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In this article some questions of legislative providing of functioning of rural medicine in USSR in 1920-1930 are considered. The research is conducted for the legal politic, state control in a sphere of rural medicine and for it realization in difficult political and economic situation.

The use of pesticides has rapidly increased in Japan since the end of World War II, significantly reducing work burdens and boosting food production. In the meantime, pesticides, responsible for poisoning and environmental pollution, have for many years posed grave issues that have had to be tackled by scientists of rural medicine for a long period. The Japanese Association of Rural Medicine, founded by the late Toshikazu Wakatsuki, has grappled with those issues for many years. Above all, the association has fulfilled its social obligations, such as by bringing the toxicity of organic mercury to light in animal tests to prompt the government to prohibit its use, and by casting light on birth defects caused by defoliants aerially sprayed during the Vietnam War to urge U.S. military forces to break off herbicide warfare. As it has become possible to make less toxic pesticides available for farm work in recent years, death-inducing accidents have seldom occurred during the spraying of pesticides, and the association's activities are now at a low ebb. Now that pesticides, which after all are biologically toxic compounds, are openly used on farms, there is the need to pay constant attention to their impacts on the human body and the environment. In the future, it is necessary to epidemiologically probe into chronic impacts on the human body and contribute to the prevention of pesticide poisoning in Southeast Asia.

What is known about the topic? Avoidable adverse events are often being attributed to health workforce shortages associated with the coronavirus disease 2019 (COVID-19) pandemic and government funding cuts. What does this paper add? Health workforce shortages were predicted well before the COVID-19 pandemic. What are the implications for practitioners? Senior executives and leaders should unitedly take action to influence change in funding and models of care.

Objective: This study investigated Pakistani physicians' decision-making concerning their decisions to stay in Pakistan, migrate abroad, or resettle back into their country after working abroad. Methods: This qualitative study employed a phenomenological research design. Thirteen Pakistani physicians characterised as 'stayers', 'leavers' and 'resettlers' were interviewed via telephone to explore their lived experience in 2008-2009. Results: Results show a dynamic nature of the physicians' career decision-making depending on their constant weighing of complex personal, family, professional and societal factors. Stayers, leavers and resettlers are not mutually exclusive groups but rather individual physicians' can move between these groups at different stages of career and life. Physicians vary in their decision making. Stayers and resettlers place more emphasis on personal and family reasons and societal factors providing there is a permanent job for them. Leavers focus on health system problems and recent societal problems of personal and societal insecurity. Conclusions: The findings of this study indicates that physician migration, retention and resettlement is a complex issue and there are multiple personal, social, political and economic factors that affect their decisions to stay, move abroad or resettle back into their countries. Therefore, it is recommended that future research focusing on health workers retention, migration and resettlement issues look at it from a holistic perspective rather than focusing only on the economic and professional imperatives. The findings of this study have international implications for health care managers dealing with a highly mobile international medical workforce. Strategies considering different stages of the physician career/ life cycle need to highlight the importance of identity, belonging and place as doctors weigh this with career goals.

Background Rural medical workforce shortage contributes to health disadvantage experienced by rural communities worldwide. This study aimed to determine the regional results of an Australian Government sponsored national program to enhance the Australian rural medical workforce by recruiting rural background students and establishing rural clinical schools (RCS). In particular, we wished to determine predictors of graduates' longer-term rural practice and whether the predictors differ between general practitioners (GPs) and specialists. Methods A cross-sectional cohort study, conducted in 2012, of 729 medical graduates of The University of Queensland 2002–2011. The outcome of interest was primary place of graduates' practice categorised as rural for at least 50% of time since graduation ('Longer-term Rural Practice', LTRP) among GPs and medical specialists. The main exposures were rural background (RB) or metropolitan background (MB), and attendance at a metropolitan clinical school (MCS) or the Rural Clinical School for one year (RCS-1) or two years (RCS-2). Results Independent predictors of LTRP (odds ratio [95% confidence interval]) were RB (2.10 [1.37–3.20]), RCS-1 (2.85 [1.77–4.58]), RCS-2 (5.38 [3.15–9.20]), GP (3.40 [2.13–5.43]), and bonded scholarship (2.11 [1.19–3.76]). Compared to being single, having a metropolitan background partner was a negative predictor (0.34 [0.21–0.57]). The effects of RB and RCS were additive—compared to MB and MCS (Reference group): RB and RCS-1 (6.58[3.32–13.04]), RB and RCS-2 (10.36[4.89–21.93]). Although specialists were less likely than GPs to be in LTRP, the pattern of the effects of rural exposures was similar, although some significant differences in the effects of the duration of RCS attendance, bonded scholarships and partner's background were apparent. Conclusions Among both specialists and GPs, rural background and rural clinical school attendance are independent, duration-dependent, and additive, predictors of longer-term rural practice. Metropolitan-based medical ...

Networks are everywhere. Health systems and public health settings are experimenting with multifarious forms. Governments and providers are heavily investing in networks with an expectation that they will facilitate the delivery of better services and improve health outcomes. Yet, we lack a suitable conceptual framework to evaluate the effectiveness and sustainability of clinical and health networks. This paper aims to present such a framework to assist with rigorous research and policy analysis. The framework was designed as part of a project to evaluate the effectiveness and sustainability of health networks. We drew on systematic reviews of the literature on networks and communities of practice in health care, and on theoretical and evidence-based studies of the evaluation of health and non-health networks. Using brainstorming and mind-mapping techniques in expert advisory group sessions, we assessed existing network evaluation frameworks and considered their application to extant health networks. Feedback from stakeholders in network studies that we conducted was incorporated. The framework encompasses network goals, characteristics and relationships at member, network and community levels, and then looks at network outcomes, taking into account intervening variables. Finally, the short-term, medium-term and long-term effectiveness of the network needs to be assessed. The framework provides an overarching contribution to network evaluation. It is sufficiently comprehensive to account for many theoretical and evidence-based contributions to the literature on how networks operate and is sufficiently flexible to assess different kinds of health networks across their life-cycle at community, network and member levels. We outline the merits and limitations of the framework and discuss how it might be further tested.

© 2019, Society of Teachers of Family Medicine. All rights reserved. BACKGROUND AND OBJECTIVES: Family medicine rural training track (RTT) residency programs produce a higher proportion of graduates who choose rural practice than other programs, yet RTTs face continuing threats to their existence. This study sought to understand threats to RTT sustainability and resilience factors that enable RTTs to thrive. METHODS: In 2014 and 2015, the authors conducted semistructured interviews of 21 RTT leaders representing two closed programs and 22 functioning programs. Interview topics included program strengths providing resilience and sustainability, risk factors for closure or vulnerabilities threatening sustainability, and advice for other RTTs. The authors performed a content analysis, coding pertinent themes in all interview data. RESULTS: From the top three assets, risks, and advice that respondents offered, the following nine themes emerged, in order from most to least mentioned: leadership, faculty and teaching resources, program support, finances, resident recruitment, program attributes, program mission, political and environmental context, and patient-related clinical experiences. Interviewees frequently reported multifactorial causes for RTT sustainability or closure. CONCLUSIONS: Numerous factors identified, such as distance, can operate as positive or negative influences for program resilience, depending on place and context. Resilience depends on multiple forms of social capital, including robust networks among individuals and various communities: the local population and patients, local health care providers, residency faculty, and RTTs in general. The small size and remoteness of RTTs make them vulnerable to multiple challenges in finances, regulations, and accreditation, requiring program adaptability and suggesting the need for flexibility in the policies that govern them.

The primary aim of the research project was to develop conceptual models of rural ambulance service delivery based on different worldviews or philosophical positions, and then to compare and contrast these new and emerging models with existing organisational policy and practice. Four research aims were explored: community expectations of pre-hospital care, the existing organization of rural ambulance services, the measurement of ambulance service performance, and the comparative suitability of different pre-hospital models of service delivery. A unique feature was the use of soft systems methodology to develop the models of service delivery. It is one of the major non-traditional systems approaches to organisational research and lends itself to problem solving in the real world. The classic literature-hypothesis-experiment-results-conclusion model of research was not followed. Instead, policy and political analysis techniques were used as counter-points to the systems approach. The program of research employed a triangulation technique to adduce evidence from various sources in order to analyse ambulance services in rural Victoria. In particular, information from questionnaires, a focus group, interviews and performance data from the ambulance services themselves were used. These formed a rich dataset that provided new insight into rural ambulance services. Five service delivery models based on different worldviews were developed, each with its own characteristics, transformation processes and performance criteria. The models developed are titled: competitive; sufficing; community; expert; and practitioner. These conceptual models are presented as metaphors and in the form of holons and rich pictures, and then transformed into patient pathways for operational implementation. All five conceptual models meet the criteria for systemic desirability and were assessed for their political and cultural feasibility in a range of different rural communities. They provide a solid foundation for future discourse, debate and ...

Abstract Background Numerous not-for-profit pharmacies have been created to improve access to medicines for the poor, but many have failed due to insufficient financial planning and management. These pharmacies are not well described in health services literature despite strong demand from policy makers, implementers, and researchers. Surveys reporting unaffordable medicine prices and high mark-ups have spurred efforts to reduce medicine prices, but price reduction goals are arbitrary in the absence of information on pharmacy costs, revenues, and profit structures. Health services research is needed to develop sustainable and "reasonable" medicine price goals and strategic initiatives to reach them. Methods We utilized cost accounting methods on inventory and financial information obtained from a not-for-profit rural pharmacy network in mountainous Kyrgyzstan to quantify costs, revenues, profits and medicine mark-ups during establishment and maintenance periods (October 2004-December 2007). Results Twelve pharmacies and one warehouse were established in remote Kyrgyzstan with 100%, respectively. Annual mark-ups increased dramatically each year to cover increasing recurrent costs, and by 2007, only 19% and 46% of products revealed mark-ups of 100%. 2007 medicine mark-ups varied substantially across these products, ranging from 32% to 244%. Mark-ups needed to sustain private pharmacies would be even higher in the absence of government subsidies. Conclusion Pharmacy networks can be established in hard-to-reach regions with little funding using public-private partnership, resource-sharing models. Medicine prices and mark-ups must be interpreted with consideration for regional costs of business. Mark-ups vary dramatically across medicines. Some mark-ups appear "excessive" but are likely necessary for pharmacy viability. Pharmacy financial data is available in remote settings and can be used towards determination of "reasonable" medicine price goals. Health systems researchers must document the positive and negative financial experiences of pharmacy initiatives to inform future projects and advance access to medicines goals.

Medical care in developing countries is challenging. The providers have the knowledge of best practices, but these often can not be used due to lack of funding and resources. This leaves healthcare less than subpar and full of innovations to make it work. This presentation is an overview of our experiences observing healthcare in Uganda. Topics include, in field operations, maternal fetal medicine, traditional healers, dentistry, lack of healthcare in rural villages, and the lack of medical tools and resources. Healthcare work was observed at the Kigezi Healthcare Foundation in Kabale, Uganda. KIHEFO is a non-profit non governmental organization (NGO) that provides care to many people throughout the Kabale area This organization is founded and operated by Dr. Geoffery Anguyo, an expert in HIV and public health. A main issue in Uganda was funding, KIHEFO didn't have enough money. The Public Health department would like to help this situation by hosting a coin drive and doing a tooth brush collection drive before our next trip. These two fundraisers should help improve medical situations at KIHEFO, providing medical supplies for those in need. During Christmas break, a group of 11 students and 2 Faculty members traveled to Kabale, Uganda to learn about global health. The best way to understand global health is to immerse yourself and experience global health.

The article describes the main stages of the formation and development of sanitary care in the Saratov province at the turn of the 19th and 20th centuries. The authors cite data on the activities of the provincial medical board of the Order of Public Charity on providing medical assistance and measures to combat epidemics to the population in the first half of the 19th century, before the introduction of zemstvo. The article shows the role of medical societies (the physico-medical society, the society of sanitary doctors and the military sanitary society) in the development of sanitary care and in the fight against infectious diseases and their prevention. It also describes the influence of the decisions of the provincial congresses of territorial doctors, the sanitary bureau, medical sanitary councils and the executive sanitary committee upon the organisation of sanitary and anti-epidemic measures and preventative vaccinations against smallpox and diphtheria. The article studies the personal contribution of prominent representatives of provincial medicine, I.I. Molleson and N.I.Tezyakov, who made a significant contribution to improving the forms and methods of organising and developing sanitary work in the Saratov province at the turn of the 19th and 20th centuries. It shows the role of scientists of the medical faculty of the Saratov University in studying the aetiology and improving the diagnosis and treatment of typhus in the early 1920s. The authors note a positive dynamic in the development of sanitary care during this period, as evidenced by the characteristic improvement in the epidemiological situation in the Saratov province.

This paper analyses the shifting images of Chinese medicine and rural doctors in the narratives of literature and film from 1949 to 2009 in order to explore the persisting tensions within rural medicine and health issues in China. Popular anxiety about health services and the government's concern that it be seen to be meeting the medical needs of China's most vulnerable citizens – its rural dwellers – has led to the production of a continuous body of literary and film works discussing these issues, such as Medical Practice Incident, Spring Comes to the Withered Tree, Chunmiao, and Barefoot Doctor Wan Quanhe. The article moves chronologically from the early years of the Chinese Communist Party's new rural health strategies through to the twenty-first century – over these decades, both health politics and arts policy underwent dramatic transformations. It argues that despite the huge political investment on the part of the Chinese Communist Party government in promoting the virtues of Chinese medicine and barefoot doctors, film and literature narratives reveal that this rustic nationalistic vision was a problematic ideological message. The article shows that two main tensions persisted prior to and during the Cultural Revolution, the economic reform era of the 1980s, and the medical marketisation era that began in the late 1990s. First, the tension between Chinese and Western medicine and, second, the tension between formally trained medical practitioners and paraprofessional practitioners like barefoot doctors. Each carried shifting ideological valences during the decades explored, and these shifts complicated their portrayal and shaped their specific styles in the creative works discussed. These reflected the main dilemmas around the solutions to rural medicine and health care, namely the integration of Chinese and Western medicines and blurring of boundaries between the work of medical paraprofessionals and professionals.

Availability of medicines for treatment of cardiovascular disease (CVD) is low in low-income and middle-income countries (LMIC). Supply chain models to improve the availability of quality CVD medicines in LMIC communities are urgently required. Our team established contextualised revolving fund pharmacies (RFPs) in rural western Kenya, whereby an initial stock of essential medicines was obtained through donations or purchase and then sold at a small mark-up price sufficient to replenish drug stock and ensure sustainability. In response to different contexts and levels of the public health system in Kenya (eg, primary versus tertiary), we developed and implemented three contextualised models of RFPs over the past decade, creating a network of 72 RFPs across western Kenya, that supplied 22 categories of CVD medicines and increased availability of essential CVD medications from <30% to 90% or higher. In one representative year, we were able to successfully supply 5 793 981 units of CVD and diabetes medicines to patients in western Kenya. The estimated programme running cost was US$6.5–25 per patient, serving as a useful benchmark for public governments to invest in medication supply chain systems in LMICs going forward. One important lesson that we have learnt from implementing three different RFP models over the past 10 years has been that each model has its own advantages and disadvantages, and we must continue to stay nimble and modify as needed to determine the optimal supply chain model while ensuring consistent access to essential CVD medications for patients living in these settings.

Background: Governments and third-sector organizations (TSOs) require support to reduce suicide mortality through funding of suicide prevention services and innovative research. One way is for researchers to engage individuals and services in multisectoral collaborations, to collaboratively design, develop and test suicide prevention services and programmes. However, despite widespread support, to date, it remains unclear as to the extent to which stakeholders are being included in the research process, or if they are, how these partnerships occur in practice. To address this gap, the authors conducted a systematic review with the aim of identifying evidence of multisectoral collaborations within the field of suicide prevention, the types of stakeholders involved and their level of involvement. Methods: The authors conducted a strategic PRISMA-compliant search of five electronic databases to retrieve literature published between January 2008 and July 2021. Hand-searching of reference lists of key systematic reviews was also completed. Of the 7937 papers retrieved, 16 papers finally met the inclusion criteria. Because of data heterogeneity, no meta-analysis was performed; however, the methodological quality of the included studies was assessed. Results: Only one paper included engagement of stakeholders across the research cycle (co-ideation, co-design, co-implementation and co-evaluation). Most stakeholders were represented by citizens or communities, with only a small number of TSOs involved in multisectoral collaborations. Stakeholder level of involvement focused on the co design or co-evaluation stage. Conclusion: This review revealed a lack of evidence of multisectoral collaborations being established between researchers and stakeholders in the flied of suicide prevention research, even while such practice is being espoused in government policies and funding guidelines. Of the evidence that is available, there is a lack of quality studies documenting the collaborative research process. Also, results showed ...

Rural communities face particular issues in accessing healthcare. These issues include: • Dispersed communities meaning that people have to travel further to access healthcare; • A lack of connectivity and the absence of physical networks that enable the easy exchange of knowledge, ideas and best-practice; • Smaller GP practices, health centres and related specialist support services, so that staff may feel professionally isolated; • Restrictions on capacity due to problems with the recruitment and retention of professionals; • A greater reliance on volunteer services; • Population demographics that include relatively more older people than in urban centres. Cumbria is a rural, it represents 50% of the land mass of the North West yet has less than 7% of the population. The county has some dispersed urban centres with varying levels of connectivity, but these are significant distances from each other and face the same issues of isolation and access to services as the rest of the county. The Cumbria Rural Health Forum was formed in September 2013 by a consortium of over 30 organisations interested in and responsible for the delivery of public health, health and social care in Cumbria, to provide leadership in developing common themes around rurality and to work strategically to improve the quality of services for rural communities in Cumbria. The Forum is developing the Cumbria Strategy for Digital Technologies in Health and Social Care, which is the subject of this paper. The approach is believed to be unique, focusing on patient outcomes, professional skill needs and with sponsorship from organisations from the public, private and voluntary sector. Similar strategies, for example in Scotland , have tended to be government led and focused on centralised service infrastructure. Our approach will build on identified demand and aspirations, to develop a dynamic roadmap that can be implemented locally by those who shape it, considering models such as Asset Based Community Development.