (76.4%). Consequently, the study recommended application of strategies which support circular economy, integrated approach, raising awareness of health workers and provision of enough resources to rural hospitals.

Due to political instability in many Third World countries doctors in simply equipped rural hospitals are sometimes confronted with war injuries. In those situations sending patients to specialized centres is often impossible. We studied a series of 100 consecutive patients with missile injuries treated during 1982/3 in an Ugandan mission hospital. Out of these 87 were available for sufficient follow-up, 11 disappeared before completing the treatment, and two died. The results are reported. It is concluded that many cases of missile injuries, except the most serious thoraco-abdominal lesions and major neurovascular problems, can be managed satisfactorily in rural hospitals with basic facilities only, provided sound surgical principles are observed, particularly wound treatment in two stages.

Under the prospective payment system (PPS), designated sole community hospitals (SCH's), usually smaller than other rural hospitals but offering comparable services, have had higher average cost levels, in part because of underutilization of plant and equipment. This has resulted in negative operating margins on patient revenues, although local financial support and other revenue sources bring margins on total revenues into the positive range. The PPS legislation has also provided SCH's temporary protection from volume declines. SCH's are more likely than other rural hospitals to experience large volume swings, but only for declines greater than the threshold specified under PPS.