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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 ...

Traditional medicine is the main, & often the only, source of medical care for a great proportion of the population of the developing world. Systems of traditional medicine are usually rooted in long-standing cultural traditions, take a holistic approach to health, & are community based. The World Health Organization has long recognized the central role traditional systems of care can play in efforts to provide primary health care, especially in rural areas. This article provides an overview of national policies adopted by African governments following World Health Organization recommendations for the incorporation of traditional & allopathic systems of care. 12 References. [Copyright 2002 Sage Publications, Inc.]

Andean traditional medicines in rural settings and community exchange networks -- Traditional medicines in new contexts: old cultural practices in new venues -- Women's roles in Andean marketplaces: shopping in the Andes -- Marketing medicines in rural Bolivia: San Pedro de Condo -- Selling medicines at Condo's regional marketplaces: Huari, Challapata, and Oruro -- Bolivian traditional medicines and urban commercialization: medicine vendors in Cochabamba -- Coca, coca medicines, and the dilemma of coca in the Andes and beyond -- Natural medicine and naturopaths in Bolivia: a new twist on traditional medicine -- Traditional medicines and intellectural property rights -- The future of traditional medicines in Bolivia

FrontMatter -- Reviewers -- Contents -- 1 Introduction -- 2 Official U.S. Rural Area Classification Systems -- 3 Other Rural Area Classification Systems Used in the United States and Internationally -- 4 Changes in Society and Economy and Their Impact on Rural Area Classifications -- 5 Different Ways to Conceptualize Rural Areas in Metropolitan Society -- 6 Uses of Current Rural Classification Systems -- 7 Changes in Social Science Data and Methods -- 8 Evaluating the Reliability and Validity of Rural Area Classifications -- 9 Closing Remarks -- Bibliography

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.

Intro -- RURAL TELEMEDICINE AND HOMELESSNESS ASSESSMENTS OF SERVICES -- RURAL TELEMEDICINE AND HOMELESSNESS ASSESSMENTS OF SERVICES -- CONTENTS -- PREFACE -- Chapter 1 TELECOMMUNICATIONS: FCC'S PERFORMANCE MANAGEMENT WEAKNESSES COULD JEOPARDIZE PROPOSED REFORMS OF THE RURAL HEALTH CARE PROGRAM -- WHY GAO DID THIS STUDY -- WHAT GAO RECOMMENDS -- WHAT GAO FOUND -- ABBREVIATIONS -- BACKGROUND -- FCC HAS NOT PERFORMED THE ANALYSIS NECESSARY TO ENSURE THAT THE PRIMARY RURAL HEALTH CARE PROGRAM MEETS THE NEEDS OF RURAL HEALTH CARE PROVIDERS -- Participation in the Program, Although Increasing, Has Not Met FCC Projections and over Half of All Program Funds Are Used in Alaska -- FCC Has Not Assessed the Telecommunications Needs of Rural Health Care Providers to Guide the Evolution of the Rural Health Care Program -- FCC'S POOR PLANNING AND COMMUNICATION DURING THE DESIGN AND IMPLEMENTATION OF THE PILOT PROGRAM CAUSED DELAYS AND DIFFICULTIES -- FCC's Limited Collaboration with USAC, Federal Agencies, and Other Knowledgeable Stakeholders Affected Pilot Program Design -- Pilot Participants Have Experienced Delays and Difficulties, in Part, Because FCC Did Not Fully Establish Requirements Prior to Calling for Applications and Did Not Provide Effective Program Guidance -- Pilot Participants Have Experienced Delays and Difficulties for Many Reasons -- FCC's Call for Applications Did Not Include Needed Information about the Eligibility of Entities, Expenses, and How to Meet the Match Requirement -- FCC Introduced New Requirements after Its Call for Applications and Selection of Pilot Participants -- Program Guidance Is Not Provided in an Effective Manner -- Program Guidance Is Not Provided in an Effective Manner

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.