Dissertations / Theses: 'Rural health services – Swaziland'

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Sun, Xiao Ming. "Health access and health financing in rural China." Thesis, Keele University, 1996. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.263121.

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Madlopha, Sboniso Charles. "A needs analysis of an employee wellness programme : the case of the Financial Services Regulatory Authority (FSRA) of Swaziland." Thesis, Rhodes University, 2015. http://hdl.handle.net/10962/d1018912.

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In 2010, the Financial Services Regulatory Authority (FSRA) of Swaziland noticed a significant increase in employee absenteeism which they discovered was related mainly to: poor health (sick leave), personal and financial stress (garnishee orders were increasing), and low staff morale, the consequence of which was low productivity and missed deadlines (FSRA, 2010:7). High levels of absenteeism meant that a sizeable number of employees were unable to complete their daily tasks (FSRA, 2010:7). Consequently, in 2011, the FSRA Human Resource Department started a wellness programme for all employees in the organization in an attempt to respond to the human resource challenges reported in 2009/10 financial year. By the end of 2012, FSRA management reported that the introduction of the EWP had not yielded the expected results. This therefore prompted management to request an evaluation of the FSRA employee wellness programme. The aim of this research was to identify and prioritize the needs of employees in terms of requirements of a wellness programme and how it should be delivered. The specific objectives of the study are as follows: to identify the wellness needs of employees, to identify employee preferences in terms of the type of interventions to be included in a wellness programme, to identify the preferred mode of delivery of the wellness programme and to make recommendations to management on the design of a wellness programme. Questionnaires with closed ended questions were used to collect data for this survey. The questionnaire used is attached as Appendix A. By means of a needs analysis survey, this research was designed to assess the FSRA employees’ needs in terms of an employee wellness programme, as well as the preferred EWP delivery methods. About 70 percent of FSRA employees participated in the survey. The respondents completed the questionnaire and submitted it online over a period of 10 working days (2 weeks). This report is structured into three sections, namely; section one, which is the evaluation report that gives details of the importance of the study, highlights research methods and then present the results, discussions and recommendations. Section two deals with the literature review while section three reports on the research methodology, research design and procedures and the limitation of the study. In light of the findings on the wellness needs of employees, 72 percent of the respondents felt the current wellness programme was very inadequate and a further 10 percent added that it was inadequate in addressing their wellness needs largely because the needs were not known. The most important wellness needs identified included: exercise, nutrition, personal hygiene, disease awareness and treatment of illness, coping with stress, coping with workload, ventilation, safety, bereavement, personal debt, and retirement planning. The most preferred wellness interventions that respondents proposed include Flexible Work Schedule, Safe Workplace, Improved Ventilation, Retirement Planning Advice and Gymnasium. Further analysis done using correlation analysis indicated that there was a significant positive relationship between the wellness needs and the wellness interventions. Concerning the delivery of the wellness programme, most of the employees indicated that outsourcing certain services was better than having them in house. The highest ranking of the services for out sourcing were nutrition education and medical checkups that ranked between 82 percent and 75 percent respectively. The respondents indicated that they want almost all the chosen interventions to be outsourced. Time slots should also be taken into consideration to ensure employee participation in the wellness programme services. The respondent FSRA employees seem to prefer interventions of an educational nature to be during the lunch hour. These include Nutrition Education, Health Education, Hygiene Education and Medical Check ups and Treatment, whereas Gymnasium was preferred to be after working hours.

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Sandbulte, Natalie J. "Rural communities and mental health care." Theological Research Exchange Network (TREN), 2007. http://www.tren.com/search.cfm?p088-0180.

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Woreta, Fikadu. "Maternal and foetal outcomes of deliveries attended to at Emkhuzweni Health Centre in Swaziland." Thesis, University of Limpopo (Medunsa Campus), 2010. http://hdl.handle.net/10386/688.

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Thesis (M Med(Family Medicine)) -- University of Limpopo, 2010.
Abstract AIM The aim of the study was to measure the maternal and foetal outcomes of the deliveries attended to at Emkhuzweni Health Centre, Swaziland. Objectives The objectives of the study were: .:. To determine maternal outcomes of the deliveries attended to at Emkhuzweni Health Centre. .:. To determine foetal outcomes of the deliveries attended to at Emkhuzweni Health Centre. .:. To identify risk factors that affect maternal and foetal outcomes at Emkhuzweni Health Centre Methods A retrospective chart review was performed for all 520 deliveries at Emkhuzweni Health Centre between January 1,2007 and December 31 2007. Labouring mothers were eligible for the study if they met the inclusion criteria. The study was conducted after ethical approvals from the relevant authorities were obtained. Data were obtained from records for the following variables: age, address, gravidity, parity, health service where ANC was attended, risk factor, mode of delivery, maternal condition after delivery and post-delivery maternal hospital stay. For each foetus, the APGAR score at the first and fifth minute, weight and sex of the neonate and condition after delivery were recorded. Results The results revealed that the maternal outcomes after delivery were normal for 89.85% of the mothers; 3.4% of those who delivered at EHC had PPH, 5.4% developed puerperal sepsis, 1 % PIH and 0.2% cases resulted in maternal death. The majority of mothers (61.7%) were discharged from the maternity ward in less than 24 hrs. As far as foetal outcomes were concerned, normal babies accounted for 68% of births, early onset neonatal sepsis for 1.9%, congenital malformation (0.6%), stillbirth (1.5%), low birth weight (9.2%), preterm babies (17.8 %) and neonatal death (0.4%0. Conclusion This study found that the maternal outcomes at Emkhuzweni Health Centre in 2007 were similar to those in Swaziland as a whole and in other developing countries, except that there was a higher rate of pre-term delivery among pregnant women assisted at Emkhuzweni Health Centre. The foetal outcomes of Emkhuzweni Health Centre in 2007 were similar to the data from developing countries. Additionally, however; significant numbers of pre-term babies were delivered and a high incidence of neonatal sepsis was observed at the Health Centre. Some of the risk factors for the observed maternal and foetal outcomes were poor antenatal care attendance, distance of the Health Centre from the home state of the pregnant woman, preterm labour, under age and teenage pregnancies.

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Beatty, Kate, Michael Meit, Emily Phillips, and Megan Heffernan. "Rural Health Departments: Capacity to Improve Communities' Health." Digital Commons @ East Tennessee State University, 2017. https://dc.etsu.edu/etsu-works/6838.

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Local health departments (LHD) serve a critical role in leveraging internal and community assets to improve health and equity in their communities; however, geography is an important factor when understanding LHD capacity and perspective. LHDs serve a critical role in leveraging internal and community assets to improve health and equity in their communities; however, geography is an important factor when understanding LHD capacity and perspective. Data were obtained from the NACCHO 2013 National Profile of Local Health Departments Study. LHDs were coded as “urban”, “micropolitan”, or “rural” based on Rural/Urban Commuting Area codes. Results demonstrate that rural LHDs differed from their urban counterparts. Specifically, rural LHDs relied more heavily on state and federal resources and have less access to local resources making them more sensitive to budget cuts. Rural LHDs also rely more heavily on clinical services as a revenue source. Larger rural LHDs provide more clinical services while urban health departments work more closely with community partners to provide important safety net services. Small rural LHDs have less partners and are unable to provide as many direct services due to their lack of human and financial resources. LHDs residing in urban communities were 16.6 times (95% confidence interval [CI], 5.3-52.3) and micropolitan LHDs were 3.4 times (95% CI, 1.1-11.3) more likely to seek PHAB accreditation than rural LHDs.

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Morrisey, Karyn Marie. "Access to health care services in rural ireland." Thesis, University of Leeds, 2008. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.502767.

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Eastman, Martha Anne. ""All for Health for All": The Local Dynamics of Rural Public Health in Maine, 1885-1950." Fogler Library, University of Maine, 2006. http://www.library.umaine.edu/theses/pdf/EastmanMA2006.pdf.

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Yan, Nicole, and 甄錦樺. "Exploring health in China's rural villages: apublic health field exercise." Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2011. http://hub.hku.hk/bib/B46943821.

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Murray, Christopher J. L. "The determinants of health improvement in developing countries : case-studies of St. Lucia, Guyana, Paraguay, Kiribati, Swaziland and Bolivia." Thesis, University of Oxford, 1988. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.304625.

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Billmeyer, Tina W. "Evaluation of a behavioral health integration program in a rural primary care facility." Huntington, WV : [Marshall University Libraries], 2007. http://www.marshall.edu/etd/descript.asp?ref=755.

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Prior, Maria E. "Added-value roles and remote communities an exploration of the contribution of health services to remote communities and of a method for measuring the contribution of institutions and individuals to community stocks of capital /." Thesis, Available from the University of Aberdeen Library and Historic Collections Digital Resources, 2009. http://digitool.abdn.ac.uk:80/webclient/DeliveryManager?application=DIGITOOL-3&owner=resourcediscovery&custom_att_2=simple_viewer&pid=33408.

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Hale, Nathan, Tamar Klaiman, Kate E. Beatty, and Michael Meit. "Rural Health Departments and Clinical Services: Transition to Whom?" Digital Commons @ East Tennessee State University, 2016. https://dc.etsu.edu/etsu-works/6845.

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Weber, Amy Judith, Olubunmi Kuku, and Edward Leinaar. "Differences in Access to Contraceptive Services Between Rural and Non-Rural Clinics in South Carolina." Digital Commons @ East Tennessee State University, 2018. https://dc.etsu.edu/asrf/2018/schedule/125.

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Unintended pregnancies, defined as either being unwanted or mistimed, represent a major public health challenge. Roughly half of all pregnancies in the United States are unintended, and have been associated with poor health and economic outcomes for infants, children, women, and families. Modern contraceptives have been proven to be both safe and effective in reducing unintended pregnancy. This is particularly true for long-acting reversible contraceptive (LARC) methods, which are associated with both higher user satisfaction and overall efficacy as compared to short-acting methods. We therefore investigated types of contraceptive services offered among rural and non-rural clinics in South Carolina. A survey was developed; all clinics in South Carolina who offer contraceptive services were invited to participate. Completion of the survey was voluntary and an incentive was provided. The survey was multi-faceted, covering several aspects of contraceptive care including scope of services provided, availability of resources, and training received. Of primary interest to this research, is the extent to which highly effective contraception methods, such as LARCs, are available in both urban and rural clinics. Findings suggest that access to highly effective LARCs is not equitable among rural and urban clinics. Approximately 62% of urban clinics offered LARC methods, compared to 36% among rural clinics (p=0.0015). These data indicate that women who reside in a rural locale have significantly lower access to these more effective contraceptive methods. As nearly 25% of women within the United States reside in a rural locale, the need to address barriers to access to contraceptive care is essential. This work will be a useful tool in understanding barriers to contraceptive care utilization and can lead to the development of novel programs to reduce the rate of unintended pregnancy, births and abortions, and corresponding savings in health care costs.

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Harris, Jenine K., Kate E. Beatty, J. P. Leider, Alana Knudson, Britta L. Anderson, and Michael Meit. "The Double Disparity Facing Rural Local Health Departments." Digital Commons @ East Tennessee State University, 2016. https://dc.etsu.edu/etsu-works/6825.

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Residents of rural jurisdictions face significant health challenges, including some of the highest rates of risky health behaviors and worst health outcomes of any group in the country. Rural communities are served by smaller local health departments (LHDs) that are more understaffed and underfunded than their suburban and urban peers. As a result of history and current need, rural LHDs are more likely than their urban peers to be providers of direct health services, leading to relatively lower levels of population-focused activities. This review examines the double disparity faced by rural LHDs and their constituents: pervasively poorer health behaviors and outcomes and a historical lack of investment by local, state, and federal public health entities.

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Guo, Sufang Oratai Rauyajin. "Health service utilization of women with reproductive tract infections in rural China /." Abstract, 1999. http://mulinet3.li.mahidol.ac.th/thesis/2542/42E-GuoSufang.pdf.

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Lackey, Douglas Eugene. "Participation in rural health development : a case study in Kenya." Thesis, London School of Economics and Political Science (University of London), 1997. http://etheses.lse.ac.uk/2479/.

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Achieving active participation of community members in community-based health care programmes (CBHC) is a challenging and complex task. It is also a criterion for successful programming and is promoted as a universal truth and requirement for primary health care development. Nevertheless, most CBHC programmes admit that more needs to be done to achieve satisfactory levels of community involvement. Thus, a better understanding is required as to why success in community involvement has been in most part, elusive. The thesis uses a historical perspective to examine the emergence of participation in the period prior to and during the community development era in Africa and the post-independent period in Kenya. The emergence of participation and it's progression as an international health strategy in the 1980's and 1990's within WHO, a leading international organisation promoting community involvement in health is critically examined. At the community level, people's perception and understanding of community participation and an analysis of how they participated in the case study CBHC programme provided an operational assessment of community participation. A particular focus was community contributions as a mechanism of participation. Thus, the primary aim of this thesis was to examine in rural Kenya the socio-economic and institutional support factors which can potentially enhance or limit participation of community members in rural community-based health development programmes. The main socio-economic factors examined were education, income, group membership and domestic factors such as harmony in the household and women's time. The roles of local structures and support personnel such as community health volunteers (CHVs), health committee members (HCMs) and local leaders in promoting participation were also analysed. The method used was interviews with a sample of these respondents. Based on the case study research results, the thesis draws conclusions on the factors that appear to be most significant in relation to community participation. The importance of education, group membership and regular monthly visits by CHVs were identified as particularly significant factors. A more informed understanding of these relationships will enable health planners in designing integrated programme strategies which can help promote broader community participation in health development programmes. An awareness of these factors and their inter-relationships by operational-level health staff will enable them to enhance community participation when developing and implementing community-based health care programmes.

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Beatty, Kate, Michael Meit, Tyler Carpenter, Amal Khoury, and Paula Masters. "Clinical Service Delivery Disparities along the Urban/Rural Continuum." Digital Commons @ East Tennessee State University, 2015. https://dc.etsu.edu/etsu-works/6847.

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background: Rural communities face numerous health disparities related to health behaviors, health outcomes, and access to medical care. LHDs serving rural communities have fewer resources to meet their community needs. The number and types of community organizations (hospitals, health clinics, not-for-profits), available to partner with may be limited geographically. These factors may affect availability of clinical services in rural communities. This study will assess LHD clinical service delivery levels based on rurality. data sets and sources: Data were obtained from the NACCHO 2013 National Profile of Local Health Departments Study. LHDs were coded as “urban”, “micropolitan”, or “rural” based on Rural/Urban Commuting Area (RUCA) Both “micropolitan” and “rural” categories are considered rural by the Federal Office of Rural Health Policy. analysis: Bivariate analysis for 25 clinical services offered by rurality . For each service, we compared the proportions of LHDs that: 1) directly performed, 2) contracted with organizations, and 3) reported that the service was provided independently by organizations in the community. principal findings: Analyses show significant differences in patterns of clinical services offered, contracted or provided by third parties based on rurality. LHDs in micropolitan areas provided more services directly than urban and rural LHDs (p≤0.001). Urban LHDs were more likely to contract with other organizations (p≤0.001). conclusions: Rural LHDs are less likely to offer, contract, or have services provided by another organization in the community, whereas larger rural (i.e., micropolitan) jurisdictions are more likely to directly provide these services. implications for public health practice and policy: Lower levels of clinical service delivery by rural LHDs may contribute to the access issues facing rural communities. Health care reform brings threats and opportunities for LHD clinical service delivery. Further analyses to assess impacts on rural LHDs and identify strategies to ensure access to clinical services is encouraged.

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Lilly, C. E., Jodi Polaha, Stacey Williams, and M. Schrift. "Rural Parents’ Perspectives on Mental Health Services: A Qualitative Study." Digital Commons @ East Tennessee State University, 2013. https://dc.etsu.edu/etsu-works/6594.

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Gangai, Bharti. "Patient satisfaction with health services in a rural district hospital." University of the Western Cape, 2015. http://hdl.handle.net/11394/5216.

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Magister Scientiae Dentium - MSc(Dent)
BACKGROUND: The concept of consumer satisfaction is gaining momentum across all business sectors worldwide. In keeping with this trend, health care systems are now also being reviewed to assess patient satisfaction with regard to the quality of care provided. Patient satisfaction is an instrumental tool for identifying shortcomings and challenges of the health system, and provides patients with a constructive outlet to rate their hospital experience. AIM: To determine the perceived levels of patient satisfaction with health care services. METHODOLOGY: A descriptive cross-sectional study was conducted using patients who attended the Outpatients Department of Untunjambili Hospital in Kwa-Zulu Natal. A sample of 250 patients was selected using systematic random sampling. The research instrument, a structured questionnaire consisted of 23 questions which were subdivided into five categories, namely: biographical data; accessibility to the hospital; infrastructure; overall satisfaction and general comments. The 5-Point Likert Scale was used to determine the perceived levels of patient satisfaction. Data collected from the responses was analysed using the SPSS Programme, Version 22.0. A Significance level of (p=0.05) was applied. RESULTS: The response rate of the study was 99.2% (n=248).The majority of the respondents were female (75.4%) and aged between 20-30 years old. The relative ratio of males to females was approximately 1:3. Nearly half of the participants (48.4%) had a secondary education, and a high degree of illiteracy was noted (21.8%). The majority of patients relied on taxis as the mode of transport to reach the hospital (71.4%), with 55.2% having to pay more than R15.00 for travel costs. While statements relating to personality such as staff friendliness, and doctors treating patients respectfully scored highly (93.5%), more than two thirds reported dissatisfaction with the lengthy waiting times (71.8%). In terms of infrastructure, respondents were mainly satisfied with the seating arrangements, cleanliness and air circulation, but were unhappy with the state of the toilet facilities and the unavailability of drinking water. Overall, 90.3% of patients were satisfied with the level of care they received at Untunjambili Hospital, with 89.5% suggesting that they would recommend the institution to others.

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Beatty, Kate, and Michael Meit. "Opportunities and Challenges Facing Rural Public Health Agencies." Digital Commons @ East Tennessee State University, 2018. https://dc.etsu.edu/etsu-works/6835.

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Chaudhuri, Anoshua. "Intended and unintended consequences of a maternal and child health program in rural Bangladesh /." Thesis, Connect to this title online; UW restricted, 2003. http://hdl.handle.net/1773/7411.

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Domapielle, Maximillian K. "Extending health services to rural residents in Jirapa District : analyses of national health insurance enrolment and access to health care services." Thesis, University of Bradford, 2015. http://hdl.handle.net/10454/14803.

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This thesis sheds light on differences in health insurance enrolment determinants and uptake barriers between urban and rural areas in the Jirapa district of Ghana. The National Health Insurance Scheme in Ghana has made significant progress in terms of enrolment, which has had a commensurate increase in utilization of health care services. However, there are challenges that pose a threat to the scheme’s transition to universal coverage; enrolment in the scheme has not progressed according to plan, and there are many barriers known to impede uptake of health care. Interestingly, these barriers vary in relation to locality, and rural residents appear to carry a disproportionate portion of the burden. A mixed method approach was employed to collect and analyse the data. On the basis of the primary qualitative and quantitative results, the thesis argues that the costs of enrolling and accessing health care is disproportionately higher for rural residents than it is their urban counterparts. It also highlights that the distribution of service benefits both in terms of the NHIS and health care in the Jirapa district favours urban residents. Lastly, the thesis found that whereas rural residents prefer health care provision to be social in nature, urban residents were more interested in the technical quality aspects of care. These findings suggest that rural residents are not benefitting from, or may not be accessing health services to the extent as their urban counterparts. Affordability, long distance to health facilities, availability and acceptability barriers were found to influence the resultant pro-urban distribution of the overall health care benefit.

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Whitener, Louise M. "Using Hongvivatana's model to evaluate health care access : a field study of adolescent women's access to reproductive health care services in rural Missouri counties /." free to MU campus, to others for purchase, 2000. http://wwwlib.umi.com/cr/mo/fullcit?p9974703.

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Sullivan, Kendra. "Simulating rural Emergency Medical Services during mass casualty disasters." Thesis, Manhattan, Kan. : Kansas State University, 2008. http://hdl.handle.net/2097/779.

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Nimegeer, Amy. "Considering community engagement for remote and rural healthcare design in Scotland : exploring the journey from rhetoric to reality." Thesis, University of the Highlands and Islands, 2013. https://pure.uhi.ac.uk/portal/en/studentthesis/considering-community-engagement-for-remote-and-rural-healthcare-design-in-scotland(9418ba56-720c-41b6-b97f-f345cfad0ffa).html.

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The way healthcare services are delivered in remote and rural Scottish communities is in a state of reconfiguration. At the same time the NHS faces pressure to plan these new services in partnership with communities themselves. Evidence, however, suggests that this is not necessarily being done well. This study considered the contextual aspects of remote and rural Scottish communities that may impact on healthcare-related engagement, and examined current understanding of what constitutes a ‘good’ engagement process. It then went on to consider a two-year action research project (RSF) that took place in four remote and rural Scottish communities to engage local residents in an anticipatory process co-designing their own future healthcare services. Finally, this study examined ways in which individuals were able to wield power within the engagement described in the RSF project, by using a combination of participant observation and Foucauldian Discourse Analysis. As well as making a number of practical recommendations for future engagement practice in a remote and rural context, this study makes three key contributions. Firstly, it contributes further contextual knowledge about the challenges of engaging with remote and rural Scottish communities for local healthcare service design; a topic about which little has been written. Secondly, it contributes a novel method for anticipatory healthcare budgeting aimed at a remote and rural Scottish context, namely the RSF Game. Thirdly, it draws the conclusion that individual (non-elite) community members have the ability to use French and Raven’s bases of social power to impact the engagement process at all stages, and also posits that discourse can be used within rural engagement as a new ‘base of power’, which contributes to the debate around individual power and agency within remote and rural community engagement for healthcare, which few studies have examined.

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Khe, Nguyen Duy. "Socioeconomic differences in a rural district in Vietnam : effects on health and use of health services /." Stockholm, 2004. http://diss.kib.ki.se/2004/91-7349-984-6/.

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Arhin, Dyna Carol. "Willingness to pay for rural health insurance : evidence from three African countries." Thesis, London School of Economics and Political Science (University of London), 1998. http://etheses.lse.ac.uk/2863/.

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The vast majority of Africans living in rural areas do not have access to health insurance and policy related questions to assist health planners design and implement financially viable rural health insurance schemes have yet to be fully addressed. This thesis seeks to fill some existing gaps in the knowledge about the performance of existing schemes and methods of assessing "willingness to pay" (WTP) and financial feasibility. It begins with a review of the literature on the theory of insurance and its practice in rural areas in Sub-Saharan Africa, that contributed to the research conceptual framework and implementation. Two health insurance schemes (La Carte d'Assurance Maladie and the Abota in Burundi and Guinea Bissau), were evaluated regarding their social and financial performance in rural areas. The research instruments were household surveys, focus group discussions and health facility costing. In both schemes access to health care appeared to have improved and the findings suggested that were quality of care improved, the schemes would considerably reduce financial concerns faced by people at the time of illness. They would also raise significant revenue. In the third study country, Ghana, a study of preferred benefit options, WTP, and community rated premiums for a proposed health insurance scheme was undertaken in a rural area. In undertaking this feasibility study, the research developed a WTP instrument and used a contingent valuation approach. Eight hundred households participated in the study. Eighty percent of households said they would be willing to pay the premium required to recover 100% of the non-salary recurrent costs of providing OPD care in a local clinic and inpatient care in a hospital. The stated WTP was conditional on; a) the insurance scheme giving access to health care in which drugs and basic laboratory investigations would be available, b) health staff being professionally qualified and respectful, and c) a local solidarity association having a role in administering the participating health facilities. Econometric analysis of households' WTP for outpatient insurance cover supported the hypothesis that WTP is influenced by a) the experience of frequent difficulties in paying for health care in the past; b) the perception that adults in the household are healthier than those in other households; and c) the household head's sex, education and religion.

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Fox, Janice M. "Rural ills and community health care : a case study 1989 to 1992." Thesis, University of East Anglia, 1994. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.384942.

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Vaughan, David James. "Acceptability of primary care a study of one community in Montana /." Thesis, Montana State University, 2007. http://etd.lib.montana.edu/etd/2007/vaughan/VaughanD0507.pdf.

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Meit, Michael, Kate E. Beatty, and Megan Heffernan. "Exploring Service Composition and Financing Among Rural LHDs." Digital Commons @ East Tennessee State University, 2018. https://dc.etsu.edu/etsu-works/6836.

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Beam, Nancy K. "Women and men's preferences for delivery services in rural Ethiopia." Thesis, University of California, San Francisco, 2016. http://pqdtopen.proquest.com/#viewpdf?dispub=10133409.

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Women and men’s preferences for delivery services in rural Ethiopia Nancy Beam Aims: This study aims to determine the combination of facility-based delivery care attributes preferred by women and men; if gender differences exist in attribute preferences; and key demographic factors associated with attribute preferences.

Background: Despite programs to promote facility-based delivery, which has been shown to decrease maternal and neonatal mortality, 80% of women in rural Ethiopia deliver at home without a skilled birth attendant.

A review of the Ethiopian literature on factors associated with delivery location revealed several weaknesses in research methods that need to be addressed. First, research participants were almost exclusively women, although male partners often make decisions about delivery location. Second, most quantitative study designs are similar in content to the Ethiopian Demographic Health Survey, limiting the generation of new knowledge. Third, cultural practices identified in qualitative studies as barriers to facility-based delivery have not been included in quantitative studies. This study addressed these weaknesses by using discrete choice experiment methodology to elicit preferences for delivery service attributes, including support persons in the delivery room, staff training and attitude, cost, distance and transportation availability.

Methods: A cross-sectional, discrete choice experiment was conducted in 109 randomly selected households in rural Ethiopia in September-October 2015. Women, who were pregnant or who had a child < 2 years old, and their male partners were interviewed. After completing a demographic questionnaire, male and female respondents were asked separately to choose between facility-based scenarios that reflected various attributes for delivering their next baby. Data were analyzed using a multilevel mixed-effects logistic regression model.

Results: Both women and men preferred health facilities where medications and supplies were available, a support person was allowed in the delivery room, cost was low, and doctors performed the delivery. Women also valued free ambulance service, while men favored nearby facilities with friendly providers. Men are disproportionately involved in making household decisions, including decisions about whether their wives seek health care. Yet, men are often unaware of their partners’ prenatal care attendance.

Implications: The Ethiopian government and health facilities could increase facility births in rural areas by responding to families’ delivery service preferences.

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McLendon, Pamela Ann. "Opening Doors for Excellent Maternal Health Services: Perceptions Regarding Maternal Health in Rural Tanzania." Thesis, University of North Texas, 2014. https://digital.library.unt.edu/ark:/67531/metadc500156/.

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The worldwide maternal mortality rate is excessive. Developing countries such as Tanzania experience the highest maternal mortality rates. The continued exploration of issues to create ease of access for women to quality maternal health care is a significant concern. A central strategy for reducing maternal mortality is that every birth be attended by a skilled birth attendant, therefore special attention was placed on motivations and factors that might lead to an increased utilization of health facilities. This qualitative study assessed the perceptions of local population concerning maternal health services and their recommendations for improved quality of care. The study was conducted in the Karatu District of Tanzania and gathered data through 66 in-depth interviews with participants from 20 villages. The following components were identified as essential for perceived quality care: medical professionals that demonstrate a caring attitude and share information about procedures; a supportive and nurturing environment during labor and delivery; meaningful and informative maternal health education for the entire community; promotion of men’s involvement as an essential part of the system of maternal health; knowledgeable, skilled medical staff with supplies and equipment needed for a safe delivery. By providing these elements, the community will gain trust in health facilities and staff. The alignment the maternal health services offered to the perceived expectation of quality care will create an environment for increased attendance at health facilities by the local population.

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Wingate, Deborah. "Accessing Children's Mental Health Services In A Rural Northern California County." CSUSB ScholarWorks, 2019. https://scholarworks.lib.csusb.edu/etd/819.

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When children are detained and enter the foster care system, social workers screen them to determine if mental health services are needed. Formal referrals to mental health providers are made, however there is a significant wait time between referral and service delivery. The focus of this study was to explore these barriers to mental health services in an effort to identify approaches that might improve service access. Qualitative face-to-face interviews were conducted with key stakeholders using an Ecological Systems Theory to fashion a hermeneutic dialect and a joint construct toward a shared action plan. Data was collected from the interviews and thematically analyzed. The project informs service delivery systems of mental health for children and adults, both for micro and macro practice, by highlighting the need for increased collaboration between agencies and growing family engagement and empowerment to reduce stigma. These efforts will improve communication, define expectations, and diminish silos. The project also contributes to child welfare practices and policies for referrals of children’s mental health services by noting the need for an embedded mental health therapist within child welfare to accept referrals for services; the addition of one study site contractual children’s mental health service provider in the rural county that will accept referrals for children and families. In summary, the study identifies strategies to reduce wait time for service delivery, how those services are best accessed, as well as efforts to better engage families in treatment.

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Polaha, Jodi. "Telehealth Services for Rural Behavioral Health: Directions for Development and Research." Digital Commons @ East Tennessee State University, 2007. https://dc.etsu.edu/etsu-works/6704.

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Beatty, Kate E., Nathan Hale, Michael Meit, Paula Masters, and Amal Khoury. "Clinical Service Delivery along the Urban/Rural Continuum." Digital Commons @ East Tennessee State University, 2016. https://dc.etsu.edu/etsu-works/6870.

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Background: Engagement in the core public health functions and ten essential services remains the standard for measuring local health department (LHD) performance; their role as providers of clinical services remains uncertain, particularly in rural and underserved communities. Purpose: To examine the role of LHDs as clinical service providers and how this role varies among rural and nonrural communities. Methods: The 2013 National Association of County and City Health Officials (NACCHO) Profile was used to examine the geographic distribution of clinical service provision among LHDs. LHDs were coded as urban, large rural, or small rural based on Rural/Urban Commuting Area codes. Bivariate analysis for clinical services was conducted by rural/urban status. For each service, the proportions of LHDs that directly performed the service, contracted with other organizations to provide the service, or reported provision of the service by independent organizations in the community was compared. Results: Analyses show significant differences in patterns of clinical services offered, contracted, or provided by others, based on rurality. LHDs serving rural communities, especially large rural LHDs, tend to provide more direct services than urban LHDs. Among rural LHDs, larger rural LHDs provided a broader array of services and reported more community capacity for delivery than small rural LHDs- particularly maternal and child health services. Implications: There are capacity differences between large and small rural LHDs. Limited capacity within small rural LHDs may result in providing less services, regardless of the availability of other providers within their communities. These findings provide valuable information on clinical service provision among LHDs, particularly in rural and underserved communities.

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Hosegood, Victoria. "Anthropometry and mortality : a cohort study of rural Bangladeshi women." Thesis, London School of Hygiene and Tropical Medicine (University of London), 1997. http://researchonline.lshtm.ac.uk/682248/.

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Many authors suggest that low anthropometric levels are associated with higher mortality risk in adults, In developing countries however there have been few opportunities to test this hypothesis. In addition, there is increasing interest in the role of women's nutritional status in their own health and survival as distinct from its impact on infant outcomes. This thesis describes the results obtained from a longitudinal historical follow-up of a cohort of 2,314 rural Bangladeshi women over a period of 19 years (1975-1993). The demographic, socio-economic, and anthropometric characteristics of the study cohort are described with reference to the methods of data extraction, preparation and validation. The risk of mortality associated with different levels of the anthropometric indicators (height, weight, arm circumference and body mass index) were analysed using Cox's proportional hazards models. In addition to the basic survival models, the effects of confounding, early mortality, missing data, and young subjects, on the estimates are discussed. A significant association between BMI and mortality (p=0.009) was found in adjusted analyses which used categories that distinguished the women in the highest and lowest 10% of the cohort BMI distribution. Women with BMI levels between 10% and 90% and >90% had hazard ratios of 0.45 (95% confidence intervals 0.27,0.73) and 0.55 (0.25,1.22) respectively, when compared to women with BMI <10%. The strength of the association between BMI and mortality risk was reduced after adjusting the models for early mortality (<4 years), (p=0.068). No significant associations were found between height, arm circumference and mortality risk. In conclusion, these data provide no evidence that these anthropometric indicators would be useful in population-based screening programmes in rural Bangladesh to identify women at higher mortality risk. The findings are considered with respect to the study's methodological constraints and comparisons with other studies in order to produce recommendations for those working in research and health programmes in women's nutrition.

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LeGrow, Tracy L. "Access to health information and health care decision-making of women in a rural Appalachian community." Huntington, WV : [Marshall University Libraries], 2007. http://www.marshall.edu/etd/descript.asp?ref=746.

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King, Wade Robert. "The demographics, health related characteristics, and primary care utilization of assisted living facility residents in Montana." Thesis, Montana State University, 2006. http://etd.lib.montana.edu/etd/2006/king/KingW0506.pdf.

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Beatty, Kate. "Clinical Service Delivery Disparities along the Urban/Rural Continuum." Digital Commons @ East Tennessee State University, 2015. https://dc.etsu.edu/etsu-works/6853.

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Uta, Joseph J. "Health communication to rural populations in developing countries : with special reference to Malawi." Thesis, Loughborough University, 1993. https://dspace.lboro.ac.uk/2134/13774.

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The findings of KAP studies and health reports indicate that in spite of continuing efforts by developing countries like Malawi, to raise health awareness among their peoples, the majority of the people remain inadequately informed and are generally found to lack basic knowledge about most prevalent diseases. As a result most people are unable to participate fully in primary health care activities. Two parallel surveys were carried out: (i) on activities of providers of information; and (ii) on information-seeking behaviour of a sample of the public. A health knowledge test was conducted to a sample of the public in order to assess their levels of Aids and bilharzia awareness. On matching the findings from the two surveys the following deficiencies were identified. The major cause of problems was that information provision was fragmented. Conflicting messages were given by different agencies which appeared to compete with each other. Distribution and access to the available information was also found to cause problems. Lack of research-based knowledge among health information providers about information needs and information-seeking behaviour of the people they are planning services for compounds the problems of information provision. Potential solutions include coordinating all activities of health communication from top-to-bottom (i.e. from planning to implementation at the community level). Efforts towards strengthening extension services, consolidating and repackaging of information, and consolidating of health grey literature are argued to be appropriate. Promoting use and marketing of the available information among the rural populations is also argued to be appropriate.

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Meit, Michael, and Kate E. Beatty. "Leveraging Assets to Improve Rural Health and Equity: Challenges and Opportunities." Digital Commons @ East Tennessee State University, 2017. https://dc.etsu.edu/etsu-works/6839.

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Adeniran, Olayemi, and Kate E. Beatty. "The Role of Public Health Funding and Improvement of Health Status of Rural Communities." Digital Commons @ East Tennessee State University, 2017. https://dc.etsu.edu/etsu-works/6863.

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Local Health Departments (LHDs) are administrative unit of a local or state government, concerned with the health of a community or county. There are approximately 2,800 agencies or units that meet the profile definition of LHD. These LHDs vary in size and composition depending on the population they serve. However, all these communitybased agencies share a common mission of “protecting and improving community wellbeing by preventing disease, illness, and injury while impacting social, economic, and environmental factors fundamental to excellent health”. One of the ongoing challenge of a focus on community-level, population-based prevention is the manner in which local public health agencies have been funded. Most LHDs funding comes from federal funds, supplemented by state and local funds. Many of these funds come to LHDs through competitive grants programs. This study was therefore undertaken to investigate the sources of funding for the Local Public Health Agencies, according to geography specifically rurality. We utilized the data already compiled by the National Association of County & City Health Officials (NACCHO) in 2013. The population served by these health agencies were compared to the funding sources, and one –way ANOVA to estimate the significance between these variables. Our dependent variables were assigned to be the funding sources, while the independent variables were the two population categories –rural and urban. A categorical variable reflecting three levels of rurality was constructed using RUCA codes. “Urban” included census tracts with towns with populations >50,000. “Large rural” included census tracts with towns of between 10,000 and 49,999 population and census tracts tied to these towns through commuting. “Small rural” included census tracts with small towns of fewer than 10,000 population, tracts tied to small towns, and isolated census tracts. Furthermore, we also determined the proportion of revenue from these funding sources received by these three population groups. All analyses were completed using SPSS. There were no differences in the amount of revenues received by both the large and small rural and urban agencies from the State & Federal sources (p value = 0.182). However, urban agencies receive more funding from Medicare and Medicaid services (19.9%) compared to small rural with 6.9% (p<0.001). Comparatively, the amount of revenue generated by rural agencies is just a fraction of what the urban agencies generate. Residents of rural areas in the United States tend to be older and poorer, report more risky health behaviors, have more barriers to accessing health care, and have worse health status and health outcomes than do their urban counterparts. These rural LHDs have fewer resources and face strenuous challenges in carrying out their activities of keeping the community safe due to limited revenues. Until public health agencies are firmly connected to payment and funding mechanisms across the health system, communities, the overall health system and accountable care organizations will not see the true benefits of population-focused, community-based, prevention services.

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Matizirofa, Lyness. "Perceived quality and utilisation of maternal health services in peri-urban, commercial farming, and rural areas in South Africa." Thesis, University of the Western Cape, 2006. http://etd.uwc.ac.za/index.php?module=etd&amp.

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This investigation aimed to determine factors that influence women's utilisation of maternal health services, with specific focus on the quality of care and services available to disadvantaged communities in South Africa. It used the women's perspectives to assess the quality of maternal healthcare services in peri-urban commercial farming and rural areas with the purpose of understanding why women utilise maternal services the way they do.

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Kildea, Sue. "Birthing business in the bush : it's time to listen /." Electronic version, 2005. http://adt.lib.uts.edu.au/public/adt-NTSM20051006.180714/index.html.

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Chilma, Dorothy Madalo. "Nutritional status and functional ability of older people in rural Malawi." Thesis, London School of Hygiene and Tropical Medicine (University of London), 1999. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.312510.

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Meit, Michael, and Kate E. Beatty. "The Changing Role of Public Health. State Office of Rural Health Regional Partnership Meeting, Region B." Digital Commons @ East Tennessee State University, 2016. https://dc.etsu.edu/etsu-works/6842.

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Allgood-Scott, Jill R. "A study of health care utilization among chronically ill rural older adults." free to MU campus, to others for purchase, 1998. http://wwwlib.umi.com/cr/mo/fullcit?p9901213.

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Rahman, Syed Azizur. "Utilisation of primary health care services in rural Bangladesh : the population and provider perspectives." Thesis, London School of Hygiene and Tropical Medicine (University of London), 2001. http://researchonline.lshtm.ac.uk/682288/.

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This thesis is about the Utilisation of Maternal and Child Health Care Services (MCH) in Rural Bangladesh. Investigations have been made to identify the underlying causes of low use of the MCH services provided through the public sector health care facilities, which is a major concern for the government of Bangladesh. This thesis focuses on the factors that are affecting the use of MCH services both from population and provider perspectives. Socio-economic condition of people, their knowledge and attitudes towards the public sector health care services are considered as population factors, while different aspects of quality of public health services, access to the service facilities and provider's behaviour are explored as the providers' factors. Aims: The aim of this research was to provide policy recommendations for improving utilisation of the public health services at the primary health care level by redesigning more accessible, acceptable and quality health care services, especially for rural women and children. Scope: Maternal health services: antenatal care; tetanus vaccination; place of child delivery; and postnatal care are considered in this study. While two major killer diseases: diarrhoea and acute respiratory infections, and immunisation of children under five years of age are included as child health care services. Methods: A combination of qualitative and quantitative methods are used to collect data /information from 360 mothers, 28 formal and informal community leaders, 44 various types of health care providers and 22 public sector facilities in a rural area of Bangladesh. The World Health Organisation (WHO) recommended 30 cluster sampling method was used in sample design. Household survey, in-depth interview, informal and formal discussion, participant observation and document analysis have been carried out to obtain necessary information/data. Data analyses: The quantitative data have been analysed by using STATA and SPSS statistical computer programme, performing descriptive, bivariate and logistic regression analysis. The qualitative information has been analysed in a descriptive way. Results: The results show that the use of government health facilities: THC, FWC and VHCP is generally very low with an exception of the use of VHCP for TT vaccination to women and child immunisation. The use of VHCP is encouraging for the government policy makers and planners. THC is partially meeting the health care need of rural people and mainly serving the interest of people of relatively high socio-economic condition. FWC is the most unused health care facility at the rural areas of Bangladesh. The majority of people (86%) received health care from non - qualified health care providers. Among the socio-economic factors - family education and income were found to be significant both individually and jointly with the variations of use of MCH services. The majority of the sample population does not have knowledge about the MCH service availability and possessed negative attitudes towards the public sector MCH services. These are attributable to the under utilisation problem. Nine gaps have been identified between peoples' `reasonable expectation' and the `existing' MCH service delivery system. Peoples' involvement in the health service organisation at the thana and union level was found almost nil. However their involvement in the operation of VHCP was encouraging. Low (2-3 minutes) consultation time, lack of privacy in treatment, unregulated involvement of public sector provider in private practice, lack of accountability, supervision and improper behaviour of providers deteriorating the quality of services hence decreases the use of public sector facilities. Unavailability of drug was found to be the single most important reason that deters people from using public facilities. Difficulties in access to quality services were found to be a major problem than access to the service facilities. Conclusions: This thesis suggests that giving priority to improving the service qualities of the existing facilities rather than construction/development of additional facilities at PHC level. It also suggests the initiation of behaviour change programmes for public sector health care providers. Secondly an effective mechanism needs to be developed to ensure peoples' involvement in the management and operation of public health care facilities to enhance accountability of public sector provider to the population and reduce the gap between them. Initiatives could be taken to improve the quality of non-qualified health care providers, as they are the main source of health care for the majority of population. Finally, increasing the education level of rural population particularly for women could increase the use of health services.

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Wen, Siying, and 溫思穎. "Health insurance effects on health care access for rural residents in Guangzhou city." Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2011. http://hub.hku.hk/bib/B46942749.

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Oum, Sophal. "Development, implementation and evaluation of community-based surveillance system in rural Cambodia." Thesis, London School of Hygiene and Tropical Medicine (University of London), 2002. http://researchonline.lshtm.ac.uk/4646504/.

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A community-based surveillance system was developed and implemented in rural areas in Cambodia. The system aimed to provide timely and representative information on major health problems and life events that would permit rapid and effective control of outbreaks and communicable diseases in general in rural communities. In the system, lay people were trained as Village Health Volunteers to report suspected outbreaks, important infectious diseases, and vital events occurring in their communities to local health staff who analysed the data and gave feedback to the volunteers during their monthly meetings. An evaluation conducted one year after implementation of the community-based surveillance system began found that the system was able to detect outbreaks early, regularly monitor communicable disease trends, and to continuously provide updated information on pregnancies, births and deaths in the rural areas. The sensitivity and specificity of case reporting by Village Health Volunteers were found to be quite high. In addition, the community-based surveillance system triggered effective responses from both health staff and Village Health Volunteers in outbreak and disease control and prevention. The results suggest that a community-based surveillance system can successfully fill the gaps of the current health facility-based disease surveillance system in the rapid detection of outbreaks, in the effective monitoring of communicable diseases, and in the notification of vital events in rural Cambodia. Empowered local people and health staff can accurately report, analyse and act upon significant health problems in their community within a surveillance system they develop, own and operate. The community-based surveillance system could easily be integrated with the current disease surveillance system. Its replication or adaptation for use in other rural areas in Cambodia and in other developing countries would be likely feasible and beneficial, as well as cost-effective.

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Dissertations / Theses on the topic 'Rural health services – Swaziland'

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