The healthcare costs of secondhand smoke exposure in rural China.

Science.gov (United States)

Yao, Tingting; Sung, Hai-Yen; Mao, Zhengzhong; Hu, Teh-wei; Max, Wendy

2015-10-01

The goal of this study was to assess the healthcare costs attributable to secondhand smoke (SHS) exposure among non-smoking adults (age ≥ 19) in rural China. We analysed data from the 2011 National Rural Household Survey which was conducted among adults in five provinces and one municipality in China (N=12,397). Respondents reported their smoking status, health conditions and healthcare expenditures. Relative risks were obtained from published sources. Healthcare costs included annual outpatient and inpatient hospitalisation expenditures for five SHS-related diseases: asthma, breast cancer (female only), heart disease, lung cancer and tuberculosis. SHS-attributable healthcare costs were estimated using a prevalence-based annual cost approach. The total healthcare costs of SHS exposure in rural China amounted to $1.2 billion in 2011, including $559 million for outpatient visits and $612.4 million for inpatient hospitalisations. The healthcare costs for women and men were $877.1 million and $294.3 million, respectively. Heart disease was the most costly condition for both women ($701.7 million) and men ($180.6 million). The total healthcare costs of SHS exposure in rural China accounted to 0.3% of China's national healthcare expenditures in 2011. Over one-fifth of the total healthcare costs of SHS exposure in rural China were paid by health insurance. The out-of-pocket expenditures per person accounted for almost half (47%) of their daily income. The adverse health effects of SHS exposure result in a large economic burden in China. Tobacco control policies that reduce SHS exposure could have an impact on reducing healthcare costs in China. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

Feasibility of a low-cost hearing screening in rural Indiana

Directory of Open Access Journals (Sweden)

Khalid M. Khan

2017-09-01

Full Text Available Abstract Background Hearing loss remains a neglected public health issue in the rural and agricultural communities in the United States and therefore, promotion of a low-cost hearing screening may be important for these underserved populations. The major objectives of our study were to assess feasibility of a low-cost telephone-administered hearing test in rural Indiana and to identify the challenges, barriers and viable implementation strategies associated with this test. Also, we evaluated whether a focus group session could change the hearing health attitude of rural residents. Methods We recruited 126 adults from six rural Indiana counties who participated in study activities in the following order: 1 a pre-focus group demographic, knowledge and attitude survey, 2 a focus group for discussing the feasibility of a telephone-administered hearing screening, 3 a post focus group attitude survey and 4 hearing was screened using an audiometer and self-assessment scale. These activities generated both qualitative and quantitative data, which were subsequently analyzed. Results Hearing impairment was perceived as an important public health issue. Many participants expressed interests to try the low-cost National Hearing Test (NHT. However, participants recommended NHT to be facilitated by community organizations to provide access to landline phones. The focus group turned out to be an excellent awareness building activity producing significant improvement in hearing health attitudes. Comparison of self and audiometric evaluations indicated underestimation of hearing handicap in our rural study population. Conclusions The study results underscore the urgent need for an effective strategy to promote low-cost hearing screening in rural US communities.

Rural electrification based on photovoltaic systems: systemic evaluation and analysis; Eletrificacao rural com sistemas fotovoltaicos: avaliacao e analise sistemicas

Energy Technology Data Exchange (ETDEWEB)

Orellana Lafuente, Renan Jorge

1995-07-01

In spite of all advances made by modern technology, there are still regions which remoteness has made electrification of poor rural localities very difficult or impossible. The only practical solution for these localities is a local, decentralized form of electrical generation, such as solar energy. Based on its availability and potential, together with the scientific and technical advances made in photovoltaic conversion, solar energy is an alternative which is viable for many rural areas in developing countries. The technology has matured sufficiently, but in its application there is still a need for systematization for experiences, especially in the areas of planning and management. The present work deals with a project carried in the community of Chimboata, Chimboata department, Bolivia. The implementation aspects are analysed and the implementation methodology described. Finally, the forms of managing and funding this type of systems are analysed. (author)

Costs of cardiovascular disease prevention care and scenarios for cost saving: a micro-costing study from rural Nigeria

NARCIS (Netherlands)

Hendriks, Marleen E.; Bolarinwa, Oladimeji A.; Nelissen, Heleen E.; Boers, Alexander C.; Gomez, Gabriela B.; Tan, Siok Swan; Redekop, William; Adenusi, Peju; Lange, Joep M. A.; Agbede, Kayode; Akande, Tanimola M.; Schultsz, Constance

2015-01-01

To assess the costs of cardiovascular disease (CVD) prevention care according to international guidelines, in a primary healthcare clinic in rural Nigeria, participating in a health insurance programme. A micro-costing study was conducted from a healthcare provider perspective. Activities per

Cost-Effectiveness of Rural Incentive Packages for Graduating Medical Students in Lao PDR.

Science.gov (United States)

Keuffell, Eric; Jaskiewicz, Wanda; Theppanya, Khampasong; Tulenko, Kate

2016-10-29

The dearth of health workers in rural settings in Lao People's Democratic Republic (PDR) and other developing countries limits healthcare access and outcomes. In evaluating non-wage financial incentive packages as a potential policy option to attract health workers to rural settings, understanding the expected costs and effects of the various programs ex ante can assist policy-makers in selecting the optimal incentive package. We use discrete choice experiments (DCEs), costing analyses and recent empirical results linking health worker density and health outcomes to estimate the future location decisions of physicians and determine the cost-effectiveness of 15 voluntary incentives packages for new physicians in Lao PDR. Our data sources include a DCE survey completed by medical students (n = 329) in May 2011 and secondary cost, economic and health data. Mixed logit regressions provide the basis for estimating how each incentive package influences rural versus urban location choice over time. We estimate the expected rural density of physicians and the cost-effectiveness of 15 separate incentive packages from a societal perspective. In order to generate the cost-effectiveness ratios we relied on the rural uptake probabilities inferred from the DCEs, the costing data and prior World Health Organization (WHO) estimates that relate health outcomes to health worker density. Relative to no program, the optimal voluntary incentive package would increase rural physician density by 15% by 2016 and 65% by 2041. After incorporating anticipated health effects, seven (three) of the 15 incentive packages have anticipated average cost-effectiveness ratio less than the WHO threshold (three times gross domestic product [GDP] per capita) over a 5-year (30 year) period. The optimal package's incremental cost-effectiveness ratio is $1454/QALY (quality-adjusted life year) over 5 years and $2380/QALY over 30 years. Capital intensive components, such as housing or facility improvement

The emergence of rural transport strategies in response to rising fuel costs

International Nuclear Information System (INIS)

Shapiro, Dana; Pearlmutter, David; Schwartz, Moshe

2012-01-01

Rising and sometimes volatile fuel prices pose a challenge for rural organizations reliant on long distance transport. To understand the coping mechanisms used by such organizations, we survey rural business strategies in Israel, where fuel prices are high and urban development is concentrated in the country's geographic center. The businesses surveyed are operated by kibbutzim, historically collective communities that are now in various stages of privatization. Analysis of the ‘transport strategies’ employed by nearly 100 organizations in three regions of varying remoteness and isolation shows that firms rely on distinct strategies such as localization and high value density. Localization was found to be prevalent in all regions, as it requires little capital investment. Strategies exploiting high value density, including information-based services, were prevalent in remote and isolated regions where sensitivity to transport costs is acute. Non-remote firms were less inclined toward strategic adaptation, preferring non-disruptive changes such as cheaper shipping modes. The development implications of these transport strategies are consistent with rural economic trends observed throughout the developed world. If transport costs continue to rise, rural firms may shrink the radius of their sales and labor pools, or search for more lucrative products to reduce their relative transport costs. - Highlights: ► We survey transport strategies used by rural businesses in Israeli kibbutzim. ► The seven distinct strategies identified include localization and value density. ► Localization is used in all regions and value density in remote and isolated regions. ► Development implications are consistent with economic trends in other rural regions. ► Rural firms will likely respond to high fuel costs by strategic transport adaptation.

Cost-effectiveness of canine vaccination to prevent human rabies in rural Tanzania.

Science.gov (United States)

Fitzpatrick, Meagan C; Hampson, Katie; Cleaveland, Sarah; Mzimbiri, Imam; Lankester, Felix; Lembo, Tiziana; Meyers, Lauren A; Paltiel, A David; Galvani, Alison P

2014-01-21

The annual mortality rate of human rabies in rural Africa is 3.6 deaths per 100 000 persons. Rabies can be prevented with prompt postexposure prophylaxis, but this is costly and often inaccessible in rural Africa. Because 99% of human exposures occur through rabid dogs, canine vaccination also prevents transmission of rabies to humans. To evaluate the cost-effectiveness of rabies control through annual canine vaccination campaigns in rural sub-Saharan Africa. We model transmission dynamics in dogs and wildlife and assess empirical uncertainty in the biological variables to make probability-based evaluations of cost-effectiveness. Epidemiologic variables from a contact-tracing study and literature and cost data from ongoing vaccination campaigns. Two districts of rural Tanzania: Ngorongoro and Serengeti. 10 years. Health policymaker. Vaccination coverage ranging from 0% to 95% in increments of 5%. Life-years for health outcomes and 2010 U.S. dollars for economic outcomes. Annual canine vaccination campaigns were very cost-effective in both districts compared with no canine vaccination. In Serengeti, annual campaigns with as much as 70% coverage were cost-saving. Across a wide range of variable assumptions and levels of societal willingness to pay for life-years, the optimal vaccination coverage for Serengeti was 70%. In Ngorongoro, although optimal coverage depended on willingness to pay, vaccination campaigns were always cost-effective and lifesaving and therefore preferred. Canine vaccination was very cost-effective in both districts, but there was greater uncertainty about the optimal coverage in Ngorongoro. Annual canine rabies vaccination campaigns conferred extraordinary value and dramatically reduced the health burden of rabies. National Institutes of Health.

Rural-urban variation in injury-related hospitalisation, health outcomes and treatment cost in New South Wales.

Science.gov (United States)

Mitchell, Rebecca J; Lower, Tony

2018-04-19

To compare differences in injury characteristics, health outcomes and treatment costs between urban and rural residents who were hospitalised following an injury. A retrospective examination of injury-linked hospitalisation and mortality data in New South Wales from 1 January 2010 to 30 June 2014. Urban (496 325) and rural (213 139) residents who were hospitalised following an injury. Demographic and injury characteristics, injury severity, hospital length of stay, 28-day hospital readmission, 90-day mortality and treatment cost. Rural residents had an increased likelihood of being hospitalised for injuries from motorcycles, vehicles, animate causes, venomous animals or plants and assault compared to urban residents. Rural residents were less likely to be readmitted to hospital within 28 days and had a lower length of stay and age-adjusted length of stay than urban residents. Injury-related hospitalisations for urban and rural residents cost $4.4 billion and $1.7 billion, respectively. Annually, acute injury treatment ($1.1 billion), rehabilitation ($130 million) and subacute non-acute patient care ($57 million) cost $1.3 billion ($990 million for urban and $384 million for rural residents) in New South Wales. Fall-related injuries and transport incidents were the costliest injury mechanisms for both urban and rural residents. Injuries contribute substantially to hospitalised morbidity and its cost. The development and implementation of injury prevention strategies targeting the most common injuries for urban and rural residents will go some way towards reducing hospitalised injury and its cost. © 2018 National Rural Health Alliance Ltd.

A cost-effective evaluation of biomass district heating in rural communities

International Nuclear Information System (INIS)

Hendricks, Aaron M.; Wagner, John E.; Volk, Timothy A.; Newman, David H.; Brown, Tristan R.

2016-01-01

Highlights: • Develop a cost-effective model using secondary data examining delivering heat through Biomass District Heating (BDH). • Eight of ten rural villages studied could cost-effectively deliver heat through BDH below the 2013 price of heating oil. • 80% of the annual cost of BDH was attributable to capital expenses. • Erratic fuel oil prices substantially impact future feasibility. • Village level feasibility is highly-influenced by the presence of large heat demanders. - Abstract: The economic feasibility of Biomass District Heating (BDH) networks in rural villages is largely unknown. A cost-effective evaluation tool is developed to examine the feasibility of BDH in rural communities using secondary data sources. The approach is unique in that it accounts for all the major capital expenses: energy center, distribution network, and energy transfer stations, as well as biomass procurement. BDH would deliver heat below #2 fuel oil in eight of the ten rural study villages examined, saving nearly $500,000 per year in heating expenses while demanding less than 5% of the forest residues sustainably available regionally. Capital costs comprised over 80% of total costs, illuminating the importance of reaching a sufficient heat density. Reducing capital costs by 1% lowers total cost by $93,000 per year. Extending capital payment period length five years or lowering interest rates has the next highest influence decreasing delivered heat price 0.49% and 0.35% for each 1% change, respectively. This highlights that specific building heat is a strong determinant of feasibility given the relative influence of high-demanding users on the overall village heat-density. Finally, we use a stochastic analysis projecting future #2 fuel oil prices, incorporating historical variability, to determine the probability of future BDH feasibility. Although future oil prices drop below the BDH feasibility threshold, the villages retain a 22–53% probability of feasibility after

Are Rural Costs of Living Lower? Evidence from a Big Mac Index Approach

OpenAIRE

Scott Loveridge; Dusan Paredes

2015-01-01

Rural leaders can point to low housing costs as a reason that their area should be competitive for business attraction. To what extent do rural housing costs offset transportation and other locational disadvantages in costs structures? The US lacks information to systematically answer the question. We adapt a strategy employed by The Economist in exploring purchasing power parity: the Big Mac Index. We gather information on Big Mac prices with a random sample of restaurants across the contigu...

The delivery of low-cost, low-carbon rural energy services

Energy Technology Data Exchange (ETDEWEB)

Casillas, Christian E., E-mail: cecasillas@berkeley.edu [Energy and Resources Group, University of California, Berkeley (United States); Kammen, Daniel M. [Energy and Resources Group, University of California, Berkeley (United States); Goldman School of Public Policy, University of California, Berkeley, CA 94720 (United States); The World Bank, Washington, DC 20433 (United States)

2011-08-15

The provision of both electrical and mechanical energy services can play a critical role in poverty alleviation for the almost two billion rural users who currently lack access to electricity. Distributed generation using diesel generators remains a common means of electricity provision for rural communities throughout the world. Due to rising fuel costs, the need to address poverty, and consequences of global warming, it is necessary to develop cost efficient means of reducing fossil fuel consumption in isolated diesel microgrids. Based on a case study in Nicaragua, a set of demand and supply side measures are ordered by their annualized costs in order to approximate an energy supply curve. The curve highlights significant opportunities for reducing the costs of delivering energy services while also transitioning to a carbon-free electrical system. In particular, the study demonstrates the significant cost savings resulting from the implementation of conventional metering, efficient residential lighting, and electricity generation using renewable energy sources. - Highlights: > We present a case study of conservation measures implemented in a diesel microgrid. > An energy conservation and supply curve is constructed using additional measures. > Energy efficiency and renewable energy result in cost savings and carbon abatement. > We discuss weaknesses of energy supply and carbon abatement curve calculations

The rural electric cooperatives in a new scenario of the electric sector; As cooperativas de eletrificacao rural no novo cenario do setor eletrico

Energy Technology Data Exchange (ETDEWEB)

Pelegrini, Marcelo Aparecido; Ribeiro, Fernando Selles; Pazzini, Luiz Henrique Alves [Universidade de Sao Paulo (USP), SP (Brazil). Escola Politecnica. Dept. de Engenharia de Energia e Automacao Eletricas], e-mail: macpel@pea.usp.br, e-mail: fribeiro@pea.usp.br, e-mail: pazzini@pea.usp.br

2004-07-01

The rural electric cooperatives are agents who have always been on the edge of the electric sector. Now, they must be regularized to the new rules of the electric energy public service established by the 1995 Concessions Law. This work provides an evaluation of the Brazilian rural electric cooperatives regulation apparatus and the regularization public policy applied in Sao Paulo. The evaluation focus is the rural citizen, the electric energy consumer and the citizens who have been excluded from this public service. The interpretation of the problem and the study of the regularization process has led to the evidence that the situation reached an impasse. The thesis is that the attitude of regulatory agencies create a paradox where the cooperatives are not covered by the regulation policies with damage to citizens in these areas. Particularly, given that the Brazilian citizens have won the right of electricity access, the citizen who lives in the cooperative area have no protection by State to do this right effective. This work offers an academic proposal to break this institutional impasse, based on the search of the agents' equilibrium. (author)

Cost-effectiveness of community screening for glaucoma in rural India: a decision analytical model.

Science.gov (United States)

John, D; Parikh, R

2018-02-01

Studies in several countries have demonstrated the cost-effectiveness of population-based screening for glaucoma when targeted at high-risk groups such as older adults and with familial history of disease. This study conducts a cost-effective analysis of a hypothetical community screening and subsequent treatment programme in comparison to opportunistic case finding for glaucoma in rural India. A hypothetical screening programme for both primary open-angle glaucoma and angle-closure disease was built for a population aged between 40 and 69 years in rural areas of India. A decision analytical model was built to model events, costs and treatment pathways with and without a hypothetical screening programme for glaucoma for a rural-based population aged between 40 and 69 years in India. The treatment pathway included both primary open-angle glaucoma and angle-closure disease. The data on costs of screening and treatment were provided by an administrator of a tertiary eye hospital in Eastern India. The probabilities for the screening and treatment pathway were derived from published literature and a glaucoma specialist. The glaucoma prevalence rates were adapted from the Chennai Glaucoma Study findings. An incremental cost-effectiveness ratio value of ₹7292.30 per quality-adjusted life-year was calculated for a community-screening programme for glaucoma in rural India. The community screening for glaucoma would treat an additional 2872 cases and prevent 2190 person-years of blindness over a 10-year period. Community screening for glaucoma in rural India appears to be cost-effective when judged by a ratio of willingness-to-pay thresholds as per WHO-CHOICE guidelines. For community screening to be cost-effective, adequate resources, such as trained medical personnel and equipment would need to be made available. Copyright © 2017 The Royal Society for Public Health. Published by Elsevier Ltd. All rights reserved.

Cost effectiveness of rural development programme instruments in Denmark

DEFF Research Database (Denmark)

Jensen, J Dejgaard; Jakobsen, L; Madsen, B

2011-01-01

The objective of this study is to investigate the cost-effectiveness of selected instruments of the Danish Rural Development Programme 2007-2013, which constitutes the Danish implementation of the EU Rural Development Programme under Pillar Two of the Common Agricultural Policy. The Programme aims...... to support sustainable economic growth and income diversification in rural areas (and in particular in economically vulnerable areas). The study combines different datasets and simulation models at farm level (register data, Farm Accountancy Data, farm sector model, run-off models, etc.), municipality level...... (micro-based “National Accounts” for municipalities, municipality economic model) and national level (national economic model), which enables analysis at a fairly detailed geographical level and hence to evaluate the spatially distributed effects of the considered policy instruments, while at the same...

Rural electrification with photovoltaic solar technology using solar home system; Eletrificacao rural com tecnologia solar fotovoltaica utilizando sistemas isolados autonomos

Energy Technology Data Exchange (ETDEWEB)

Salviano, Carlos Jose Caldas

1999-02-01

The utilization of solar energy, inexhaustible on the earthly scale of time, as heat and light source, today is one of the energetics alternatives more to confront the challenges of the new millennium. Remarkable is the impulse that power generation photovoltaic has received in Brazil. In Pernambuco, state of Brazil, the CELPE - Electric Power Company of Pernambuco, already implanted more than 750 photovoltaic solar home system (95 kW installed) for power supply to rural communities far from the grid connection that come across in commercial operation since 1994. Eight configurations were studied with modifications in their components (panel, battery and charge) with the objective to evaluate the performance and the adequacy of the size these configurations. The parameters utilized for this evaluation were: solar energy diary incident on the panel plat, diary efficiency generator, output voltage on the generator and state of charge the batteries bank. A system of data acquisition automated was fined to measure in real conditions the function of each components, the following parameters: solar radiation incident and temperature on the photovoltaic generator, voltage and generator current, batteries bank and charge and ambient temperature. About the configurations studied, it follows that analysis the operational of characteristics capacity and battery capacity of the SHS utilized, simulating the rural electrification conditions. It was possible to certify the adequate configurations for the load profile will be supply. (author)

The participation of the sectors of electric energy consumption in a rural electrification cooperative; A participacao dos setores de consumo de energia eletrica em uma cooperativa de eletrificacao rural

Energy Technology Data Exchange (ETDEWEB)

Higuchi, Cristiane Aparecida Pelegrin [Instituicao Toledo de Ensino (ITE), Bauru, SP (Brazil). Fac. de Ciencias Contabeis], e-mail: cristiane.higuchi@itelefonica.com.br; Siqueira, Jair Antonio Cruz [UNESP, Botucatu, SP (Brazil). Faculdade de Ciencias Agronomicas. Curso de Pos-Graduacao em Energia na Agricultura], e-mail: jairsiqueira@fca.unesp.br; Seraphim, Odivaldo Jose [UNESP, Botucatu, SP (Brazil). Faculdade de Ciencias Agronomicas. Dept. de Engenharia Rural], e-mail: seraphim@fca.unesp.br; Ielo, Frederico G. de Paula F. [Universidade Estadual de Ponta Grossa, PR (Brazil). Dept. de Informatica

2004-07-01

This work had the objective of to evaluate the behavior of the electrical energy distribution in a Rural Electrification Cooperative, placed inside the State of Sao Paulo, embracing the region of the county of Itai, Avare and Paranapanema. Were appraised the electric energy distribution data of the Rural Electrification Cooperative of Itai, Avare and Paranapanema - CERIPA, during the years of 2000, 2001 and 2002. Was evaluated the sale of energy evolution, clearance evolution, general load factor and the electrical distribution for consumer type. The found results allowed to end that the Rural electrification Cooperative, show a good electric energy distribution in residential, rural and irrigation sectors. (author)

Cheaper fuel and higher health costs among the poor in rural Nepal

Energy Technology Data Exchange (ETDEWEB)

Pant, Krishna Prasad [Ministry of Agriculture and Cooperatives, Vidhya Lane, Devnagar, Kathmandu (Nepal)], email: kppant@yahoo.com

2012-03-15

Biomass fuels are used by the majority of resource poor households in low-income countries. Though biomass fuels, such as dung-briquette and firewood are apparently cheaper than the modern fuels indoor pollution from burning biomass fuels incurs high health costs. But, the health costs of these conventional fuels, mostly being indirect, are poorly understood. To address this gap, this study develops probit regression models using survey data generated through interviews from households using either dung-briquette or biogas as the primary source of fuel for cooking. The study investigates factors affecting the use of dung-briquette, assesses its impact on human health, and estimates the associated household health costs. Analysis suggests significant effects of dung-briquette on asthma and eye diseases. Despite of the perception of it being a cheap fuel, the annual health cost per household due to burning dung-briquette (US$ 16.94) is 61.3% higher than the annual cost of biogas (US$ 10.38), an alternative cleaner fuel for rural households. For reducing the use of dung-briquette and its indirect health costs, the study recommends three interventions: (1) educate women and aboriginal people, in particular, and make them aware of the benefits of switching to biogas; (2) facilitate tree planting in communal as well as private lands; and (3) create rural employment and income generation opportunities.

Rural electrical process and the agroindustrial expansion in Goias state, Brazil; Processo de eletrificacao rural e a expansao da agroindustria no extremo sudoeste goiano

Energy Technology Data Exchange (ETDEWEB)

Alves, Josias Manoel [Universidade Federal de Goias (UFG), Goiania, GO (Brazil); Instituto Federal de Educacao, Ciencia e Tecnologia de Goias (CEFET/GO), Goiania, GO (Brazil)

2004-07-01

The electric energy is an important tool to rural communities, promoting quality of life through its use at home or as part of the productive process. The Rural Electrical Project of the State of Goias began with the collaboration between The Overseas Economic Cooperation Fund (OECF) and the Electric Company of the State of Goias. The subject of this paper is to characterize the electric energy use in three farms attended by OECF project, in Rio Verde, Jatai and Mineiro. It was done the checking, analysis and description of situations related to the electric installation, motors starting, conservation and use of alternative energy source. It was evident that all farms use electric motors to several purposes (irrigation, manufacture of ration, triturates, mechanic milking, etc). Two farms used electric fences, while only one used hybrid system. It was verified at the visited farms presented an expressive use of the electric energy in its domestic usage as much as an input to the productive process. (author)

Evaluation as a tool for planning: a case study on rural electrification; Avaliacao como instrumento de planejamento: estudo de caso em eletrificacao rural

Energy Technology Data Exchange (ETDEWEB)

Pereira, Marcio Giannini; Rodrigues, Alexia de Freitas; Paz, Luciana Rocha Leal da [Centro de Pesquisas de Energia Eletrica (CEPEL), Rio de Janeiro, RJ (Brazil); Camacho, Cristiane Farias [Fundacao Padre Leonel Franca, Rio de Janeiro, RJ (Brazil)

2008-07-01

The universalization of access of the electric energy is one of the goals established by the Brazilian government so as to attend the rural and urban population. The arrival of electric energy in remote and low income areas allows these populations to reach one of the basic conditions to improve the quality of life and citizenship. In order to achieve this goal efficiently, it is necessary to build tools that make possible the impact and process evaluation, searching the continuous improvement of the planning and decision making, either in the direction of the attendance of the proposed goals, or in the poverty mitigation. The knowledge originated from evaluation impact studies provides an important contribution to the improvement of social programs, and a return to society as how the public fund is being managed, promoting transparency and focus. In this context, tolls are developed so as to support the impact and process evaluation in terms of rural electrification publics policies, using a study case that includes about 23.000 questionnaires in 21 states, considering the moment before the access (ex-ante) and after (ex-post), during the years of 2000 and 2004. (author)

Guidebook : managing operating costs for rural and small urban public transit systems.

Science.gov (United States)

2013-05-01

This guidebook is a resource for rural and small urban transit agency managers to use in better understanding, predicting, and managing operational costs. Doing so can improve the efficiency, effectiveness, and sustainability of public transit in the...

Geography, private costs and uptake of screening for abdominal aortic aneurysm in a remote rural area.

Science.gov (United States)

Lindsay, Sandra M; Duncan, John L; Cairns, John; Godden, David J

2006-03-29

The relationship between geographical location, private costs, health provider costs and uptake of health screening is unclear. This paper examines these relationships in a screening programme for abdominal aortic aneurysm in the Highlands and Western Isles of Scotland, a rural and remote area of over 10,000 square miles. Men aged 65-74 (n = 9323) were invited to attend screening at 51 locations in 50 settlements. Effects of geography, deprivation and age on uptake were examined. Among 8,355 attendees, 8,292 completed a questionnaire detailing mode of travel and costs incurred, time travelled, whether accompanied, whether dependants were cared for, and what they would have been doing if not attending screening, thus allowing private costs to be calculated. Health provider (NHS) costs were also determined. Data were analysed by deprivation categories, using the Scottish Indices of Deprivation (2003), and by settlement type ranging from urban to very remote rural. Uptake of screening was high in all settlement types (mean 89.6%, range 87.4-92.6%). Non-attendees were more deprived in terms of income, employment, education and health but there was no significant difference between non-attendees and attendees in terms of geographical access to services. Age was similar in both groups. The highest private costs (median 7.29 pound sterling per man) and NHS screening costs (18.27 pound sterling per man invited) were observed in very remote rural areas. Corresponding values for all subjects were: private cost 4.34 pound sterling and NHS cost 15.72 pound sterling per man invited. Uptake of screening for abdominal aortic aneurysm in is remote and rural setting was high in comparison with previous studies, and this applied across all settlement types. Geographical location did not affect uptake, most likely due to the outreach approach adopted. Private and NHS costs were highest in very remote settings but still compared favourably with other published studies.

Geography, private costs and uptake of screening for abdominal aortic aneurysm in a remote rural area

Directory of Open Access Journals (Sweden)

Cairns John

2006-03-01

Full Text Available Abstract Background The relationship between geographical location, private costs, health provider costs and uptake of health screening is unclear. This paper examines these relationships in a screening programme for abdominal aortic aneurysm in the Highlands and Western Isles of Scotland, a rural and remote area of over 10,000 square miles. Methods Men aged 65–74 (n = 9323 were invited to attend screening at 51 locations in 50 settlements. Effects of geography, deprivation and age on uptake were examined. Among 8,355 attendees, 8,292 completed a questionnaire detailing mode of travel and costs incurred, time travelled, whether accompanied, whether dependants were cared for, and what they would have been doing if not attending screening, thus allowing private costs to be calculated. Health provider (NHS costs were also determined. Data were analysed by deprivation categories, using the Scottish Indices of Deprivation (2003, and by settlement type ranging from urban to very remote rural. Results Uptake of screening was high in all settlement types (mean 89.6%, range 87.4 – 92.6%. Non-attendees were more deprived in terms of income, employment, education and health but there was no significant difference between non-attendees and attendees in terms of geographical access to services. Age was similar in both groups. The highest private costs (median £7.29 per man and NHS screening costs (£18.27 per man invited were observed in very remote rural areas. Corresponding values for all subjects were: private cost £4.34 and NHS cost £15.72 per man invited. Conclusion Uptake of screening for abdominal aortic aneurysm in this remote and rural setting was high in comparison with previous studies, and this applied across all settlement types. Geographical location did not affect uptake, most likely due to the outreach approach adopted. Private and NHS costs were highest in very remote settings but still compared favourably with other published studies.

Instructor guide : managing operating cost for rural and small urban transit systems.

Science.gov (United States)

2013-01-01

The purpose of the workshop is to provide rural and small urban transit managers and staff with tools to analyze, track, predict, and manage operational costs. The workshop will have a beginning and ending general session, and will provide six sessio...

Measuring rural allied health workforce turnover and retention: what are the patterns, determinants and costs?

Science.gov (United States)

Chisholm, Marita; Russell, Deborah; Humphreys, John

2011-04-01

To measure variations in patterns of turnover and retention, determinants of turnover, and costs of recruitment of allied health professionals in rural areas. Data were collected on health service characteristics, recruitment costs and de-identified individual-level employment entry and exit data for dietitians, occupational therapists, physiotherapists, podiatrists, psychologists, social workers and speech pathologists employed between 1 January 2004 and 31 December 2009. Health services providing allied health services within Western Victoria were stratified by geographical location and town size. Eighteen health services were sampled, 11 participated. Annual turnover rates, stability rates, median length of stay in current position, survival probabilities, turnover hazards and median costs of recruitment were calculated. Analysis of commencement and exit data from 901 allied health professionals indicated that differences in crude workforce patterns according to geographical location emerge 12 to 24 months after commencement of employment, although the results were not statistically significant. Proportional hazards modelling indicated profession and employee age and grade upon commencement were significant determinants of turnover risk. Costs of replacing allied health workers are high. An opportunity for implementing comprehensive retention strategies exists in the first year of employment in rural and remote settings. Benchmarks to guide workforce retention strategies should take account of differences in patterns of allied health turnover and retention according to geographical location. Monitoring allied health workforce turnover and retention through analysis of routinely collected data to calculate selected indicators provides a stronger evidence base to underpin workforce planning by health services and regional authorities. © 2011 The Authors. Australian Journal of Rural Health © National Rural Health Alliance Inc.

Perspectives for rural electrification in the new economic and institutional scenario of the brazilian electric sector; Perspectivas para a eletrificacao rural no novo cenario economico-institucional do setor eletrico brasileiro

Energy Technology Data Exchange (ETDEWEB)

Oliveira, Luciana Correa de

2001-03-15

This thesis discusses the energy deficit in Brazilian rural areas, from the viewpoint of the ongoing reform, which is establishing a new economic and institutional model for the electric sector. The main objective of this inquiry is to reveal the perspectives for the solution of the rural energy problem, by means of a critical examination of the legal and executive initiatives related to the expansion of electric coverage, indicating the priority level of rural electrification within the reform. This analysis infers the need of an innovative reform approach, different from the solutions employed by developed countries, due to peculiar characteristics of the Brazilian case. (author)

The Effectiveness and Cost-Effectiveness of a Rural Employer-Based Wellness Program

Science.gov (United States)

Saleh, Shadi S.; Alameddine, Mohamad S.; Hill, Dan; Darney-Beuhler, Jessica; Morgan, Ann

2010-01-01

Context: The cost-effectiveness of employer-based wellness programs has been previously investigated with favorable financial and nonfinancial outcomes being detected. However, these investigations have mainly focused on large employers in urban settings. Very few studies examined wellness programs offered in rural settings. Purpose: This paper…

Plaadid / Immo Mihkelson

Index Scriptorium Estoniae

Mihkelson, Immo, 1959-

2004-01-01

Uutest heliplaatidest Gretchen Wilson "Here For The Party", A Bossa Eletrica "Eletrificacao", "Liinatuuraq", The Temptations "Legacy", Mike & The Mechanics+Paul Carrack "Rewired", Pauline London "Quiet Skies"

Intermunicipal cooperation, privatization and waste management costs: Evidence from rural municipalities

International Nuclear Information System (INIS)

Bel, Germa; Mur, Melania

2009-01-01

The aim of this paper is to analyze the effects of intermunicipal cooperation and privatization on the delivery costs of urban solid waste services in rural environments. The results of our empirical analysis, which we conducted among a sample of very small municipalities, indicate that small towns that cooperate incur lower costs for their waste collection service. Cooperation also raises collection frequency and improves the quality of the service in small towns. By contrast, the form of production, whether it is public or private, does not result in systematic differences in costs. Interestingly, the degree of population dispersion, that is, the number of population units within the municipal jurisdiction, has a significant positive relation with service costs. No evidence of scale economies is found because small municipalities have likely exploited them by means of intermunicipal cooperation.

Energy solutions in rural Africa: mapping electrification costs of distributed solar and diesel generation versus grid extension

Energy Technology Data Exchange (ETDEWEB)

Szabo, S; Bodis, K; Huld, T [European Commission Joint Research Centre, Institute for Energy, Renewable Energy Unit, 2749 via Enrico Fermi, TP450, 21027 Ispra (Vatican City State, Holy See) (Italy); Moner-Girona, M, E-mail: Sandor.Szabo@ec.europa.eu [UNEP Energy Branch Division of Technology, Industry and Economics, 15 rue de Milan, F-75441, Paris CEDEX09 (France)

2011-07-15

Three rural electrification options are analysed showing the cost optimal conditions for a sustainable energy development applying renewable energy sources in Africa. A spatial electricity cost model has been designed to point out whether diesel generators, photovoltaic systems or extension of the grid are the least-cost option in off-grid areas. The resulting mapping application offers support to decide in which regions the communities could be electrified either within the grid or in an isolated mini-grid. Donor programs and National Rural Electrification Agencies (or equivalent governmental departments) could use this type of delineation for their program boundaries and then could use the local optimization tools adapted to the prevailing parameters.

Energy solutions in rural Africa: mapping electrification costs of distributed solar and diesel generation versus grid extension

International Nuclear Information System (INIS)

Szabo, S; Bodis, K; Huld, T; Moner-Girona, M

2011-01-01

Three rural electrification options are analysed showing the cost optimal conditions for a sustainable energy development applying renewable energy sources in Africa. A spatial electricity cost model has been designed to point out whether diesel generators, photovoltaic systems or extension of the grid are the least-cost option in off-grid areas. The resulting mapping application offers support to decide in which regions the communities could be electrified either within the grid or in an isolated mini-grid. Donor programs and National Rural Electrification Agencies (or equivalent governmental departments) could use this type of delineation for their program boundaries and then could use the local optimization tools adapted to the prevailing parameters.

Cost-effectiveness of the "helping babies breathe" program in a missionary hospital in rural Tanzania.

Science.gov (United States)

Vossius, Corinna; Lotto, Editha; Lyanga, Sara; Mduma, Estomih; Msemo, Georgina; Perlman, Jeffrey; Ersdal, Hege L

2014-01-01

The Helping Babies Breathe" (HBB) program is an evidence-based curriculum in basic neonatal care and resuscitation, utilizing simulation-based training to educate large numbers of birth attendants in low-resource countries. We analyzed its cost-effectiveness at a faith-based Haydom Lutheran Hospital (HLH) in rural Tanzania. Data about early neonatal mortality and fresh stillbirth rates were drawn from a linked observational study during one year before and one year after full implementation of the HBB program. Cost data were provided by the Tanzanian Ministry of Health and Social Welfare (MOHSW), the research department at HLH, and the manufacturer of the training material Lærdal Global Health. Costs per life saved were USD 233, while they were USD 4.21 per life year gained. Costs for maintaining the program were USD 80 per life saved and USD 1.44 per life year gained. Costs per disease adjusted life year (DALY) averted ranged from International Dollars (ID; a virtual valuta corrected for purchasing power world-wide) 12 to 23, according to how DALYs were calculated. The HBB program is a low-cost intervention. Implementation in a very rural faith-based hospital like HLH has been highly cost-effective. To facilitate further global implementation of HBB a cost-effectiveness analysis including government owned institutions, urban hospitals and district facilities is desirable for a more diverse analysis to explore cost-driving factors and predictors of enhanced cost-effectiveness.

Cost-effectiveness of the "helping babies breathe" program in a missionary hospital in rural Tanzania.

Directory of Open Access Journals (Sweden)

Corinna Vossius

Full Text Available The Helping Babies Breathe" (HBB program is an evidence-based curriculum in basic neonatal care and resuscitation, utilizing simulation-based training to educate large numbers of birth attendants in low-resource countries. We analyzed its cost-effectiveness at a faith-based Haydom Lutheran Hospital (HLH in rural Tanzania.Data about early neonatal mortality and fresh stillbirth rates were drawn from a linked observational study during one year before and one year after full implementation of the HBB program. Cost data were provided by the Tanzanian Ministry of Health and Social Welfare (MOHSW, the research department at HLH, and the manufacturer of the training material Lærdal Global Health.Costs per life saved were USD 233, while they were USD 4.21 per life year gained. Costs for maintaining the program were USD 80 per life saved and USD 1.44 per life year gained. Costs per disease adjusted life year (DALY averted ranged from International Dollars (ID; a virtual valuta corrected for purchasing power world-wide 12 to 23, according to how DALYs were calculated.The HBB program is a low-cost intervention. Implementation in a very rural faith-based hospital like HLH has been highly cost-effective. To facilitate further global implementation of HBB a cost-effectiveness analysis including government owned institutions, urban hospitals and district facilities is desirable for a more diverse analysis to explore cost-driving factors and predictors of enhanced cost-effectiveness.

Cost of childhood diarrhoea in rural South Africa: exploring cost-effectiveness of universal zinc supplementation.

Science.gov (United States)

Chhagan, Meera K; Van den Broeck, Jan; Luabeya, Kany-Kany Angelique; Mpontshane, Nontobeko; Bennish, Michael L

2014-09-01

To describe the cost of diarrhoeal illness in children aged 6-24 months in a rural South African community and to determine the threshold prevalence of stunting at which universal Zn plus vitamin A supplementation (VAZ) would be more cost-effective than vitamin A alone (VA) in preventing diarrhoea. We conducted a cost analysis using primary and secondary data sources. Using simulations we examined incremental costs of VAZ relative to VA while varying stunting prevalence. Data on efficacy and societal costs were largely from a South African trial. Secondary data were from local and international published sources. The trial included children aged 6-24 months. The secondary data sources were a South African health economics survey and the WHO-CHOICE (CHOosing Interventions that are Cost Effective) database. In the trial, stunted children supplemented with VAZ had 2·04 episodes (95 % CI 1·37, 3·05) of diarrhoea per child-year compared with 3·92 episodes (95 % CI 3·02, 5·09) in the VA arm. Average cost of illness was $Int 7·80 per episode (10th, 90th centile: $Int 0·28, $Int 15·63), assuming a minimum standard of care (oral rehydration and 14 d of therapeutic Zn). In simulation scenarios universal VAZ had low incremental costs or became cost-saving relative to VA when the prevalence of stunting was close to 20 %. Incremental cost-effectiveness ratios were sensitive to the cost of intervention and coverage levels. This simulation suggests that universal VAZ would be cost-effective at current levels of stunting in parts of South Africa. This requires further validation under actual programmatic conditions.

Costs and outcome of assertive community treatment (ACT) in a rural area in Denmark

DEFF Research Database (Denmark)

Hastrup, Lene Halling; Aagaard, Jørgen

2015-01-01

Purpose: Health economic evidence of assertive community treatment (ACT) in Denmark is limited. The aim of the study was to assess the costs and outcome of ACT among 174 patients with severe and persistent mental illness in a rural area of Denmark. Methods: The study was based on a quasi-experime......Purpose: Health economic evidence of assertive community treatment (ACT) in Denmark is limited. The aim of the study was to assess the costs and outcome of ACT among 174 patients with severe and persistent mental illness in a rural area of Denmark. Methods: The study was based on a quasi...... only. Results: Seventy eight percent of the patients receiving ACT were in contact with psychiatric services at the 4-year follow-up, while 69% of the patients in the control group had contact with psychiatric services (P

Caste Discrimination and Transaction Costs in the Labor Market: Evidence from Rural North India

OpenAIRE

Takahiro Ito

2007-01-01

This paper is an empirical attempt to quantify caste-based discrimination in thelabor market using household data taken from rural North India. In the regressionanalysis, transaction costs associated with entry into the labor market and reservationwages are estimated simultaneously along with market wages. The estimation resultsprovide evidence of the existence of transaction costs in the labor market anddiscrimination against backward classes with regard to access to regular employment. Inli...

Rural electrification in Chihuahua, Mexico at one third of the cost vs a conventional substation

Energy Technology Data Exchange (ETDEWEB)

Ramirez, Omar; Gomez, Rolando; Solano, Arturo; Acosta, Eduardo

2010-09-15

This paper and presentation describes technical details about a successful experience in a unique project in Mexico for making possible the rural electrification at one third of the total cost vs a traditional substation. This alternate solution for electrification of rural communities where construction of distribution lines or traditional substations are not economically possible due to local government's budget limits or because the electrical companies are looking for the ROI Return Over Investment in poverty communities.

A technical framework for costing health workforce retention schemes in remote and rural areas

NARCIS (Netherlands)

Zurn, P.; Vujicic, M.; Lemiere, C.; Juquois, M.; Stormont, L.; Campbell, J.; Rutten, M.M.; Braichet, J.M.

2011-01-01

Background: Increasing the availability of health workers in remote and rural areas through improved health workforce recruitment and retention is crucial to population health. However, information about the costs of such policy interventions often appears incomplete, fragmented or missing, despite

Economic Costs of Patients Attending the Prevention of Mother-to- Child Transmission of HIV/AIDS (PMTCT Services in Ethiopia: Urban-Rural Settings

Directory of Open Access Journals (Sweden)

Elias Asfaw Zegeye

2016-08-01

Full Text Available Economic analyses of patients’ costs are pertinent to improve effective healthcare services including the prevention of mother-to-child HIV/AIDS transmission (PMTCT. This study assessed the direct and non-direct medical costs borne by pregnant women attending PMTCT services in urban (high-HIV prevalence and rural (low-HIV prevalence settings, in Ethiopia. Patient-level direct medical costs and direct non-medical data were collected from HIV-positive pregnant women in six regions. The cost estimation was classified as direct medical (service fee, drugs and laboratory and direct non-medical (food, transportation and accommodation. The mean direct medical expense per patient per year was Ethiopian birr (ETB 746 (US$ 38 in the urban settings, as compared to ETB 368 (US$ 19 in the rural settings. On average, a pregnant woman from urban and rural catchments incurred direct non-medical costs of ETB 6,435 (US$ 327 and ETB 2,154 (US$ 110 per year, respectively. On average, non-medical costs of friend/relative/guardian were ETB 2,595 (US$ 132 and ETB 2,919 (US$ 148.39 in the urban and rural settings, respectively. Although the PMTCT service is provided free of charge, HIV-positive pregnant women and infant pairs still face a substantial amount of out-of-pocket spending due to direct medical and non-medical costs.

A cost comparison of travel models and behavioural telemedicine for rural, Native American populations in New Mexico.

Science.gov (United States)

Horn, Brady P; Barragan, Gary N; Fore, Chis; Bonham, Caroline A

2016-01-01

The purpose of this study was to model the cost of delivering behavioural health services to rural Native American populations using telecommunications and compare these costs with the travel costs associated with providing equivalent care. Behavioural telehealth costs were modelled using equipment, transmission, administrative and IT costs from an established telecommunications centre. Two types of travel models were estimated: a patient travel model and a physician travel model. These costs were modelled using the New Mexico resource geographic information system program (RGIS) and ArcGIS software and unit costs (e.g. fuel prices, vehicle depreciation, lodging, physician wages, and patient wages) that were obtained from the literature and US government agencies. The average per-patient cost of providing behavioural healthcare via telehealth was US$138.34, and the average per-patient travel cost was US$169.76 for physicians and US$333.52 for patients. Sensitivity analysis found these results to be rather robust to changes in imputed parameters and preliminary evidence of economies of scale was found. Besides the obvious benefits of increased access to healthcare and reduced health disparities, providing behavioural telehealth for rural Native American populations was estimated to be less costly than modelled equivalent care provided by travelling. Additionally, as administrative and coordination costs are a major component of telehealth costs, as programmes grow to serve more patients, the relative costs of these initial infrastructure as well as overall per-patient costs should decrease. © The Author(s) 2015.

Household cost of malaria overdiagnosis in rural Mozambique

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Armázio Luiz

2008-02-01

Full Text Available Abstract Background It is estimated that over 70% of patients with suspected malaria in sub-Saharan Africa, diagnose and manage their illness at home without referral to a formal health clinic. Of those patients who do attend a formal health clinic, malaria overdiagnosis rates are estimated to range between 30–70%. Methods This paper details an observational cohort study documenting the number and cost of repeat consultations as a result of malaria overdiagnosis at two health care providers in a rural district of Mozambique. 535 adults and children with a clinical diagnosis of malaria were enrolled and followed over a 21 day period to assess treatment regimen, symptoms, number and cost of repeat visits to health providers in patients misdiagnosed with malaria compared to those with confirmed malaria (determined by positive bloodfilm reading. Results Diagnosis based solely on clinical symptoms overdiagnosed 23% of children ( Conclusion Overdiagnosis of malaria results in a greater number of healthcare visits and associated cost for adult patients. Additionally, it is clear that the poorest individuals pay significantly more proportionally for their healthcare making it imperative that the treatment they receive is correct in order to prevent wastage of limited economic resources. Thus, investment in accurate malaria diagnosis and appropriate management at primary level is critical for improving health outcomes and reducing poverty.

Improving Maternal Care through a State-Wide Health Insurance Program: A Cost and Cost-Effectiveness Study in Rural Nigeria.

Science.gov (United States)

Gomez, Gabriela B; Foster, Nicola; Brals, Daniella; Nelissen, Heleen E; Bolarinwa, Oladimeji A; Hendriks, Marleen E; Boers, Alexander C; van Eck, Diederik; Rosendaal, Nicole; Adenusi, Peju; Agbede, Kayode; Akande, Tanimola M; Boele van Hensbroek, Michael; Wit, Ferdinand W; Hankins, Catherine A; Schultsz, Constance

2015-01-01

While the Nigerian government has made progress towards the Millennium Development Goals, further investments are needed to achieve the targets of post-2015 Sustainable Development Goals, including Universal Health Coverage. Economic evaluations of innovative interventions can help inform investment decisions in resource-constrained settings. We aim to assess the cost and cost-effectiveness of maternal care provided within the new Kwara State Health Insurance program (KSHI) in rural Nigeria. We used a decision analytic model to simulate a cohort of pregnant women. The primary outcome is the incremental cost effectiveness ratio (ICER) of the KSHI scenario compared to the current standard of care. Intervention cost from a healthcare provider perspective included service delivery costs and above-service level costs; these were evaluated in a participating hospital and using financial records from the managing organisations, respectively. Standard of care costs from a provider perspective were derived from the literature using an ingredient approach. We generated 95% credibility intervals around the primary outcome through probabilistic sensitivity analysis (PSA) based on a Monte Carlo simulation. We conducted one-way sensitivity analyses across key model parameters and assessed the sensitivity of our results to the performance of the base case separately through a scenario analysis. Finally, we assessed the sustainability and feasibility of this program's scale up within the State's healthcare financing structure through a budget impact analysis. The KSHI scenario results in a health benefit to patients at a higher cost compared to the base case. The mean ICER (US$46.4/disability-adjusted life year averted) is considered very cost-effective compared to a willingness-to-pay threshold of one gross domestic product per capita (Nigeria, US$ 2012, 2,730). Our conclusion was robust to uncertainty in parameters estimates (PSA: median US$49.1, 95% credible interval 21

Improving Maternal Care through a State-Wide Health Insurance Program: A Cost and Cost-Effectiveness Study in Rural Nigeria.

Directory of Open Access Journals (Sweden)

Gabriela B Gomez

Full Text Available While the Nigerian government has made progress towards the Millennium Development Goals, further investments are needed to achieve the targets of post-2015 Sustainable Development Goals, including Universal Health Coverage. Economic evaluations of innovative interventions can help inform investment decisions in resource-constrained settings. We aim to assess the cost and cost-effectiveness of maternal care provided within the new Kwara State Health Insurance program (KSHI in rural Nigeria.We used a decision analytic model to simulate a cohort of pregnant women. The primary outcome is the incremental cost effectiveness ratio (ICER of the KSHI scenario compared to the current standard of care. Intervention cost from a healthcare provider perspective included service delivery costs and above-service level costs; these were evaluated in a participating hospital and using financial records from the managing organisations, respectively. Standard of care costs from a provider perspective were derived from the literature using an ingredient approach. We generated 95% credibility intervals around the primary outcome through probabilistic sensitivity analysis (PSA based on a Monte Carlo simulation. We conducted one-way sensitivity analyses across key model parameters and assessed the sensitivity of our results to the performance of the base case separately through a scenario analysis. Finally, we assessed the sustainability and feasibility of this program's scale up within the State's healthcare financing structure through a budget impact analysis. The KSHI scenario results in a health benefit to patients at a higher cost compared to the base case. The mean ICER (US$46.4/disability-adjusted life year averted is considered very cost-effective compared to a willingness-to-pay threshold of one gross domestic product per capita (Nigeria, US$ 2012, 2,730. Our conclusion was robust to uncertainty in parameters estimates (PSA: median US$49.1, 95% credible

Value-chain analysis of a rural health program: toward understanding the cost benefit of telemedicine applications.

Science.gov (United States)

Gamble, John E; Savage, Grant T; Icenogle, Marjorie L

2004-01-01

While telemedicine's clinical effectiveness and educational benefits are accepted, its cost-effectiveness is controversial. This study focuses on telemedicine's cost-effectiveness from a provider's perspective. Reviews of the cost-effectiveness literature in telemedicine are critical of past studies' (a) methodological and analytical weaknesses; (b) focus on answering "Can we do this?" rather than "Should we do this?"; and (c) emphasis on patient benefits. Value chain analysis examines structural and executional cost drivers; a self-sustaining business model balances the cost and value associated with each telemedicine activity. We illustrate this analysis in a rural health program, examining teleradiography and telerehabilitation.

When does unreliable grid supply become unacceptable policy? Costs of power supply and outages in rural India

International Nuclear Information System (INIS)

Harish, Santosh M.; Morgan, Granger M.; Subrahmanian, Eswaran

2014-01-01

Despite frequent blackouts and brownouts, extension of the central grid remains the Indian government's preferred strategy for the country's rural electrification policy. This study reports an assessment that compares grid extension with distributed generation (DG) alternatives, based on the subsidies they will necessitate, and costs of service interruptions that are appropriate in the rural Indian context. Using cross-sectional household expenditure data and region fixed-effects models, average household demand is estimated. The price elasticity of demand is found to be in the range of −0.3 to −0.4. Interruption costs are estimated based on the loss of consumer surplus due to reduced consumption of electric lighting energy that results from intermittent power supply. Different grid reliability scenarios are simulated. Despite the inclusion of interruption costs, standalone DG does not appear to be competitive with grid extension at distances of less than 17 km. However, backing up unreliable grid service with local DG plants is attractive when reliability is very poor, even in previously electrified villages. Introduction of energy efficient lighting changes these economics, and the threshold for acceptable grid unreliability significantly reduces. A variety of polices to promote accelerated deployment and the wider adoption of improved end-use efficiency, warrant serious consideration. - Highlights: • We question the reliance on conventional grid in rural electricity supply in India. • Alternatives compared through government subsidies and consumer interruption costs. • Interruption costs are estimated based on loss of consumer surplus due to outages. • Augmenting unreliable grid with local biomass or diesel based backups preferable. • With efficient lighting, standalone biomass plants are optimal at very low distances

Adaptation of rural electricity cooperatives in the State of Parana to the scenario of the electric sector; Adaptacao das cooperativas de eletrificacao rural do estado do Parana ao cenario do setor eletrico

Energy Technology Data Exchange (ETDEWEB)

Oliveira, Celso Eduardo Lins de [Universidade de Sao Paulo (FZEA/USP), Pirassununga, SP (Brazil). Fac. de Zootecnia e Engenharia de Alimentos. Dept. de Engenharia de Alimentos], Email: celsooli@fzea.usp.br; Halmenan, Maria Cristina Rodrigues; Reisdoerfer, Eli Carlos; Massochin, Amauri [Universidade Estadual do Oeste do Parana (UNIOESTE), Cascavel, PR (Brazil). Programa de Pos Graduacao em Engenharia Agricola], Email: cristhalmeman@gmail.com

2006-07-01

Rural Electrification Cooperatives (REC) has already played a fundamental role in rural electrification process. Bearing in mind changes in legislation towards specific laws that tend to facilitate energy distribution and trade relations, REC has increased there potential to contribute even more to above mentioned process. The present work intended to assess how REC settled in Parana State have adapted themselves to the privatised electrical business scenario as well as to new legal requirements and the presence of great national and international corporations disputing the energy market. Such new electrical market model favors huge changes to the electrification cooperatives, with the possibility of transforming cooperatives into public service energy with governmental permission. Moreover, it also represents a giant challenge for their insertion and continuity in such new scenario, in as much as the REC classification process as public service companies for electric energy distribution has been carried out for years, added to the scarcity of investments on state cooperatives, therefore restricting electric energy supply to residential, rural and irrigation sectors. (author)

Modified ground-truthing: an accurate and cost-effective food environment validation method for town and rural areas.

Science.gov (United States)

Caspi, Caitlin Eicher; Friebur, Robin

2016-03-17

A major concern in food environment research is the lack of accuracy in commercial business listings of food stores, which are convenient and commonly used. Accuracy concerns may be particularly pronounced in rural areas. Ground-truthing or on-site verification has been deemed the necessary standard to validate business listings, but researchers perceive this process to be costly and time-consuming. This study calculated the accuracy and cost of ground-truthing three town/rural areas in Minnesota, USA (an area of 564 miles, or 908 km), and simulated a modified validation process to increase efficiency without comprising accuracy. For traditional ground-truthing, all streets in the study area were driven, while the route and geographic coordinates of food stores were recorded. The process required 1510 miles (2430 km) of driving and 114 staff hours. The ground-truthed list of stores was compared with commercial business listings, which had an average positive predictive value (PPV) of 0.57 and sensitivity of 0.62 across the three sites. Using observations from the field, a modified process was proposed in which only the streets located within central commercial clusters (the 1/8 mile or 200 m buffer around any cluster of 2 stores) would be validated. Modified ground-truthing would have yielded an estimated PPV of 1.00 and sensitivity of 0.95, and would have resulted in a reduction in approximately 88 % of the mileage costs. We conclude that ground-truthing is necessary in town/rural settings. The modified ground-truthing process, with excellent accuracy at a fraction of the costs, suggests a new standard and warrants further evaluation.

The costs of coping with poor water supply in rural Kenya

Science.gov (United States)

Cook, Joseph; Kimuyu, Peter; Whittington, Dale

2016-02-01

As the disease burden of poor access to water and sanitation declines around the world, the nonhealth benefits-mainly the time burden of water collection - will likely grow in importance in sector funding decisions and investment analyses. We measure the coping costs incurred by households in one area of rural Kenya. Sixty percent of the 387 households interviewed were collecting water outside the home, and household members were spending an average of 2-3 h doing so per day. We value these time costs using an individual-level value of travel time estimate based on a stated preference experiment. We compare these results to estimates obtained assuming that the value of time saved is a fraction of unskilled wage rates. Coping cost estimates also include capital costs for storage and rainwater collection, money paid either to water vendors or at sources that charge volumetrically, costs of treating diarrhea cases, and expenditures on drinking water treatment (primarily boiling in our site). Median total coping costs per month are approximately US$20 per month, higher than average household water bills in many utilities in the United States, or 12% of reported monthly cash income. We estimate that coping costs are greater than 10% of income for over half of households in our sample. They are higher among larger and wealthier households, and households whose primary source is not at home. Even households with unprotected private wells or connections to an intermittent piped network spend money on water storage containers and on treating water they recognize as unsafe.

Upgrading Domestic-Plus Systems in Rural Senegal: An Incremental Income-Cost (I-C Analysis

Directory of Open Access Journals (Sweden)

Ralph P. Hall

2015-10-01

Full Text Available There is growing evidence that rural and peri-urban households depend on water not only for basic domestic needs but also for a wide variety of livelihood activities. In recognition of this reality, an alternative approach to water service planning, known as multiple-use water services (MUS, has emerged to design water services around householdsʼ multiple water needs. The benefits of MUS are diverse and include improved health, food security, income generation, and women’s empowerment. A common argument put forth by WASH sector professionals in favour of upgrading existing water systems is that productive water uses allow for income generation that, in turn, enhances the ability to pay for services. However, there has been limited rigorous research to assess whether the additional income generated from productive use activities justifies water service upgrading costs. This paper describes an income-cost (I-C analysis based on survey data and EPANET models for 47 domestic-plus water systems in rural Senegal to assess whether the theoretical financial benefits to households from additional piped-water-based productive activities would be greater than the estimated system upgrade costs. The paper provides a transparent methodology for performing an I-C analysis. We find that the potential incremental income earned by upgrading the existing domestic-plus systems to provide intermediate-level MUS would be equivalent to the funds needed to recover the system upgrade costs in just over one year. Thus, hypothetically, water could pay for water. A sensitivity analysis shows that even with a 55% reduction in household income earned per cubic meter of water, the incremental income is still greater than the upgrade costs over a ten-year period for the majority of the systems.

Energy for rural India

International Nuclear Information System (INIS)

Urban, Frauke; Benders, Rene M.J.; Moll, Henri C.

2009-01-01

About 72 million households in rural India do not have access to electricity and rely primarily on traditional biofuels. This research investigates how rural electrification could be achieved in India using different energy sources and what the effects for climate change mitigation could be. We use the Regional Energy Model (REM) to develop scenarios for rural electrification for the period 2005-2030 and to assess the effects on greenhouse gas emissions, primary energy use and costs. We compare the business-as-usual scenario (BAU) with different electrification scenarios based on electricity from renewable energy, diesel and the grid. Our results indicate that diesel systems tend to have the highest CO 2 emissions, followed by grid systems. Rural electrification with primarily renewable energy-based end-uses could save up to 99% of total CO 2 emissions and 35% of primary energy use in 2030 compared to BAU. Our research indicates that electrification with decentralised diesel systems is likely to be the most expensive option. Rural electrification with renewable energy tends to be the most cost-effective option when end-uses are predominantly based on renewable energy, but turns out to be more costly than grid extensions when electric end-use devices are predominantly used. This research therefore elaborates whether renewable energy is a viable option for rural electrification and climate change mitigation in rural India and gives policy recommendations.

Costs and Cost-Effectiveness of Hypertension Screening and Treatment in Adults with Hypertension in Rural Nigeria in the Context of a Health Insurance Program.

Directory of Open Access Journals (Sweden)

Nicole T A Rosendaal

Full Text Available High blood pressure is a leading risk factor for death and disability in sub-Saharan Africa (SSA. We evaluated the costs and cost-effectiveness of hypertension care provided within the Kwara State Health Insurance (KSHI program in rural Nigeria.A Markov model was developed to assess the costs and cost-effectiveness of population-level hypertension screening and subsequent antihypertensive treatment for the population at-risk of cardiovascular disease (CVD within the KSHI program. The primary outcome was the incremental cost per disability-adjusted life year (DALY averted in the KSHI scenario compared to no access to hypertension care. We used setting-specific and empirically-collected data to inform the model. We defined two strategies to assess eligibility for antihypertensive treatment based on 1 presence of hypertension grade 1 and 10-year CVD risk of >20%, or grade 2 hypertension irrespective of 10-year CVD risk (hypertension and risk based strategy and 2 presence of hypertension in combination with a CVD risk of >20% (risk based strategy. We generated 95% confidence intervals around the primary outcome through probabilistic sensitivity analysis. We conducted one-way sensitivity analyses across key model parameters and assessed the sensitivity of our results to the performance of the reference scenario.Screening and treatment for hypertension was potentially cost-effective but the results were sensitive to changes in underlying assumptions with a wide range of uncertainty. The incremental cost-effectiveness ratio for the first and second strategy respectively ranged from US$ 1,406 to US$ 7,815 and US$ 732 to US$ 2,959 per DALY averted, depending on the assumptions on risk reduction after treatment and compared to no access to antihypertensive treatment.Hypertension care within a subsidized private health insurance program may be cost-effective in rural Nigeria and public-private partnerships such as the KSHI program may provide opportunities

Restrictions and Countermeasures of Rural Vocational Education in Urban-rural Integration

Institute of Scientific and Technical Information of China (English)

2012-01-01

Developing rural vocational education is of great significance to urban-rural integration: developing rural vocational education is helpful to cultivating new farmers for construction of new socialist countryside,favorable to improving farmers’ ability of finding jobs and starting undertaking, and beneficial to transfer of rural surplus labor and acceleration of urbanization. Restrictions on development rural vocational education mainly include: low value cognition of society and social assessment of rural vocational education; out of balance of cost and expected return of rural vocational education; the quality of supply of rural vocational education failure to satisfy demand of socio-economic development; imperfect rural vocational education system. In view of these,following countermeasures and suggestions are put forward: strengthen propaganda and guidance to build environment of public opinion for rural vocational education; push forward rural vocational compulsory education system to lay social foundation for rural vocational education; reinforce policy support to assist in building rural vocational education system; improve education system to build overall framework of rural vocational education; perfect laws and regulations to establish system and norm for development of rural vocational education.

Recruitment of rural healthcare professionals for live continuing education.

Science.gov (United States)

Holuby, Ronnie Scott; Pellegrin, Karen L; Barbato, Anna; Ciarleglio, Anita

2015-01-01

The availability of rural healthcare is a growing concern in the United States as fewer healthcare providers choose to work in rural areas. Accessing quality continuing education (CE) for rural healthcare practitioners (HCPs) remains a challenge and may pose a barrier to quality care. To maximize attendance at a live, in-person, free CE program focusing on geriatric medication and issues specifically targeted to HCPs in rural areas, two methods were implemented sequentially. The first method used formal advertising implemented by a professional marketing service to promote CE events. The second method enlisted local healthcare organizations and physician groups to promote the CE event to their employees. Cost per attendee was calculated for comparison. Professional marketing services recruited 31 HCPs (March 2011) and resulted in a per-participant recruitment cost of US$428.62. Local healthcare organizations and physician groups' marketing recruited 48 HCPs (July-August 2011) and resulted in a per-participant recruitment cost of US$55.19. Providing free CE coordinated through local healthcare organizations and physician groups was the most cost-effective method of recruiting rural HCPs for CE. Formal advertising added cost without increasing the number of participants per event. Although this is the first study of the cost-effectiveness of recruitment methods targeting HCPs in rural areas, results are consistent with research on cost-effectiveness of outreach to rural lay community members.

Cost-Effectiveness of a Family Planning Voucher Program in Rural Pakistan.

Science.gov (United States)

Broughton, Edward Ivor; Hameed, Waqas; Gul, Xaher; Sarfraz, Shabnum; Baig, Imam Yar; Villanueva, Monica

2017-01-01

This study reports on the effectiveness and efficiency from the program funder's perspective of the Suraj Social Franchise (SSF) voucher program in which private health-care providers in remote rural areas were identified, trained, upgraded, and certified to deliver family planning services to underserved women of reproductive age in 29 districts of Sindh and 3 districts of Punjab province, Pakistan between October 2013 and June 2016. A decision tree compared the cost of implementing SSF to the program funder and its effects of providing additional couple years of protection (CYPs) to targeted women, compared to business-as-usual. Costs included vouchers given to women to receive a free contraceptive method of their choice from the SSF provider. The vouchers were then reimbursed to the SSF provider by the program. A total of 168,206 married women of reproductive age (MWRA) received SSF vouchers between October 2013 and June 2016, costing $3,278,000 ($19.50/recipient). The average effectiveness of the program per voucher recipient was an additional 1.66 CYPs, giving an incremental cost-effectiveness of the program of $4.28 per CYP compared to not having the program (95% CI: $3.62-5.31). The result compares favorably to other interventions with similar objectives and appears affordable for the Pakistan national health-care system. It is therefore recommended to help address the unmet need for contraception among MWRA in these areas of Pakistan and is worthy of trial implementation in the country more widely.

Rural Policy in a New Century.

Science.gov (United States)

Marshall, Ray

Past rural policies are reviewed, noting the effects of globalization and information technology. Rural business profits can be maximized by direct cost or value-added competition, but cost competition limits the development of productive capacity and leads to unequal income distribution. In contrast, value-added competition could create steep…

Otoacoustic Emissions in Rural Nicaragua: Cost Analysis and Implications for Newborn Hearing Screening.

Science.gov (United States)

Wong, Lye-Yeng; Espinoza, Francisca; Alvarez, Karen Mojica; Molter, Dave; Saunders, James E

2017-05-01

Objective (1) Determine the incidence and risk factors for congenital hearing loss. (2) Perform cost analysis of screening programs. Study Design Proportionally distributed cross-sectional survey. Setting Jinotega, Nicaragua. Subjects and Methods Otoacoustic emissions (OAEs) were used to screen 640 infants home birth settings. Data on 15 risk factors were analyzed. Cost of 4 implementation strategies was studied: universal screening, screening at the regional health center (RHC), targeted screening, and screening at the RHC plus targeted screening. Cost-effectiveness analysis over 10 years was based on disability-adjusted life year estimates, with the World Health Organization standard of cost-effectiveness ratio (CER) / gross domestic product (GDP) births, 325 (50.8%) were in the RHC, 69 (10.8%) in the neonatal intensive care unit, and 29 (4.5%) at home. Family history and birth defect were significant in univariate analysis; birth defect was significant in multivariate analysis. Cost-effectiveness analysis demonstrated that OAE screening is cost-effective without treatment (CER/GDP = 0.06-2.00) and with treatment (CER/GDP = 0.58-2.52). Conclusions Our rate of OAE failures was comparable to those of developed countries and lower than hearing loss rates noted among Nicaraguan schoolchildren, suggesting acquired or progressive etiology in the latter. Birth defects and familial hearing loss correlated with OAE failure. OAE screening of infants is feasible and cost-effective in rural Nicaragua, although highly influenced by estimated hearing loss severity in identified infants and the high travel costs incurred in a targeted screening strategy.

Comparing Costs of Telephone versus Face-to-Face Extended Care Programs for the Management of Obesity in Rural Settings

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Radcliff, Tiffany A.; Bobroff, Linda B.; Lutes, Lesley D.; Durning, Patricia E.; Daniels, Michael J.; Limacher, Marian C.; Janicke, David M.; Martin, A. Daniel; Perri, Michael G.

2012-01-01

Background A major challenge following successful weight loss is continuing the behaviors required for long-term weight maintenance. This challenge may be exacerbated in rural areas with limited local support resources. Objective This study describes and compares program costs and cost-effectiveness for 12-month extended care lifestyle maintenance programs following an initial 6-month weight loss program. Design A 1-year prospective controlled randomized clinical trial. Participants/Setting The study included 215 female participants age 50 or older from rural areas who completed an initial 6-month lifestyle program for weight loss. The study was conducted from June 1, 2003, to May 31, 2007. Intervention The intervention was delivered through local Cooperative Extension Service offices in rural Florida. Participants were randomly-assigned to a 12-month extended care program using either individual telephone counseling (n=67), group face-to-face counseling (n=74), or a mail/control group (n=74). Main Outcome Measures Program delivery costs, weight loss, and self-reported health status were directly assessed through questionnaires and program activity logs. Costs were estimated across a range of enrollment sizes to allow inferences beyond the study sample. Statistical Analyses Performed Non-parametric and parametric tests of differences across groups for program outcomes were combined with direct program cost estimates and expected value calculations to determine which scales of operation favored alternative formats for lifestyle maintenance. Results Median weight regain during the intervention year was 1.7 kg for participants in the face-to-face format, 2.1 kg for the telephone format, and 3.1 kg for the mail/control format. For a typical group size of 13 participants, the face-to-face format had higher fixed costs, which translated into higher overall program costs ($420 per participant) when compared to individual telephone counseling ($268 per participant) and

Recruitment of rural healthcare professionals for live continuing education

Directory of Open Access Journals (Sweden)

Ronnie Scott Holuby

2015-11-01

Full Text Available Introduction: The availability of rural healthcare is a growing concern in the United States as fewer healthcare providers choose to work in rural areas. Accessing quality continuing education (CE for rural healthcare practitioners (HCPs remains a challenge and may pose a barrier to quality care. Methods: To maximize attendance at a live, in-person, free CE program focusing on geriatric medication and issues specifically targeted to HCPs in rural areas, two methods were implemented sequentially. The first method used formal advertising implemented by a professional marketing service to promote CE events. The second method enlisted local healthcare organizations and physician groups to promote the CE event to their employees. Cost per attendee was calculated for comparison. Results: Professional marketing services recruited 31 HCPs (March 2011 and resulted in a per-participant recruitment cost of US$428.62. Local healthcare organizations and physician groups’ marketing recruited 48 HCPs (July–August 2011 and resulted in a per-participant recruitment cost of US$55.19. Discussion: Providing free CE coordinated through local healthcare organizations and physician groups was the most cost-effective method of recruiting rural HCPs for CE. Formal advertising added cost without increasing the number of participants per event. Although this is the first study of the cost-effectiveness of recruitment methods targeting HCPs in rural areas, results are consistent with research on cost-effectiveness of outreach to rural lay community members.

Cost evaluation of reproductive and primary health care mobile service delivery for women in two rural districts in South Africa.

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Kathryn Schnippel

Full Text Available Cervical cancer screening is a critical health service that is often unavailable to women in under-resourced settings. In order to expand access to this and other reproductive and primary health care services, a South African non-governmental organization established a van-based mobile clinic in two rural districts in South Africa. To inform policy and budgeting, we conducted a cost evaluation of this service delivery model.The evaluation was retrospective (October 2012-September 2013 for one district and April-September 2013 for the second district and conducted from a provider cost perspective. Services evaluated included cervical cancer screening, HIV counselling and testing, syndromic management of sexually transmitted infections (STIs, breast exams, provision of condoms, contraceptives, and general health education. Fixed costs, including vehicle purchase and conversion, equipment, operating costs and mobile clinic staffing, were collected from program records and public sector pricing information. The number of women accessing different services was multiplied by ingredients-based variable costs, reflecting the consumables required. All costs are reported in 2013 USD.Fixed costs accounted for most of the total annual costs of the mobile clinics (85% and 94% for the two districts; the largest contributor to annual fixed costs was staff salaries. Average costs per patient were driven by the total number of patients seen, at $46.09 and $76.03 for the two districts. Variable costs for Pap smears were higher than for other services provided, and some services, such as breast exams and STI and tuberculosis symptoms screening, had no marginal cost.Staffing costs are the largest component of providing mobile health services to rural communities. Yet, in remote areas where patient volumes do not exceed nursing staff capacity, incorporating multiple services within a cervical cancer screening program is an approach to potentially expand access to

A review of the availability and cost effectiveness of chronic obstructive pulmonary disease (COPD) management interventions in rural Australia and New Zealand.

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Brooke, Michelle E; Spiliopoulos, Nicolaos; Collins, Margaret

2017-01-01

Chronic obstructive pulmonary disease (COPD) is a chronic, progressive disease, which consumes a significant proportion of the Australian and New Zealand healthcare budget. Studies have shown that people living with COPD outside of urban areas have higher rates of hospitalisations. Two international reviews have demonstrated reduced hospital admissions and length of stay in people with COPD who participate in an integrated disease management program. However, most studies included in these reviews are in urban settings. The purpose of this review is to explore the type and cost-effectiveness of COPD management interventions located in rural or remote settings of Australia and New Zealand in order to inform planning and ongoing service development in the authors' local health district. Six databases and Google scholar were searched to find literature relating to the availability and cost-effectiveness of non-pharmaceutical interventions for the management of COPD in rural and remote areas of Australia and New Zealand. Two studies were found that met the inclusion criteria. Both studies had small sample sizes, were single intervention studies and showed a positive influence on variables such as number of hospital admissions and length of stay at 12 months post-intervention. However, because of the limited number of studies and the lack of homogeneity of interventions, no conclusions regarding availability and cost-effectiveness of COPD interventions in rural and remote areas of Australia and New Zealand could be drawn. Limited literature exists to inform planning and development of services for people with COPD living in rural and remote areas of Australia and New Zealand. Approximately 50% of pulmonary rehabilitation programs are situated in rural and remote locations in Australia and New Zealand. Outcomes from existing programs need to be reported in a consistent and coordinated manner to allow evaluation of health resource utilisation.

Cost-Effectiveness of a Family Planning Voucher Program in Rural Pakistan

Directory of Open Access Journals (Sweden)

Edward Ivor Broughton

2017-09-01

Full Text Available IntroductionThis study reports on the effectiveness and efficiency from the program funder’s perspective of the Suraj Social Franchise (SSF voucher program in which private health-care providers in remote rural areas were identified, trained, upgraded, and certified to deliver family planning services to underserved women of reproductive age in 29 districts of Sindh and 3 districts of Punjab province, Pakistan between October 2013 and June 2016.MethodA decision tree compared the cost of implementing SSF to the program funder and its effects of providing additional couple years of protection (CYPs to targeted women, compared to business-as-usual. Costs included vouchers given to women to receive a free contraceptive method of their choice from the SSF provider. The vouchers were then reimbursed to the SSF provider by the program.ResultsA total of 168,206 married women of reproductive age (MWRA received SSF vouchers between October 2013 and June 2016, costing $3,278,000 ($19.50/recipient. The average effectiveness of the program per voucher recipient was an additional 1.66 CYPs, giving an incremental cost-effectiveness of the program of $4.28 per CYP compared to not having the program (95% CI: $3.62–5.31.ConclusionThe result compares favorably to other interventions with similar objectives and appears affordable for the Pakistan national health-care system. It is therefore recommended to help address the unmet need for contraception among MWRA in these areas of Pakistan and is worthy of trial implementation in the country more widely.

Household experience and costs of seeking measles vaccination in rural Guinea-Bissau.

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Byberg, S; Fisker, A B; Rodrigues, A; Balde, I; Enemark, U; Aaby, P; Benn, C S; Griffiths, U K

2017-01-01

Children younger than 12 months of age are eligible for childhood vaccines through the public health system in Guinea-Bissau. To limit open vial wastage, a restrictive vial opening policy has been implemented; 10-dose measles vaccine vials are only opened if six or more children aged 9-11 months are present at the vaccination post. Consequently, mothers who bring their child for measles vaccination can be told to return another day. We aimed to describe the household experience and estimate household costs of seeking measles vaccination in rural Guinea-Bissau. Within a national sample of village clusters under demographic surveillance, we interviewed mothers of children aged 9-21 months about their experience with seeking measles vaccination. From information about time and money spent, we calculated household costs of seeking measles vaccination. We interviewed mothers of 1308 children of whom 1043 (80%) had sought measles vaccination at least once. Measles vaccination coverage was 70% (910/1308). Coverage decreased with increasing distance to the health centre. On average, mothers who had taken their child for vaccination took their child 1.4 times. Mean costs of achieving 70% coverage were 2.04 USD (SD 3.86) per child taken for vaccination. Half of the mothers spent more than 2 h seeking vaccination and 11% spent money on transportation. We found several indications of missed opportunities for measles vaccination resulting in suboptimal coverage. The household costs comprised 3.3% of the average monthly income and should be taken into account when assessing the costs of delivering vaccinations. © 2016 John Wiley & Sons Ltd.

Household Rates of Return to Education in Rural Bangladesh: Accounting for Direct Costs, Child Labour, and Option Value

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Shafiq, M. Najeeb

2007-01-01

This study estimates the returns to boys' education for rural Bangladeshi households by accounting for some conventionally neglected items: direct costs of education, foregone child labour earnings, and option value. The estimated returns are 13.5% for primary education, 7.8% for junior-secondary education, 12.9% for higher-secondary education,…

Rural energy and development

Energy Technology Data Exchange (ETDEWEB)

Stern, R.

1997-12-01

The author discusses the worldwide problem and need for rural electrification to support development. He points out that rural areas will pay high rates to receive such services, but cannot afford the capital cost for conventional services. The author looks at this problem from the point of energy choices, subsides, initial costs, financing, investors, local involvement, and governmental actions. In particular he is concerned with ways to make better use of biofuels, to promote sustainable harvesting, and to encourage development of more modern fuels.

Efficient solar energy conversion in a low cost flat-plate solar cooker fabricated for use in rural areas of the south asian countries

International Nuclear Information System (INIS)

Jamil, Y.; Raza, M.; Muhammad, N.

2008-01-01

Solar flat plate cooker has been designed and fabricated for use in the rural areas of the South Asian countries. Indigenous low cost materials have been utilized for the fabrication of the cooker. The manufacturing cost of the cooker is less than US$ 150. The aim of this work is to utilize direct solar energy for cooking purpose. A flat plate absorber made of copper is used to absorb the heat energy from the sun. The maximum recorded plate temperature of the cooker was 110 degree C at an ambient temperature of 37 degree C. At this temperature sufficient steam is produced which is channeled to the cooking region though copper pipes. The cooker is found to be effective for cooking traditional food items like pulses, vegetables, meat, eggs, etc. It may be used as an alternative of fossil fuels in the rural areas of the South Asian countries, particularly by the rural women. (author)

Fee-Free Public or Low-Fee Private Basic Education in Rural Ghana: How Does the Cost Influence the Choice of the Poor?

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Akaguri, Luke

2014-01-01

The paper uses data from a household survey of three rural communities and interviews in the Mfantseman Municipality in the Central Region of Ghana to investigate the costs incurred by households that choose either fee-free public schools or low-fee private schools. The paper shows that both provisions impose costs that place those with lower…

The Sensitivity of Primary School Enrollment to the Cost of Post-Primary Schooling in Rural Pakistan: A Gender Perspective.

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Hazarika, Gautam

2001-01-01

Examines gender differences in the sensitivity of primary-school enrollment to the costs of postprimary schooling in rural Pakistan. Finds that distance from primary school is a significant determinant of female primary-school enrollment and distance from middle school is a significant determinant of male primary-school enrollment. Suggests…

Low-cost engineering techniques in sustainable operation of a rural clean water plant in thailand

International Nuclear Information System (INIS)

Pengchai, P.; Keawkhun, K.; Suwapaet, N.

2012-01-01

Problems of water supply in many rural regions of Thailand result from the lack of awareness and financial limitations. Payanghang Clean Water Plant is an example of the rural water plant that has been suffering from the poor operation since 2003. The objective of this study was to modify the operation processes of this water plant to achieve cleaner water and better financial condition. Low-cost engineering techniques, such as the use of floating switches in filtration ponds, the use of water drip system for alum dosing and the addition of Tamarindus indica Linn seed solution was applied. As a result, 76% of turbidity removal efficiency was derived. Although, the difference was not statistically significant at 95% confidence level, higher removal efficiency in comparison with the one before modification (65%) suggested better operation. In the view of financial aspect, l07 dollars (1 baht = 0.0326 U.S. dollar) benefit was obtained from 7 month-operation period. (author)

Rural Gas Program manual

Energy Technology Data Exchange (ETDEWEB)

1987-11-01

The intent and purpose of this manual is to describe the various guideliness and administrative procedures associated with the Alberta Rural Gas Program and to consolidate and expand upon the legislation under which the Program has been developed. It is intended primarily for the use and information of rural gas distributors, their agents, and other private or government parties having an interest in the Rural Gas Program. Information is presented on: rural gas franchises, technical applications, contracts and tenders, determination of system capital costs for grant support, grants, Gas Alberta brokerage arrangements, insurance coverage, utility rights-of-way, and lien notes.

Comparison of Program Costs for Parent-Only and Family-Based Interventions for Pediatric Obesity in Medically Underserved Rural Settings

Science.gov (United States)

Janicke, David M.; Sallinen, Bethany J.; Perri, Michael G.; Lutes, Lesley D.; Silverstein, Janet H.; Brumback, Babette

2009-01-01

Purpose: To compare the costs of parent-only and family-based group interventions for childhood obesity delivered through Cooperative Extension Services in rural communities. Methods: Ninety-three overweight or obese children (aged 8 to 14 years) and their parent(s) participated in this randomized controlled trial, which included a 4-month…

Towards sustainable sanitation management: Establishing the costs and willingness to pay for emptying and transporting sludge in rural districts with high rates of access to latrines.

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Soumya Balasubramanya

Full Text Available Proper management of fecal sludge has significant positive health and environmental externalities. Most research on managing onsite sanitation so far either simulates the costs of, or the welfare effects from, managing sludge in situ in pit latrines. Thus, designing management strategies for onsite rural sanitation is challenging, because the actual costs of transporting sludge for treatment, and sources for financing these transport costs, are not well understood.In this paper we calculate the actual cost of sludge management from onsite latrines, and identify the contributions that latrine owners are willing to make to finance the costs. A spreadsheet-based model is used to identify a cost-effective transport option, and to calculate the cost per household. Then a double-bound contingent valuation method is used to elicit from pit-latrine owners their willingness-to-pay to have sludge transported away. This methodology is employed for the case of a rural subdistrict in Bangladesh called Bhaluka, a unit of administration at which sludge management services are being piloted by the Government of Bangladesh.The typical sludge accumulation rate in Bhaluka is calculated at 0.11 liters/person/day and a typical latrine will need to be emptied approximately once every 3 to 4 years. The costs of emptying and transport are high; approximately USD 13 per emptying event (circa 14% of average monthly income; household contributions could cover around 47% of this cost. However, if costs were spread over time, the service would cost USD 4 per year per household, or USD 0.31 per month per household-comparable to current expenditures of rural households on telecommunications.This is one of few research papers that brings the costs of waste management together with financing of that cost, to provide evidence for an implementable solution. This framework can be used to identify cost effective sludge management options and private contributions towards that cost

Towards sustainable sanitation management: Establishing the costs and willingness to pay for emptying and transporting sludge in rural districts with high rates of access to latrines.

Science.gov (United States)

Balasubramanya, Soumya; Evans, Barbara; Hardy, Richard; Ahmed, Rizwan; Habib, Ahasan; Asad, N S M; Rahman, Mominur; Hasan, M; Dey, Digbijoy; Fletcher, Louise; Camargo-Valero, Miller Alonso; Chaitanya Rao, Krishna; Fernando, Sudarshana

2017-01-01

Proper management of fecal sludge has significant positive health and environmental externalities. Most research on managing onsite sanitation so far either simulates the costs of, or the welfare effects from, managing sludge in situ in pit latrines. Thus, designing management strategies for onsite rural sanitation is challenging, because the actual costs of transporting sludge for treatment, and sources for financing these transport costs, are not well understood. In this paper we calculate the actual cost of sludge management from onsite latrines, and identify the contributions that latrine owners are willing to make to finance the costs. A spreadsheet-based model is used to identify a cost-effective transport option, and to calculate the cost per household. Then a double-bound contingent valuation method is used to elicit from pit-latrine owners their willingness-to-pay to have sludge transported away. This methodology is employed for the case of a rural subdistrict in Bangladesh called Bhaluka, a unit of administration at which sludge management services are being piloted by the Government of Bangladesh. The typical sludge accumulation rate in Bhaluka is calculated at 0.11 liters/person/day and a typical latrine will need to be emptied approximately once every 3 to 4 years. The costs of emptying and transport are high; approximately USD 13 per emptying event (circa 14% of average monthly income); household contributions could cover around 47% of this cost. However, if costs were spread over time, the service would cost USD 4 per year per household, or USD 0.31 per month per household-comparable to current expenditures of rural households on telecommunications. This is one of few research papers that brings the costs of waste management together with financing of that cost, to provide evidence for an implementable solution. This framework can be used to identify cost effective sludge management options and private contributions towards that cost in other

Influence of transportation cost on long-term retention in clinic for HIV patients in rural Haiti.

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Sowah, Leonard A; Turenne, Franck V; Buchwald, Ulrike K; Delva, Guesly; Mesidor, Romaine N; Dessaigne, Camille G; Previl, Harold; Patel, Devang; Edozien, Anthony; Redfield, Robert R; Amoroso, Anthony

2014-12-01

With improved access to antiretroviral therapy in resource-constrained settings, long-term retention in HIV clinics has become an important means of reducing costs and improving outcomes. Published data on retention in HIV clinics beyond 24 months are, however, limited. In our clinic in rural Haiti, we hypothesized that individuals residing in locations with higher transportation costs to clinic would have poorer retention than those who had lower costs. We used a retrospective cohort design to evaluate potential predictors of HIV clinic retention. Patient information was abstracted from the electronic medical records. Cox proportional hazards regression was used to identify independent predictors of 4-year clinic retention. There were 410 patients in our cohort, 266 (64.9%) females and 144 (35.1%) males. Forty-five (11%) patients lived in locations with transportation costs >$2. Males were 1.5 times more likely to live in municipalities with transportation costs to clinic of >$2. Multivariate analysis suggested that age transportation cost were independent predictors of loss to follow-up (LTFU): risk ratio of 2.98, 95% confidence interval (CI): 1.73 to 4.96, P transportation costs greater than $2 were 1.9 times more likely to be lost to care compared with those who paid less for transportation. HIV treatment programs in resource-constrained settings may need to pay closer attention to issues related to transportation cost to improve patient retention.

Net costs of health worker rural incentive packages: an example from the Lao People's Democratic Republic.

Science.gov (United States)

Keuffel, Eric; Jaskiewicz, Wanda; Paphassarang, Chanthakhath; Tulenko, Kate

2013-11-01

Many developing countries are examining whether to institute incentive packages that increase the share of health workers who opt to locate in rural settings; however, uncertainty exists with respect to the expected net cost (or benefit) from these packages. We utilize the findings from the discrete choice experiment surveys applied to students training to be health professionals and costing analyses in Lao People's Democratic Republic to model the anticipated effect of incentive packages on new worker location decisions and direct costs. Incorporating evidence on health worker density and health outcomes, we then estimate the expected 5-year net cost (or benefit) of each incentive packages for 3 health worker cadres--physicians, nurses/midwives, and medical assistants. Under base case assumptions, the optimal incentive package for each cadre produced a 5-year net benefit (maximum net benefit for physicians: US$ 44,000; nurses/midwives: US$ 5.6 million; medical assistants: US$ 485,000). After accounting for health effects, the expected net cost of select incentive packages would be substantially less than the original estimate of direct costs. In the case of Lao People's Democratic Republic, incentive packages that do not invest in capital-intensive components generally should produce larger net benefits. Combining discrete choice experiment surveys, costing surveys and cost-benefit analysis methods may be replicated by other developing countries to calculate whether health worker incentive packages are viable policy options.

Sustainable Energy Solutions for Rural Alaska

Energy Technology Data Exchange (ETDEWEB)

Allen, Riley [Regulatory Assistance Project, Montpelier, VT (United States); Brutkoski, Donna [Regulatory Assistance Project, Montpelier, VT (United States); Farnsworth, David [Regulatory Assistance Project, Montpelier, VT (United States); Larsen, Peter [Lawrence Berkeley National Lab. (LBNL), Berkeley, CA (United States)

2016-04-22

The state of Alaska recognizes the challenges these rural communities face and provides financial support via the Power Cost Equalization (PCE) program. The PCE subsidizes the electricity prices paid by customers of these high-cost utilities. The PCE program is designed to spread the benefits of Alaska’s natural resources more evenly throughout the state. Yet even with this subsidy, electricity is still much more expensive for these rural customers. And beyond the PCE, other forms of assistance to rural utilities are becoming scarce given the state’s current fiscal environment. Nearly 90 percent of Alaska’s unrestricted budget funds in recent years have been tied to oil royalties—a sector experiencing significant declines in production and oil prices. Consequently, as Alaska looks to tighten budgets, the challenge of lowering rural utility costs, while encouraging self-sufficiency, has become more urgent.This study examines reliability, capital and strategic planning, management, workforce development, governance, financial performance and system efficiency in the various communities visited by the research team. Using those attributes, a tier system was developed to categorize rural Alaska utilities into Leading and Innovating Systems (Tier I), Advanced Diesel Systems (Tier II), Basic Systems (Tier III), and Underperforming Systems (Tier IV). The tier approach is not meant to label specific utilities, but rather to provide a general set of benchmarks and guideposts for improvement.

Cost of installing and operating an electronic clinical decision support system for maternal health care: case of Tanzania rural primary health centres.

Science.gov (United States)

Saronga, Happiness Pius; Dalaba, Maxwell Ayindenaba; Dong, Hengjin; Leshabari, Melkizedeck; Sauerborn, Rainer; Sukums, Felix; Blank, Antje; Kaltschmidt, Jens; Loukanova, Svetla

2015-04-02

Poor quality of care is among the causes of high maternal and newborn disease burden in Tanzania. Potential reason for poor quality of care is the existence of a "know-do gap" where by health workers do not perform to the best of their knowledge. An electronic clinical decision support system (CDSS) for maternal health care was piloted in six rural primary health centers of Tanzania to improve performance of health workers by facilitating adherence to World Health Organization (WHO) guidelines and ultimately improve quality of maternal health care. This study aimed at assessing the cost of installing and operating the system in the health centers. This retrospective study was conducted in Lindi, Tanzania. Costs incurred by the project were analyzed using Ingredients approach. These costs broadly included vehicle, computers, furniture, facility, CDSS software, transport, personnel, training, supplies and communication. These were grouped into installation and operation cost; recurrent and capital cost; and fixed and variable cost. We assessed the CDSS in terms of its financial and economic cost implications. We also conducted a sensitivity analysis on the estimations. Total financial cost of CDSS intervention amounted to 185,927.78 USD. 77% of these costs were incurred in the installation phase and included all the activities in preparation for the actual operation of the system for client care. Generally, training made the largest share of costs (33% of total cost and more than half of the recurrent cost) followed by CDSS software- 32% of total cost. There was a difference of 31.4% between the economic and financial costs. 92.5% of economic costs were fixed costs consisting of inputs whose costs do not vary with the volume of activity within a given range. Economic cost per CDSS contact was 52.7 USD but sensitive to discount rate, asset useful life and input cost variations. Our study presents financial and economic cost estimates of installing and operating an

Task-sharing or public finance for the expansion of surgical access in rural Ethiopia: an extended cost-effectiveness analysis.

Science.gov (United States)

Shrime, Mark G; Verguet, Stéphane; Johansson, Kjell Arne; Desalegn, Dawit; Jamison, Dean T; Kruk, Margaret E

2016-07-01

Despite a high burden of surgical disease, access to surgical services in low- and middle-income countries is often limited. In line with the World Health Organization's current focus on universal health coverage and equitable access to care, we examined how policies to expand access to surgery in rural Ethiopia would impact health, impoverishment and equity. An extended cost-effectiveness analysis was performed. Deterministic and stochastic models of surgery in rural Ethiopia were constructed, utilizing pooled estimates of costs and probabilities from national surveys and published literature. Model calibration and validation were performed against published estimates, with sensitivity analyses on model assumptions to check for robustness. Outcomes of interest were the number of deaths averted, the number of cases of poverty averted and the number of cases of catastrophic expenditure averted for each policy, divided across wealth quintiles. Health benefits, financial risk protection and equity appear to be in tension in the expansion of access to surgical care in rural Ethiopia. Health benefits from each of the examined policies accrued primarily to the poor. However, without travel vouchers, many policies also induced impoverishment in the poor while providing financial risk protection to the rich, calling into question the equitable distribution of benefits by these policies. Adding travel vouchers removed the impoverishing effects of a policy but decreased the health benefit that could be bought per dollar spent. These results were robust to sensitivity analyses. © The Author 2015. Published by Oxford University Press. All rights reserved. For permissions, please email: journals.permissions@oup.com.

Pre-design and life cycle cost analysis of a hybrid power system for rural and remote communities in Afghanistan

Directory of Open Access Journals (Sweden)

Mir Sayed Shah Danish

2014-08-01

Full Text Available In view of the present situation of the Afghanistan electricity sector, the photovoltaic and diesel generator stand-alone hybrid power system is increasingly attractive for application in rural and remote communities. Thousands of rural communities in Afghanistan depend solely on traditional kerosene for illumination and rarely have access to electricity sources such as DC battery for radio and other small appliances. This study is conducted to offer real-life solution to this problem. The hybrid system is investigated to meet the domestic load demand that is estimated based on the communities’ electricity consumption culture. At first, customary pre-design is pursued. Afterwards, the break-even point and net present value algorithms are applied for economic analysis. That makes this study differ from the previous academic literature. The concepts developed in this study are targeted for a cost-effective hybrid system, which is appropriate for rural and remote residents’ lifestyle change and improvement. Based on the academic research methods, overall analysis procedures can fit as an analogy, especially for developing countries.

Costes asociados a las horas de cuidado informal de los mayores dependientes en un ámbito rural Costs associated to informal caregiving hours for older people living in rural communities [Spain

Directory of Open Access Journals (Sweden)

Pablo Moya Martínez

2009-04-01

Full Text Available Objetivos: Determinar el coste asociado a las variables que mejor predicen las horas de cuidado informal (CI en mayores residentes en su domicilio con algún grado de dependencia para las actividades de la vida diaria (AVD.Métodos: Estudio observacional transversal en 241 personas mayores de 64 años, de ámbito rural y de ambos sexos (un 37,8% hombres y un 62,2% mujeres. La media (desviación estándar de edad fue de 81,07 (7,01 años. Mediante el cuestionario RAI-HC (Resident Assessment Instrument Home Care se recogieron variables sociodemográficas, dependencia en AVD y horas de CI recibido. Se empleó el análisis de regresión lineal múltiple para determinar la relación existente entre la variable dependiente horas de CI y el total de variables independientes, sociodemográficas, de las actividades básicas de la vida diaria e instrumentales.Resultados: Las variables que mejor explican las horas de Cl son vivir solo, la necesidad de ayuda para comer, preparar comidas, moverse en la cama y salir a la calle, que representan el 46,3% de la variabilidad en la necesidad de horas de CI. Los coeficientes estandarizados mayores corresponden a las variables dependencia para comer (0,272 y para preparar las comidas (0,205. Ser dependiente para comer supone un incremento de 275 h de CI anual y un coste incremental asociado de 2.406,15 €/año. La dependencia para la preparación de comidas supone un incremento de 307,2h anuales y un coste incremental asociado de 2.688,18 €/año. La dependencia en función de las AVD tiene un coste de entre 4.972,72 y 21.479,15 € por año.Conclusiones: Casi la mitad del coste de las horas de CI que precisa una persona mayor con algún grado de dependencia se puede atribuir a vivir solo y a la necesidad de ayuda para un reducido grupo de AVD fáciles de evaluar, como comer, cocinar, moverse en la cama y salir a la calle.Objectives: To determine the costs associated with the variables that best predict hours of

Well water quality in rural Nicaragua using a low-cost bacterial test and microbial source tracking.

Science.gov (United States)

Weiss, Patricia; Aw, Tiong Gim; Urquhart, Gerald R; Galeano, Miguel Ruiz; Rose, Joan B

2016-04-01

Water-related diseases, particularly diarrhea, are major contributors to morbidity and mortality in developing countries. Monitoring water quality on a global scale is crucial to making progress in terms of population health. Traditional analytical methods are difficult to use in many regions of the world in low-resource settings that face severe water quality issues due to the inaccessibility of laboratories. This study aimed to evaluate a new low-cost method (the compartment bag test (CBT)) in rural Nicaragua. The CBT was used to quantify the presence of Escherichia coli in drinking water wells and aimed to determine the source(s) of any microbial contamination. Results indicate that the CBT is a viable method for use in remote rural regions. The overall quality of well water in Pueblo Nuevo, Nicaragua was deemed unsafe, and results led to the conclusion that animal fecal wastes may be one of the leading causes of well contamination. Elevation and depth of wells were not found to impact overall water quality. However rope-pump wells had a 64.1% reduction in contamination when compared with simple wells.

Economic burden and cost determinants of coronary heart disease in rural southwest China: a multilevel analysis.

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Le, C; Fang, Y; Linxiong, W; Shulan, Z; Golden, A R

2015-01-01

To estimate the economic burden of coronary heart disease (CHD) in a given year (2010), including direct and indirect costs, and examine the impact of contextual and individual socio-economic (SES) predictors on the costs of CHD among adults in rural southwest China. Cross-sectional community survey. In total, 4595 adults (aged ≥18 years) participated in this study. A prevalence-based cost-of-illness approach was used to estimate the economic burden of CHD. Information on demographic characteristics of the study population and the economic consequences of CHD was obtained using a standard questionnaire. Multilevel linear regression was used to model the variation in costs of CHD. In the study population, the overall prevalence of CHD was 2.9% (3.5% for males, 2.3% for females). The total cost of CHD was estimated to be US$17 million. Inpatient hospitalizations represented the main component of direct costs of CHD, and direct costs accounted for the greatest proportion of the economic burden of CHD. Males were more likely to have a higher economic burden of CHD than females. A positive association was found between the individual's level of education and the economic burden of CHD. Residence in a higher-income community was associated with higher costs related to CHD. This study found that both contextual and individual SES were closely associated with the costs of CHD. Future strategies for CHD interventions and improved access to affordable medications to treat and control CHD should focus on less-educated individuals and communities with lower SES. Copyright © 2014 The Royal Society for Public Health. Published by Elsevier Ltd. All rights reserved.

Recruiting a young adolescent rural cohort: Costs and lessons learnt

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Krestina L. Amon

2016-04-01

Full Text Available Background: Adolescent recruitment into longitudinal health studies is challenging. The aim of this paper is to report the detailed process and costs of recruiting young adolescents and their families into an intensive longitudinal study of the effects of puberty hormones on health, behaviour and wellbeing in early adolescence, based in regional/rural Australia. Methods: Participants were recruited using a saturation strategy of targeted methods (including school visits and community events and non-targeted recruitment approaches (including print and electronic media advertising, and social media. Direct (face-to-face contact with the public and indirect (behind-the-scenes preparatory activities researcher hours were calculated for each of the recruitment strategies. Results: The study recruited 342 adolescent participants and a parent/guardian over two years. School and community-based recruitment required 6.2 and 6.0 researcher hours per activity, respectively. Direct researcher hours were primarily spent on delivering presentations and connecting with community members at community events. The majority of indirect hours were spent preparing and assembling information packs for distribution to students and parents during school visits. Non-targeted recruitment strategies using media advertising were the most frequently used methods. Researchers were estimated to have spent less than one hour for each media activity. In 27 months, an estimated $250,000 was spent on recruitment activities and resources. A combination of methods was used to recruit young adolescents and their families into a longitudinal health study. Conclusions: The financial costs and researcher time committed to this study highlight the labour-intensive nature of recruitment. The data presented are useful for researchers planning longitudinal studies in adolescents.

Effectiveness, cost-effectiveness and cost-benefit of a single annual professional intervention for the prevention of childhood dental caries in a remote rural Indigenous community.

Science.gov (United States)

Lalloo, Ratilal; Kroon, Jeroen; Tut, Ohnmar; Kularatna, Sanjeewa; Jamieson, Lisa M; Wallace, Valda; Boase, Robyn; Fernando, Surani; Cadet-James, Yvonne; Scuffham, Paul A; Johnson, Newell W

2015-08-29

The aim of the study is to reduce the high prevalence of tooth decay in children in a remote, rural Indigenous community in Australia, by application of a single annual dental preventive intervention. The study seeks to (1) assess the effectiveness of an annual oral health preventive intervention in slowing the incidence of dental caries in children in this community, (2) identify the mediating role of known risk factors for dental caries and (3) assess the cost-effectiveness and cost-benefit of the intervention. The intervention is novel in that most dental preventive interventions require regular re-application, which is not possible in resource constrained communities. While tooth decay is preventable, self-care and healthy habits are lacking in these communities, placing more emphasis on health services to deliver an effective dental preventive intervention. Importantly, the study will assess cost-benefit and cost-effectiveness for broader implementation across similar communities in Australia and internationally. There is an urgent need to reduce the burden of dental decay in these communities, by implementing effective, cost-effective, feasible and sustainable dental prevention programs. Expected outcomes of this study include improved oral and general health of children within the community; an understanding of the costs associated with the intervention provided, and its comparison with the costs of allowing new lesions to develop, with associated treatment costs. Findings should be generalisable to similar communities around the world. The research is registered with the Australian New Zealand Clinical Trials Registry (ANZCTR), registration number ACTRN12615000693527; date of registration: 3rd July 2015.

Rural Electricity and Isolated Systems

International Nuclear Information System (INIS)

Ruiz, Otto; Solorzano, Benjamin

2000-01-01

The paper describes the impact of the cost of investment, operation and trading of rural electricity and discuss cost-benefit analysis. This evaluation covers a three different periods: before 1990, the period 1990-1996 and 1997-1999. Also the trends of demand and supply of energy are presented

Implementing Patient Safety Initiatives in Rural Hospitals

Science.gov (United States)

Klingner, Jill; Moscovice, Ira; Tupper, Judith; Coburn, Andrew; Wakefield, Mary

2009-01-01

Implementation of patient safety initiatives can be costly in time and energy. Because of small volumes and limited resources, rural hospitals often are not included in nationally driven patient safety initiatives. This article describes the Tennessee Rural Hospital Patient Safety Demonstration project, whose goal was to strengthen capacity for…

Estimating Long-Term Care Costs among Thai Elderly: A Phichit Province Case Study

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Pattaraporn Khongboon

2018-01-01

Full Text Available Background. Rural-urban inequality in long-term care (LTC services has been increasing alongside rapid socioeconomic development. This study estimates the average spending on LTC services and identifies the factors that influence the use and cost of LTC for the elderly living in urban and rural areas of Thailand. Methods. The sample comprised 837 elderly aged 60 years drawn from rural and urban areas in Phichit Province. Costs were assessed over a 1-month period. Direct costs of caregiving and indirect costs (opportunity cost method were analyzed. Binary logistic regression was performed to determine which factors affected LTC costs. Results. The total annual LTC spending for rural and urban residents was on average USD 7,285 and USD 7,280.6, respectively. Formal care and informal care comprise the largest share of payments. There was a significant association between rural residents and costs for informal care, day/night care, and home renovation. Conclusions. Even though total LTC expenditures do not seem to vary significantly across rural and urban areas, the fundamental differences between areas need to be recognized. Reorganizing country delivery systems and finding a balance between formal and informal care are alternative solutions.

The household costs of health care in rural South Africa with free public primary care and hospital exemptions for the poor.

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Goudge, Jane; Gilson, Lucy; Russell, Steve; Gumede, Tebogo; Mills, Anne

2009-04-01

To measure the direct cost burdens (health care expenditure as a percent of total household expenditure) for households in rural South Africa, and examine the expenditure and use patterns driving those burdens, in a setting with free public primary health care and hospital exemptions for the poor. Data on illness events, treatment patterns and health expenditure in the previous month were assessed from a cross-sectional survey of 280 households conducted in the Agincourt Health and Demographic Surveillance site, South Africa. On average, a household experiencing illness incurred a direct cost burden of 4.5% of total household expenditure. A visit to a public clinic generated a mean burden of 1.3%. Complex sequences of treatments led 20% of households to incur a burden over 10%, with transport costs generating 42% of this burden. An outpatient public hospital visit generated a burden of 8.2%, as only 58% of those eligible obtained an exemption; inpatient stays incurred a burden of 45%. Consultations with private providers incurred a mean burden of 9.5%. About 38% of individuals who reported illness did not take any treatment action, 55% of whom identified financial and perceived supply-side barriers as reasons. The low overall mean cost burden of 4.5% suggests that free primary care and hospital exemptions provided financial protection. However, transport costs, the difficulty of obtaining hospital exemptions, use of private providers, and complex treatment patterns meant state-provided protection had limitations. The significant non-use of care shows the need for other measures such as more outreach services and more exemptions in rural areas. The findings also imply that fee removal anywhere must be accompanied by wider measures to ensure improved access.

Costs of rearing children in agricultural economies: an alternative estimation approach and findings from rural Bangladesh.

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Khan, M M; Magnani, R J; Mock, N B; Saadat, Y S

1993-03-01

There are changes in child costs during demographic transition. This study examines household time allocation from 66 agricultural households in 3 villages in Tangail District in rural north central Bangladesh in 1984-85 (371 days). Component and total child-rearing costs are estimated in alternative ways. Conventional "opportunity wage" measures are considered overestimated. The methodological shortcomings of direct cost accounting procedures and consumer demand methods in computing time cost and monetary cost of child rearing are pointed out. In this study's alternative computation, age standardized equivalent costs are generated. Child food consumption costs were generated from a large national survey conducted in 1983. Nonfood expenditures were estimated by food to nonfood expenditure ratios taken from the aforementioned survey. For estimating breast-feeding costs, an estimate was produced based on the assumption that costs for infant food consumption were a fixed proportion of food costs for older children. Land ownership groups were set up to reflect socioeconomic status: 1) landless households, 2) marginal farm households with 1 acre or .4 hectares of land, 3) middle income households with 1-2 acres of land, 4) upper middle income households with 2-4 acres of land, and 5) upper income or rich households with over 4 acres of land. The nonmarket wage rate for hired household help was used to determine the value of cooking, fetching water, and household cleaning and repairing. The results confirm the low costs of child rearing in high fertility societies. Productive nonmarket activities are effective in subsidizing the costs of children. The addition of a child into households already with children has a low impact on time costs of children; "this economies of scale effect is estimated ... at 20%." The highest relative costs were found in the lowest income households, and the lowest costs were in the highest income households. 5% of total household income is

Future economic outlook of Nebraska rural community pharmacies based on break-even analysis of community operational costs and county population.

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Keast, Shellie L; Jacobs, Elgene; Harrison, Donald; Farmer, Kevin; Thompson, David

2010-09-01

There is growing concern over increasingly limited access to local health care, including pharmacies, for rural citizens of the United States. Although geographically distant from most competitors, rural pharmacies may still struggle to generate an acceptable profit to remain economically viable. Therefore, a method for calculating the economic viability for a community pharmacy to recruit a potential new owner to assume the entrepreneurial risk is an important issue to consider when evaluating rural pharmacy access. The primary objective of this study was to use a modified break-even analysis to predict the future financial potential of the current pharmacy business to attract a new owner. The secondary objective was to forecast a risk level for a Nebraska county to sustain the number of pharmacies in the country beyond current ownership. This research used data provided by pharmacies that responded to a Nebraska Medicaid cost of dispensing (COD) survey in addition to data from the US Census Bureau, US Office of Management and Budget, and the Nebraska State Board of Pharmacy. Break-even analysis was used to determine the point where the prescription volume of the pharmacy not only covered the variable and fixed costs but also maintained a reasonable profit to attract new ownership. Counties were classified into 3 risk levels based on the projected available prescription volume and the number of pharmacies in each county. Sensitivity analysis was performed on the risk levels to determine the impact of variance in projected available prescription volume on the projected future outlook for the pharmacies in each county. Regression analysis of responses to the COD survey indicated that the annual break-even prescription volume ranged from 44,790 to 49,246 prescriptions per pharmacy per annum. The number of rural Nebraska pharmacies was projected to decline from 126 to 78. The number of counties in Nebraska without a single pharmacy was projected to increase from 19 to

Cost and cost-effectiveness of newborn home visits: findings from the Newhints cluster-randomised controlled trial in rural Ghana.

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Pitt, Catherine; Tawiah, Theresa; Soremekun, Seyi; ten Asbroek, Augustinus H A; Manu, Alexander; Tawiah-Agyemang, Charlotte; Hill, Zelee; Owusu-Agyei, Seth; Kirkwood, Betty R; Hanson, Kara

2016-01-01

Every year, 2·9 million newborn babies die worldwide. A meta-analysis of four cluster-randomised controlled trials estimated that home visits by trained community members in programme settings in Ghana and south Asia reduced neonatal mortality by 12% (95% CI 5-18). We aimed to estimate the costs and cost-effectiveness of newborn home visits in a programme setting. We prospectively collected detailed cost data alongside the Newhints trial, which tested the effect of a home-visits intervention in seven districts in rural Ghana and showed a reduction of 8% (95% CI -12 to 25%) in neonatal mortality. The intervention consisted of a package of home visits to pregnant women and their babies in the first week of life by community-based surveillance volunteers. We calculated incremental cost-effectiveness ratios (ICERs) with Monte Carlo simulation and one-way sensitivity analyses and characterised uncertainty with cost-effectiveness planes and cost-effectiveness acceptability curves. We then modelled the potential cost-effectiveness for baseline neonatal mortality rates of 20-60 deaths per 1000 livebirths with use of a meta-analysis of effectiveness estimates. In the 49 zones randomly allocated to receive the Newhints intervention, a mean of 407 (SD 18) community-based surveillance volunteers undertook home visits for 7848 pregnant women who gave birth to 7786 live babies in 2009. Annual economic cost of implementation was US$203 998, or $0·53 per person. In the base-case analysis, the Newhints intervention cost a mean of $10 343 (95% CI 2963 to -7674) per newborn life saved, or $352 (95% CI 104 to -268) per discounted life-year saved, and had a 72% chance of being highly cost effective with respect to Ghana's 2009 gross domestic product per person. Key determinants of cost-effectiveness were the discount rate, protective effectiveness, baseline neonatal mortality rate, and implementation costs. In the scenarios modelled with the meta-analysis results, the ICER

Rural China will gain if Beijing cultivates change in farm support schemes

DEFF Research Database (Denmark)

Yu, Wusheng

2017-01-01

Direct payments and more open farm trade can help China to reduce agricultural support costs and so free up resources for rural development needs.......Direct payments and more open farm trade can help China to reduce agricultural support costs and so free up resources for rural development needs....

78 FR 8353 - Rural Broadband Access Loans and Loan Guarantees

Science.gov (United States)

2013-02-06

... outsourcing specialized medical procedures. One study of 24 rural hospitals placed the annual cost of not... a key to economic growth. For rural businesses, broadband gives access to national and international...

Importance of rural bioenergy for developing countries

International Nuclear Information System (INIS)

Demirbas, Ayse Hilal; Demirbas, Imren

2007-01-01

Energy resources will play an important role in the world's future. Rural bioenergy is still the predominant form of energy used by people in the less developed countries, and bioenergy from biomass accounts for about 15% of the world's primary energy consumption and about 38% of the primary energy consumption in developing countries. Furthermore, bioenergy often accounts for more than 90% of the total rural energy supplies in some developing countries. Earth life in rural areas of the world has changed dramatically over time. Industrial development in developing countries, coming at a time of low cost plentiful oil supplies, has resulted in greater reliance on the source of rural bioenergy than is true in the developed countries. In developed countries, there is a growing trend towards employing modern technologies and efficient bioenergy conversion using a range of biofuels, which are becoming cost wise competitive with fossil fuels. Currently, much attention has been a major focus on renewable alternatives in the developing countries. Renewable energy can be particularly appropriate for developing countries. In rural areas, particularly in remote locations, transmission and distribution of energy generated from fossil fuels can be difficult and expensive. Producing renewable energy locally can offer a viable alternative. Renewable energy can facilitate economic and social development in communities but only if the projects are intelligently designed and carefully planned with local input and cooperation. Particularly in poor rural areas, the costs of renewable energy projects will absorb a significant part of participants' small incomes. Bio-fuels are important because they replace petroleum fuels. Biomass and biofuels can be used as a substitute for fossil fuels to generate heat, power and/or chemicals. Generally speaking, biofuels are generally considered as offering many benefits, including sustainability, reduction of greenhouse gas emissions, regional

Economic Evaluation of Pediatric Telemedicine Consultations to Rural Emergency Departments.

Science.gov (United States)

Yang, Nikki H; Dharmar, Madan; Yoo, Byung-Kwang; Leigh, J Paul; Kuppermann, Nathan; Romano, Patrick S; Nesbitt, Thomas S; Marcin, James P

2015-08-01

Comprehensive economic evaluations have not been conducted on telemedicine consultations to children in rural emergency departments (EDs). We conducted an economic evaluation to estimate the cost, effectiveness, and return on investment (ROI) of telemedicine consultations provided to health care providers of acutely ill and injured children in rural EDs compared with telephone consultations from a health care payer prospective. We built a decision model with parameters from primary programmatic data, national data, and the literature. We performed a base-case cost-effectiveness analysis (CEA), a probabilistic CEA with Monte Carlo simulation, and ROI estimation when CEA suggested cost-saving. The CEA was based on program effectiveness, derived from transfer decisions following telemedicine and telephone consultations. The average cost for a telemedicine consultation was $3641 per child/ED/year in 2013 US dollars. Telemedicine consultations resulted in 31% fewer patient transfers compared with telephone consultations and a cost reduction of $4662 per child/ED/year. Our probabilistic CEA demonstrated telemedicine consultations were less costly than telephone consultations in 57% of simulation iterations. The ROI was calculated to be 1.28 ($4662/$3641) from the base-case analysis and estimated to be 1.96 from the probabilistic analysis, suggesting a $1.96 return for each dollar invested in telemedicine. Treating 10 acutely ill and injured children at each rural ED with telemedicine resulted in an annual cost-savings of $46,620 per ED. Telephone and telemedicine consultations were not randomly assigned, potentially resulting in biased results. From a health care payer perspective, telemedicine consultations to health care providers of acutely ill and injured children presenting to rural EDs are cost-saving (base-case and more than half of Monte Carlo simulation iterations) or cost-effective compared with telephone consultations. © The Author(s) 2015.

Telecommunications technology and rural education in the United States

Science.gov (United States)

Perrine, J. R.

1975-01-01

The rural sector of the US is examined from the point of view of whether telecommunications technology can augment the development of rural education. Migratory farm workers and American Indians were the target groups which were examined as examples of groups with special needs in rural areas. The general rural population and the target groups were examined to identify problems and to ascertain specific educational needs. Educational projects utilizing telecommunications technology in target group settings were discussed. Large scale regional ATS-6 satellite-based experimental educational telecommunications projects were described. Costs and organizational factors were also examined for large scale rural telecommunications projects.

Development of a nurse case management service: a proposed business plan for rural hospitals.

Science.gov (United States)

Adams, Marsha Howell; Crow, Carolyn S

2005-01-01

The nurse case management service (NCMS) for rural hospitals is an entrepreneurial endeavor designed to provide rural patients with quality, cost-effective healthcare. This article describes the development of an NCMS. A detailed marketing and financial plan, a review of industry trends, and the legal structure and risks associated with the development of the venture are presented. The financial plan projects a minimum savings of 223,200 dollars for rural institutions annually. To improve quality and reduce cost for rural hospitals, the authors recommend implementation of an NCMS.

Integrated rural industrialization through biogas

International Nuclear Information System (INIS)

Anon.

1992-01-01

Role of biogas in rural industrialization in India is explained. The Khadi and Village Industries Commission has installed over 2 lakhs (0.2 million) biogas plants during the last 30 years. A 15 cu.m. capacity plant costs Rs. 35,000/-. It produces 65 tons bio-manure worth Rs. 13,000/- in a year and fuel gas equivalent to 3,285 litres of kerosene worth Rs. 9855/-. It provides employment to 300 man days. In addition to serving as a source of energy and manure, it reduces deforestation, solves rural sanitation problem and maintain environmental equilibrium. Industrial activities suitable for rural areas and which can use biogas as a source of power are indicated. (M.G.B.)

An approach to rural distribution network design for sub-Saharan Africa

International Nuclear Information System (INIS)

Sebitosi, A.B.; Pillay, P.; Khan, M.A.

2006-01-01

The bulk of rural populations in sub-Saharan Africa have no access to electricity and are under-served by any other form of modern infrastructure. The cost of infrastructure to mainly scattered communities has been perennially cited as largely to blame. Quite often rural networks are overdesigned, resulting in under utilization and, therefore, costly overheads. One reason often cited for the overspecification is anticipation of load growth. In most sub-Sahara African rural areas, however, economic growth rates are low, and a designer has no justification in specifying an infrastructure capacity exceeding more than a few percent of existing consumer requirements. This paper proposes methods that critically look at the geometry of small grid network designs to address the construction challenges in rural sub-Saharan Africa

State-level employment, accessibility and rurality

Directory of Open Access Journals (Sweden)

Casey Abington

2014-09-01

Full Text Available Employment and economic growth in rural areas as a policy issue has been recently highlighted by the federal government. In August 2011, the White House released a report entitled “Jobs and Economic Security for Rural America”. While the document listed various programs and policies that have reportedly benefited rural America, it also stated that rural communities are still facing many challenges. For example, many rural communities have lower incomes and higher poverty rates than more urban areas. One possible reason for rural communities being at a disadvantage compared to urban areas involves transportation, especially in terms of journey to work. Thus, one can ask how employment rates vary with accessibility, as measured by journey to work times, as well as location (rural versus urban. Using 2007 state level data, OLS analysis is used to examine the relationship between employment rates and journey to work times and rurality. The analysis confirms that employment rates decrease with increased journey to work times. However, measures of rurality were only marginally significant and the negative coefficient on each measure indicates that employment rates decrease with greater urbanization. Improving accessibility between (very rural and larger areas might improve employment opportunities. Although weighing the benefits of such (reduced unemployment against the costs of providing better highways or public transit might lead to a different conclusion.

Role of Bhabhatron in rural cancer care

International Nuclear Information System (INIS)

Singh, Manjit

2009-01-01

Radiotherapy, using cobalt-60 is the most cost-effective and the most relevant method of cancer treatment in India. However, there is acute shortage of radiotherapy machines in the country, due the high cost of imported machines. As most of the radiotherapy machines in the country are located in urban areas, patients from rural areas have to travel a long distance and stay there to get treatment. BARC has developed Bhabhatron to meet the demand for affordable telecobalt machines. Compared to any imported unit, the indigenous machine is cheaper, superior in features and more suitable for rural use. Bhabhatrons are installed in many cancer hospitals in the country. (author)

Assessment of rural energy resources

International Nuclear Information System (INIS)

Rijal, K.; Bansal, N.K.; Grover, P.D.

1990-01-01

This article presents the methodological guidelines used to assess rural energy resources with an example of its application in three villages each from different physiographic zones of Nepal. Existing energy demand patterns of villages are compared with estimated resource availability, and rural energy planning issues are discussed. Economics and financial supply price of primary energy resources are compared, which provides insight into defective energy planning and policy formulation and implication in the context of rural areas of Nepal. Though aware of the formidable consequences, the rural populace continues to exhaust the forest as they are unable to find financially cheaper alternatives. Appropriate policy measures need to be devised by the government to promote the use of economically cost-effective renewable energy resources so as to change the present energy usage pattern to diminish the environmental impact caused by over exploitation of forest resources beyond their regenerative capacity

Rural electrification in isolated systems

International Nuclear Information System (INIS)

Solorzano, Benjamin; Ruiz, Otto

2000-01-01

This paper discusses the plan of the rural electrification in Guatemala considering the factors that affect costs of installation of power systems such as topography, energy consumption and homes density. Also advantages and limitations of hydro power, solar energy and wind energy are discussed with analyses of costs of production of wind energy. The geothermal energy in Guatemala is also described with analyses of feasibility

7 CFR 1944.254 - Program costs.

Science.gov (United States)

2010-01-01

... Regulations of the Department of Agriculture (Continued) RURAL HOUSING SERVICE, RURAL BUSINESS-COOPERATIVE... supplies (including food) necessary to provide services; (iv) Operational costs of a transportation service... development of the application and plan of operations before the effective date of CHSP grant award; (vi...

DEVELOPMENT OF RURAL TERRITORIES IN LATVIA IMPLEMENTING TELEWORK

OpenAIRE

Vītola, Alise; Baltiņa, Iveta; Ādamsone, Liena; Judrupa, Ilze; Šenfelde, Maija

2013-01-01

Population decline is taking place in rural areas in Latvia as well as in rural areas in Europe. There is a question of utmost importance - will people choose to live in the rural area doing remote work or will they choose the job in the towns. Increased pace of population declining is forecasted in the event of steady decreasing working places and services. Growing service costs per inhabitant may infl uence lowering of accessibility of some services in the territory. Till nowadays measureme...

Acceptance of anti-retroviral therapy among patients infected with HIV and tuberculosis in rural Malawi is low and associated with cost of transport.

Directory of Open Access Journals (Sweden)

Rony Zachariah

Full Text Available BACKGROUND: A study was conducted among newly registered HIV-positive tuberculosis (TB patients systematically offered anti-retroviral treatment (ART in a district hospital in rural Malawi in order to a determine the acceptance of ART b conduct a geographic mapping of those placed on ART and c examine the association between "cost of transport" and ART acceptance. METHODOLOGY/PRINCIPAL FINDINGS: A retrospective cross-sectional analysis was performed on routine program data for the period of February 2003 to July 2004. Standardized registers and patient cards were used to gather data. The place of residence was used to determine road distances to the Thyolo district hospital. Cost of transport from different parts of the district was based on the known cost for public transport to the road-stop closest to the patient's residence. Of 1,290 newly registered TB patients, 1,003(78% underwent HIV-testing of whom 770 (77% were HIV-positive. 742 of these individuals (pulmonary TB = 607; extra-pulmonary TB = 135 were considered eligible for ART of whom only 101(13.6% accepted ART. Cost of transport to the hospital ART site was significantly associated with ART acceptance and there was a linear trend in association between cost and ART acceptance (chi(2 for trend = 25.4, P<0.001. Individuals who had to pay 50 Malawi Kwacha (1 United States Dollar = 100 Malawi Kwacha, MW or less for a one-way trip to the Thyolo hospital were four times more likely to accept ART than those who had to pay over 100 MW (Adjusted Odds ratio = 4.0, 95% confidence interval: 2.0-8.1, P<0.001. CONCLUSIONS/SIGNIFICANCE: ART acceptance among TB patients in a rural district in Malawi is low and associated with cost of transport to the centralized hospital based ART site. Decentralizing the ART offer from the hospital to health centers that are closer to home communities would be an essential step towards reducing the overall cost and burden of travel.

Benchmarking Local Government Performance on Rural Sanitation : Learning from Himachal Pradesh, India

OpenAIRE

World Bank

2010-01-01

Open defecation is a traditional behavior in rural India. Conventional rural sanitation programs have been based on the assumption that people defecate in the open because they are too poor to afford the cost of constructing a toilet. Therefore, subsidies for upfront capital costs were provided to generate demand for 'sanitation,' interpreted narrowly as a pour-flush toilet. These programs...

Collaborative Rural Healthcare Network: A Conceptual Model

Directory of Open Access Journals (Sweden)

U. Raja

2011-07-01

Full Text Available Healthcare is a critical issue in rural communities throughout the world. Provision of timely and cost effective health care in these communities is a challenge since it is coupled with a lack of adequate infrastructure and manpower support. Twenty percent of the United States of America‘s population resides in rural communities, i.e., 59 million people; however, only nine percent of the nation’s physicians practice in rural communities. Shortage of health care personnel and the lack of equipment and facilities often force rural residents to travel long distances to receive needed medical treatment. Researchers and practitioners are in search of solutions to address these unique challenges. In this research, we present a proposed collaborative model of a health information system for rural communities and the challenges and opportunities of this global issue.

Does It or Doesn't It? Geographic Differences and the Costs of Living

Science.gov (United States)

Zimmerman, Julie N.; Ham, Sunny; Frank, Sarah Michelle

2008-01-01

The relative cost of living in rural areas has long been of interest to rural sociologists. Today, the popular perception is that rural prices are lower. This study examines geographic differences in the costs of living in Kentucky. The results indicate that, contrary to the popular perception, when prices of the same products and services were…

Renewable energy for rural electrification

Energy Technology Data Exchange (ETDEWEB)

Strebkov, D. [All Russian Research Institute for Electrification of the Agriculture, Moscow (Russian Federation); Bezrukich, P. [Ministry for Fuel and Energy of Russian Federation, Moscow (Russian Federation); Kozlov, V. [Intersolarcenter Association, Moscow (Russian Federation)

1997-12-31

In spite of quite good centralized power supply system, rural electrification level across Russia vary widely: in some regions there are densely populated communities which lack power, while in the other the most pressing need is to electrify dispersed, isolated villages or homes. The main objective of the Russian project `Renewable energy for rural electrification` is the elaboration and application of new technologies of rural electrification in order to ensure the sustainable development of unelectrified areas of the Russia. The long-term objective of the project are: to improve the living standards of people in rural areas, who lack centralized energy supply systems, by introducing a new system for generation, transmission and distribution of electric power on the base of renewable energy systems; to provide a reliable cost-effective electric service for electrified and uncertified communities; to reduce the consumption of organic fuel in power generation systems; to support the military industry in converting their activity into the renewable energy sector; and to protect the environment

Renewable energy for rural electrification

Energy Technology Data Exchange (ETDEWEB)

Strebkov, D [All Russian Research Institute for Electrification of the Agriculture, Moscow (Russian Federation); Bezrukich, P [Ministry for Fuel and Energy of Russian Federation, Moscow (Russian Federation); Kozlov, V [Intersolarcenter Association, Moscow (Russian Federation)

1998-12-31

In spite of quite good centralized power supply system, rural electrification level across Russia vary widely: in some regions there are densely populated communities which lack power, while in the other the most pressing need is to electrify dispersed, isolated villages or homes. The main objective of the Russian project `Renewable energy for rural electrification` is the elaboration and application of new technologies of rural electrification in order to ensure the sustainable development of unelectrified areas of the Russia. The long-term objective of the project are: to improve the living standards of people in rural areas, who lack centralized energy supply systems, by introducing a new system for generation, transmission and distribution of electric power on the base of renewable energy systems; to provide a reliable cost-effective electric service for electrified and uncertified communities; to reduce the consumption of organic fuel in power generation systems; to support the military industry in converting their activity into the renewable energy sector; and to protect the environment

Socio-economic and Environmental impacts, planning and administration of rural electrification

International Nuclear Information System (INIS)

Sam, Haroun Osman

1999-01-01

The majority of the population in Sudan still lives in the rural areas where they still suffer from problems of poverty, unemployment, high rates of illiteracy, poor health services, shortage of water, and migration to urban areas. Development plans within decentralization efforts taking place in the country should give great importance to rural development by activating rural productive sector comprising agriculture and small scale industries. Rural electrification (RE) can play an important role as akey infrastructure for rural development, and could change the rural communities socially and economically to the better. RE also have desirable environmental impacts when substituting polluting and scare fuels such as petroleum fuel and fuel wood by electricity. Compared with urban electrification, RE is characterized by scattered consumers, low demands, and low load factors. This results in high connection costs of electricity per consumer, and high unit (Kwh) cost. In Sudan, rural electricity demands range from small industries of 50 or industries and individual farms. To bring electricity supply to these different categories of rural consumers at a reasonable investment cost requires proper planning. It needs regular data collection and updating, selection of appropriate technology, project formulation, financing implementation, management, and follow-up. The Sudan National Electricity Corporation (NEC), gives priority to the generation and transmission of electricity to the big urban and industrial areas. NEC treats RE as low priority to which resources are only devoted after the more urgent needs of the urban and industrial consumers not impossible, for a utility like the NEC to construct, operate, and maintain a large number of small scale projects in rural areas. To enable RE to play an effective institution with RE as its primary objectives is very crucial. This paper aims to highlight the importance of RE and its impacts on the rural inhabitants socially

Costs and consequences of a cash transfer for hospital births in a rural district of Uttar Pradesh, India.

Science.gov (United States)

Coffey, Diane

2014-08-01

The Janani Suraksha Yojana, India's "safe motherhood program," is a conditional cash transfer to encourage women to give birth in health facilities. Despite the program's apparent success in increasing facility-based births, quantitative evaluations have not found corresponding improvements in health outcomes. This study analyses original qualitative data collected between January, 2012 and November, 2013 in a rural district in Uttar Pradesh to address the question of why the program has not improved health outcomes. It finds that health service providers are focused on capturing economic rents associated with the program, and provide an extremely poor quality care. Further, the program does not ultimately provide beneficiaries a large net monetary transfer at the time of birth. Based on a detailed accounting of the monetary costs of hospital and home deliveries, this study finds that the value of the transfer to beneficiaries is small due to costs associated with hospital births. Finally, this study also documents important emotional and psychological costs to women of delivering in the hospital. These findings suggest the need for a substantial rethinking of the program, paying careful attention to incentivizing health outcomes. Copyright © 2014 Elsevier Ltd. All rights reserved.

Integration and Optimization of Renewables and Storages for Rural Electrification

Directory of Open Access Journals (Sweden)

Morris Brenna

2016-09-01

Full Text Available The electricity access in Sub-Saharan African countries is below 10%; thus, introducing a microgrid for rural electrification can overcome the endemic lack of modern electricity access that hampers the provision of basic services such as education, healthcare, safety, economic and social growth for rural communities. This work studies different possible comparison methods considering variations such as land area required, location for the storage, efficiency, availability and reliability of energy resources, and technology cost variability (investment cost and levelized cost of electricity, which are among the major key parameters used to assess the best possible utilization of renewables and storage system, either using them in the form of integrated, hybrid or independent systems. The study is carried out largely with the help of the Micropower optimization modeling simulator called HOMER for Ethiopia. As a result, the study proposes the use of Photovoltaic (PV–Wind–Hydro–Battery hybrid system model that concludes the optimal configuration of power systems at affordable price for underserved rural communities.

A cost-effectiveness analysis of three components of a syndromic surveillance system for the early warning of epidemics in rural China.

Science.gov (United States)

Ding, Yan; Sauerborn, Rainer; Xu, Biao; Shaofa, Nie; Yan, Weirong; Diwan, Vinod K; Dong, Hengjin

2015-11-14

Syndromic surveillance systems (SSSs) collect non-specific syndromes in early stages of disease outbreaks. This makes an SSS a promising tool for the early detection of epidemics. An Integrated Surveillance System in rural China (ISSC project), which added an SSS to the existing Chinese surveillance system for the early warning of epidemics, was implemented from April 2012 to March 2014 in Jiangxi and Hubei Provinces. This study aims to measure the costs and effectiveness of the three components of the SSS in the ISSC project. The central measures of the cost-effectiveness analysis of the three components of the syndromic surveillance system were: 1) the costs per reported event, respectively, at the health facilities, the primary schools and the pharmacies; and 2) the operating costs per surveillance unit per year, respectively, at the health facilities, the primary schools and the pharmacies. Effectiveness was expressed by reporting outputs which were numbers of reported events, numbers of raw signals, and numbers of verified signals. The reported events were tracked through an internal data base. Signal verification forms and epidemiological investigation reports were collected from local country centers for disease control and prevention. We adopted project managers' perspective for the cost analysis. Total costs included set-up costs (system development and training) and operating costs (data collection, quality control and signal verification). We used self-designed questionnaires to collect cost data and received, respectively, 369 and 477 facility and staff questionnaires through a cross-sectional survey with a purposive sampling following the ISSC project. All data were entered into Epidata 3.02 and exported to Stata for descriptive analysis. The number of daily reported events per unit was the highest at pharmacies, followed by health facilities and finally primary schools. Variances existed within the three groups and also between Jiangxi and Hubei

Design Strategies and Preliminary Prototype for a Low-Cost Arsenic Removal System for Rural Bangladesh

Energy Technology Data Exchange (ETDEWEB)

Mathieu, Johanna L.; Gadgil, Ashok J.; Kowolik, Kristin; Qazi, Shefah; Agogino, Alice M.

2009-09-14

Researchers have invented a material called ARUBA -- Arsenic Removal Using Bottom Ash -- that effectively and affordably removes arsenic from Bangladesh groundwater. Through analysis of studies across a range of disciplines, observations, and informal interviews conducted over three trips to Bangladesh, we have applied mechanical engineering design methodology to develop eight key design strategies, which were used in the development of a low-cost, community-scale water treatment system that uses ARUBA to removearsenic from drinking water. We have constructed, tested, and analysed a scale version of the system. Experiments have shown that the system is capable of reducing high levels of arsenic (nearly 600 ppb) to below the Bangladesh standard of 50 ppb, while remaining affordable to people living on less than US$2/day. The system could be sustainably implemented as a public-private partnership in rural Bangladesh.

Microscopic observation drug-susceptibility assay vs. Xpert® MTB/RIF for the diagnosis of tuberculosis in a rural African setting: a cost-utility analysis.

Science.gov (United States)

Wikman-Jorgensen, Philip E; Llenas-García, Jara; Pérez-Porcuna, Tomàs M; Hobbins, Michael; Ehmer, Jochen; Mussa, Manuel A; Ascaso, Carlos

2017-06-01

To compare the cost-utility of microscopic observation drug-susceptibility assay (MODS) and Xpert ® MTB/RIF implementation for tuberculosis (TB) diagnosis in rural northern Mozambique. Stochastic transmission compartmental TB model from the healthcare provider perspective with parameter input from direct measurements, systematic literature reviews and expert opinion. MODS and Xpert ® MTB/RIF were evaluated as replacement test of smear microscopy (SM) or as an add-on test after a negative SM. Costs were calculated in 2013 USD, effects in disability-adjusted life years (DALY). Willingness to pay threshold (WPT) was established at once the per capita Gross National Income of Mozambique. MODS as an add-on test to negative SM produced an incremental cost-effectiveness ratio (ICER) of 5647.89USD/DALY averted. MODS as a substitute for SM yielded an ICER of 5374.58USD/DALY averted. Xpert ® MTB/RIF as an add-on test to negative SM yielded ICER of 345.71USD/DALY averted. Xpert ® MTB/RIF as a substitute for SM obtained an ICER of 122.13USD/DALY averted. TB prevalence and risk of infection were the main factors impacting MODS and Xpert ® MTB/RIF ICER in the one-way sensitivity analysis. In the probabilistic sensitivity analysis, Xpert ® MTB/RIF was most likely to have an ICER below the WPT, whereas MODS was not. Our cost-utility analysis favours the implementation of Xpert ® MTB/RIF as a replacement of SM for all TB suspects in this rural high TB/HIV prevalence African setting. © 2017 John Wiley & Sons Ltd.

Girl child in rural India.

Science.gov (United States)

Devendra, K

1995-01-01

This article discusses the status of the girl child in rural India. Rural children lack the advantages of modern amenities and facilities, such as transportation, electricity, media, hygiene, health care, and access to education. A young girl's status is related to her mother's status. Women are valued the most when a son is born. Girl children are considered an economic liability in child care costs, dowry costs, and marriage support. Since the 1970s, dowry demands have increased. Daughters must meet the demands of prospective in-law for education and dowry even after marriage. The attitudes of parents, families, and society encourage sex-selective abortion, infanticide, abuse in childhood, and domestic violence in adulthood. It was reported in 1994 that a woman is molested every 26 minutes and raped every 52 minutes. The government of India developed an action plan in 1992 for developing the girl child. Rural girl children spend their time cooking, cleaning, fetching wood and water, caring for children, and working in the fields sowing, transplanting, and weeding. Girl children contribute over 20% of total work at home. The only advantage a girl child has in rural areas is visibility. The greatest disadvantage is that her mother, who faced neglect herself, discriminates against her. Increasingly girl children contribute income to their household from Beedi making, gem polishing, embroidering, or paper bag making. Sometimes girls and boys work in hazardous occupations. Gender disparity is evident in school enrollment, drop out rates, literacy, and employment. In 1994, India passed a universal female education bill that offers parents incentives for access and punishment for keeping a girl out of school. Communities need to create a demand for rural girl children's education.

Health Clinic Cost Reports

Data.gov (United States)

U.S. Department of Health & Human Services — Healthcare Cost Report Information System (HCRIS) Dataset - Independent Rural Health Clinic and Freestanding Federally Qualified Health Center (HCLINIC).This data...

Rural farmers' perspectives on stock theft: police crime statistics ...

African Journals Online (AJOL)

Rural farmers are not only facing challenges of severe drought blamed on the El Nino weather pattern, but the stock theft as well. The South African Police's annual crime statistics report and surveys indicates that rural livestock farmers are mostly affected by stock theft in South Africa. The costs paid by these farmers to ...

Least cost analysis of renewable energy projects

International Nuclear Information System (INIS)

Cosgrove-Davies, M.; Cabraal, A.

1994-01-01

This paper describes the methodology for evaluating dispersed and centralized rural energy options on a least cost basis. In defining the load to be served, each supply alternative must provide equivalent levels of service. The village to be served is defined by the number of loads, load density, distance from the nearest power distribution line, and load growth. Appropriate rural energy alternatives are identified and sized to satisfy the defined load. Lastly, a net present value analysis (including capital, installation, O and M, fuel, and replacement costs, etc.) is performed to identify the least cost option. A spreadsheet-based analytical tool developed by the World Bank's Asia Alternative Energy Unit (ASTAE) incorporates this approach and has been applied to compare photovoltaic solar home systems with other rural energy supply options in Indonesia. Load size and load density are found to be the critical factors in choosing between a grid and off-grid solution

Non-Emergency Medical Transportation Needs of Middle-Aged and Older Adults: A Rural-Urban Comparison in Delaware, USA.

Science.gov (United States)

Smith, Matthew Lee; Prohaska, Thomas R; MacLeod, Kara E; Ory, Marcia G; Eisenstein, Amy R; Ragland, David R; Irmiter, Cheryl; Towne, Samuel D; Satariano, William A

2017-02-10

Background : Older adults in rural areas have unique transportation barriers to accessing medical care, which include a lack of mass transit options and considerable distances to health-related services. This study contrasts non-emergency medical transportation (NEMT) service utilization patterns and associated costs for Medicaid middle-aged and older adults in rural versus urban areas. Methods : Data were analyzed from 39,194 NEMT users of LogistiCare-brokered services in Delaware residing in rural (68.3%) and urban (30.9%) areas. Multivariable logistic analyses compared trip characteristics by rurality designation. Results : Rural (37.2%) and urban (41.2%) participants used services more frequently for dialysis than for any other medical concern. Older age and personal accompaniment were more common and wheel chair use was less common for rural trips. The mean cost per trip was greater for rural users (difference of $2910 per trip), which was attributed to the greater distance per trip in rural areas. Conclusions : Among a sample who were eligible for subsidized NEMT and who utilized this service, rural trips tended to be longer and, therefore, higher in cost. Over 50% of trips were made for dialysis highlighting the need to address prevention and, potentially, health service improvements for rural dialysis patients.

Non-Emergency Medical Transportation Needs of Middle-Aged and Older Adults: A Rural-Urban Comparison in Delaware, USA

Directory of Open Access Journals (Sweden)

Matthew Lee Smith

2017-02-01

Full Text Available Background: Older adults in rural areas have unique transportation barriers to accessing medical care, which include a lack of mass transit options and considerable distances to health-related services. This study contrasts non-emergency medical transportation (NEMT service utilization patterns and associated costs for Medicaid middle-aged and older adults in rural versus urban areas. Methods: Data were analyzed from 39,194 NEMT users of LogistiCare-brokered services in Delaware residing in rural (68.3% and urban (30.9% areas. Multivariable logistic analyses compared trip characteristics by rurality designation. Results: Rural (37.2% and urban (41.2% participants used services more frequently for dialysis than for any other medical concern. Older age and personal accompaniment were more common and wheel chair use was less common for rural trips. The mean cost per trip was greater for rural users (difference of $2910 per trip, which was attributed to the greater distance per trip in rural areas. Conclusions: Among a sample who were eligible for subsidized NEMT and who utilized this service, rural trips tended to be longer and, therefore, higher in cost. Over 50% of trips were made for dialysis highlighting the need to address prevention and, potentially, health service improvements for rural dialysis patients.

Edentulism in high poverty rural counties.

Science.gov (United States)

Mitchell, Jordan; Bennett, Kevin; Brock-Martin, Amy

2013-01-01

To examine the differences in oral health status among residents of high-poverty counties, as compared to residents of other rural or urban counties, specifically on the prevalence of edentulism. We used the 2005 Behavioral Risk Factor Surveillance System (BRFSS) and the 2006 Area Resource File (ARF). All analyses were conducted with SAS and SAS-callable SUDAAN, in order to account for weighting and the complex sample design. Characteristics significantly related to edentulism include: geographic location, gender, race, age, health status, employment, insurance, not having a usual source of care, education, marital status, presence of chronic disease, having an English interview, not deferring care due to cost, income, and dentist saturation within the county. Significant associations between high-poverty rural and other rural counties and edentulism were found, and other socioeconomic and health status indicators remain strong predictors of edentulism. © 2012 National Rural Health Association.

Infrastructure Development: Public Private Partnership Path for Developing Rural Telecommunications in Africa

Directory of Open Access Journals (Sweden)

Idongesit William Williams

2012-06-01

Full Text Available It is the quest of every government to achieve universal Access and service of telecommunication services and ICTs. Unfortunately due to the high cost of deploying infrastructure in rural areas of developing countries due to non-significant or no economic activity, this dream of achieving Universal access and service of telecommunications/ICTs have been stalled. This paper throws light on a possible Public Private Partnership framework as a development path that will enable affordable network technologies to be deployed in rural areas at a cost that will translate to what the rural dweller in a developing country in Africa can afford. The paper is a conceptual paper

Emerging potential for radical e-enabled improvements in rural collaboration and accessibility

CSIR Research Space (South Africa)

Naude, AH

2007-05-01

Full Text Available volumes, as well as problems associated with limited local human capacities and uncoordinated or misdirected rural development planning; and enhanced accessibility - addressing the typical problems of rural isolation such as inadequated or costly digital...

The economic burden of type 2 diabetes mellitus in rural southwest China.

Science.gov (United States)

Le, Cai; Lin, Li; Jun, Dong; Jianhui, He; Keying, Zhao; Wenlong, Cui; Ying, Song; Tao, Wei

2013-05-10

This study was conducted in order to estimate the economic burden of diabetes in a given year in rural Yunnan province of China, including direct, indirect and intangible costs. A cross-sectional survey was conducted in rural southwest China in early 2011 among 9396 consenting individuals aged ≥ 18 years. Information on participants' demographic characteristics, and economic consequences and related aspects of diabetes were obtained using a standard questionnaire. Fasting blood sugar level was also measured for each individual. Years of life lost (YLL) due to diabetes was estimated using medical death certificates. A prevalence-based cost-of-illness method was used to estimate the economic burden of diabetes. The overall prevalence and YLL of diabetes was 6.5% and 1168.1 years in the study population, respectively. Total cost of illness related to diabetes was estimated to be $46.8 million. Mean unit direct medical costs, direct non-medical costs, morbidity costs, mortality costs, intangible costs, and cost of illness were $863.2, $44.6, $59.7, $7797.7, $936.2, and $9686.6, respectively. Direct costs accounted for the largest proportion of the economic costs of diabetes. Age was positively associated with direct costs whereas negatively associated with indirect costs. Patients aged 45-59 years incurred the highest intangible costs. Both indirect and intangible costs increased with level of education. Diabetes is a major public health problem in terms of morbidity and economic burden in rural southwest China. The region should increase investment in the further control of diabetes, and improvement of patient quality of life. Copyright © 2011 Elsevier Ireland Ltd. All rights reserved.

Livelihood strategies, environmental dependency and rural poverty

DEFF Research Database (Denmark)

Walelign, Solomon Zena

2016-01-01

This article attempts to explore the nexus between rural households’ environmental dependency, poverty and livelihood strategies. Households’ income from each livelihood activities formed the basis for categorizing households according to livelihood strategies. The principal component analysis...... of livelihood choice were analyzed using multinomial logit model. The results indicate the existence of marked differences in environmental dependency, rural poverty and asset endowments across the livelihood groups. Household’s total saving, access to credit, production implements, business cost, exposure...

Costs and outcome of assertive community treatment (ACT) in a rural area in Denmark: 4-year register-based follow-up.

Science.gov (United States)

Hastrup, Lene Halling; Aagaard, Jørgen

2015-02-01

Health economic evidence of assertive community treatment (ACT) in Denmark is limited. The aim of the study was to assess the costs and outcome of ACT among 174 patients with severe and persistent mental illness in a rural area of Denmark. The study was based on a quasi-experimental design with a control group from the neighbouring region. Costs and retention in mental health services were analysed by using register data 1 year before and 4 years after inclusion in the study. Data on the use of supportive housing were available for the year before baseline and the subsequent 2 years only. Seventy eight percent of the patients receiving ACT were in contact with psychiatric services at the 4-year follow-up, while 69% of the patients in the control group had contact with psychiatric services (P < 0.17). Days in supportive housing were lower for the ACT group before baseline and remained so (dropping to zero) for the subsequent 2 years. Over 4 years, the mean total costs per patient in the group receiving ACT were DDK 493,442 (SE = 34,292). Excluding costs of supportive housing, the mean total costs per patient of the control group were DDK 537,218 (SE = 59,371), P < 0.53. If these costs are included, however, the mean total costs for the ACT group are unchanged, whereas costs for the control group rise to DDK 671,500 (SE = 73,671), P < 0.03. While ACT appears to have resulted in a significant reduction in costs for psychiatric hospitalizations, baseline differences in use of supportive housing make the effects of ACT on overall costs more ambiguous. At worst, however, overall costs did not increase. Given the generally acknowledged clinical benefits of ACT over standard outpatient care, the results support further dissemination of ACT in Denmark.

Kwaabana: File sharing for rural networks

CSIR Research Space (South Africa)

Johnson, DL

2013-12-01

Full Text Available , Zambia. The results show that our localized file sharing service facilitates reliable sharing amongst rural users. Importantly, it also removes the cost barrier present for similar Internet-based services. We outline the process used by Kwaabana...

What determines firms' decisions to formalize? Evidence from rural Indonesia

OpenAIRE

McCulloch, Neil; Schulze, Günther G.; Voss, Janina

2010-01-01

In this paper we analyze the decision of small and micro firms to formalize, i.e. to obtain business and other licenses in rural Indonesia. We use the rural investment climate survey (RICS) that consists of non-farm rural enterprises, most of them microenterprises, and analyze the effect of formalization on tax payments, corruption, access to credit and revenue, taking into account the endogeneity of the formalization decision to such benefits and costs. We show, contrary to most of the liter...

Retinopathy of prematurity: the high cost of screening regional and remote infants.

Science.gov (United States)

Yu, Tzu-Ying; Donovan, Tim; Armfield, Nigel; Gole, Glen A

2018-01-25

Demand for retinopathy of prematurity (ROP) screening is increasing for infants born at rural and regional hospitals where the service is not generally available. The health system cost for screening regional/remote infants has not been reported. The objective of this study is to evaluate the cost of ROP screening at a large centralized tertiary neonatal service for infants from regional/rural hospitals. This is a retrospective study to establish the cost of transferring regional/rural infants to the Royal Brisbane and Women's Hospital for ROP screening over a 28-month period. A total of 131 infants were included in this study. Individual infant costs were calculated from analysis of clinical and administrative records. Economic cost of ROP screening for all transfers from regional/rural hospitals to Royal Brisbane and Women's Hospital. The average economic cost of ROP screening for this cohort was AUD$5110 per infant screened and the total cost was AUD$669 413. The average cost per infant screened was highest for infants from a regional centre with a population of 75 000 (AUD$14 856 per child), which was also geographically furthest from Brisbane. No infant in this cohort transferred from a regional nursery reached criteria for intervention for ROP by standard guidelines. Health system costs for ROP screening of remote infants at a centralized hospital are high. Alternative strategies using telemedicine can now be compared with centralized screening. © 2018 Royal Australian and New Zealand College of Ophthalmologists.

Effect of medicare payment on rural health care systems.

Science.gov (United States)

McBride, Timothy D; Mueller, Keith J

2002-01-01

Medicare payments constitute a significant share of patient-generated revenues for rural providers, more so than for urban providers. Therefore, Medicare payment policies influence the behavior of rural providers and determine their financial viability. Health services researchers need to contribute to the understanding of the implications of changes in fee-for-service payment policy, prospects for change because of the payment to Medicare+Choice risk plans, and implications for rural providers inherent in any restructuring of the Medicare program. This article outlines the basic policy choices, implications for rural providers and Medicare beneficiaries, impacts of existing research, and suggestions for further research. Topics for further research include implications of the Critical Access Hospital program, understanding how changes in payment to rural hospitals affect patient care, developing improved formulas for paying rural hospitals, determining the payment-to-cost ratio for physicians, measuring the impact of changes in the payment methodology used to pay for services delivered by rural health clinics and federally qualified health centers, accounting for the reasons for differences in historical Medicare expenditures across rural counties and between rural and urban counties, explicating all reasons for Medicare+Choice plans withdrawing from some rural areas and entering others, measuring the rural impact of proposals to add a prescription drug benefit to the Medicare program, and measuring the impact of Medicare payment policies on rural economies.

The Effectiveness of New Solar Photovoltaic System with Supercapacitor for Rural Areas

Directory of Open Access Journals (Sweden)

Muhammad Izuan Fahmi Romli

2016-11-01

Full Text Available Countries like Malaysia have more that 70% of its population living in rural areas. Majority of these rural areas lie in regions where most villages do not have grid connected electricity. Renewable energy using photovoltaic (PV panels offers an alternative and cost efficient solution that exploits the yearlong abundance of sunlight available in countries like Malaysia. The main problem with PV systems is the high maintenance costs in replacing batteries every few years which makes PV systems unattractive for rural areas. A full scale PV system, developed in Semenyih Malaysia, aims to increase battery lifetime and reduce maintenance costs by incorporating supercapacitors. The system was developed in a life-sized cabin to mimic a rural home. A programmable load is used to test the system with the load profile of a typical rural household usage. Experimental and simulation results show that the supercapacitor bank is able to reduce the stress on the battery by absorbing peak current surges. Results also show that the system is able to maintain a high battery state of charge during the entire day. Article History: Received June 17th 2016; Received in revised form August 16th 2016; Accepted Sept 10th 2016; Available online How to Cite This Article: Fahmi, M.I., Rajkumar, R.,  Wong, Y.W., Chong, L.W., Arelhi, R., and Isa, D. (2016 The Effectiveness of New Solar Photovoltaic System with Supercapacitor for Rural Areas. Int. Journal of Renewable Energy Development, 5(3, 249-257. http://dx.doi.org/10.14710/ijred.5.3.249-257

Low-cost domestic water filter: The case for a process-based ...

African Journals Online (AJOL)

Low-cost domestic water filter: The case for a process-based approach for the development of a rural technology product. ... Since the project aims at technology transfer to the rural poor for generating rural livelihoods, appropriate financial models and the general sustainability issues for such an activity are briefly discussed ...

Economically viable biochemical processes for the advanced rural biorefinery and downstream recovery operations

Science.gov (United States)

Rural biorefineries offer an alternative to traditional ethanol production by providing the opportunity to produce fuel on site to reduce costs associated with biomass transportation thus making the fuel economically viable. Widespread installation of rural biorefineries could lead to increased upt...

Vertical integration of local fuel producers into rural district heating systems – Climate impact and production costs

International Nuclear Information System (INIS)

Kimming, M.; Sundberg, C.; Nordberg, Å.; Hansson, P.-A.

2015-01-01

Farmers can use their own agricultural biomass residues for heat production in small-scale systems, enabling synergies between the district heating (DH) sector and agriculture. The barriers to entry into the Swedish heat market were extremely high as long as heat distribution were considered natural monopoly, but were recently lowered due to the introduction of a regulated third party access (TPA) system in the DH sector. This study assesses the potential impact on greenhouse gas emissions and cost-based heat price in the DH sector when farmers vertically integrate into the heat supply chain and introduce more local and agricultural crops and residues into the fuel mix. Four scenarios with various degree of farmer integration, were assessed using life cycle assessment (LCA) methodology, and by analysis of the heat production costs. The results show that full integration of local farm and forest owners in the value chain can reduce greenhouse gas emissions and lower production costs/heat price, if there is an incentive to utilise local and agricultural fuels. The results imply that farmer participation in the DH sector should be encouraged by e.g. EU rural development programmes. - Highlights: • Five DH production systems based on different fuels and ownership were analysed. • Lower GHG emissions were obtained when farmers integrate fully into the DH chain. • Lower heat price was obtained by full vertical integration of farmers. • Salix and straw-based production resulted in the lowest GHG and heat price

Rural model dedicated education unit: partnership between college and hospital.

Science.gov (United States)

Harmon, Lisa M

2013-02-01

This article describes the pilot project development of a rural model Dedicated Education Unit (DEU) by a rural college nursing program and a rural hospital to increase student nurses' confidence and proficiency and improve recruitment of prepared rural staff nurses. Traditionally, for economies of scale, most student clinical rotations occurred in urban settings with the number of students per clinical instructor allowed by the state board of nursing. College budget constraints negated the placement of fewer than this mandated maximum number of students in a rural hospital with a clinical instructor; moreover, rural hospitals could not accommodate 10 students at one time. Rural nursing students were anxious in the urban settings, and this anxiety precluded learning in many instances. Rural hospitals face higher registered nurse vacancies than urban centers. Of the nurses applying for open positions, many were not prepared for the demands of rural nursing, resulting in increased turnover and high orientation costs. The rural model DEU addressed issues of both the nursing program and the hospital. The design and development of the rural model DEU and the advantages of the partnership for the college nursing program and the hospital are discussed. Initial outcomes and serendipitous findings from the pilot project are also discussed. Copyright 2013, SLACK Incorporated.

Rural Hospital Wages and the Area Wage Index

Science.gov (United States)

Dalton, Kathleen; Slifkin, Rebecca T.; Howard, Hilda A.

2002-01-01

We examined data on hospital hourly wages and the prospective payment system (PPS) wage index from 1990 to 1997, to determine if incremental changes to the index have improved its precision and equity as a regional cost adjuster. The differential between average rural and urban PPS hourly wages has declined by almost one-fourth over the 8-year study period. Nearly one-half of the decrease is attributable to regulatory and reporting changes in the annual hospital wage survey. Patterns of within-market wage variation across rural-urban continuum codes identify three separate sub-markets within the State-level aggregates defining rural labor markets. Geographic reclassification decisions appear to eliminate one of the three. Remaining systematic within-market rural wage differences work to the reimbursement advantage of hospitals in the smaller and more isolated communities. PMID:12545604

Measuring population health: costs of alternative survey approaches in the Nouna Health and Demographic Surveillance System in rural Burkina Faso

Directory of Open Access Journals (Sweden)

Henrike Lietz

2015-08-01

Full Text Available Background: There are more than 40 Health and Demographic Surveillance System (HDSS sites in 19 different countries. The running costs of HDSS sites are high. The financing of HDSS activities is of major importance, and adding external health surveys to the HDSS is challenging. To investigate the ways of improving data quality and collection efficiency in the Nouna HDSS in Burkina Faso, the stand-alone data collection activities of the HDSS and the Household Morbidity Survey (HMS were integrated, and the paper-based questionnaires were consolidated into a single tablet-based questionnaire, the Comprehensive Disease Assessment (CDA. Objective: The aims of this study are to estimate and compare the implementation costs of the two different survey approaches for measuring population health. Design: All financial costs of stand-alone (HDSS and HMS and integrated (CDA surveys were estimated from the perspective of the implementing agency. Fixed and variable costs of survey implementation and key cost drivers were identified. The costs per household visit were calculated for both survey approaches. Results: While fixed costs of survey implementation were similar for the two survey approaches, there were considerable variations in variable costs, resulting in an estimated annual cost saving of about US$45,000 under the integrated survey approach. This was primarily because the costs of data management for the tablet-based CDA survey were considerably lower than for the paper-based stand-alone surveys. The cost per household visit from the integrated survey approach was US$21 compared with US$25 from the stand-alone surveys for collecting the same amount of information from 10,000 HDSS households. Conclusions: The CDA tablet-based survey method appears to be feasible and efficient for collecting health and demographic data in the Nouna HDSS in rural Burkina Faso. The possibility of using the tablet-based data collection platform to improve the quality

Analysis of optimum density of forest roads in rural properties

Directory of Open Access Journals (Sweden)

Flávio Cipriano de Assis do Carmo

2013-09-01

Full Text Available This study analyzed the density of roads in rural properties in the south of the Espírito Santo and compared it with the calculation of the optimal density in forestry companies in steep areas. The work was carried out in six small rural properties based on the costs of roads of forest use, wood extraction and the costs of loss of productive area. The technical analysis included time and movement study and productivity. The economic analysis included operational costs, production costs and returns for different scenarios of productivity (180m.ha-1, 220m.ha-1and 250 m.ha-1. According to the results, all the properties have densities of road well above the optimum, which reflects the lack of criteria in the planning of the forest stands, resulting in a inadequate use of plantation area. Property 1 had the highest density of roads (373.92 m.ha-1 and the property 5 presented the lowest density (111.56 m.ha-1.

Wireless multihop backhauls for rural areas: A preliminary study.

Directory of Open Access Journals (Sweden)

Zainab Zaidi

Full Text Available Rural areas have very low revenue potential. The major issue in providing low-cost broadband to rural areas is to provide reliable backhaul connections that spread over tens or even hundreds of miles, connecting villages to the nearest service provider. Along with aerial networks of Google and Facebook, there has been a considerable amount of research toward long-distance terrestrial WiFi links. As a comparison, WiFi routers are easier to be deployed and maintained by non-technical people from the local communities, whereas the aerial networks require professional support to operate. Moreover, they are still in the experimentation phase. However, the long distance WiFi links require high-gain directional antennas and very expensive tall towers for high data rates. On the other hand, multihop paths with stronger links may provide better data rates without the need of tall towers. In this paper, we evaluated the concept of using such multihop WiFi links for long backhaul connections. Our simulation results show that these networks can possibly be a cost-effective and practical solution for rural connectivity. These initial results can serve as a first step to understand the comprehensive feasibility of using multihop WiFi networks for backhaul connections in rural area.

Wireless multihop backhauls for rural areas: A preliminary study.

Science.gov (United States)

Zaidi, Zainab; Lan, Kun-Chan

2017-01-01

Rural areas have very low revenue potential. The major issue in providing low-cost broadband to rural areas is to provide reliable backhaul connections that spread over tens or even hundreds of miles, connecting villages to the nearest service provider. Along with aerial networks of Google and Facebook, there has been a considerable amount of research toward long-distance terrestrial WiFi links. As a comparison, WiFi routers are easier to be deployed and maintained by non-technical people from the local communities, whereas the aerial networks require professional support to operate. Moreover, they are still in the experimentation phase. However, the long distance WiFi links require high-gain directional antennas and very expensive tall towers for high data rates. On the other hand, multihop paths with stronger links may provide better data rates without the need of tall towers. In this paper, we evaluated the concept of using such multihop WiFi links for long backhaul connections. Our simulation results show that these networks can possibly be a cost-effective and practical solution for rural connectivity. These initial results can serve as a first step to understand the comprehensive feasibility of using multihop WiFi networks for backhaul connections in rural area.

Wireless multihop backhauls for rural areas: A preliminary study

Science.gov (United States)

Zaidi, Zainab; Lan, Kun-chan

2017-01-01

Rural areas have very low revenue potential. The major issue in providing low-cost broadband to rural areas is to provide reliable backhaul connections that spread over tens or even hundreds of miles, connecting villages to the nearest service provider. Along with aerial networks of Google and Facebook, there has been a considerable amount of research toward long-distance terrestrial WiFi links. As a comparison, WiFi routers are easier to be deployed and maintained by non-technical people from the local communities, whereas the aerial networks require professional support to operate. Moreover, they are still in the experimentation phase. However, the long distance WiFi links require high-gain directional antennas and very expensive tall towers for high data rates. On the other hand, multihop paths with stronger links may provide better data rates without the need of tall towers. In this paper, we evaluated the concept of using such multihop WiFi links for long backhaul connections. Our simulation results show that these networks can possibly be a cost-effective and practical solution for rural connectivity. These initial results can serve as a first step to understand the comprehensive feasibility of using multihop WiFi networks for backhaul connections in rural area. PMID:28403167

Increasing Access to Rural Finance in Bangladesh : The Forgotten "Missing Middle"

OpenAIRE

Ferrari, Aurora

2007-01-01

Increasing access to rural finance is often the last frontier for financial sector development in developing countries. Financial institutions aiming to operate in rural areas in these countries usually have to deal with high transaction costs, low population densities, remote areas, and a heavy focus on agriculture, with related weather and commodity risks. Although Bangladesh is highly v...

The design and installation of Solar Home Systems in rural Cambodia

Directory of Open Access Journals (Sweden)

Rebecca Alice Watts

2016-09-01

Full Text Available This study contends that solar home systems (SHS are an appropriate solution to provide affordable, reliable and clean electricity in rural Cambodia. SHS provide decentralised electricity suitable for the electricity needs of rural households and with the decreasing cost of solar energy technologies, SHS are becoming an increasingly competitive source of energy. This study details the design and installation of two SHS in a rural community in Cambodia. The SHS have replaced the use of kerosene lamps and supplemented car battery usage, which has generated a cost saving of USD$2.50-3.20 per month. The SHS have increased the hours of quality lighting making it possible for users to improve educational outcomes by studying at night and participating in private education classes as well as potentially extending their working hours that provides an opportunity to increase their income. Community involvement in the installation of SHS and participation in an education program has ensured transfer of knowledge about system operation and maintenance at a local level that has ensured economic, social and environmental were benefits. This study builds a case in support of solar energy at the household level in rural Cambodia and makes recommendations for the deployment of SHS in rural communities throughout the developing world.

Modern energy access to all in rural India: An integrated implementation strategy

International Nuclear Information System (INIS)

Balachandra, P.

2011-01-01

Expanding energy access to the rural population of India presents a critical challenge for its government. The presence of 364 million people without access to electricity and 726 million who rely on biomass for cooking indicate both the failure of past policies and programs, and the need for a radical redesign of the current system. We propose an integrated implementation framework with recommendations for adopting business principles with innovative institutional, regulatory, financing and delivery mechanisms. The framework entails establishment of rural energy access authorities and energy access funds, both at the national and regional levels, to be empowered with enabling regulatory policies, capital resources and the support of multi-stakeholder partnership. These institutions are expected to design, lead, manage and monitor the rural energy interventions. At the other end, trained entrepreneurs would be expected to establish bioenergy-based micro-enterprises that will produce and distribute energy carriers to rural households at an affordable cost. The ESCOs will function as intermediaries between these enterprises and the international carbon market both in aggregating carbon credits and in trading them under CDM. If implemented, such a program could address the challenges of rural energy empowerment by creating access to modern energy carriers and climate change mitigation. - Highlights: ► Expanding rural energy access in India is critical with majority lacking access to modern energy. ► Innovative and integrated implementation strategy for achieving universal rural energy access. ► Design of an integrated rural energy policy and proposal for new institutional mechanism. ► Establishing rural energy access authorities and energy access funds as supporting mechanisms. ► Bioenergy-based micro-enterprises for delivering energy services at an affordable cost.

Attracting and retaining health workers in rural areas: investigating nurses’ views on rural posts and policy interventions

Directory of Open Access Journals (Sweden)

Goodman Catherine

2010-07-01

Full Text Available Abstract Background Kenya has bold plans for scaling up priority interventions nationwide, but faces major human resource challenges, with a lack of skilled workers especially in the most disadvantaged rural areas. Methods We investigated reasons for poor recruitment and retention in rural areas and potential policy interventions through quantitative and qualitative data collection with nursing trainees. We interviewed 345 trainees from four purposively selected Medical Training Colleges (MTCs (166 pre-service and 179 upgrading trainees with prior work experience. Each interviewee completed a self-administered questionnaire including likert scale responses to statements about rural areas and interventions, and focus group discussions (FGDs were conducted at each MTC. Results Likert scale responses indicated mixed perceptions of both living and working in rural areas, with a range of positive, negative and indifferent views expressed on average across different statements. The analysis showed that attitudes to working in rural areas were significantly positively affected by being older, but negatively affected by being an upgrading student. Attitudes to living in rural areas were significantly positively affected by being a student at the MTC furthest from Nairobi. During FGDs trainees raised both positive and negative aspects of rural life. Positive aspects included lower costs of living and more autonomy at work. Negative issues included poor infrastructure, inadequate education facilities and opportunities, higher workloads, and inadequate supplies and supervision. Particular concern was expressed about working in communities dominated by other tribes, reflecting Kenya’s recent election-related violence. Quantitative and qualitative data indicated that students believed several strategies could improve rural recruitment and retention, with particular emphasis on substantial rural allowances and the ability to choose their rural location

Recruitment of Physicians to Rural America: A View through the Lens of Transaction Cost Theory

Science.gov (United States)

Fannin, J. Matthew; Barnes, James N.

2007-01-01

Context: Many rural hospitals in the United States continue to have difficulties recruiting physicians. While several studies have examined some of the factors affecting the nature of this problem, we know far less about the role of economic incentives between rural providers and physicians. Purpose: This conceptual article describes an economic…

Leveraging community health worker system to map a mountainous rural district in low resource setting: a low-cost approach to expand use of geographic information systems for public health.

Science.gov (United States)

Munyaneza, Fabien; Hirschhorn, Lisa R; Amoroso, Cheryl L; Nyirazinyoye, Laetitia; Birru, Ermyas; Mugunga, Jean Claude; Murekatete, Rachel M; Ntaganira, Joseph

2014-12-06

Geographic Information Systems (GIS) have become an important tool in monitoring and improving health services, particularly at local levels. However, GIS data are often unavailable in rural settings and village-level mapping is resource-intensive. This study describes the use of community health workers' (CHW) supervisors to map villages in a mountainous rural district of Northern Rwanda and subsequent use of these data to map village-level variability in safe water availability. We developed a low literacy and skills-focused training in the local language (Kinyarwanda) to train 86 CHW Supervisors and 25 nurses in charge of community health at the health center (HC) and health post (HP) levels to collect the geographic coordinates of the villages using Global Positioning Systems (GPS). Data were validated through meetings with key stakeholders at the sub-district and district levels and joined using ArcMap 10 Geo-processing tools. Costs were calculated using program budgets and activities' records, and compared with the estimated costs of mapping using a separate, trained GIS team. To demonstrate the usefulness of this work, we mapped drinking water sources (DWS) from data collected by CHW supervisors from the chief of the village. DWSs were categorized as safe versus unsafe using World Health Organization definitions. Following training, each CHW Supervisor spent five days collecting data on the villages in their coverage area. Over 12 months, the CHW supervisors mapped the district's 573 villages using 12 shared GPS devices. Sector maps were produced and distributed to local officials. The cost of mapping using CHW supervisors was $29,692, about two times less than the estimated cost of mapping using a trained and dedicated GIS team ($60,112). The availability of local mapping was able to rapidly identify village-level disparities in DWS, with lower access in populations living near to lakes and wetlands (p villages even in mountainous rural areas. These data

7 CFR 4280.15 - Ultimate Recipient Projects eligible for Rural Economic Development Loan funding.

Science.gov (United States)

2010-01-01

... Agriculture (Continued) RURAL BUSINESS-COOPERATIVE SERVICE AND RURAL UTILITIES SERVICE, DEPARTMENT OF... may only be used to provide the following assistance: (a) Start-Up Venture costs, including, but not... capital; (b) Business expansion; (c) Business Incubators; (d) Technical Assistance; (e) Project...

A guide to understanding the variation in premiums in rural health insurance marketplaces.

Science.gov (United States)

Barker, Abigail R; McBride, Timothy D; Kemper, Leah M; Mueller, Keith

2014-05-01

Key Findings. (1) State-level decisions in implementing the Patient Protection and Affordable Care Act of 2010 (ACA) have led to significant state variation in the design of Health Insurance Marketplace (HIM) rating areas. In some designs, rural counties are grouped together, while in others, rural and urban counties have been deliberately mixed. (2) Urban counties have, on average, approximately one more firm participating in the marketplaces, representing about 11 more plan offerings, than rural counties have. (3) The highest-valued "platinum" plan types are less likely to be available in rural areas. Thus, the overall mix of plan types should be factored into the reporting of average premiums. (4) Levels of competition are likely to have a greater impact on the decisions of firms considering whether to operate in higher-cost areas or not, as those firms must determine how they can pass such costs on to consumers, conditional on the market share they are likely to control.

Deployment of community health workers across rural sub-Saharan Africa: financial considerations and operational assumptions.

Science.gov (United States)

McCord, Gordon C; Liu, Anne; Singh, Prabhjot

2013-04-01

To provide cost guidance for developing a locally adaptable and nationally scalable community health worker (CHW) system within primary-health-care systems in sub-Saharan Africa. The yearly costs of training, equipping and deploying CHWs throughout rural sub-Saharan Africa were calculated using data from the literature and from the Millennium Villages Project. Model assumptions were such as to allow national governments to adapt the CHW subsystem to national needs and to deploy an average of 1 CHW per 650 rural inhabitants by 2015. The CHW subsystem described was costed by employing geographic information system (GIS) data on population, urban extents, national and subnational disease prevalence, and unit costs (from the field for wages and commodities). The model is easily replicable and configurable. Countries can adapt it to local prices, wages, population density and disease burdens in different geographic areas. The average annual cost of deploying CHWs to service the entire sub-Saharan African rural population by 2015 would be approximately 2.6 billion (i.e. 2600 million) United States dollars (US$). This sum, to be covered both by national governments and by donor partners, translates into US$ 6.86 per year per inhabitant covered by the CHW subsystem and into US$ 2.72 per year per inhabitant. Alternatively, it would take an annual average of US$ 3750 to train, equip and support each CHW. Comprehensive CHW subsystems can be deployed across sub-Saharan Africa at cost that is modest compared with the projected costs of the primary-health-care system. Given their documented successes, they offer a strong complement to facility-based care in rural African settings.

Rural power supply with local management: Examples from Bolivia, India and Nepal

Energy Technology Data Exchange (ETDEWEB)

Gerger, Aa; Gullberg, M

1997-08-01

Local management of rural power supply is being evaluated in a joint research project conducted by Tanzania Electric Supply Company Limited (TANESCO) and Stockholm Environment Institute (SEI) on new approaches to management and organization of rural electrification. The study is based on literature, and on data from eight visited local organizations for management of power supply in Bolivia (4), India (1) and Nepal (3). Common for these countries is that the national, rural electrification programmes have encountered difficulties. Governments have failed to generate enough funds from existing power supply systems to cover the cost for a continued rural electrification. In cases where large private companies exist, they have had few incentives for expanding into rural areas since it is often not profit making. A third category may be defined as local initiators to power supply, private or co-operative. In all these countries, locally managed power supply systems have developed as a complement to governmental and other large scale programmes. The national policies pertaining to rural power supply in general and local management thereof in particular are described for each country. From the study, it appears that local management of rural power supply is a feasible approach in developing countries. Local management of rural power supply can slightly lower the costs of electrification, and it may help accelerate the pace of load development in newly electrified areas. For successful local organizations though, the most significant factor appears to be local peoples` willingness to develop their own area. Important though, is that proper financial and technical assistance is provided the local organizations. Crucial for sound external assistance is that the national rural electrification policies are clear and consistent. 53 refs, 1 fig, 11 tabs

The economics of potential reduction of the rural road system in Kansas.

Science.gov (United States)

2011-11-01

Benefitcost analysis was used to examine the question of road closure in the three counties. The cost of road : closure is the additional travel cost of rural residents due to more circuitous routing to their destinations. The benefit is : the avo...

Patients direct costs to undergo TB diagnosis.

Science.gov (United States)

de Cuevas, Rachel M Anderson; Lawson, Lovett; Al-Sonboli, Najla; Al-Aghbari, Nasher; Arbide, Isabel; Sherchand, Jeevan B; Nnamdi, Emenyonu E; Aseffa, Abraham; Yassin, Mohammed A; Abdurrahman, Saddiq T; Obasanya, Joshua; Olanrewaju, Oladimeji; Datiko, Daniel; Theobald, Sally J; Ramsay, Andrew; Squire, S Bertel; Cuevas, Luis E

2016-03-24

A major impediment to the treatment of TB is a diagnostic process that requires multiple visits. Descriptions of patient costs associated with diagnosis use different protocols and are not comparable. We aimed to describe the direct costs incurred by adults attending TB diagnostic centres in four countries and factors associated with expenditure for diagnosis. Surveys of 2225 adults attending smear-microscopy centres in Nigeria, Nepal, Ethiopia and Yemen. Adults >18 years with cough >2 weeks were enrolled prospectively. Direct costs were quantified using structured questionnaires. Patients with costs >75(th) quartile were considered to have high expenditure (cases) and compared with patients with costs <75(th) quartile to identify factors associated with high expenditure. The most significant expenses were due to clinic fees and transport. Most participants attended the centres with companions. High expenditure was associated with attending with company, residing in rural areas/other towns and illiteracy. The costs incurred by patients are substantial and share common patterns across countries. Removing user fees, transparent charging policies and reimbursing clinic expenses would reduce the poverty-inducing effects of direct diagnostic costs. In locations with limited resources, support could be prioritised for those most at risk of high expenditure; those who are illiterate, attend the service with company and rural residents.

Household costs of leprosy reactions (ENL in rural India.

Directory of Open Access Journals (Sweden)

David J Chandler

2015-01-01

Full Text Available Erythema nodosum leprosum (ENL is a common immune-mediated complication of lepromatous (LL and borderline lepromatous (BL leprosy. Most patients experience chronic or multiple acute ENL over many years during an economically active period of their lives. Understanding the economic burden of ENL is essential to provide effective patient support, yet this area has not been investigated.Ninety-one patients with LL or BL leprosy attending a leprosy hospital in Purulia district of West Bengal, India, were interviewed using a structured questionnaire. Cases (n = 53 were identified as those who had one or more episodes of ENL within the last 3 years. Controls (n = 38 had LL or BL leprosy but no history of ENL. Data were collected on household income, direct and indirect costs, and coping strategies.The total household cost was Rs 1543 per month or 27.9% (IQR 13.2-52.6 of monthly household income for cases, and Rs 237 per month or 4.9% (IQR 1.7-13.4 of monthly household income for controls. Indirect costs accounted for 65% of total household costs for cases. Direct costs accounted for the remaining 35% of household costs, and resulted almost entirely from treatment-seeking in the private sector. Total household costs exceeded 40% of household income for 37.7% of cases (n = 20 and 2.6% of controls (n = 1 [1 USD = 59 INR].Households affected by ENL face significant economic burden and are at risk of being pushed further into poverty. Health policy should acknowledge the importance of private sector provision and the significant contribution to total household costs of lost productivity (indirect cost. Further work is needed to explore this area and identify solutions.

The role of clean coal technologies in a deregulated rural utility market

Energy Technology Data Exchange (ETDEWEB)

Neal, J.W. [National Rural Electric Cooperative Association, Arlington, VA (United States)

1997-12-31

The nation`s rural electric cooperatives own a high proportion of coal-fired generation, in excess of 80 percent of their generating capacity. As the electric utility industry moves toward a competitive electricity market, the generation mix for electric cooperatives is expected to change. Distributed generation will likely serve more customer loads than is now the case, and that will lead to an increase in gas-fired generation capacity. But, clean low-cost central station coal-fired capacity is expected to continue to be the primary source of power for growing rural electric cooperatives. Gasification combined cycle could be the lowest cost coal based generation option in this new competitive market if both capital cost and electricity production costs can be further reduced. This paper presents anticipated utility business scenarios for the deregulated future and identifies combined cycle power plant configurations that might prove most competitive.

Wind, Sun and Water: Complexities of Alternative Energy Development in Rural Northern Peru

Science.gov (United States)

Love, Thomas; Garwood, Anna

2011-01-01

Drawing on recent research with NGO-driven projects in rural Cajamarca, Peru, we examine the paradoxes of relying on wind, solar and micro-hydro generation of electricity for rural community development. In spite of cost, vagaries of these energy resources and limited material benefits, especially with wind and solar systems, villagers are eagerly…

Franchise Cellular Operator in Rural Areas (Operator Seluler Model Franchise Di Daerah Rural)

OpenAIRE

Parewe, Nurfadillah A; Hasan, Taufik; Kurniawan, Adit

2013-01-01

The rapid development in telecommunication motivates organizations or business person to gain some profits in telco-based business. However, very limited Indonesian villagers had access to these technologies. This problem was caused by the less attractive condition (even unfeasible) to invest in the rural areas because the cost to build a conventional telecommunication infrastructure was very high, eventhough this was a potential new market. The other is the limitations of the spectrum allo...

management and growth paradox of rural small-scale industrial

African Journals Online (AJOL)

User

Keywords: Rural Small-Scale Industries, firm growth, management, proprietors, workforce ... veloping countries as a solution to the problem of scarcity .... In the analysis logistic regression sta- ..... of imported raw materials such as high cost and.

The Impact of Rural Electrification. Challenges and Ways Forward

International Nuclear Information System (INIS)

Torero, Maximo; Vincent, Nicolas

2015-05-01

Rigorous impact evaluation that includes appropriately selected control groups must be a part of rural electrification program designs. Budgeting evaluation activities and engaging with evaluators at an early stage improves to likelihood of having a high quality evaluation design; plus, if deviations occur after the design stage, the evaluators are better prepared to adjust the design so that the impact results remain informative to policy makers and future program designers. Another take-away is to use unified framework to specify the expected outcomes and the plausible sizes of impacts. If done at the beginning of the program, this will provide context to the kind of discussion that policy makers should engage in (e.g. if they should focus on health benefits or the potential to diffuse information campaigns to rural households). These points focus mostly on internal validity, but we also need to focus on external validity as well. Large scale rural electrification programs will provide an opportunity to test if the results from small scale impact evaluations translate to other settings. Something we have not stressed so far but that is important to keep in mind are the complementarities in the provision of different type of infrastructure. Large projects can provide an opportunity to explore complementarities with other infrastructure programs, such as mobile telephony, road access, and improved water and sanitation access. They can shed light on what are the most welfare-enhancing policy options when deciding what types of infrastructure to provide in rural areas, and especially to poor rural households. Finally, we reiterate the need to use an objective function that casts a wider net when deciding where to place electrification programs. Focusing solely on cost minimization can result in missed opportunities. When deciding where to deploy the electric grid in rural areas it is imperative to take into account the potential profits, specifically the agricultural

Higher Prices, Fewer Choices: Shopping for Food in Rural America.

Science.gov (United States)

Morris, Patricia McGrath

The Food Stamp Program is the U.S. government's primary program to prevent the rural poor from going hungry. Food stamp allotments are set each year based on the cost of the "Thrifty Food Plan" (TFP), a minimally adequate diet defined by the U.S. Department of Agriculture (USDA), which sets costs by examining average food prices in urban…

Impact of Biogas Technology in the Development of Rural Population

Directory of Open Access Journals (Sweden)

Sakhawat Ali1

2013-12-01

Full Text Available Biogas technology is useful technology to produce a renewable, high-quality fuel i.e. biogas. In Rural areas people use biomass fuels (firewood and dried dung for meeting their energy utilization demands. This demand is fulfilled by deforestation and land degradation which results in different health and societal problems and also cause excessive emission of greenhouse gases. The rural population of developing countries is in dire need of biogas for cooking, lighting, heating and feedstock etc. The biogas production derives from various agricultural resources, such as manure and harvest remains enormously available. Biogas technology represents a sustainable way to produce energy for household, particularly in developing countries. It can be cost-effective and environment friendly technology for the people in rural areas. So, Biogas can be a best substitute of biomass fuels for use in rural areas. This review evaluates the use of biogas in developing rural areas and glances at problems and challenges as well as benefits and success factors.

Impact of Biogas Technology in the Development of Rural Population

International Nuclear Information System (INIS)

Ali, S.; Nasreen, Z.; Usman, S.; Zahra, N.

2013-01-01

Biogas technology is useful technology to produce a renewable, high-quality fuel i.e. biogas. In Rural areas people use biomass fuels (firewood and dried dung) for meeting their energy utilization demands. This demand is fulfilled by deforestation and land degradation which results in different health and societal problems and also cause excessive emission of greenhouse gases. The rural population of developing countries is in dire need of biogas for cooking, lighting, heating and feedstock etc. The biogas production derives from various agricultural resources, such as manure and harvest remains enormously available. Biogas technology represents a sustainable way to produce energy for household, particularly in developing countries. It can be cost-effective and environment friendly technology for the people in rural areas. So, Biogas can be a best substitute of biomass fuels for use in rural areas. This review evaluates the use of biogas in developing rural areas and glances at problems and challenges as well as benefits and success factors. (author)

Impact of government subsidies on household biogas use in rural China

International Nuclear Information System (INIS)

Sun, Dingqiang; Bai, Junfei; Qiu, Huanguang; Cai, Yaqing

2014-01-01

In this paper, we evaluate empirically the impact of biogas subsidies on household biogas energy use in rural China. Special attention was given to the problem of sample selection bias in assessing the impact of subsidies on biogas energy use because biogas subsidies often change the propensity for installing biogas digesters. Using data from a large-scale household survey, the results indicate that biogas subsidies did promote the construction of biogas digesters. The results suggest that a 10 percentage point increase in subsidy-cost ratio would lead to a 3% increase in digester installations. We also found that biogas subsidies correlated negatively with average time of digester use. A 10 percentage point increase in the subsidy-cost ratio would result in a 4.3% reduction in the average working time of digesters. These results suggest that the net effect of the current subsidy policy on rural household biogas use was near-negligible. Indeed, a 10 percentage point increase in the subsidy-cost ratio resulted in a mere 1.15% increase in biogas use. These findings indicate that biogas subsidies have possibly not been targeted effectively at households that would actually prefer to use biogas energy. - Highlights: • We evaluate empirically the impact of biogas subsidies on household biogas energy use in rural China. • Results indicate that biogas subsidies did promote the construction of biogas digesters. • We also find that biogas subsidies were correlated negatively with average time of digester use. • The results suggest that the net effect of the current subsidy policy on rural household biogas use was near-negligible. • A 10 percentage point increase in the subsidy-cost ratio leads to merely 1.15% increases in biogas use

A Rural Next Generation Network (R-NGN and Its Testbed

Directory of Open Access Journals (Sweden)

Armein Z. R. Langi

2007-05-01

Full Text Available Rural Next Generation Networks (R-NGN technology allows Internet protocol (IP based systems to be used in rural areas. This paper reports a testbed of R-NGN that uses low cost Ethernet radio links, combined with media gateways and a softswitch. The network consists of point-to-point IP Ethernet 2.4 GHz wireless link, IP switches and gateways in each community, standard copper wires and telephone sets for users. It uses low power consumption, and suitable for low density users. This combination allows low cost systems as well as multiservices (voice, data, and multimedia for rural communications. An infrastructure has been deployed in two communities in Cipicung Girang, a village 10 km outside Bandung city, Indonesia. Two towers link the communities with a network of Institut Teknologi Bandung (ITB campus. In addition, local wirelines connect community houses to the network. Currently there are four houses connected to each community node (for a total of eight house, upon which we can perform various tests and measurements.

A Rural Next Generation Network (R-NGN and Its Testbed

Directory of Open Access Journals (Sweden)

Armein Z. R. Langi

2013-09-01

Full Text Available Rural Next Generation Networks (R-NGN technology allows Internet protocol (IP based systems to be used in rural areas. This paper reports a testbed of R-NGN that uses low cost Ethernet radio links, combined with media gateways and a softswitch. The network consists of point-to-point IP Ethernet 2.4 GHz wireless link, IP switches and gateways in each community, standard copper wires and telephone sets for users. It uses low power consumption, and suitable for low density users. This combination allows low cost systems as well as multiservices (voice, data, and multimedia for rural communications. An infrastructure has been deployed in two communities in Cipicung Girang, a village 10 km outside Bandung city, Indonesia. Two towers link the communities with a network of Institut Teknologi Bandung (ITB campus. In addition, local wirelines connect community houses to the network. Currently there are four houses connected to each community node (for a total of eight house, upon which we can perform various tests and measurements.

Electric distribution infrastructures for rural areas in developing countries

International Nuclear Information System (INIS)

Thirault, D.

2004-03-01

The main objective of the thesis was to study the architecture (network topology, mode of distribution, operation of energy sources, etc) distribution networks possible and adapted to the problem of rural electrification. Chapter I sets the context of rural electrification by detailing first the challenges of rural electrification for sustainable economic development and energy resources of these countries and the various existing network architectures. Specifications for the study is finally defined. Chapter II describes the design method developed to compare the costs of different architectures and choose the most suitable. Chapter III shows a method of sizing systems Decentralized Rural Electrification including generators, batteries and windmills. Chapter IV describes the results of a reliability study was carried out on different solutions. Chapter V describes the work done to analyze the operation of a production center consists of a generator and a wind turbine. (author)

Estimating long-term clinical effectiveness and cost-effectiveness of HPV 16/18 vaccine in China.

Science.gov (United States)

Zhang, Qian; Liu, Yi-Jun; Hu, Shang-Ying; Zhao, Fang-Hui

2016-11-04

Human papillomavirus (HPV) 16 and 18 are the two most common HPV oncogenic types that can be prevented by vaccination. This study aimed at assessing the cost-effectiveness of 3 doses of the bivalent HPV vaccine in rural and urban settings in China. A Markov model was adapted to reflect the lifetime of a modelled 100,000 12-year-old girls cohort in rural and urban settings in China. Input parameters were obtained from published literature, official reports and a two-round expert review panel. Clinical and economic outcomes of vaccination at age 12 with screening was compared to screening only. In the base case analysis, a 3 % discount rate, the vaccine cost of 247 CNY (US$ 39, PAHO vaccine cost in 2013), two rounds of screening in a life time and 70 % coverage for both screening and vaccination were used. One-way, two-way and probabilistic sensitivity analyses were performed. We used different thresholds of cost-effectiveness to reflect the diversity of economic development in China. Vaccination in addition to screening could prevent 60 % more cervical cancer cases and deaths than screening only. The incremental cost effectiveness ratio varied largely when changing cost of vaccination and discount in one way analysis. Vaccination was very cost-effective when the vaccine cost ranged 87-630 CNY (US$ 13.8-100) in rural and 87-750 CNY (US$ 13.8-119) in urban; and remained cost-effective when the vaccine cost ranged 630-1,700 CNY (US$ 100-270) in rural and 750-1,900 CNY (US$ 119-302) in urban in two way analysis. Probabilistic sensitivity analyses showed that model results were robust. In both rural and urban, the vaccination cost and discounting are important factors determining the cost-effectiveness of HPV vaccination; policy makers in China should take these into account when making a decision on the introduction of HPV vaccine. In areas with a high burden of cervical cancer and limited screening activities, HPV vaccination should be prioritized. However, the vaccine

OPTIMIZATION OF LONG RURAL FEEDERS USING A GENETIC ALGORITHM

International Nuclear Information System (INIS)

Wishart, Michael; Ledwich, Gerard; Ghosh, Arindam; Ivanovich, Grujica

2010-01-01

This paper describes the optimization of conductor size and the voltage regulator location and magnitude of long rural distribution lines. The optimization minimizes the lifetime cost of the lines, including capital costs and losses while observing voltage drop and operational constraints using a Genetic Algorithm (GA). The GA optimization is applied to a real Single Wire Earth Return (SWER) network in regional Queensland and results are presented.

Rural Electrification through Decentralized Concentrating Solar Power: Technological and Socio-Economic Aspects

Directory of Open Access Journals (Sweden)

Sylvain Quoilin

2013-09-01

Full Text Available This paper presents the development of small-scale solar Organic Rankine Cycles for rural electrification in remote areas of Lesotho. It is subdivided in two parts. The first part deals with the success conditions of decentralized rural electrification projects. Through a literature survey, relevant guiding principles and recommendations are formulated. The second part of the paper describes the proposed system, which is designed in agreement with the formulated recommendations. A framework for benchmarking the performance and cost of various micro-utility platforms and rural electrification distribution models is proposed.

Reducing the Cost of Grid Extension for Rural Electrification

OpenAIRE

NRECA International, Ltd.

2000-01-01

This study first reviews the cost of grid extension in a number of countries. It then identifies ways to reduce costs by examining how they are affected by a variety of factors. An electricity supply system may be divided into two discrete components: the grid extension and the low-voltage distribution system. This study will focus on the first of these two components, the cost of grid ext...

Rural-Urban Differences in Access to Preventive Health Care Among Publicly Insured Minnesotans.

Science.gov (United States)

Loftus, John; Allen, Elizabeth M; Call, Kathleen Thiede; Everson-Rose, Susan A

2018-02-01

Reduced access to care and barriers have been shown in rural populations and in publicly insured populations. Barriers limiting health care access in publicly insured populations living in rural areas are not understood. This study investigates rural-urban differences in system-, provider-, and individual-level barriers and access to preventive care among adults and children enrolled in a public insurance program in Minnesota. This was a secondary analysis of a 2008 statewide, cross-sectional survey of publicly insured adults and children (n = 4,388) investigating barriers associated with low utilization of preventive care. Sampling was stratified with oversampling of racial/ethnic minorities. Rural enrollees were more likely to report no past year preventive care compared to urban enrollees. However, this difference was no longer statistically significant after controlling for demographic and socioeconomic factors (OR: 1.37, 95% CI: 1.00-1.88). Provider- and system-level barriers associated with low use of preventive care among rural enrollees included discrimination based on public insurance status (OR: 2.26, 95% CI: 1.34-2.38), cost of care concerns (OR: 1.72, 95% CI: 1.03-2.89) and uncertainty about care being covered by insurance (OR: 1.70, 95% CI: 1.01-2.85). These and additional provider-level barriers were also identified among urban enrollees. Discrimination, cost of care, and uncertainty about insurance coverage inhibit access in both the rural and urban samples. These barriers are worthy targets of interventions for publicly insured populations regardless of residence. Future studies should investigate additional factors associated with access disparities based on rural-urban residence. © 2017 National Rural Health Association.

Rural emergency medical technician pre-hospital electrocardiogram transmission.

Science.gov (United States)

Powell, A M; Halon, J M; Nelson, J

2014-01-01

Emergent care of the acute heart attack patient continues to be at the forefront of quality and cost reduction strategies throughout the healthcare industry. Although the average cardiac door-to-balloon (D2B) times have decreased substantially over the past few years, there are still vast disparities found in D2B times in populations that reside in rural areas. Such disparities are mostly related to prolonged travel time and subsequent delays in cardiac catherization lab team activation. Urban ambulance companies that are routinely staffed with paramedic level providers have been successful in the implementation of pre-hospital 12-lead electrocardiogram (ECG) protocols as a strategy to reduce D2B times. The authors sought to evaluate the evidence related to the risk and benefits associated with the replication of an ECG transmission protocol in a small rural emergency medical service. The latter is staffed with emergency medical technician-basics (EMT-B), emergency medical technician-advanced (EMT-A), and emergency medical technician-intermediate (EMT-I) level. The evidence reviewed was limited to studies with relevant data regarding the challenges and complexities of the ECG transmission process, the difficulties associated with ECG transmission in rural settings, and ECG transmission outcomes by provider level. The evidence supports additional research to further evaluate the feasibility of ECG transmission at the non-paramedic level. Multiple variables must be investigated including equipment cost, utilization, and rural transmission capabilities. Clearly, pre-hospital ECG transmission and early activation of the cardiac catheterization laboratory are critical components to successfully decreasing D2B times.

Renewable energy for rural communities in Maharashtra, India

International Nuclear Information System (INIS)

Blenkinsopp, T.; Coles, S.R; Kirwan, K.

2013-01-01

The desire for universal access to modern energy and the use of renewable energy technologies (RETs) as a means of delivering low carbon solutions are driven by several local and global factors, including climate change, population increase and future energy security. Social attitudes are a major challenge to overcome in order to successfully introduce low carbon technologies as a sustainable alternative to more traditional means of energy provision. It becomes a challenge to educate the target population in order to counteract any negative preconceptions or scepticisms in using these technologies which can have adverse effect upon their viability and long term success. This work presents the results of a rural energy survey conducted in the Indian state of Maharashtra. The survey highlights the opportunities and attitudes of these rural communities towards sustainable modern energy services and the technologies used to deliver them. Results from the survey show that there is interest in using sustainable or renewable technologies for energy provision and suggest that cost, reliability and ease of use are more important factors than the environmental benefits. A suggestion for a way to improve RET adoption in rural communities is also presented based on the results of this study. - Highlights: • Survey used to assess energy usage and perception of RETs in rural communities. • Despite lack of preference towards one RET the majority believe in their expanded use. • Cost, reliability and ease of use most influential factors when selecting a fuel. • Assessment of community needs can aid RET adoption by improving long term viability

Ultra low-cost, portable smartphone optosensors for mobile point-of-care diagnostics

Science.gov (United States)

Wang, Li-Ju; Chang, Yu-Chung; Sun, Rongrong; Li, Lei

2018-02-01

Smartphone optosensors with integrated optical components make mobile point-of-care (MPoC) diagnostics be done near patients' side. It'll especially have a significant impact on healthcare delivery in rural or remote areas. Current FDA-approved PoC devices achieving clinical level are still at high cost and not affordable in rural hospitals. We present a series of ultra low-cost smartphone optical sensing devices for mobile point-of-care diagnosis. Aiming different targeting analytes and sensing mechanisms, we developed custom required optical components for each smartphone optosensros. These optical devices include spectrum readers, colorimetric readers for microplate, lateral flow device readers, and chemiluminescence readers. By integrating our unique designed optical components into smartphone optosening platform, the anlaytes can be precisely detected. Clinical testing results show the clinical usability of our smartphone optosensors. Ultra low-cost portable smartphone optosensors are affordable for rural/remote doctors.

Renewable Energy for Rural Health Clinics (Energia Removable para Centros de Salud Rurales)

Energy Technology Data Exchange (ETDEWEB)

Jimenez, A. C.; Olson, K.

1998-09-01

This guide provides a broad understanding of the technical, social, and organizational aspects of health clinic electrification, especially through the use of renewable energy sources. It is intended to be used primarily by decision makers within governments or private agencies to accurately assess their health clinic's needs, select appropriate and cost-effective technologies to meet those needs, and to put into place effective infrastructure to install and maintain the hardware. This is the first in a series of rural applications guidebooks that the National Renewable Energy Laboratory (NREL) Village Power Program is commissioning to couple commercial renewable systems with rural applications. The guidebooks are complemented by NREL's Village Power Program's development activities, international pilot projects, and visiting professionals program. For more information on the NREL Village Power Program, visit the Renewables for Sustainable Village Power web site at http://www.rsvp.nrel .gov/rsvp/.

Providing Cardiology Care in Rural Areas Through Visiting Consultant Clinics.

Science.gov (United States)

Gruca, Thomas S; Pyo, Tae-Hyung; Nelson, Gregory C

2016-06-30

Workforce experts predict a future shortage of cardiologists that is expected to impact rural areas more severely than urban areas. However, there is little research on how rural patients are currently served through clinical outreach. This study examines the impact of cardiology outreach in Iowa, a state with a large rural population, on participating cardiologists and on patient access. Outreach clinics are tracked annually in the Office of Statewide Clinical Education Programs Visiting Medical Consultant Database (University of Iowa Carver College of Medicine). Data from 2014 were analyzed. In 2014, an estimated 5460 visiting consultant clinic days were provided in 96 predominantly rural cities by 167 cardiologists from Iowa and adjoining states. Forty-five percent of Iowa cardiologists participated in rural outreach. Visiting cardiologists from Iowa and adjoining states drive an estimated 45 000 miles per month. Because of monthly outreach clinics, the average driving time to the nearest cardiologist falls from 42.2±20.0 to 14.7±11.0 minutes for rural Iowans. Cardiology outreach improves geographic access to office-based cardiology care for more than 1 million Iowans out of a total population of 3 million. Direct travel costs and opportunity costs associated with physician travel are estimated to be more than $2.1 million per year. Cardiologists in Iowa and adjoining states have expanded access to office-based cardiology care from 18 to 89 of the 99 counties in Iowa. In these 71 counties without a full-time cardiologist, visiting consultant clinics can accommodate more than 50% of office visits in the patients' home county. © 2016 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley Blackwell.

Sino/American cooperation for rural electrification in China

International Nuclear Information System (INIS)

Wallace, W.L.; Tsuo, Y.S.

1997-01-01

Rapid growth in economic development, coupled with the absence of an electric grid in large areas of the rural countryside, have created a need for new energy sources both in urban centers and rural areas in China. There is a very large need for new sources of energy for rural electrification in China as represented by 120 million people in remote regions who do not have access to an electric grid and by over 300 coastal islands in China that are unelectrified. In heavily populated regions in China where there is an electric grid, there are still severe shortages of electric power and limited access to the grid by village populations. In order to meet energy demands in rural China, renewable energy in the form of solar, wind, and biomass resources are being utilized as a cost effective alternative to grid extension and use of diesel and gasoline generators. An Energy Efficiency and Renewable Energy Protocol Agreement was signed by the U.S. Department of Energy with the Chinese State Science and Technology Commission in Beijing in February, 1995. Under this agreement, projects using photovoltaics for rural electrification are being conducted in Gansu Province in western China and Inner Mongolia in northern China, providing the basis for much wider deployment and use of photovoltaics for meeting the growing rural energy demands of China. copyright 1997 American Institute of Physics

Rural Residents’ Perception of Construction Project Delays in Pakistan

Directory of Open Access Journals (Sweden)

Shahid Hussain

2017-11-01

Full Text Available The construction industry is one of the key sectors that facilitate sustainable economic and social development in the region. Currently, community development mechanisms are adopted by many developed and developing nations, aimed at enhancing economic growth and quality of life along with social welfare of the local community. This study reviews the rural residents’ perception of public construction project delays and aims to explore economic and social challenges confronted by residents, especially in rural areas in Pakistan. A questionnaire with 26 factors identified from the literature was sent to rural educated residents. Through a questionnaire survey, the opinions of rural residents were sought and tested. Based on 366 (73% valid responses, this study examined the socio-economic influencing factors. The findings of the study revealed that problems faced while traveling, increase the price of consumer goods, high transportation costs, lack of educational opportunities, more expenditures on education, and barriers to primary healthcare access were the top most important factors. Research results confirmed that the delays in construction projects negatively affect the socio-economic conditions of the rural community, which directly influence the rural dwells’ sustainable life. The research findings suggest that the practitioners in public sector organization make sure to execute the project on time and within the quality. Otherwise, it has negative socio-economic implications for the rural community.

Students’ opinions on working in rural practice in Slovenia

Directory of Open Access Journals (Sweden)

Rok Petrovcic

2016-12-01

Full Text Available Background. All over the world, there is a lack of interest for specialty training in family medicine and for work in rural practice. Objectives . The objective of our study was to survey the opinion of medical students of the Maribor Medical Faculty, Slovenia, about rural medicine. Material and methods . This was a qualitative study. A semi-structured questionnaire with open-ended questions was used. In the period from December 2013 to February 2014, an electronic form was forwarded via e-mail to a stratified sample of 30 students of the Maribor Medical Faculty. Results. 21 students (70% participated. Students stated several conditions that would make them work in rural practice. Their accounts were summarized as organizational (e.g. work hours, number of patients, infrastructural (e.g. equipment, local (e.g. cost of living or personal (e.g. employment opportunities for their partner. Students associate rural practice with hard work, where physicians have to rely on their own abilities. Students see rural doctors as versatile personalities, knowledgeable, resourceful, optimistic, hard working and smart, but also as unambitious and elderly. Students connect rural practice with greater responsibility, diverse pathology, less availability of equipment and with less support for diagnostics. 15 (71% of the surveyed students want more emphasis placed on rural medicine in the undergraduate curriculum and electives. The reasons for accepting a rural scholarship would generally depend on the location for which it was offered and if it was tendered for the desired specialist training. Conclusions . Students should be presented with opportunities for personal and professional development in rural areas during undergraduate programs. Rural scholarship programs need to be strengthened.

Rural electrification in an imperfect world: A case study from Mozambique

International Nuclear Information System (INIS)

Mulder, Peter; Tembe, Jonas

2008-01-01

Electricity is universally recognized as a necessary, although not sufficient, requirement for social and economic development. However, increasing access to electricity in developing countries has proven to be difficult and expensive, particularly in rural areas. In this article, we analyze the dynamics of the relationship between electricity and socio-economic development by means of a cost-benefit analysis of a typical rural electrification project in Mozambique, assessing the impact of electricity on households, education, agro-business, commerce, and the public sector. We show that rural electrification can be commercially viable and cause structural transformation in rural areas within a short period of time. Finally, illustrated by the actual policy practice in Mozambique, we argue that low institutional quality is a key barrier to promote increased access to electricity for the poor

US Health Care Reform and Rural America: Results From the ACA's Medicaid Expansions.

Science.gov (United States)

Benitez, Joseph A; Seiber, Eric E

2018-03-01

Medicaid expansions, prompted by the Affordable Care Act, generated generally positive effects on coverage and alleviated much of the financial burden associated with seeking health care. We do not know if these shifts also extend to the nation's rural populations. Using 2011-2015 Behavioral Risk Factor Surveillance System data, this study compares trend changes for coverage, access to care, and health care utilization in response to Medicaid expansion among urban and rural residents using a difference-in-differences regression approach. Following Medicaid expansion, low-income rural and urban residents both experienced reductions in uninsurance; however, the coverage uptake in rural settings (8.5 percentage points [pp], P .10). In spite of larger uptakes in coverage among rural residents, reductions in cost-related barriers to medical care were slightly larger among urban residents, and access to a regular source of medical care (5.2 pp, P rural residents than urban residents; however, it appears there remain opportunities to improve access to care among potentially vulnerable rural residents. © 2017 National Rural Health Association.

Cost-effectiveness analysis of infant feeding strategies to prevent ...

African Journals Online (AJOL)

Changing feeding practices is beneficial, depending on context. Breastfeeding is dominant (less costly, more effective) in rural settings, whilst formula feeding is a dominant strategy in urban settings. Cost-effectiveness was most sensitive to proportion of women on lifelong antiretroviral therapy (ART) and infant mortality rate ...

47 CFR 54.316 - Rate comparability review and certification for areas served by non-rural carriers.

Science.gov (United States)

2010-10-01

... Rates, Price Indices, and Expenditures for Telephone Service published by the Wireline Competition... areas served by non-rural carriers. 54.316 Section 54.316 Telecommunication FEDERAL COMMUNICATIONS... High Cost Areas § 54.316 Rate comparability review and certification for areas served by non-rural...

A quantitative analysis of major determinants of rural-urban migration in Nigeria.

Science.gov (United States)

Anyanwu, S O

1992-11-01

"This paper discusses some major determinants of rural-urban migration in Nigeria using the logit estimation technique. It utilizes cross-sectional data generated from a national sample survey of internal migration conducted...between January and March 1988.... The empirical results revealed that the significant determinants of rural-urban migration in Nigeria are income, contact, cost, spoken English, ability to speak two Nigerian languages, distance, marital status, sex and ethnicity. The results further suggest that rural-urban migration is selective of single people and males. Proximity to urban areas where prospective migrants have relatives, friends and townspeople is an important factor." excerpt

Labour migration and rural transformation in Nigeria.

Science.gov (United States)

Onyeonoru, I P

1994-06-01

The trends in rural-urban migration in Nigeria responded to changes in political and socioeconomic developments which occurred during the 1980s. Since the 1980s, rural-urban migration trends were rapidly reversed, and migrants returned to rural areas. In 1981, government revenues from oil declined. The oil production and price declines between 1980 and 1986 resulted in a foreign exchange crisis. Import restrictions were imposed, and stabilization measures resulted in scarcities of raw materials and spare parts and declines in industrial capacity. About 50% of import substitution factories went bankrupt. Between 1981 and 1983, about one million workers were estimated to have been laid off, of which 55,000 were federal and state employees. Other estimates indicated one million laid off just in the industrial sector. The government reinforced this urban-rural movement by emphasizing increased food production. In 1992, government wages were increased in order to offset high inflation. In 1986 and 1992, State and Local Government Areas were established as political entities tied to grassroots development; local offices were situated in greater proximity to local populations. In 1986, the objective was to provide infrastructure, promote production, and organize rural areas for development. Several community banks devoted to rural areas were established. Development programs for rural women were initiated. Federal revenue allocations to rural areas increased from 10% to 15%. Inducements were given to attract private formal and informal commerce and industry. The result was less than expected. Obstacles to rural development included the absence of an effective and integrated approach, inadequate funding, and corruption. Provision of good roads and schools did meet objectives and may have induced out-migration. Delays in provision of entitlements exacerbated the ability of return migrants to establish new economic activity. The new political divisions did not conform to

Information needs of rural health professionals: a review of the literature.

Science.gov (United States)

Dorsch, J L

2000-10-01

This review analyzes the existing research on the information needs of rural health professionals and relates it to the broader information-needs literature to establish whether the information needs of rural health professionals differ from those of other health professionals. The analysis of these studies indicates that rural health practitioners appear to have the same basic needs for patient-care information as their urban counterparts, and that both groups rely on colleagues and personal libraries as their main sources of information. Rural practitioners, however, tend to make less use of journals and online databases and ask fewer clinical questions; a difference that correlates with geographic and demographic factors. Rural practitioners experience pronounced barriers to information access including lack of time, isolation, inadequate library access, lack of equipment, lack of skills, costs, and inadequate Internet infrastructure. Outreach efforts to this group of underserved health professionals must be sustained to achieve equity in information access and to change information-seeking behaviors.

We cannot staff for 'what ifs': the social organization of rural nurses' safeguarding work.

Science.gov (United States)

MacKinnon, Karen

2012-09-01

Rural nurses play an important role in the provision of maternity care for Canadian women. This care is an important part of how rural nurses safeguard the patients who receive care in small rural hospitals. This study utilized institutional ethnography as an approach for describing rural nursing work and for exploring how nurses' work experiences are socially organized. Rural nurses advocated for safe healthcare environments by ensuring that skilled nurses were available for every shift, day and night, at their local hospital. Rural nurses noted that this work was particularly difficult for the provision of maternity care. This article explores two threads or cues to institutional organization that were identified in our interviews and observations; namely staffing and safety standards, and the need for flexibility in staffing in small rural hospitals. Rural nurses' concerns about ensuring that skilled nurses are available in small rural hospitals do not enter into current management discourses that focus on efficiency and cost savings or find a home within current discourses of patient safety 'competencies'. © 2011 Blackwell Publishing Ltd.

Restraining Factors and Improving Paths for the Operation Mechanism of New Rural Cooperative Medical System in China

Institute of Scientific and Technical Information of China (English)

2011-01-01

The new rural cooperative medical system has achieved periodical achievements since its establishment.Nevertheless,there are many factors hampering the development of the new system,such as the high cost,the difficulties in fund procurement,the lack of management,the narrow coverage of benefit,the ineffective constraint to the designated medical institutions,the high fund balance rate,and the poor medical facilities and services in rural areas.Countermeasures are put forward to solve these problems,including improving the system design,expanding the coverage of the system,expanding the fund sources,reducing the financing costs,strengthening the fund supervision,enhancing the supervision of designated medical institutions,and improving the capacity of health services in rural areas.

Evaluation of a low-cost liquid-based Pap test in rural El Salvador: a split-sample study.

Science.gov (United States)

Guo, Jin; Cremer, Miriam; Maza, Mauricio; Alfaro, Karla; Felix, Juan C

2014-04-01

We sought to test the diagnostic efficacy of a low-cost, liquid-based cervical cytology that could be implemented in low-resource settings. A prospective, split-sample Pap study was performed in 595 women attending a cervical cancer screening clinic in rural El Salvador. Collected cervical samples were used to make a conventional Pap (cell sample directly to glass slide), whereas residual material was used to make the liquid-based sample using the ClearPrep method. Selected samples were tested from the residual sample of the liquid-based collection for the presence of high-risk Human papillomaviruses. Of 595 patients, 570 were interpreted with the same diagnosis between the 2 methods (95.8% agreement). There were comparable numbers of unsatisfactory cases; however, ClearPrep significantly increased detection of low-grade squamous intraepithelial lesions and decreased the diagnoses of atypical squamous cells of undetermined significance. ClearPrep identified an equivalent number of high-grade squamous intraepithelial lesion cases as the conventional Pap. High-risk human papillomavirus was identified in all cases of high-grade squamous intraepithelial lesion, adenocarcinoma in situ, and cancer as well as in 78% of low-grade squamous intraepithelial lesions out of the residual fluid of the ClearPrep vials. The low-cost ClearPrep Pap test demonstrated equivalent detection of squamous intraepithelial lesions when compared with the conventional Pap smear and demonstrated the potential for ancillary molecular testing. The test seems a viable option for implementation in low-resource settings.

Routine implementation costs of larviciding with Bacillus thuringiensis israelensis against malaria vectors in a district in rural Burkina Faso.

Science.gov (United States)

Dambach, Peter; Schleicher, Michael; Stahl, Hans-Christian; Traoré, Issouf; Becker, Norbert; Kaiser, Achim; Sié, Ali; Sauerborn, Rainer

2016-07-22

The key tools in malaria control are early diagnosis and treatment of cases as well as vector control. Current strategies for malaria vector control in sub-Saharan Africa are largely based on long-lasting insecticide-treated nets (LLINs) and to a much smaller extent on indoor residual spraying (IRS). An additional tool in the fight against malaria vectors, larval source management (LSM), has not been used in sub-Saharan Africa on a wider scale since the abandonment of environmental spraying of DDT. Increasing concerns about limitations of LLINs and IRS and encouraging results from large larvicide-based LSM trials make a strong case for using biological larviciding as a complementary tool to existing control measures. Arguments that are often quoted against such a combined approach are the alleged high implementation costs of LSM. This study makes the first step to test this argument. The implementation costs of larval source management based on Bacillus thuringiensis israelensis (Bti) (strain AM65-52) spraying under different implementation scenarios were analysed in a rural health district in Burkina Faso. The analysis draws on detailed cost data gathered during a large-scale LSM intervention between 2013 and 2015. All 127 villages in the study setup were assigned to two treatment arms and one control group. Treatment either implied exhaustive spraying of all available water collections or targeted spraying of the 50 % most productive larval sources via remote-sensing derived and entomologically validated risk maps. Based on the cost reports from both intervention arms, the per capita programme costs were calculated under the assumption of covering the whole district with either intervention scenario. Cost calculations have been generalized by providing an adaptable cost formula. In addition, this study assesses the sensitivity of per capita programme costs with respect to changes in the underlying cost components. The average annual per capita costs of

Renewable Energy for Rural Health Clinics (Energia Removable para Centros de Salud Rurales); TOPICAL

International Nuclear Information System (INIS)

Jimenez, A. C.; Olson, K.

1998-01-01

This guide provides a broad understanding of the technical, social, and organizational aspects of health clinic electrification, especially through the use of renewable energy sources. It is intended to be used primarily by decision makers within governments or private agencies to accurately assess their health clinic's needs, select appropriate and cost-effective technologies to meet those needs, and to put into place effective infrastructure to install and maintain the hardware. This is the first in a series of rural applications guidebooks that the National Renewable Energy Laboratory (NREL) Village Power Program is commissioning to couple commercial renewable systems with rural applications. The guidebooks are complemented by NREL's Village Power Program's development activities, international pilot projects, and visiting professionals program. For more information on the NREL Village Power Program, visit the Renewables for Sustainable Village Power web site at http://www.rsvp.nrel .gov/rsvp/

Recruiting and retaining high-quality teachers in rural areas.

Science.gov (United States)

Monk, David H

2007-01-01

In examining recruitment and retention of teachers in rural areas, David Monk begins by noting the numerous possible characteristics of rural communities--small size, sparse settlement, distance from population concentrations, and an economic reliance on agricultural industries that are increasingly using seasonal and immigrant workers to minimize labor costs. Many, though not all, rural areas, he says, are seriously impoverished. Classes in rural schools are relatively small, and teachers tend to report satisfaction with their work environments and relatively few problems with discipline. But teacher turnover is often high, and hiring can be difficult. Monk observes that rural schools have a below-average share of highly trained teachers. Compensation in rural schools tends to be low, perhaps because of a lower fiscal capacity in rural areas, thus complicating efforts to attract and retain teachers. Several student characteristics, including relatively large shares of students with special needs and with limited English skills and lower shares of students attending college, can also make it difficult to recruit and retain high-quality teachers. Other challenges include meeting the needs of highly mobile children of low-income migrant farm workers. With respect to public policy, Monk asserts a need to focus on a subcategory of what might be called hard-to-staff rural schools rather than to develop a blanket set of policies for all rural schools. In particular, he recommends a focus on such indicators as low teacher qualifications, teaching in fields far removed from the area of training, difficulty in hiring, high turnover, a lack of diversity among teachers in the school, and the presence of migrant farm workers' children. Successful efforts to stimulate economic growth in these areas would be highly beneficial. He also calls attention to the potential for modern telecommunication and computing technologies to offset some of the drawbacks associated with teaching

FAR from the grid: A rural electrification field study

Energy Technology Data Exchange (ETDEWEB)

Diaz, P.; Pena, R. [Escuela Politecnica, Universidad de Alcala, Campus Universitario, 28805 Alcala de Henares, Madrid (Spain); Arias, C.A.; Sandoval, D. [Empresa Jujena de Servicios Energeticos Dispersos (EJSEDSA), Independencia 60, 4600 San Salvador de Jujuy, Jujuy (Argentina)

2010-12-15

This paper analyses the field performance of different off-grid generation technologies applied to the electrification of rural villages. Autonomous diesel generators are the most extended technology. It is a well known application, although it has also some disadvantages: fuel transportation and consumption costs, maintenance needs or environmental problems. In places where accessibility is difficult and costly, the use of local energy resources (basically renewable) constitutes a significant advantage. Due to the intermittent character of those resources, renewable generation systems are sometimes associated to diesel gen-sets in order to increase the reliability of supply of small and medium-size communities. A comparative analysis between diesel, hydro-diesel and photovoltaic-diesel technologies is presented in this article. It is based on data collected from systems installed in the rural area of the province of Jujuy, northwest of Argentina. The study covers from year 2001 to 2008, with a research universe of 16 locations supplied by thermal diesel generation (1 with a large-diesel system and other 15 with smaller ones), 5 locations with hydro-diesel and 7 with photovoltaic-diesel systems. The energy demand evolution of rural villages is also studied because of its influence on the system operation and sustainability. (author)

The Association between Natural Amenities, Rural Population Growth, and Long-Term Residents' Economic Well-Being

Science.gov (United States)

Hunter, Lori M; Boardman, Jason D.; Saint Onge, Jarron M.

2005-01-01

Population growth in rural areas characterized by high levels of natural amenities has recently received substantial research attention. A noted concern with amenity-driven rural population growth is its potential to raise local costs-of-living while yielding only low-wage service sector employment for long-term residents. The work presented here…

Energy and GHG Analysis of Rural Household Biogas Systems in China

Directory of Open Access Journals (Sweden)

Lixiao Zhang

2014-02-01

Full Text Available The Chinese government has taken great efforts to popularize rural household scale biogas digesters, since they are regarded as an effective approach to address energy shortage issues in rural areas and as a potential way of reducing greenhouse gas (GHG emissions. Focusing on a typical rural household biogas system, the aim of this study is to systematically quantify its total direct and indirect energy, concentrating on non-renewable energy and the associated GHG emission cost over the entire life cycle to understand its net dynamic benefits. The results show that the total energetic cost for biogas output is 2.19 J/J, of which 0.56 J is from non-renewable energy sources and the GHG emission cost is 4.54 × 10−5 g CO2-equivalent (CO2-eq, with respect to its design life cycle of 20 years. Correspondingly, a net non-renewable energy saving of 9.89 × 1010 J and GHG emission reduction of 50.45 t CO2-eq can be obtained considering the coal substitution and manure disposal. However, it must be run for at least 10 and 3 years, to obtain positive net non-renewable energy savings and GHG emission reduction benefits, respectively. These results have policy implications for development orientation, follow-up services, program management and even national financial subsidy methods.

Trends in Rural Water Supply: Towards a Service Delivery Approach

Directory of Open Access Journals (Sweden)

Patrick Moriarty

2013-10-01

The papers in this special issue argue that tackling these challenges requires a shift in emphasis in rural water supply in developing countries: away from a de-facto focus on the provision of hardware for first-time access towards the proper use of installed hardware as the basis for universal access to rural water services. The outline of the main actions required to achieve this shift are becoming clearer. Chief amongst these are the professionalisation of community management and/or provision of direct support to community service providers; adoption of a wider range of service delivery models than community management alone; and addressing the sustainable financing of all costs with a particular focus on financing capital maintenance (asset management and direct support costs. This introductory paper provides an overview of these issues and a guide to the other articles, which demonstrate these points.

Considerations for decision-making on distributed power generation in rural areas

International Nuclear Information System (INIS)

Holtmeyer, Melissa L.; Wang, Shuxiao; Axelbaum, Richard L.

2013-01-01

Energy resources for rural electrification are variable and widely dispersed, such that a solution for one region might not be appropriate for another. This study evaluates the feasibility of renewable energy technologies, centralized grid extension and local coal-fired power for rural areas that currently do not have sufficient access to electricity. The renewable power generation options considered are solar photovoltaic and wind power, with battery storage or fossil fuel generator backup. New local coal-fired power, as well as extension of the grid from an existing centralized power system, are considered to compare the impacts of scale and traditional approaches to power generation. A case study for a rural area in Northwestern China demonstrates the complexity of energy decision-making when faced with low peak demands and non-ideal renewable resource availability. Economic factors, including cost of electricity generation, breakeven grid extension distance, capacity shortage fraction (the ratio of the annual capacity shortage to the annual electric load) and land use are evaluated. - Highlights: • Considerations include technical and non-technical factors for energy decisions. • Coal and renewable power are compared based on cost and availability of resources. • Key factors for renewable power generation are capacity shortage and availability of resources. • Rural China case study evaluates the viability of distributed wind or solar power relative to coal

Response to health insurance by previously uninsured rural children.

Science.gov (United States)

Tilford, J M; Robbins, J M; Shema, S J; Farmer, F L

1999-08-01

To examine the healthcare utilization and costs of previously uninsured rural children. Four years of claims data from a school-based health insurance program located in the Mississippi Delta. All children who were not Medicaid-eligible or were uninsured, were eligible for limited benefits under the program. The 1987 National Medical Expenditure Survey (NMES) was used to compare utilization of services. The study represents a natural experiment in the provision of insurance benefits to a previously uninsured population. Premiums for the claims cost were set with little or no information on expected use of services. Claims from the insurer were used to form a panel data set. Mixed model logistic and linear regressions were estimated to determine the response to insurance for several categories of health services. The use of services increased over time and approached the level of utilization in the NMES. Conditional medical expenditures also increased over time. Actuarial estimates of claims cost greatly exceeded actual claims cost. The provision of a limited medical, dental, and optical benefit package cost approximately $20-$24 per member per month in claims paid. An important uncertainty in providing health insurance to previously uninsured populations is whether a pent-up demand exists for health services. Evidence of a pent-up demand for medical services was not supported in this study of rural school-age children. States considering partnerships with private insurers to implement the State Children's Health Insurance Program could lower premium costs by assembling basic data on previously uninsured children.

Constructing low emitting power systems through grid extension in Papua New Guinea (PNG) with rural electrification

Energy Technology Data Exchange (ETDEWEB)

Nagai, Y. [Institute of Industrial Science, The University of Tokyo, Ogimoto Lab. 4-6-1 Komaba, Meguro-ku, Tokyo 153-8505 (Japan); Yamamoto, H. [Department of Advanced Energy, The University of Tokyo, 5-4-5 Kashiwanoha, Kashiwa-shi, Chiba-ken 277-8561 (Japan); Yamaji, K. [Department of Electrical Engineering and Information Systems, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8656 (Japan)

2010-05-15

The effective rural electrification method varies with economic status and geographical location, and the benefits of decentralized generation differ for each energy system depending on its characteristics. This paper evaluates the most effective generation strategies with rural electrification in an optimized power system of Papua New Guinea (PNG) using a linear programming model. The energy system model developed for the study includes decentralized generation, centralized generation, and grid systems of electricity and gas with consideration for the current energy system and infrastructure. Two methods of rural electrification, decentralized generation and grid extension, are compared with and without the Clean Development Mechanism (CDM). The results of simulations show that extending the power grid that allows economical generation such as coal-fired power and hydropower to supply rural electricity is a more cost effective way for rural electrification. Although grid extension is more capital intensive than decentralized generation, the former reduces the total system cost through reduction of the fossil fuel use. Extending the power grid is also effective at attracting CDM investments, since it makes the power system flexible and provides opportunities to advance low emitting energy such as hydropower. (author)

Out-of-pocket costs and other determinants of access to healthcare for children with febrile illnesses: a case-control study in rural Tanzania.

Directory of Open Access Journals (Sweden)

Joëlle Castellani

Full Text Available To study private costs and other determinants of access to healthcare for childhood fevers in rural Tanzania.A case-control study was conducted in Tanzania to establish factors that determine access to a health facility in acute febrile illnesses in children less than 5 years of age. Carers of eligible children were interviewed in the community; cases were represented by patients who went to a facility and controls by those who did not. A Household Wealth Index was estimated using principal components analysis. A multivariable logistic regression analysis was performed to understand the factors which influenced attendance of healthcare facility including severity of the illness and household wealth/socio-demographic indicators. To complement the data on costs from community interviews, a hospital-based study obtained details of private expenditures for hospitalised children under the age of 5.Severe febrile illness is strongly associated with health facility attendance (OR: 35.76, 95%CI: 3.68-347.43, p = 0.002 compared with less severe febrile illness. Overall, the private costs of an illness for patients who went to a hospital were six times larger than private costs of controls ($5.68 vs. $0.90, p<0.0001. Household wealth was not significantly correlated with total costs incurred. The separate hospital based cost study indicated that private costs were three times greater for admissions at the mission versus public hospital: $13.68 mission vs. $4.47 public hospital (difference $ 9.21 (95% CI: 7.89 -10.52, p<0.0001. In both locations, approximately 50% of the cost was determined by the duration of admission, with each day in hospital increasing private costs by about 12% (95% CI: 5% - 21%.The more severely ill a child, the higher the probability of attending hospital. We did not find association between household wealth and attending a health facility; nor was there an association between household wealth and private cost.

Multifunctional centers in rural areas

DEFF Research Database (Denmark)

Svendsen, Gunnar Lind Haase

2009-01-01

abandoned. One outcome has been closings of schools in remote rural areas. This evidently contributes to exacerbate depopulation in these areas. To stop this tendency, we need new models for high-quality, cost effective public services in rural areas as those as we find in Denmark. This chapter introduces...... ideological roots in history pointing at 19th c. national civic movements and an early 20th c. transnational Garden City movement within urban planning as crucial. Drawing on contemporary case studies of multifunctional centers in Holland and Denmark, I then suggest that public and private donors should...... invest in multifunctional centers in which the local public school is the dynamo. This in order to increase local levels of social as well as human capital. Ideally, such centers should contain both public services such as school, library and health care, private enterprises as hairdressers and banks...

The rural energy alternatives project

International Nuclear Information System (INIS)

Hoffstatter, L.; Panetti, C.; DeWein, M.

1993-01-01

A cooperative survey by the New York State Energy Office (SEO) and Office of Rural Affairs (ORA) identified hundreds of residences without utility electric power due to excessive line extension costs. SEO selected several of these residences for feasibility studies which compared site specific options for electricity generation, including existing fossil fuel generator(s), generator/battery sets, photovoltaic (PV) hybrid and micro-hydroelectric systems as well as utility provided electric service. Comprehensive reports included examination of a range of energy conservation measures. Alternatives to present fossil fuel systems were assessed for domestic hot water, refrigeration, and water pumping. Results included electric load data, solar and hydroelectric potential, life cycle cost estimates for electricity, and estimated system sizing information based on energy cost considerations. In addition to providing useful information to individual homeowners, these studies served as the basis for cooperative efforts to install and monitor stand-alone prototype PV hybrid systems

Managerial Strategies for the Conservation of Rurality in Rural Tourism

Directory of Open Access Journals (Sweden)

Cornelia Petroman

2010-10-01

Full Text Available If we admit that rurality designates small densities, open areas, small settlements below 1,000 inhabitants, and land reserved mainly to agricultural and forestry practices, and as natural area, if we admit that society tends to be traditional and that government al policies tend to conserve rather than to make rapid or radical changes, then we should admit that rural tourism should be an activity generating new incomes in the area. Rurality also means preserving a continuum in the approach of different types of areas with different characteristics, a concept that can also be of use in the identification of activities specific to rural tourism. Be they activities specific to the rural environment or activities common to the rural area, they need to aim at the conservation of rurality as a main tourism resource. Managerial strategies in rural tourism contribute effectively to rural development, provided they are sustainable and that rural tourism be not the only solution for rural development.

Rural electric energy services in China: Implementing the renewable energy challenge

Energy Technology Data Exchange (ETDEWEB)

Weingart, J.W.

1996-12-31

This paper discusses issues related to rural electrification in China, with emphasis on a pilot project in Mongolia to implement small scale renewable energy sources. These projects consist of photovoltaic systems, wind electric systems, photovoltaic/wind hybrid systems, and wind/gasoline generator sets. These systems are small enough to implement in rural environments, more cost effective than grid type systems, and have lower cost than standard generator sets alone because of the improved reliability. The author also discusses the use of such systems for village power sources. A number of factors are contributing to the increase in such systems. Individuals are able and willing to pay for such systems, lending institutions are willing to fund such small-scale projects, they provide reliable, high quality services which support social and economic development.

Rural migration: what attracts new residents to non-metropolitan areas.

Science.gov (United States)

Maynard, L J; Kelsey, T W; Thee, R J; Fousekis, P

1997-01-01

"This study uses the experience of three non-metropolitan counties in Pennsylvania to explore which community characteristics have the greatest influence on people's decisions to move to rural areas. Personal characteristics affected how in-migrants evaluated prospective rural residential locations. Higher income in-migrants placed a high priority on job opportunities, housing quality, a short commute to work, quality of schools, and low local taxes. Lower income in-migrants were more likely to value a location near family and friends. Ability to own a home, housing costs, and local taxes were also important." excerpt

The economics of renewable energy expansion in rural Sub-Saharan Africa

International Nuclear Information System (INIS)

Deichmann, Uwe; Meisner, Craig; Murray, Siobhan; Wheeler, David

2011-01-01

Accelerating development in Sub-Saharan Africa will require massive expansion of access to electricity-currently reaching only about one third of households. This paper explores how essential economic development might be reconciled with the need to keep carbon emissions in check. We develop a geographically explicit framework and use spatial modeling and cost estimates from recent engineering studies to determine where stand-alone renewable energy generation is a cost effective alternative to centralized grid supply. Our results suggest that decentralized renewable energy will likely play an important role in expanding rural energy access. However, it will be the lowest cost option for a minority of households in Africa, even when likely cost reductions over the next 20 years are considered. Decentralized renewables are competitive mostly in remote and rural areas, while grid connected supply dominates denser areas where the majority of households reside. These findings underscore the need to decarbonize the fuel mix for centralized power generation as it expands in Africa. - Research highlights: → Expansion of electricity access in Sub-Saharan Africa remains a development priority. → Low carbon options are important to reduce GHG emissions growth and avoid lock-ins. → Spatially explicit cost modeling guides choice of supply options. → Decentralized renewables are lowest cost for a significant minority of households. → Grid supply remains attractive, suggesting focus on decarbonizing centralized supply.

An Analysis of Benefit and Cost of Local Chicken Production By the ...

African Journals Online (AJOL)

Newcastle disease (ND) has high seroprevalence rate and inflicts heavy economic losses on poultry as often the case in rural poultry production. This study examined the socialeconomic characteristics of the respondents and the benefit/ cost analysis of rural chicken farmers in two local council areas of Kogi State of igeria ...

Prevalence of and Differences in Salad Bar Implementation in Rural Versus Urban Arizona Schools.

Science.gov (United States)

Blumenschine, Michelle; Adams, Marc; Bruening, Meg

2018-03-01

Rural children consume more calories per day on average than urban children, and they are less likely to consume fruit. Self-service salad bars have been proposed as an effective approach to better meet the National School Lunch Program's fruit and vegetable recommendations. No studies have examined how rural and urban schools differ in the implementation of school salad bars. To compare the prevalence of school-lunch salad bars and differences in implementation between urban and rural Arizona schools. Secondary analysis of a cross-sectional web-based survey. School nutrition managers (N=596) in the state of Arizona. National Center for Education Statistics locale codes defined rural and urban classifications. Barriers to salad bar implementation were examined among schools that have never had, once had, and currently have a school salad bar. Promotional practices were examined among schools that once had and currently have a school salad bar. Generalized estimating equation models were used to compare urban and rural differences in presence and implementation of salad bars, adjusting for school-level demographics and the clustering of schools within districts. After adjustment, the prevalence of salad bars did not differ between urban and rural schools (46.9%±4.3% vs 46.8%±8.5%, respectively). Rural schools without salad bars more often reported perceived food waste and cost of produce as barriers to implementing salad bars, and funding was a necessary resource for offering a salad bar in the future, as compared with urban schools (Pbar promotion, challenges, or resources among schools that currently have or once had a salad bar. After adjustment, salad bar prevalence, implementation practices, and concerns are similar across geographic settings. Future research is needed to investigate methods to address cost and food waste concerns in rural areas. Copyright © 2018 Academy of Nutrition and Dietetics. Published by Elsevier Inc. All rights reserved.

A task shifting approach to primary mental health care for adults in South Africa: human resource requirements and costs for rural settings.

Science.gov (United States)

Petersen, Inge; Lund, Crick; Bhana, Arvin; Flisher, Alan J

2012-01-01

BACKGROUND A recent situational analysis suggests that post-apartheid South Africa has made some gains with respect to the decentralization and integration of mental health into primary health care. However, service gaps within and between provinces remain, with rural areas particularly underserved. Aim This study aims to calculate and cost a hypothetical human resource mix required to populate a framework for district adult mental health services. This framework embraces the concept of task shifting, where dedicated low cost mental health workers at the community and clinic levels supplement integrated care. METHOD The expected number and cost of human resources was based on: (a) assumptions of service provision derived from existing services in a sub-district demonstration site and a literature review of evidence-based packages of care in low- and middle-income countries; and (b) assumptions of service needs derived from other studies. RESULTS For a nominal population of 100 000, minimal service coverage estimates of 50% for schizophrenia, bipolar affective disorder, major depressive disorder and 30% for post-traumatic stress disorder and maternal depression would require that the primary health care staffing package include one post for a mental health counsellor or equivalent and 7.2 community mental health worker posts. The cost of these personnel amounts to £28 457 per 100 000 population. This cost can be offset by a reduction in the number of other specialist and non-specialist health personnel required to close service gaps at primary care level. CONCLUSION The adoption of the concept of task shifting can substantially reduce the expected number of health care providers otherwise needed to close mental health service gaps at primary health care level in South Africa at minimal cost and may serve as a model for other middle-income countries.

Development of an electronic converter with maximum power point tracking for photovoltaic systems applied to rural electrification; Desenvolvimento de conversor eletronico para maxima transferencia de potencia em sistemas fotovoltaicos aplicados a eletrificacao rural

Energy Technology Data Exchange (ETDEWEB)

Machado Neto, Lauro de Vilhena Brandao [Pontificia Universidade Catolica de Minas Gerais (PUC-Minas), Belo Horizonte, MG (Brazil); Cabral, Claudia Valeria Tavora; Oliveira Filho, Delly [Universidade Federal de Vicosa (UFV), MG (Brazil); Diniz, Antonia Sonia Alves Cardoso [Companhia Energetica de Minas Gerais (CEMIG), Belo Horizonte, MG (Brazil); Cortizo, Porfirio Cabaleiro [Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, MG (Brazil)

2004-07-01

The maximization of the efficiency in the electric energy conversion is essential to the developing of technical and economic viability of photovoltaic solar energy systems. This paper presents the development of an electronic converter with maximum power point tracking for photovoltaic systems applied to rural electrification. The standalone photovoltaic system used is similar to the systems installed by Companhia Energetica de Minas Gerais - CEMIG in the schools of isolated communities, inside the Solar Light Program. Initially were developed test procedures of the equipment used in the system like photovoltaic generators, electronic ballasts, inverters, charge controllers and batteries, covering minimum performance requirements and in compliance with national and international standards, as possible, due to the instrumentation availability. A data acquisition system was assembled to monitoring the photovoltaic system. A simulation of the system was implemented and the aims were to optimize the project and carry out a comparative study with the monitoring results. The converter with maximum power point tracking consists of a direct current converter in the buck configuration and the control algorithm was implemented in a micro controller, being the first results presented here. After finished the prototype, it will be incorporated in the photovoltaic system and will be accomplished a study of the technical and economic viability. The first results of the tests, of the monitoring and of the converter with maximum power point tracking are helping the sustainability of the systems installed by CEMIG, funding the government initiatives in the quality control of equipment and promoting the development of national technology. (author)

Creation of a mobile rural workforce following undergraduate longitudinal rural immersion.

Science.gov (United States)

Playford, Denese E; Ng, Wen Qi; Burkitt, Tessa

2016-05-01

This study followed the workforce choices of 10-years of graduates from a longitudinal rural immersion programme, which involved living for one academic year in a rural location as a medical student. The Rural Clinical School of Western Australia is a whole-of-state Rural Clinical School partnership involving two medical schools and fourteen rural/remote towns. For this longitudinal cohort study, all consenting graduates were contacted annually after graduation, with the outcome measure being rural work location (defined by the Australian Standard Geographical Classification -Remoteness Area) of any duration. There were 417 consenting graduates. Between 16 and 50% of contacted alumni worked rurally for a period of each post-graduate year. Aggregated over time, the majority took up to 30% of their postgraduate training rurally. There was considerable movement in and out of rural work. About 17% of contacted and practicing graduates were working full time rurally at the 2013 contact point. The majority remained in their state of training. The majority identified with GP and other rural-related colleges, and College-affiliation predicted amount of rural training time. Entry into rural work was equivalent for urban-origin and rural origin alumni, suggesting one year of RCS is sufficient to convert commitment to rural work. Undergraduate rural immersion is sufficient to create a graduate rural workforce that is far more mobile that was previously appreciated.

The cost of antiretroviral therapy in Haiti

Directory of Open Access Journals (Sweden)

Fitzgerald Daniel W

2008-02-01

Full Text Available Abstract Background We determined direct medical costs, overhead costs, societal costs, and personnel requirements for the provision of antiretroviral therapy (ART to patients with AIDS in Haiti. Methods We examined data from 218 treatment-naïve adults who were consecutively initiated on ART at the GHESKIO Center in Port-au-Prince, Haiti between December 23, 2003 and May 20, 2004 and calculated costs and personnel requirements for the first year of ART. Results The mean total cost of treatment per patient was $US 982 including $US 846 in direct costs, $US 114 for overhead, and $US 22 for societal costs. The direct cost per patient included generic ART medications $US 355, lab tests $US 130, nutrition $US 117, hospitalizations $US 62, pre-ART evaluation $US 58, labor $US 51, non-ART medications $US 39, outside referrals $US 31, and telephone cards for patient retention $US 3. Higher treatment costs were associated with hospitalization, change in ART regimen, TB treatment, and survival for one year. We estimate that 1.5 doctors and 2.5 nurses are required to treat 1000 patients in the first year after initiating ART. Conclusion Initial ART treatment in Haiti costs approximately $US 1,000 per patient per year. With generic first-line antiretroviral drugs, only 36% of the cost is for medications. Patients who change regimens are significantly more expensive to treat, highlighting the need for less-expensive second-line drugs. There may be sufficient health care personnel to treat all HIV-infected patients in urban areas of Haiti, but not in rural areas. New models of HIV care are needed for rural areas using assistant medical officers and community health workers.

Assessment and evaluation of PV based decentralized rural electrification: An overview

International Nuclear Information System (INIS)

Chaurey, Akanksha; Kandpal, Tara Chandra

2010-01-01

The challenges of providing electricity to rural households are manifold. Ever increasing demand-supply gap, crumbling electricity transmission and distribution infrastructure, high cost of delivered electricity are a few of these. Use of renewable energy technologies for meeting basic energy needs of rural communities has been promoted by the Governments world over for many decades. Photovoltaic (PV) technology is one of the first among several renewable energy technologies that was adopted globally as well as in India for meeting basic electricity needs of rural areas that are not connected to the grid. This paper attempts at reviewing and analyzing PV literature pertaining to decentralized rural electrification into two main categories - (1) experiences from rural electrification and technology demonstration programmes covering barriers and challenges in marketing and dissemination; institutional and financing approaches; and productive and economic applications, (2) techno-economic aspects including system design methodologies and approaches; performance evaluation and monitoring; techno-economic comparison of various systems; and environmental implications and life cycle analysis. The paper discusses the emerging trends in its concluding remarks. (author)

The impact of geography on energy infrastructure costs

International Nuclear Information System (INIS)

Zvoleff, Alex; Kocaman, Ayse Selin; Huh, Woonghee Tim; Modi, Vijay

2009-01-01

Infrastructure planning for networked infrastructure such as grid electrification (or piped supply of water) has historically been a process of outward network expansion, either by utilities in response to immediate economic opportunity, or in response to a government mandate or subsidy intended to catalyze economic growth. While significant progress has been made in access to grid electricity in Asia, where population densities are greater and rural areas tend to have nucleated settlements, access to grid electricity in Sub-Saharan Africa remains low; a problem generally ascribed to differences in settlement patterns. The discussion, however, has remained qualitative, and hence it has been difficult for planners to understand the differing costs of carrying out grid expansion in one region as opposed to another. This paper describes a methodology to estimate the cost of local-level distribution systems for a least-cost network, and to compute additional information of interest to policymakers, such as the marginal cost of connecting additional households to a grid as a function of the penetration rate. We present several large datasets of household locations developed from satellite imagery, and examine them with our methodology, providing insight into the relationship between settlement pattern and the cost of rural electrification.

Affordability of comprehensive community health worker programmes in rural sub-Saharan Africa.

Science.gov (United States)

Taylor, Celia; Griffiths, Frances; Lilford, Richard

2017-01-01

Community health worker (CHW) programmes have low costs per person served and are central to achieving universal healthcare. However, their total cost is high and the target of one million CHWs for sub-Saharan Africa by 2015 was not met. We consider the affordability of rural CHW programmes by estimating total programme costs relative to national healthcare expenditure at different CHW salaries and resources available for healthcare. We combine an existing source of rural CHW programme costs with World Bank data to estimate relative CHW programme costs in 37 countries. We consider three 'salaries' (CHWs as volunteers, paid the local equivalent of US$80 per month and paid the national minimum wage) and four potential healthcare budgets (both actual and Abuja declaration allocations alone and increased by external funding received and potential foreign aid, respectively). Costs are shown in 2012 nominal US$. With CHWs paid the local equivalent of US$80 per month and financed from existing central government healthcare budgets, the median relative cost of a CHW programme would be 27% of the healthcare budget. While less than 2.5% in five countries (Botswana, Equatorial Guinea, Gabon, Namibia and South Africa), this relative cost would exceed 100% in three (Chad, Eritrea and Niger). There is a strong negative linear relationship (R 2 =0.83, psub-Saharan Africa. In many countries, such programmes are not yet affordable unless significant foreign aid is received.

Distance, accessibility and costs. Decision-making during childbirth in rural Sierra Leone: A qualitative study.

Directory of Open Access Journals (Sweden)

Laura Treacy

Full Text Available Sierra Leone has one of the highest maternal mortality ratios in the world. Efforts to reduce maternal mortality have included initiatives to encourage more women to deliver at health facilities. Despite the introduction of the free health care initiative for pregnant women, many women still continue to deliver at home, with few having access to a skilled birth attendant. In addition, inequalities between rural and urban areas in accessing and utilising health facilities persist. Further insight into how and why women make decisions around childbirth will help guide future plans and initiatives in improving maternal health in Sierra Leone. The objective of this study was to explore the perceptions and decision-making processes of women and their communities during childbirth in rural Sierra Leone.Data were collected through seven focus group discussions and 22 in-depth interviews with recently pregnant women and their community members in two rural villages. Data were analysed using systematic text condensation. Findings revealed that decision-making processes during childbirth are dynamic, intricate and need to be understood within the broader social context that they take place. Factors such as distance and lack of transport, perceived negative behaviour of hospital staff, direct and indirect financial obstacles, as well as the position of women in society all interact and influence how and what decisions are made.Pregnant women face multiple interacting vulnerabilities that influence their healthcare-seeking decisions during pregnancy and childbirth. Future initiatives to improve access and utilisation of safe healthcare services for pregnant women need to be based on adequate knowledge of structural constraints and health inequities that affect women in rural Sierra Leone.

Why do households invest in sanitation in rural Benin: Health, wealth, or prestige?

Science.gov (United States)

Gross, Elena; Günther, Isabel

2014-10-01

Seventy percent of the rural population in sub-Saharan Africa does not use adequate sanitation facilities. In rural Benin, as much as 95% of the population does not use improved sanitation. By analyzing a representative sample of 2000 rural households, this paper explores why households remain without latrines. Our results show that wealth and latrine prices play the most decisive role for sanitation demand and ownership. At current income levels, sanitation coverage will only increase to 50% if costs for construction are reduced from currently 190 USD to 50 USD per latrine. Our analysis also suggests that previous sanitation campaigns, which were based on prestige and the allure of a modern lifestyle as motives for latrine construction, have had no success in increasing sanitation coverage. Moreover, improved public health, which is the objective of public policies promoting sanitation, will not be effective at low sanitation coverage rates. Fear at night, especially of animals, and personal harassment, are stated as the most important motivational factors for latrine ownership and the intention to build one. We therefore suggest changing the message of sanitation projects and introduce new low-cost technologies into rural markets; otherwise, marketing strategies will continue to fail in increasing sanitation demand.

Indonesia solar home systems project for rural electrification

Energy Technology Data Exchange (ETDEWEB)

Sanghvi, A.P.

1997-12-01

This paper presents, from a financing aspect the broad issues involved in a plan to provide solar home systems (SHS) to provide rural electrification in several areas of rural Indonesia. The paper discusses the approaches being used to provide funding, develop awareness of the technology, and assure the success of the project. The plan involves the use of grant money to help with some of the initial costs of such systems, and thereby to encourage local financing on a terms rather than cash basis. There are needs for market development, and development of a business structure in the country to support this type of technology. Provided this plan can succeed, it may serve as a model for further efforts.

Leapfrogging over development? Promoting rural renewables for climate change mitigation

Energy Technology Data Exchange (ETDEWEB)

Zerriffi, Hisham [Liu Institute for Global Issues, 6476 NW Marine Dr., University of British Columbia, Vancouver BC (Canada); Wilson, Elizabeth [Hubert Humphrey Institute of Public Affairs, University of Minnesota, Minneapolis MN (United States)

2010-04-15

Renewable energy technologies have the potential to help solve two pressing problems. On one hand, carbon-free energy sources must play a role in climate change mitigation. On the other hand, renewables might help meet needs of rural people without access to modern energy services. However, if renewables are deployed to combat climate change (primarily resulting from emissions in the developed economies) then providing basic energy services in the developing world may be compromised. The tendency to conflate the two drivers by installing renewables in rural areas for carbon mitigation reasons rather than for development reasons could compromise both goals. The danger is supporting sub-optimal policies for mitigating carbon and for rural energy. This is problematic given the limited funds available for energy development and reducing greenhouse gases. This paper analyzes how these goals have been balanced by the Global Environment Facility (GEF). Project documents are used to determine whether incremental costs of installing renewables were covered by GEF funds and whether the costs are comparable with other carbon mitigation options. The results raise concerns about the effectiveness and appropriateness of GEF funding of such projects and highlight the importance of post-Kyoto framework design to reduce emissions and promote development. (author)

Leapfrogging over development? Promoting rural renewables for climate change mitigation

International Nuclear Information System (INIS)

Zerriffi, Hisham; Wilson, Elizabeth

2010-01-01

Renewable energy technologies have the potential to help solve two pressing problems. On one hand, carbon-free energy sources must play a role in climate change mitigation. On the other hand, renewables might help meet needs of rural people without access to modern energy services. However, if renewables are deployed to combat climate change (primarily resulting from emissions in the developed economies) then providing basic energy services in the developing world may be compromised. The tendency to conflate the two drivers by installing renewables in rural areas for carbon mitigation reasons rather than for development reasons could compromise both goals. The danger is supporting sub-optimal policies for mitigating carbon and for rural energy. This is problematic given the limited funds available for energy development and reducing greenhouse gases. This paper analyzes how these goals have been balanced by the Global Environment Facility (GEF). Project documents are used to determine whether incremental costs of installing renewables were covered by GEF funds and whether the costs are comparable with other carbon mitigation options. The results raise concerns about the effectiveness and appropriateness of GEF funding of such projects and highlight the importance of post-Kyoto framework design to reduce emissions and promote development.

PROTECTION, UTILIZATION AND ANALYSIS OF HIGH MAST STREET LIGHT IN RURAL AREA.

OpenAIRE

Bhagawati Chandra , Miss Anjali Karsh

2017-01-01

High Mast Light gives the several cost effective advantages and cost is a major issue for rural area general services. This project illustrates the theoretical basis and the analytical development of the high mast lighting poles. In the late 1960"s, studies were conducted to investigate the impact that high-mast lighting gives on traffic performance, driver visibility, and illumination costs. It was found that increasing the height of the lighting offered a noticeable advantage in that it pr...

A Life-cycle Approach to Improve the Sustainability of Rural Water Systems in Resource-Limited Countries

Directory of Open Access Journals (Sweden)

Nicholas Stacey

2012-11-01

Full Text Available A WHO and UNICEF joint report states that in 2008, 884 million people lacked access to potable drinking water. A life-cycle approach to develop potable water systems may improve the sustainability for such systems, however, a review of the literature shows that such an approach has primarily been used for urban systems located in resourced countries. Although urbanization is increasing globally, over 40 percent of the world’s population is currently rural with many considered poor. In this paper, we present a first step towards using life-cycle assessment to develop sustainable rural water systems in resource-limited countries while pointing out the needs. For example, while there are few differences in costs and environmental impacts for many improved rural water system options, a system that uses groundwater with community standpipes is substantially lower in cost that other alternatives with a somewhat lower environmental inventory. However, a LCA approach shows that from institutional as well as community and managerial perspectives, sustainability includes many other factors besides cost and environment that are a function of the interdependent decision process used across the life cycle of a water system by aid organizations, water user committees, and household users. These factors often present the biggest challenge to designing sustainable rural water systems for resource-limited countries.

Rural-urban differences in the long-term care of the disabled elderly in China.

Science.gov (United States)

Li, Mei; Zhang, Yang; Zhang, Zhenyu; Zhang, Ying; Zhou, Litao; Chen, Kun

2013-01-01

In China, the rapid rate of population aging and changes in the prevalence of disability among elderly people could have significant effects on the demand for long-term care. This study aims to describe the urban-rural differences in use and cost of long-term care of the disabled elderly and to explore potential influencing factors. This study uses data from a cross-sectional survey and a qualitative investigation conducted in Zhejiang province in 2012. The participants were 826 individuals over 60 years of age, who had been bedridden or suffered from dementia for more than 6 months. A generalized linear model and two-part regression model were applied to estimate costs, with adjustment of covariates. Pensions provide the main source of income for urban elderly, while the principal income source for rural elderly is their family. Urban residents spend more on all services than do rural residents. Those who are married spend less on daily supplies and formal care than the unmarried do. Age, incapacitation time, comorbidity number, level of income, and bedridden status influence spending on medical care (β=-0.0316, -0.0206, 0.1882, 0.3444, and -0.4281, respectively), but the cost does not increase as the elderly grow older. Urban residents, the married, and those with a higher income level tend to spend more on medical equipment. Urban residence and living status are the two significant factors that affect spending on personal hygiene products. The use of long-term care services varies by living area. Long-term care of the disabled elderly imposes a substantial burden on families. Our study revealed that informal care involves huge opportunity costs to the caregivers. Chinese policy makers need to promote community care and long-term care insurance to relieve the burden of families of disabled elderly, and particular attention should be given to the rural elderly.

Developing better casemix education for rural New South Wales.

Science.gov (United States)

Bridges, J F; Mazevska, D; Haas, M

2001-08-01

Casemix is now an important mechanism for the planning, evaluation and funding of health services in Australia. In New South Wales (NSW) it was believed that while staff from most hospitals in metropolitan Sydney had become both literate and vocal about casemix, staff from rural areas were less familiar and much less likely to participate in casemix initiatives. In conjunction with the NSW Casemix Clinical Committee (NCCC), NSW Health considered a special program of casemix education for rural NSW. Before an education program was attempted, NSW Health inquired into the specific needs for casemix education in rural NSW. Qualitative and quantitative methods of analysis were used. Results of the quantitative analysis indicate that the understanding of casemix classifications is highest among managers. Of concern were the relatively low proportion of Allied Health staff who had more than a vague understanding of the Sub- and Non-Acute Patient (SNAP) classification; the lack of any knowledge of the Mental Health Costing And Service Classification (MH-CASC) by nursing staff; and the lack of any knowledge of the emergency department classification: Urgency, Disposition and Age-related Groups (UDAG), either by clinical or nursing staff. The results of the qualitative analysis show that casemix education for rural areas needs to differ from metropolitan education programs. The analysis also highlights the perception of casemix in rural areas and the special circumstances in rural hospitals that place limits on the ability to use casemix more fully.

Psychiatric treatment of children and adolescents in rural communities. Myths and realities.

Science.gov (United States)

Cook, A D; Copans, S A; Schetky, D H

1998-07-01

Rural child and adolescent psychiatry offers many challenges, a varied and interesting practice, and the satisfaction of performing needed and important work in an environment in which one's presence is valued. The successful psychiatrist can expect to be an integrated and appreciated member of the community. The fit is not a good one for every practitioner, however. Not only are incomes lower, although the cost of living is low as well, but practitioners may find they have only exchanged urban stresses for rural pressures. The characteristics important for the child and adolescent psychiatrist are the same for rural and urban settings: flexibility, creativity and innovation, competence, self confidence, a good sense of boundaries, a good balance between personal and private life, supportive personal relationships, and a sense of humor. One must be a child advocate, have a willingness to give of one's self and one's time, and be down to earth, comfortable with oneself, and capable of self entertainment. Training programs with access to rural populations can introduce residents to rural child and adolescent psychiatry while supporting those who are already in practice. The authors hope that this article will promote a dialogue with psychiatrists considering relocation to a rural area and encourage training programs to prepare residents for rural practice.

The provision of neuropsychological services in rural/regional settings: professional and ethical issues.

Science.gov (United States)

Allott, Kelly; Lloyd, Susan

2009-07-01

Despite rapid growth of the discipline of clinical neuropsychology during recent times, there is limited information regarding the identification and management of professional and ethical issues associated with the practice of neuropsychology within rural settings. The aim of this article is to outline the characteristics unique to practicing neuropsychology in rural communities and to describe the potential professional and ethical dilemmas that might arise. Issues are illustrated using examples from neuropsychological practice in a rural/regional setting in Victoria, Australia. Relative to urban regions, there is an inequality in the distribution of psychologists, including neuropsychologists, in rural areas. The unique characteristics of rural and regional communities that impact on neuropsychological practice are: 1) limited resources in expertise, technology, and community services, 2) greater travel distances and costs, 3) professional isolation, and 4) beliefs about psychological services. These characteristics lower the threshold for particular ethical issues. The ethical issues that require anticipation and careful management include: 1) professional competence, 2) multiple relationships, and 3) confidentiality. Through increased awareness and management of rural-specific professional and ethical issues, rural neuropsychologists can experience their work as rewarding and enjoyable. Specific guidelines for identifying, managing, and resolving ethically and professionally challenging situations that may arise during rural practice are provided.

A case study of the counterpart technical support policy to improve rural health services in Beijing

Science.gov (United States)

2012-01-01

Background There is, globally, an often observed inequality in the health services available in urban and rural areas. One strategy to overcome the inequality is to require urban doctors to spend time in rural hospitals. This approach was adopted by the Beijing Municipality (population of 20.19 million) to improve rural health services, but the approach has never been systematically evaluated. Methods Drawing upon 1.6 million cases from 24 participating hospitals in Beijing (13 urban and 11 rural hospitals) from before and after the implementation of the policy, changes in the rural–urban hospital performance gap were examined. Hospital performance was assessed using changes in six indices over-time: Diagnosis Related Groups quantity, case-mix index (CMI), cost expenditure index (CEI), time expenditure index (TEI), and mortality rates of low- and high-risk diseases. Results Significant reductions in rural–urban gaps were observed in DRGs quantity and mortality rates for both high- and low-risk diseases. These results signify improvements of rural hospitals in terms of medical safety, and capacity to treat emergency cases and more diverse illnesses. No changes in the rural–urban gap in CMI were observed. Post-implementation, cost and time efficiencies worsened for the rural hospitals but improved for urban hospitals, leading to a widening rural–urban gap in hospital efficiency. Conclusions The strategy for reducing urban–rural gaps in health services adopted, by the Beijing Municipality shows some promise. Gains were not consistent, however, across all performance indicators, and further improvements will need to be tried and evaluated. PMID:23272703

Preventing Adolescent Risk Behavior in the Rural Context: An Integrative Analysis of Adolescent, Parent, and Provider Perspectives

Science.gov (United States)

Rishel, Carrie W.; Cottrell, Lesley; Kingery, Tricia

2012-01-01

Adolescent risk behavior remains prevalent and contributes to numerous social problems and growing health care costs. Contrary to popular perception, adolescents in rural areas engage in risky behaviors at least as much as youth from urban or suburban settings. Little research, however, focuses on risk behavior prevention in the rural context.…

The theory-practice gap of black carbon mitigation technologies in rural China

Science.gov (United States)

Zhang, Weishi; Li, Aitong; Xu, Yuan; Liu, Junfeng

2018-02-01

Black carbon mitigation has received increasing attention for its potential contribution to both climate change mitigation and air pollution control. Although different bottom-up models concerned with unit mitigation costs of various technologies allow the assessment of alternative policies for optimized cost-effectiveness, the lack of adequate data often forced many reluctant explicit and implicit assumptions that deviate away from actual situations of rural residential energy consumption in developing countries, where most black carbon emissions occur. To gauge the theory-practice gap in black carbon mitigation - the unit cost differences that lie between what is estimated in the theory and what is practically achieved on the ground - this study conducted an extensive field survey and analysis of nine mitigation technologies in rural China, covering both northern and southern regions with different residential energy consumption patterns. With a special focus on two temporal characteristics of those technologies - lifetimes and annual utilization rates, this study quantitatively measured the unit cost gaps and explain the technical as well as sociopolitical mechanisms behind. Structural and behavioral barriers, which have affected the technologies' performance, are discussed together with policy implications to narrow those gaps.

Rurality as an Asset for Inclusive Teaching in Chemical Engineering

Science.gov (United States)

Gomez, Jamie; Svihla, Vanessa

2018-01-01

We developed and tested a pedagogical strategy--asset-based design challenges--to enhance diversity in early chemical engineering coursework. Using qualitative methods, we found first-year students justified high-cost solutions with ethical arguments; teams that included rural expertise argued instead for economically-viable solutions. In the…

A HYBRID APPROACH FOR RURAL FEEDER DESIGN

Directory of Open Access Journals (Sweden)

DAMANJEET KAUR

2012-08-01

Full Text Available In this paper, a population based approach for conductor size selection in rural radial distribution system is presented. The proposed hybrid approach implies a particle swarm optimization (PSO approach in combination with mutant property of differential evolution (DE for conductor size selection in radial distribution system. The conductor size for each feeder segment is selected such that the total cost of capital investment and capitalized cost of energy losses is minimized while constraints of voltage at each node and current carrying capacity of conductor is within the limits. The applicability and effectiveness of the proposed method is demonstrated with the help of 32-node test system.

Building relationships with physicians. Internal marketing efforts help strengthen organizational bonds at a rural health care clinic.

Science.gov (United States)

Peltier, J W; Boyt, T; Westfall, J E

1997-01-01

Physician turnover is costly for health care organizations, especially for rural organizations. One approach management can take to reduce turnover is to promote physician loyalty by treating them as an important customer segment. The authors develop an information--oriented framework for generating physician loyalty and illustrate how this framework has helped to eliminate physician turnover at a rural health care clinic. Rural health care organizations must develop a more internal marketing orientation in their approach to establishing strong relationship bonds with physicians.

The cost of home-based terminal care for people with AIDS in South ...

African Journals Online (AJOL)

Even with this level of HBC input, patients still incurred hospital costs of R2 522 and primary care clinic costs of R1 154 per patient per year. HBC costs are increased in rural areas where a vehicle is required for staff transport. HBC shows considerable potential to deal cost-effectively with growing palliative care needs in the ...

Cost estimate of bovine tuberculosis to Ethiopia.

Science.gov (United States)

Tschopp, Rea; Hattendorf, Jan; Roth, Felix; Choudhury, Adnan Ali Khan; Choudhoury, Adnan; Shaw, Alexandra; Aseffa, Abraham; Zinsstag, Jakob

2013-01-01

While bovine tuberculosis (BTB) has been eliminated in some industrialized countries, it prevails worldwide, particularly in Africa. In Ethiopia, BTB is prevalent as numerous studies have shown its occurrence in livestock and in abattoirs but it has not been demonstrated in wildlife and only very few cases have been found in humans. The objective of this study is to estimate the cost of BTB to Ethiopia with the aim of informing Ethiopian policy on options for BTB control. BTB in livestock affects both animal productivity and herd demographic composition. The Livestock Development Planning System (LDPS2, FAO) was modified to allow for stochastic simulation of parameters. We performed an incremental cost of disease analysis, comparing livestock production with and without BTB. For the rural scenario we considered an endemically stable 4 % comparative intradermal test (CIDT) prevalence and for the urban scenario an endemically stable 32 % CIDT prevalence among cattle. The net present value of rural Ethiopian livestock products in 2005 is estimated at 65.7 billion (thousand million) Ethiopian Birr (95 % Confidence Interval (CI) 53.8-77.7 billion Birr), which is the equivalent of 7.5 billion US$ (95 %CI 6.1-8.9 billion US$) at a rate of 8.7 Birr per US$ in 2005. The cost of BTB ranges from 646 million Birr (75.2 million US$) in 2005 to 3.1 Billion Birr in 2011 (358 million US$) but is within the range of uncertainty of our estimate and can thus not be distinguished from zero. The cost of disease in the urban livestock production ranges from 5 to 42 million Birr (500,000-4.9 million US$) between 2005 and 2011 but is also within the range of uncertainty of our estimate. Our study shows no measurable loss in asset value or cost of disease due to BTB in rural and urban production systems in Ethiopia. This does not mean that there is not a real cost of disease, but the variability of the productivity parameters and prices are high and would require more precise estimates

Has Rural Banking Developed Rural Nigeria? | Amadasu | African ...

African Journals Online (AJOL)

There is problem of rural development in Nigeria because of increasing poverty in the rural areas where about 70% of the people live. Reducing poverty means increasing income. Increasing income means increasing bank loans and advances for efficient application to agricultural and industrial activities in the rural Nigeria ...

Energy conservation and self-sufficiency in rural property; Geracao e auto-suficiencia de energias em imovel rural familiar

Energy Technology Data Exchange (ETDEWEB)

Schuch, Sergio Luis [Instituto Paranaense de Assistencia Tecnica e Extensao Rural (EMATER), Toledo, PR (Brazil)], e-mail: slschuch@hotmail.com; Lawder, Jose Henrique [Evolucao Engenharia Eletrica, Toledo, PR (Brazil)], e-mail: jose_lawder@uol.com.br; Feiden, Armin; Nogueira, Carlos Eduardo Camargo; Siqueira, Jair Antonio Cruz [Universidade Estadual do Oeste do Parana (UNIOESTE), Cascavel, PR (Brazil)], e-mails: armin_feiden@yahoo.com.br, cecn1@yahoo.com.br, jairsiqueira@unioeste.br

2011-07-01

This paper aims to highlight an innovative system designed to generate bioenergy in Toledo - PR, applied in a rural residential property. This system is composed by a simple digester model, because it eliminates masonry and hood storage. Cattle slurry and water from barn's floor cleaning are conducted to an anaerobic biodigester chamber. Biogas production is stored in a polypropylene canvas balloon. After compression, the biogas is used to replace liquefied petroleum gas in central water heating and cooking foods. The wood used in sugar cane molasses has been replaced with higher efficiency by biogas. Also was installed Otto engine providing thermal and electrical power generation at the same time. The electrical power output is biphasic and about 70 Amperes. This system deployed in rural property provides energy self-sufficiency and contribute to the reduction of operational costs of the property. (author)

Energy conservation and self-sufficiency in rural property; Geracao e auto-suficiencia de energias em imovel rural familiar

Energy Technology Data Exchange (ETDEWEB)

Schuch, Sergio Luis [Instituto Paranaense de Assistencia Tecnica e Extensao Rural (EMATER), Toledo, PR (Brazil)], e-mail: slschuch@hotmail.com; Lawder, Jose Henrique [Evolucao Engenharia Eletrica, Toledo, PR (Brazil)], e-mail: jose_lawder@uol.com.br; Feiden, Armin; Nogueira, Carlos Eduardo Camargo; Siqueira, Jair Antonio Cruz [Universidade Estadual do Oeste do Parana (UNIOESTE), Cascavel, PR (Brazil)], e-mails: armin_feiden@yahoo.com.br, cecn1@yahoo.com.br, jairsiqueira@unioeste.br

2011-07-01

This paper aims to highlight an innovative system designed to generate bioenergy in Toledo - PR, applied in a rural residential property. This system is composed by a simple digester model, because it eliminates masonry and hood storage. Cattle slurry and water from barn's floor cleaning are conducted to an anaerobic biodigester chamber. Biogas production is stored in a polypropylene canvas balloon. After compression, the biogas is used to replace liquefied petroleum gas in central water heating and cooking foods. The wood used in sugar cane molasses has been replaced with higher efficiency by biogas. Also was installed Otto engine providing thermal and electrical power generation at the same time. The electrical power output is biphasic and about 70 Amperes. This system deployed in rural property provides energy self-sufficiency and contribute to the reduction of operational costs of the property. (author)

Why doctors choose small towns: a developmental model of rural physician recruitment and retention.

Science.gov (United States)

Hancock, Christine; Steinbach, Alan; Nesbitt, Thomas S; Adler, Shelley R; Auerswald, Colette L

2009-11-01

Shortages of health care professionals have plagued rural areas of the USA for more than a century. Programs to alleviate them have met with limited success. These programs generally focus on factors that affect recruitment and retention, with the supposition that poor recruitment drives most shortages. The strongest known influence on rural physician recruitment is a "rural upbringing," but little is known about how this childhood experience promotes a return to rural areas, or how non-rural physicians choose rural practice without such an upbringing. Less is known about how rural upbringing affects retention. Through twenty-two in-depth, semi-structured interviews with both rural- and urban-raised physicians in northeastern California and northwestern Nevada, this study investigates practice location choice over the life course, describing a progression of events and experiences important to rural practice choice and retention in both groups. Study results suggest that rural exposure via education, recreation, or upbringing facilitates future rural practice through four major pathways. Desires for familiarity, sense of place, community involvement, and self-actualization were the major motivations for initial and continuing small-town residence choice. A history of strong community or geographic ties, either urban or rural, also encouraged initial rural practice. Finally, prior resilience under adverse circumstances was predictive of continued retention in the face of adversity. Physicians' decisions to stay or leave exhibited a cost-benefit pattern once their basic needs were met. These results support a focus on recruitment of both rural-raised and community-oriented applicants to medical school, residency, and rural practice. Local mentorship and "place-specific education" can support the integration of new rural physicians by promoting self-actualization, community integration, sense of place, and resilience. Health policy efforts to improve the physician

Rural electrification in Sub Saharan Africa in a context of fluctuating oil-prices

DEFF Research Database (Denmark)

Nygaard, Ivan; Bindner, Henrik W.; Katic, Ivan

2009-01-01

matured and markets have gradually developed, PV for rural electrification has often been perceived with scepticism from potential users, donors, government officials and researchers, and solar PV has in many camps been labelled as donor driven, expensive and fragile technology mainly serving the richest......Solar PV is one among other low carbon technologies for rural electrification in Sub Saharan Africa (SSA). Solar PV systems have for almost 30 years been disseminated in SSA, resulting in more than half a million installations concentrated in a few countries. While PV systems have technically...... grid rural electrification schemes based on hybrid solar PVdiesel generators. This may bring PV systems in line with fossil fuel based systems in terms of consumer cost and options for productive use and it changes the market for PV from mainly donor supported schemes into mainstream rural...

The costs and effectiveness of various decontamination procedures

International Nuclear Information System (INIS)

Robinson, C.A.; Haywood, S.M.; Brown, J.

1991-01-01

Knowledge of the cost and effectiveness of decontamination techniques is necessary to optimise the implementation of this countermeasure. These factors vary depending upon the nature of the land affected. There is a great deal of data available on the cost and efficacy of specific decontamination techniques on particular surfaces, but little information for combinations of techniques in real environments. This paper describes the preliminary stages of a project, in progress at the National Radiological Protection Board (NRPB), aimed at providing this information, for inner city, residential and rural areas. The efficacies of individual decontamination processes on specific surfaces were from the available literature. The NRPB EXPURT (EXPosure from Urban Radionuclide Transfer) compartmental model was used to determine the effectiveness of a number of representative decontamination programmes; each programme represents a combination of common decontamination techniques which may be applied to the various surfaces comprising an inner-city, residential or rural environment, ie, paving, walls, roofs and soil. The effectiveness of each programme was measured in terms of the reduction in dose, or dose rate, to an individual in that environment, taking account of the building characteristics, and the occupancy of the population in these buildings. The costs of each programme were derived, based on data available in current literature on the cost of the constituent decontamination techniques. Representative cost and effectiveness data are presented and their application is discussed

The direct economic impact of alternative types of the rural tourism

Directory of Open Access Journals (Sweden)

Simona Miškolci

2005-01-01

Full Text Available Rural tourism has come to occupy a prominent position in the debate about rural restructuring in all OECD countries, partly because of demand changes which favour rural tourism and partly because rural agencies recognise a need to provide economic activities with potential for growth in a rural economy in which traditional providers of rural employment (such as agriculture have been shedding labour at a rapid rate. Well-designed strategy is essential to its success in impacting on the rural economy. The structures for collaboration and co-operation must be developed and combined with a process of education and training. Co-operative effort must be effective and sustainable. The tourism related businesses should not be isolated from the larger community and its issues.The principal motivation for a community, business or region to serve tourists is generally economic. An individual business is interested primarily in its own revenues and costs, while a community or region is concerned with tourism’s overall contribution to the economy, as well as social, fiscal and environmental impacts. A good understanding of tourism’s economic impacts is therefore important for the tourism industry, government officials, and the community as a whole.The principal objective of the study, that is reported here, was to determine the potential income of farmers from the provision of agro-tourism services. First, the paper reviews selected results of the visitor spending survey in alternative types of rural tourism of the region Southeast (Czech Republic; second the direct economic benefit of the agro-tourism in this region is estimated, and finally, critical factors reducing the effectiveness of agro-tourism as a rural development instrument are drawn.

Impact assessment and cost-effectiveness of m-health application used by community health workers for maternal, newborn and child health care services in rural Uttar Pradesh, India: a study protocol

OpenAIRE

Prinja, Shankar; Nimesh, Ruby; Gupta, Aditi; Bahuguna, Pankaj; Thakur, Jarnail Singh; Gupta, Madhu; Singh, Tarundeep

2016-01-01

Background: An m-health application has been developed and implemented with community health workers to improve their counseling in a rural area of India. The ultimate aim was to generate demand and improve utilization of key maternal, neonatal, and child health services. The present study aims to assess the impact and cost-effectiveness of this project.Methods/design: A pre–post quasi-experimental design with a control group will be used to undertake difference in differences analysis for as...

Hub and spoke model: making rural healthcare in India affordable, available and accessible.

Science.gov (United States)

Devarakonda, Srichand

2016-01-01

Quality health care should be within everyone's reach, especially in a developing country. While India has the largest private health sector in the world, only one-fifth of healthcare expenditure is publically financed; it is mostly an out-of-pocket expense. About 70% of Indians live in rural areas making about $3 per day, and a major portion of that goes towards food and shelter and, thus, not towards health care. Transportation facilities in rural India are poor, making access to medical facilities difficult, and infrastructure facilities are minimal, making the available medical care insufficient. The challenge presented to India was to provide health care that was accessible, available and affordable to people in rural areas and the low-income bracket. The intent of this article is to determine whether the hub and spoke model (HSM), when implemented in the healthcare industry, can expand the market reach and increase profits while reducing costs of operations for organizations and, thereby, cost to customers. This article also discusses the importance of information and communications technologies (ICT) in the HSM approach, which the handful of published articles in this topic have failed to discuss. This article opts for an exploratory study, including review of published literature, web articles, viewpoints of industry experts, published journals, and in-depth interviews. This article will discuss how and why the HSM works in India's healthcare industry while isolating its strengths and weaknesses, and analyzing the impact of India's success. India's HSM implementation has become a paramount example of an acceptable model that, while exceeding the needs and expectations of its patients, is cost-effective and has obtained operational and health-driven results. Despite being an emerging nation, India takes the top spot in terms of affordability of ICT as well as for having the highest number of computer-literate graduates and healthcare workers in the world

Intelligent Devices in Rural Wireless Networks

Directory of Open Access Journals (Sweden)

Daniel FUENTES

2014-03-01

Full Text Available The rural wireless networks are increasingly in demand by associations and autarchies to expand Internet access in this type of areas. The problem of such solutions centers not only in network deployment and its maintenance, but also in the equipment installation on clients, which always has big costs. This installation and configuration must be performed by a technician on site, so that the equipment can be integrated in the infrastructure. To try to mitigate this problem, it is presented a solution that allows the clients to install, with transparency, the device at home, reducing not only the cost for the management entity but also for the clients. This way, for info-excluded people or with new technology low experience level, it is the user that integrates himself in the network, making him part of the process, fostering the network usage.In this article are specified not only the system architecture but also the way that it works and how it obtains the desirable result. The tests made to the solution show the quickness, reliability and autonomy in the execution of the tasks, making it a benefit for rural wireless networks.This solution, by its robustness and simplicity, allowed an uptake to the IT by people who never thought to do it, namely an advanced age group (elderly who want to join the world of the new technologies

Rural Communatcation: legitimizing digital inclusion in rural field

Directory of Open Access Journals (Sweden)

Juliana Correa Bernardes

2016-03-01

Full Text Available Through contemporary analysis, it was noted that the countryside of São Paulo experienced drastic transformation and demanded rural family farmers to adapt themselves to technological innovations, where the most striking is the use of the internet in search of information to the sustainable development of rural property.  The research adopted a methodological way of exploratory, through the case study, which analyzed the general objective the dissemination and usability of information and communication technologies in rural areas in the interior of forms-based applied to farmers in the family farms belonging to theAssociation of banana growers of Tupã. In seeking to achieve this goal, reflected on the use of internet in rural areas and measured-factors that enhance digital communication barriers in rural addressing the digital divide becomes a limiting factor to access. In this sense, the rural communication emerges as relational link mediating solutions and incorporating the diffusion of innovations in the pursuit of digital literacy of farmers contributing to the democratization of society in the information age.

Review and comparison study of hybrid diesel/solar/hydro/fuel cell energy schemes for a rural ICT Telecenter

Energy Technology Data Exchange (ETDEWEB)

Abdullah, M.O.; Yung, V.C.; Anyi, M.; Othman, A.K.; Ab. Hamid, K.B. [Universiti Malaysia Sarawak (UNIMAS), 94300 Kota Samarahan, Sarawak (Malaysia); Tarawe, J. [e-Bario ICT Telecenter, Bario, Sarawak (Malaysia)

2010-02-15

In this paper, the rural electrification study of an ICT Telecenter in particular reference to the Kelabit Highland of Sarawak is presented. The use of diesel generator and its associated environmental implications is first discussed. The cost-effectiveness of the present solar PV system and the solar/hydro schemes for rural electrification of the rural ICT are evaluated employing the HOMER simulation software, considering sustainability factors such as system efficiency, weather, fuel costs, operating and maintaining costs. Subsequently, simple novel Hybrid Energy Performance Equations and the associated Energy Performance Curves are derived and introduced, respectively, which provide a visualization model, simplifying hybrid system analysis. Results obtained in this study have shown that combined power schemes is more sustainable in terms of supplying electricity to the Telecenter compared to a stand-alone PV system due to prolong cloudy and dense haze periods. The hybrid systems can have efficiency range of {proportional_to}15%-75% compared to PV stand-alone of only {proportional_to}10%, indicating hybrid systems are more reliable and sustainable - in minimizing both energy losses and excess energy. (author)

Migration and rural women in China: a look at the gendered impact of large-scale migration.

Science.gov (United States)

Davin, D

1996-01-01

This preliminary study explored the impact on women of economic migration from rural to urban areas in China. Data were obtained from the 1990 census. The study focused on economic migration, which accounted for 29% of the reasons for moving. In some provinces such as Guangdong, economic reasons account for almost 60% of in-migrants. Interprovincial migration is primarily economic, followed by marriage, which varies widely by province. Migrants tend to assume occupations that are assigned by gender. Male migrants tend to outnumber female migrants, and women are left to farm. Where migration is gender balanced, the sex ratio in the sending area may be stable, but gender division within individual households is upset. Children may be tended by grandparents in rural areas, when their parents find work in cities. Migrants in urban areas do not have the same rights as permanent urban household registrants and cannot send their children to school or use free or low cost health care. Migrants keep in close contact with home villages. Urban migrants without permanent household registration status face the loss of welfare benefits in urban areas as well as the high cost of purchase of a permanent residence permit, social discrimination, stigma from mass media portrayals, and poor housing. Most rural-urban migration is circular. Female return migrants bring back cash remittances and new family roles and status. Rural migrants are exposed to new urban experiences that are retold in rural areas and that may pose difficulties in readjustment to the hardships of rural life. Urban fertility is delayed and lower than that of rural fertility.

Small-scale bioenergy projects in rural China: Lessons to be learnt

NARCIS (Netherlands)

Han, Jingyi; Mol, A.P.J.; Lu, Y.; Zhang, L.

2008-01-01

Large amounts of small-scale bioenergy projects were carried out in China's rural areas in light of its national renewable energy policies. These projects applied pyrolysis gasification as the main technology, which turns biomass waste at low costs into biogas. This paper selects seven bioenergy

Electrification of small rural properties in the Cangucu-Brazil city using alternative sources for electricity generation; Eletrificacao de pequenas propriedades rurais do municipio de Cangucu empregando fontes alternativas para a producao de energia eletrica

Energy Technology Data Exchange (ETDEWEB)

Hecktheuer, Lucio Almeida [Rio Grande do Sul Univ., Porto Alegre, RS (Brazil). Nucleo de Energia

1998-12-31

This paper aims at specifying and measuring the main alternative electrification system components, such as solar and eolic, which make use of the property`s energetical potential that, to a small extent, do not represent pollution sources to the environment. The results indicated that, the small rural properties of Cangucu country, which present a low daily electric energy consumption, these alternative systems are able to technically and economically supply electric energy and provide reasonable subsidies to electrification projects which can eventually be developed in the country. (author) 4 refs., 2 figs., 5 tabs.

Risk projection and the fertility of rural families.

Science.gov (United States)

Song, R

1991-01-01

The author comments on the theories and empirical evidence which aid in understanding the determinants of the reproductive behavior of farmers in China. The issues are defined, and discussion expands on the needs for a specific number of children in rural versus urban areas, M. Cain's risk insurance hypothesis, the importance of modes of production for the farm family, the farmer's security versus risks, and the balance between risk projection and the maximization of interest. The significance of risk projection is presented as are the implications for policy making. Neither theory of farmer's reproductive behavior, 1) the economic cost and benefit theory or 2) the need for labor theory is considered suitable. The idea that benefits exceed the costs of rearing children cannot justify the repeated cycle of poverty among farmers with many children. The Hubei Province, Danjiankou City, study which estimates rearing costs of 3360 yuan/child benefits of 305 yuan/year to the parents in old age is considered incorrect. The second theory agrees that children are needed for production but recognized surplus labor and does not account for the fact that the more children, the poorer the family. Micro demographic theories identify factors affecting demographic behavior, the extent to which factors affect fertility, and the interrelatedness of factors. The rural family feels jeopardized with one child, and the lowest tolerable number of children is 2-3 in rural areas. Manual labor is the basis of the traditional peasant economy. In this economy, loss of income is a threat whether due to crop failure, weather changes, or market changes. Payment occurs at the end of the year only. Child health is a risk due to poor nutrition and poor health facilities. Following a one-child policy might jeopardize perpetuation of the family line and provision for parents by sons. Urban risks are different. Rural families limit risk by keeping material resources, enlarging and strengthening the

Cost-Prioritized Droop Schemes for Autonomous AC Microgrids

DEFF Research Database (Denmark)

Nutkani, Inam Ullah; Loh, Poh Chiang; Wang, Peng

2015-01-01

This paper presents two cost-prioritized droop sche- mes for distributed generators (DGs) in a rural or islanded microgrid. Dispatch prioritization of the schemes allows autonomous identification of the appropriate DGs for generation, in accordance to the overall load conditions of the microgrid....

Surgical referral coordination from a first-level hospital: a prospective case study from rural Nepal.

Science.gov (United States)

Fleming, Matthew; King, Caroline; Rajeev, Sindhya; Baruwal, Ashma; Schwarz, Dan; Schwarz, Ryan; Khadka, Nirajan; Pande, Sami; Khanal, Sumesh; Acharya, Bibhav; Benton, Adia; Rogers, Selwyn O; Panizales, Maria; Gyorki, David; McGee, Heather; Shaye, David; Maru, Duncan

2017-09-25

Patients in isolated rural communities typically lack access to surgical care. It is not feasible for most rural first-level hospitals to provide a full suite of surgical specialty services. Comprehensive surgical care thus depends on referral systems. There is minimal literature, however, on the functioning of such systems. We undertook a prospective case study of the referral and care coordination process for cardiac, orthopedic, plastic, gynecologic, and general surgical conditions at a district hospital in rural Nepal from 2012 to 2014. We assessed the referral process using the World Health Organization's Health Systems Framework. We followed the initial 292 patients referred for surgical services in the program. 152 patients (52%) received surgery and four (1%) suffered a complication (three deaths and one patient reported complication). The three most common types of surgery performed were: orthopedics (43%), general (32%), and plastics (10%). The average direct and indirect cost per patient referred, including food, transportation, lodging, medications, diagnostic examinations, treatments, and human resources was US$840, which was over 1.5 times the local district's per capita income. We identified and mapped challenges according to the World Health Organization's Health Systems Framework. Given the requirement of intensive human capital, poor quality control of surgical services, and the overall costs of the program, hospital leadership decided to terminate the referral coordination program and continue to build local surgical capacity. The results of our case study provide some context into the challenges of rural surgical referral systems. The high relative costs to the system and challenges in accountability rendered the program untenable for the implementing organization.

Urban versus rural populations' views of health care in Scotland.

Science.gov (United States)

Farmer, Jane; Hinds, Kerstin; Richards, Helen; Godden, David

2005-10-01

To compare satisfaction with, and expectations of, health care of people in rural and urban areas of Scotland. Questions were included in the 2002 Scottish Social Attitudes Survey (SSAS). The Scottish House-hold Survey urban-rural classification was used to categorize locations. A random sample of 2707 people was contacted to participate in a face-to-face interview and a self-completion questionnaire survey. SPSS (v.10) was used to analyse the data. Relationships between location category and responses were explored using logistic regression analysis. In all, 1665 (61.5%) interviews were conducted and 1507 (56.0%) respondents returned self-completion questionnaires. Satisfaction with local doctors and hospital services was higher in rural locations. While around 40% of those living in remote areas thought A&E services too distant, this did not rank as a top priority for health service improvement. This could be due to expectations that general practitioners would assist in out-of-hours emergencies. Most Scots thought services should be good in rural areas even if this was costly, and that older people should not be discouraged from moving to rural areas because of their likely health care needs. In all, 79% of respondents thought that care should be as good in rural as urban areas. Responses to many questions were independently significantly affected by rural/urban location. Most Scots want rural health care to continue to be good, but the new UK National Health Service (NHS) general practitioner contract and service redesign will impact on provision. Current high satisfaction, likely to be due to access and expectations about local help, could be affected. This study provides baseline data on attitudes and expectations before potential service redesign, which should be monitored at intervals in future.

The financial performance of rural hospitals and implications for elimination of the Critical Access Hospital program.

Science.gov (United States)

Holmes, George M; Pink, George H; Friedman, Sarah A

2013-01-01

To compare the financial performance of rural hospitals with Medicare payment provisions to those paid under prospective payment and to estimate the financial consequences of elimination of the Critical Access Hospital (CAH) program. Financial data for 2004-2010 were collected from the Healthcare Cost Reporting Information System (HCRIS) for rural hospitals. HCRIS data were used to calculate measures of the profitability, liquidity, capital structure, and financial strength of rural hospitals. Linear mixed models accounted for the method of Medicare reimbursement, time trends, hospital, and market characteristics. Simulations were used to estimate profitability of CAHs if they reverted to prospective payment. CAHs generally had lower unadjusted financial performance than other types of rural hospitals, but after adjustment for hospital characteristics, CAHs had generally higher financial performance. Special payment provisions by Medicare to rural hospitals are important determinants of financial performance. In particular, the financial condition of CAHs would be worse if they were paid under prospective payment. © 2012 National Rural Health Association.

The value of water for the landscape and the rural environment

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Davide Viaggi

2006-07-01

Full Text Available The paper illustrates and discusses the methodologies for the economic evaluation of water in the rural territory, in the light of the recent evolution of the legal framework, with the implementation of directive 60/2000. In the application of the directive, a major role is played by the economic analysis and by the concept of full cost of water. The full cost includes financial costs, opportunity costs and environmental costs. Such issues are particularly important for agriculture, also taking into account the evolution of the sector towards a multifunctional role. The solution envisaged for the present evaluation problems is based on a parallel and consistent development of methodologies and operational protocols aimed at the problems raised by the decision-makers.

Mathematical tool to size rural digesters

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Florentino Helenice de Oliveira

2003-01-01

Full Text Available Anaerobic digesters have been highlighted due to the current energy crisis and its consequent search for alternative energy sources, allied to the intense process of livestock farming and agriculture modernization, which besides demanding a lot of energy, produces a great amount of crop and animal residues, most of the times generating sanitary problems. The aim of this work is to provide a mathematical tool to establish parameters for projects of construction of rural digesters, considering the response to energy demand, the suitability of the dimensions of the systems, yield factors and the guarantee of functionality. Non-linear optimization models, of easy resolution, for the three main types of rural digesters were formulated in this way. With the resolution of these models one can determine the height and the diameter that lead to a minimum volume for each type, so reducing the necessary amount of masonry and, consequently, diminishing the cost.

Defining and Describing Rural: Implications for Rural Special Education Research and Policy

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Hawley, Leslie R.; Koziol, Natalie A.; Bovaird, James A.; McCormick, Carina M.; Welch, Greg W.; Arthur, Ann M.; Bash, Kirstie

2016-01-01

A critical aspect of rural research is carefully defining and describing the rural context. This is particularly important in rural special education research because different definitions of rural may influence resource allocation, grant funding eligibility, and/or research findings. In order to highlight the importance of operationalizing rural,…

The calculation of costs of postal network and universal postal service based on standard and average cost principles

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Blagojević Mladenka Z.

2017-01-01

Full Text Available The provision of universal postal service involves high costs for operator, especially in rural areas. The aim of this paper is to propose and test tool for managing the cost of providing universal postal service and maintaining the postal network in order to facilitate understanding of the problem in the sector. The proposed approach use standard prices and standard quantities (the redefined number of postal units, the number of employees, etc. as well as average costs for calculation of the costs of the universal postal service and postal network. The methodology provides the efficiency analysis, benchmarking and identification of causes of poor performance of management and resource allocation. It can be used for postal operators that do not have modern accounting systems.

Balancing medicine prices and business sustainability: analyses of pharmacy costs, revenues and profit shed light on retail medicine mark-ups in rural Kyrgyzstan.

Science.gov (United States)

Waning, Brenda; Maddix, Jason; Soucy, Lyne

2010-07-13

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. 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). 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. 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

Rural Entrepreneurship or Entrepreneurship in the Rural

DEFF Research Database (Denmark)

Korsgaard, Steffen; Müller, Sabine; Tanvig, Hanne Wittorff

2015-01-01

Purpose: This article investigates how rural entrepreneurship engages with place and space. It explores the concept of “rural” in rural enterprise, and illustrates the importance of distinguishing between types of rural entrepreneurship. Design/methodology/approach: The constructs of “place” and ...... these processes are enabled and constrained by the immediate context or “place”. The paper weaves space and place in order to show the importance of context for entrepreneurship, which responds to the recent calls for contextualizing entrepreneurship research and theories....

Outpatient prescription practices in rural township health centers in Sichuan Province, China

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Jiang Qian

2012-09-01

Full Text Available Abstract Background Sichuan Province is an agricultural and economically developing province in western China. To understand practices of prescribing medications for outpatients in rural township health centers is important for the development of the rural medical and health services in this province and western China. Methods This is an observational study based on data from the 4th National Health Services Survey of China. A total of 3,059 prescriptions from 30 township health centers in Sichuan Province were collected and analyzed. Seven indicators were employed in the analyses to characterize the prescription practices. They are disease distribution, average cost per encounter, number of medications per encounter, percentage of encounters with antibiotics, percentage of encounters with glucocorticoids, percentage of encounters with combined glucocorticoids and antibiotics, and percentage of encounters with injections. Results The average medication cost per encounter was 16.30 Yuan ($2.59. About 60% of the prescriptions contained Chinese patent medicine (CPM, and almost all prescriptions (98.07% contained western medicine. 85.18% of the prescriptions contained antibiotics, of which, 24.98% contained two or more types of antibiotics; the percentage of prescriptions with glucocorticoids was 19.99%; the percentage of prescriptions with both glucocorticoids and antibiotics was 16.67%; 51.40% of the prescriptions included injections, of which, 39.90% included two or more injections. Conclusions The findings from this study demonstrated irrational medication uses of antibiotics, glucocorticoids and injections prescribed for outpatients in the rural township health centers in Sichuan Province. The reasons for irrational medication uses are not only solely due to the pursuit of maximizing benefits in the township health centers, but also more likely attributable to the lack of medical knowledge of rational medication uses among rural doctors and the

Rural origin plus a rural clinical school placement is a significant predictor of medical students' intentions to practice rurally: a multi-university study.

Science.gov (United States)

Walker, Judith H; Dewitt, Dawn E; Pallant, Julie F; Cunningham, Christine E

2012-01-01

Health workforce shortages are a major problem in rural areas. Australian medical schools have implemented a number of rural education and training interventions aimed at increasing medical graduates' willingness to work in rural areas. These initiatives include recruiting students from rural backgrounds, delivering training in rural areas, and providing all students with some rural exposure during their medical training. However there is little evidence regarding the impact of rural exposure versus rural origin on workforce outcomes. The aim of this study is to identify and assess factors affecting preference for future rural practice among medical students participating in the Australian Rural Clinical Schools (RCS) Program. Questionnaires were distributed to 166 medical students who had completed their RCS term in 2006; 125 (75%) responded. Medical students were asked about their preferred location and specialty for future practice, their beliefs about rural work and life, and the impact of the RCS experience on their future rural training and practice preferences. Almost half the students (47%; n=58) self-reported a 'rural background'. Significantly, students from rural backgrounds were 10 times more likely to prefer to work in rural areas when compared with other students (ppreferring general practice, 80% (n=24) wished to do so rurally. Eighty-five per cent (n=105) of students agreed that their RCS experience increased their interest in rural training and practice with 62% (n=75) of students indicating a preference for rural internship/basic training after their RCS experience. A substantial percentage (86%; n=108) agreed they would consider rural practice after their RCS experience. This baseline study provides significant evidence to support rural medical recruitment and retention through education and training, with important insights into the factors affecting preference for future rural practice. By far the most significant predictor of rural practice

Personalized Health Monitoring System for Managing Well-Being in Rural Areas.

Science.gov (United States)

Nedungadi, Prema; Jayakumar, Akshay; Raman, Raghu

2017-12-14

Rural India lacks easy access to health practitioners and medical centers, depending instead on community health workers. In these areas, common ailments that are easy to manage with medicines, often lead to medical escalations and even fatalities due to lack of awareness and delayed diagnosis. The introduction of wearable health devices has made it easier to monitor health conditions and to connect doctors and patients in urban areas. However, existing initiatives have not succeeded in providing adequate health monitoring to rural and low-literate patients, as current methods are expensive, require consistent connectivity and expect literate users. Our design considerations address these concerns by providing low-cost medical devices connected to a low-cost health platform, along with personalized guidance based on patient physiological parameters in local languages, and alerts to medical practitioners in case of emergencies. This patient-centric integrated healthcare system is designed to manage the overall health of villagers with real-time health monitoring of patients, to offer guidance on preventive care, and to increase health awareness and self-monitoring at an affordable price. This personalized health monitoring system addresses the health-related needs in remote and rural areas by (1) empowering health workers in monitoring of basic health conditions for rural patients in order to prevent escalations, (2) personalized feedback regarding nutrition, exercise, diet, preventive Ayurveda care and yoga postures based on vital parameters and (3) reporting of patient data to the patient's health center with emergency alerts to doctor and patient. The system supports community health workers in the diagnostic procedure, management, and reporting of rural patients, and functions well even with only intermittent access to Internet.

The prevalence of angina symptoms and association with cardiovascular risk factors, among rural, urban and rural to urban migrant populations in Peru

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Gilman Robert H

2010-10-01

Full Text Available Abstract Background Rural-to-urban migration in low- and middle-income countries causes an increase in individual cardiovascular risk. Cost-effective interventions at early stages of the natural history of coronary disease such as angina may stem an epidemic of premature coronary deaths in these countries. However, there are few data on the prevalence of angina in developing countries, whilst the understanding the aetiology of angina is complicated by the difficulty in measuring it across differing populations. Methods The PERU MIGRANT study was designed to investigate differences between rural-to-urban migrant and non-migrant groups in specific cardiovascular disease risk factors. Mass-migration seen in Peru from 1980s onwards was largely driven by politically motivated violence resulting in less 'healthy migrant' selection bias. The Rose angina questionnaire was used to record chest pain, which was classified definite, possible and non-exertional. Mental health was measured using the General Health Questionnaire (GHQ-12. Mantel-Haenszel odds ratios (adjusted for age, sex, cardiovascular disease risk factors and mental health were used to assess the risk of chest pain in the migrant and urban groups compared to the rural group, and further to assess the relationship (age and sex-adjusted between risk factors, mental health and chest pain. Results Compared to the urban group, rural dwellers had a greatly increased likelihood of possible/definite angina (multi-adjusted OR 2.82 (1.68- 4.73. Urban and migrant groups had higher levels of risk factors (e.g. smoking - 20.1% urban, 5.5% rural. No diabetes was seen in the rural dwellers who complained of possible/definite angina. Rural dwellers had a higher prevalence of mood disorder and the presence of a mood disorder was associated with possible/definite angina in all three groups, but not consistently with non-exertional chest pain. Conclusion Rural groups had a higher prevalence of angina as

Making space for wind farms: Practices of territorial stigmatisation in rural Denmark

DEFF Research Database (Denmark)

Rudolph, David Philipp; Kirkegaard, Julia Kirch

of territorial stigmatisation are mobilised and aligned by developers and municipalities in order to make space for and legitimise large wind farm projects in rural areas. In doing so, the paper will illustrate how stigmatisation practices are embedded in discourses of rurality as ‘Outskirts......Whilst issues of siting wind farms have mostly revolved around their public acceptance resulting from an unequal distribution of local costs and benefits, the perceived fairness of the planning process and the disruption of places, the challenge of finding adequate locations and getting access...... community involvement and ownership of wind farms, access to diminishing spatial resources reflects a key concern for developers, while putting the role of private landowners at the core of successful projects. By drawing on case studies from rural Northern Denmark it will be demonstrated how narratives...

The rural pipeline to longer-term rural practice: General practitioners and specialists.

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Marcella M S Kwan

Full Text Available 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.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.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.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

Rural transformations in the context of changing rural-urban connections

DEFF Research Database (Denmark)

Birch-Thomsen, Torben; Ørtenblad, Sinne Borby; Msese, Lukelo

, the infrastructure, including road systems and means of communication, has in general increased and improved. This development has among a number of other things caused changing patterns of mobility. These changes are highly interrelated and connected to changing rural-urban linkages, which include flows of people......, capital, resources, agricultural commodities, goods, services, technology and information, between rural and urban locations. We emphasize that the rural-urban connections go beyond the spatial dichotomy and that the linkages often occur in a dynamic rural-urban continuum. Influenced by these changes......, this paper sets out to elucidate patterns and dynamics of rural transformation in Tanzania in the context of changing rural-urban linkages by presenting data from a particularly dynamic region; namely Njombe Region in the Southern Highlands of Tanzania. Based on fieldwork conducted during 2014 and 2015...

A comparative study on indoor air quality in a low cost and a green ...

African Journals Online (AJOL)

A study on Indoor Air Quality (IAQ) is important because people spend most of their time inside houses. IAQ was monitored in two different types of rural houses namely a low cost house and a “green” house built with pyramidal shape of roof in the rural area. Carbon monoxide (CO) and Carbon Dioxide (CO2) concentrations ...

Rural-urban differences in the long-term care of the disabled elderly in China.

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Mei Li

Full Text Available BACKGROUND: In China, the rapid rate of population aging and changes in the prevalence of disability among elderly people could have significant effects on the demand for long-term care. This study aims to describe the urban-rural differences in use and cost of long-term care of the disabled elderly and to explore potential influencing factors. METHODS: This study uses data from a cross-sectional survey and a qualitative investigation conducted in Zhejiang province in 2012. The participants were 826 individuals over 60 years of age, who had been bedridden or suffered from dementia for more than 6 months. A generalized linear model and two-part regression model were applied to estimate costs, with adjustment of covariates. RESULTS: Pensions provide the main source of income for urban elderly, while the principal income source for rural elderly is their family. Urban residents spend more on all services than do rural residents. Those who are married spend less on daily supplies and formal care than the unmarried do. Age, incapacitation time, comorbidity number, level of income, and bedridden status influence spending on medical care (β=-0.0316, -0.0206, 0.1882, 0.3444, and -0.4281, respectively, but the cost does not increase as the elderly grow older. Urban residents, the married, and those with a higher income level tend to spend more on medical equipment. Urban residence and living status are the two significant factors that affect spending on personal hygiene products. CONCLUSIONS: The use of long-term care services varies by living area. Long-term care of the disabled elderly imposes a substantial burden on families. Our study revealed that informal care involves huge opportunity costs to the caregivers. Chinese policy makers need to promote community care and long-term care insurance to relieve the burden of families of disabled elderly, and particular attention should be given to the rural elderly.

Solarising tropical Africa’s rural homes to sustainably overcome energy poverty

Science.gov (United States)

Kanyarusoke, K. E.

2017-11-01

At less than 30% electrification, Tropical Africa is the most energy-poor electrified region of the world. At home level, the annual per-capita electric energy consumption ranges between 0 and 150 kWh in rural areas, where 83% of the population reside. This is well below the 250 kWh recommended by the International Energy Agency (IEA) as the threshold for exiting rural ‘Energy Poverty’. Some governments have tried to extend the grid to such areas but these efforts have not yielded much. The approaches of rural electrification - as is being done now have therefore failed - and they may not be able to electrify every home in the countries concerned. An alternative approach promoting stand-alone photovoltaic (PV) and other solar powered heat and mass transfer systems at home level is proposed. An example of the approach in a village home in rural Uganda, East Africa is given. It is estimated that the combined unit energy cost over the systems’ lifespan would be just about US 3 cents. Health, Education, and Sustainability in all its forms would be greatly improved. The main recommendation is for policy makers to adopt this approach for rural homes while sparing grid supply only for commercial and industrial activities.

The End of Rural Society and the Future of Rural Sociology.

Science.gov (United States)

Friedland, William H.

Rural sociology confronts a continuing crisis of identity because of its failure to develop a sociology of agriculture. Historically, despite an initial focus on agriculture, rural sociology became deflected to the analysis of rurality. Recent emphasis of rural sociologists on the turnaround phenomenon is symptomatic, but fails to deal with the…

78 FR 78493 - National Rural Transportation Assistance Program: Solicitation for Proposals

Science.gov (United States)

2013-12-26

... effective and efficient public transportation in rural areas. Objective 2--To support State and local...; leveraging and adopting the current technology developed and used by National RTAP in the Cloud; performing... specifies what will be the costs associated with the project. A progress report after each project quarter...

Bangkok as a magnet for rural labour: changing conditions, 1900-1970.

Science.gov (United States)

Ouyyanont, P

1998-06-01

This article describes labor force shifts, in Thailand, from rural areas to Bangkok during 1900-1970 and is a revision of a chapter from a doctoral thesis. Urban growth of Bangkok occurred primarily after World War II. Pre-war wages in rural areas were higher than coolie wages in Bangkok. Opportunity costs of changing occupations were high. Chinese immigration was the key to development of non-farm occupations. The Chinese from Siam were drawn to higher wages in Bangkok than were possible in South China ports. After the war, the Lewis-Fei and Ranis migration model fits a pattern of migration that adjusts the disequilibrium between urban and rural markets. There are shifts from low productivity rural sectors to urban high productivity sectors. Capital investment in commerce and industry raised urban labor productivity. The wage data suggest a growing gap between urban and rural sectors postwar. Rail travel during the 1950s brought higher wages for the unskilled in railroad construction. There was high agricultural productivity relative to labor input due to availability of land. Underpopulation meant little unemployment. After 1950, conditions changed. The population growth rate increased. More in rural areas lived below the poverty line. Low rice productivity constrained rural wages and incomes during the 1950s and 1960s. The more favored commercial crops needed less labor. Chinese immigration declined, and demand for labor increased in urban areas. Low urban wages due to cheap labor stimulated profits and growth. Major roads connected Bangkok to the south and the north. Bangkok was viewed as a magical and desirable place.

The role of rural libraries in the attainment of rural development ...

African Journals Online (AJOL)

The paper examines the role that rural libraries could play in the attainment of rural development with a view to accelerate growth in all areas of human endeavors in rural areas of Nigeria. The study took cognizance of inherent problems that undermine the establishment of rural libraries such as funding, illiteracy, clientele ...

Teaching by videoconference: a commentary on best practice for rural education in health professions.

Science.gov (United States)

Birden, Hudson; Page, Sue

2005-01-01

This article offers a primer on how to get started in videoconferencing, focusing on practical approaches to technical and protocol issues. The technical capabilities of videoconferencing systems, linked with initiatives supporting greater rural access to broadband, means videoconferencing is expanding rapidly as a health education tool. Forethought allows the purchase of the most appropriate equipment, reducing costs overall and increasing the functionality of the system. Adherence to simple matters, including etiquette, ensures the experience is enjoyable as well as educational. Consideration should be given to the role of videoconferencing in expanding the social as well as academic opportunities for rural clinicians and students. Videoconferencing is a useful adjunct to traditional educational delivery modes, and can enable quality education opportunities that would be prohibitive due to time, travel, and cost constraints.

Effects of rural-urban youth migration on farm families in Benue state, Nigeria

Directory of Open Access Journals (Sweden)

E.N. Mbah

2016-06-01

Full Text Available The study was assessed to determine the effects of rural-urban youth migration on farm families in Benue state, Nigeria during November 2014 to June 2015. Interview schedule was used to collect data from a sample of 80 respondents. Data were analyzed using frequency, percentage, mean scores and standard deviation. Results indicate that majority (76.3% of the respondents were males, middle aged and married. Major causes of rural-urban youth migration indicated by the respondents include inadequate employment opportunities in rural areas (M=3.6, search for better education (M=3.5, inadequate social infrastructure such as schools (M=3.4, poor medical care services in rural areas (M=3.4, looking for money through labour (M=3.4, apprenticeship programme (M=3.2, etc. Findings of the study also indicate that reduction of agricultural labour force (M=3.5, low agricultural productivity (M=3.3, high cost of labour (M= 3.3, reduction on demand for locally grown foods (M=2.9, decrease in dependency ratio in the rural areas (M=2.7, reduction on number of mouths to feed (M=2.7, among others were major effects of rural-urban youth migration among farm families. The study recommends that Nigerian government should provide adequate physical and social infrastructure in rural areas in order to encourage youths to remain in agriculture, reduce rural-urban youth migration as well as sustain agriculture for enhanced food security.

Appropriate technology for solar energy system aiming water heating for human bath in houses of rural areas; Tecnologia apropriada para sistema de energia solar visando aquecimento de agua para o banho humano em moradias do meio rural

Energy Technology Data Exchange (ETDEWEB)

Rispoli, Italo Alberto Gatica [Universidade Estadual de Campinas (UNICAMP), SP (Brazil). Faculdade de Engenharia Civil, Arquitetura e Urbanismo], e-mail: gatica@dglnet.com.br; Mariotoni, Carlos Alberto [Universidade Estadual de Campinas (UNICAMP), SP (Brazil). Fac. de Engenharia Civil, Arquitetura e Urbanismo. Nucleo Interdisciplinar de Planejamento Energetico], e-mail: cam@fec.unicamp.br

2004-07-01

The Brazilian land receives a great amount of solar radiation all over the year, therefore, because both the culture and practical aspects, Brazilians use in a non-moderate way the electricity to boil the water for human bath in the rural homes, in the lower income residences even at part of the medium class homes. That happens due to the very low price of an electrical shower, about US$ 6,5. In fact, that way of heating water is largely used because, besides the very low electrical shower price, it is not necessary to install a complete hot water both hydraulic and electrical building systems, but just both single hydraulic pipes and electrical devices. On the other hands, at rural regions where the electricity does not achieve the rural people uses firewood in order to get hot water for human bath. At the rural places the use of electrical showers has meaning an increase in the electrical transformers powers, heavier electrical transmission rural lines, with greater prices and, at the urban zones, the use of electrical showers in the lower social classes has contributed to a more expressive electrical load at the nacional electrical system load peck, between 5:30 to 8:30 a.m. The public administration, mostly, does not take into account both social, economic and environmental costs in order to think about the electricity offer. The solar heating systems, generally used in Brazil, conserves the same reservoirs used in France at 1880. Therefore, this paper presents some technical subsidies applied to rural homes, even to lower income people's homes aiming to stimulate the Brazilian public authorities to make a public police to facilitate both the industrialization and dissemination of solar heating systems, appropriate to the rural area, with lower costs, compounded by good technology equipment, with guarantee of lasting and quality. (author)

Implementing an anti-smoking program in rural-remote communities: challenges and strategies.

Science.gov (United States)

Tall, Julie A; Brew, Bronwyn K; Saurman, Emily; Jones, Therese C

2015-01-01

Rural-remote communities report higher smoking rates and poorer health outcomes than that of metropolitan areas. While anti-smoking programs are an important measure for addressing smoking and improving health, little is known of the challenges faced by primary healthcare staff implementing those programs in the rural-remote setting. The aim of this study was to explore the challenges and strategies of implementing an anti-smoking program by primary healthcare staff in rural-remote Australia. Guided by a phenomenological approach, semi-structured interviews and focus groups were conducted with health service managers, case managers and general practitioners involved in program implementation in Australian rural-remote communities between 2008 and 2010. Program implementation was reported to be challenged by limited primary and mental healthcare resources and client access to services; limited collaboration between health services; the difficulty of accessing staff training; high levels of community distress and disadvantage; the normalisation of smoking and its deleterious impact on smoking abstinence among program clients; and low morale among health staff. Strategies identified to overcome challenges included appointing tobacco-dedicated staff; improving health service collaboration, access and flexibility; providing subsidised pharmacotherapies and boosting staff morale. Findings may assist health services to better tailor anti-smoking programs for the rural-remote setting, where smoking rates are particularly high. Catering for the unique challenges of the rural-remote setting is necessary if anti-smoking programs are to be efficacious, cost-effective and capable of improving rural-remote health outcomes.

Rural residents' perspectives on the rural 'good death': a scoping review.

Science.gov (United States)

Rainsford, Suzanne; MacLeod, Roderick D; Glasgow, Nicholas J; Wilson, Donna M; Phillips, Christine B; Wiles, Robert B

2018-05-01

The 'good death' is one objective of palliative care, with many 'good death' viewpoints and research findings reflecting the urban voice. Rural areas are distinct and need special consideration. This scoping review identified and charted current research knowledge on the 'good' rural death through the perspectives of rural residents, including rural patients with a life-limiting illness, to identify evidence and gaps in the literature for future studies. A comprehensive literature search of English language articles (no date filter applied) was conducted in 2016 (2 January to 14 February) using five library databases. Reference lists of included articles, recent issues of eight relevant journals and three grey literature databases were also hand-searched. Twenty articles (for 17 studies and one systematic review) were identified after a two-phase screening process by two reviewers, using pre-determined inclusion criteria. Data from each study were extracted and charted, analysed using a thematic analysis of the included articles' content, and with a quantitative analysis of the scoping review. These papers revealed data collected from rural patients with a life-limiting illness and family caregivers, rural healthcare providers, the wider rural community, rural community leaders and rural health administrators and policy makers. Rural locations were heterogeneous. Residents from developed and developing countries believe a 'good death' is one that is peaceful, free of pain and without suffering; however, this is subjective and priorities are based on personal, cultural, social and religious perspectives. Currently, there is insufficient data to generalise rural residents' perspectives and what it means for them to die well. Given the extreme importance of a 'good death', there is a need for further studies to elicit rural patient and family caregiver perspectives. © 2016 John Wiley & Sons Ltd.

Impact of the introduction of a colposcopy service in a rural South ...

African Journals Online (AJOL)

Africa, and assess its impact on colposcopy uptake. Design. A retrospective double-group cohort .... existing diathermy machine with disposable large loop excision of the transformation zone (LLETZ) loops and ..... What is the least costly strategy to evaluate cervical abnormalities in rural women? Comparing telemedicine ...

LO RURAL. UN CAMPO INACABADO THE RURAL AREA: AN UNFINISHED “FIELD”

Directory of Open Access Journals (Sweden)

Nelly del Carmen Suárez Restrepo

2008-12-01

Full Text Available El surgimiento de nuevas lecturas de la realidad social rural latinoamericana, e incluso europea, y los efectos de las políticas internacionales sobre qué producir, cuánto, cómo y dónde, han puesto en la agenda académica el debate entorno al significado y contenido de lo rural y del desarrollo rural. En el centro de esta controversia está la superación o ruptura entre lo rural y lo agrario, dos términos otrora considerados como sinónimos. Trascender esta dicotomía reduccionista abre la posibilidad de repensar los caminos y las estrategias mediante las cuales las sociedades en general, en sus esfuerzos por autoproducirse crean condiciones de vida, proveen recursos necesarios y pertinentes y movilizan las capacidades y las libertades de los pobladores rurales. Este documento recoge los elementos más sobresalientes de la investigación “Repensando lo rural y el desarrollo rural” en la que se hizo una revisión de literatura sobre el tema y se buscó, mediante entrevistas semiestructuradas³, la participación de funcionarios institucionales, representantes gremiales y académicos. En términos generales se pretendía identificar los significados y los contenidos que se atribuyen a lo rural y al desarrollo rural. El texto se organiza en tres partes: En la primera parte, Reiteración o resignificación, se analizan los posibles avances y permanencias en los significados y contenidos de lo rural y del desarrollo rural. En la segunda, denominada Elementos constitutivos del desarrollo rural, se hace referencia a las dimensiones, los indicadores y los actores identificados mediante la información obtenida. En la tercera parte, se establece una relación entre el discurso y las prácticas de desarrollo en Colombia y sus implicaciones en el diseño de políticas públicas. Finalmente se concluye que el desarrollo rural ha tenido como trasfondo una orientación modernizadora de la sociedad rural en general y del sector agrario en particular

Pedagogy of the Rural: Implications of Size on Conceptualisations of Rural

Science.gov (United States)

Walker-Gibbs, Bernadette; Ludecke, Michelle; Kline, Jodie

2015-01-01

This paper proposes a concept of Pedagogy of the Rural that draws together current rural education theory and practice to illustrate the complexities of rural space and place often overlooked in teacher education more broadly. We firstly examine notions of size, and then we explore how this impacts on the ways in which teachers in rural locations…

Women's access needs in maternity care in rural Tasmania, Australia: a mixed methods study.

Science.gov (United States)

Hoang, Ha; Le, Quynh; Terry, Daniel

2014-03-01

This study investigates (i) maternity care access issues in rural Tasmania, (ii) rural women's challenges in accessing maternity services and (iii) rural women's access needs in maternity services. A mixed-method approach using a survey and semi-structured interviews was conducted. The survey explored women's views of rural maternity services from antenatal to postnatal care, while interviews reinforced the survey results and provided insights into the access issues and needs of women in maternity care. The survey was completed by n=210 women, with a response rate of 35%, with n=22 follow-up interviews being conducted. The survey indicated the majority of rural women believed antenatal education and check-ups and postnatal check-ups should be provided locally. The majority of women surveyed also believed in the importance of having a maternity unit in the local hospital, which was further iterated and clarified within the interviews. Three main themes emerged from the interview data, namely (i) lack of access to maternity services, (ii) difficulties in accessing maternity services, and (iii) rural women's access needs. The study suggested that women's access needs are not fully met in some rural areas of Tasmania. Rural women face many challenges when accessing maternity services, including financial burden and risk of labouring en route. The study supports the claim that the closure of rural maternity units shifts cost and risk from the health care system to rural women and their families. Copyright © 2013 Australian College of Midwives. Published by Elsevier Ltd. All rights reserved.

Multidisciplinary chronic pain management in a rural Canadian setting.

Science.gov (United States)

Burnham, Robert; Day, Jeremiah; Dudley, Wallace

2010-01-01

Chronic pain is prevalent, complex and most effectively treated by a multidisciplinary team, particularly if psychosocial issues are dominant. The limited access to and high costs of such services are often prohibitive for the rural patient. We describe the development and 18-month outcomes of a small multidisciplinary chronic pain management program run out of a physician's office in rural Alberta. The multidisciplinary team consisted of a family physician, physiatrist, psychologist, physical therapist, kinesiologist, nurse and dietician. The allied health professionals were involved on a part-time basis. The team triaged referral information and patients underwent either a spine or medical care assessment. Based on the findings of the assessment, the team managed the care of patients using 1 of 4 methods: consultation only, interventional spine care, supervised medication management or full multidisciplinary management. We prospectively and serially recorded self-reported measures of pain and disability for the supervised medication management and full multidisciplinary components of the program. Patients achieved clinically and statistically significant improvements in pain and disability. Successful multidisciplinary chronic pain management services can be provided in a rural setting.

A HEDONIC APPROACH TO ESTIMATING OPERATION AND MAINTENANCE COSTS FOR NEW YORK MUNICIPAL WATER SYSTEMS

OpenAIRE

Schmit, Todd M.; Boisvert, Richard N.

1997-01-01

A hedonic cost function is used to isolate the operation and maintenance costs for water treatments. For small systems, costs are substantial for some technologies, but not for others. When regional differences in input costs are accounted for, small systems located in rural areas may have a cost advantage over similar systems closer to urban centers; however, costs of water treatment to meet Safe Drinking Water Act amendments may still be substantial.

Non-farm entrepreneurship in rural sub-Saharan Africa: New empirical evidence.

Science.gov (United States)

Nagler, Paula; Naudé, Wim

2017-02-01

We report on the prevalence and patterns of non-farm enterprises in six sub-Saharan African countries, and study their performance in terms of labor productivity, survival and exit, using the World Bank's Living Standards Measurement Study - Integrated Surveys on Agriculture (LSMS-ISA). Rural households operate enterprises due to both push and pull factors and tend to do so predominantly in easy-to-enter activities, such as sales and trade, rather than in activities that require higher starting costs, such as transport services, or educational investment, such as professional services. Labor productivity differs widely: rural and female-headed enterprises, those located further away from population centers, and businesses that operate intermittently have lower levels of labor productivity compared to urban and male-owned enterprises, or enterprises that operate throughout the year. Finally, rural enterprises exit the market primarily due to a lack of profitability or finance, and due to idiosyncratic shocks.

The Impact of Expanding Access to Early Childhood Education Services in Rural Indonesia

NARCIS (Netherlands)

Brinkman, S.A.; Hasan, A.; Jung, H.; Kinnell, A.; Pradhan, M.

2017-01-01

This paper examines the effects of an intervention that expanded access to low-cost, government-sponsored, community-based playgroups in rural Indonesia. Instrumental variables and difference-in-differences models indicate that while the intervention raised enrollment rates and durations of

The impact of expanding access to early childhood education services in rural Indonesia

NARCIS (Netherlands)

Brinkman, Sally Anne; Hasan, Amer; Jung, Haeil; Kinnell, Angela; Pradhan, M.P.

2017-01-01

This paper examines the effects of an intervention that expanded access to low-cost, government-sponsored, community-based playgroups in rural Indonesia. Instrumental variables and difference-in-differences models indicate that while the intervention raised enrollment rates and durations of

Rural-Urban Differences in Household Treatment-Seeking Behaviour for Suspected Malaria in Children at Bata District, Equatorial Guinea.

Directory of Open Access Journals (Sweden)

Maria Romay-Barja

Full Text Available Malaria remains a major cause of morbidity and mortality among children under five years old in Equatorial Guinea. However, little is known about the community management of malaria and treatment-seeking patterns. We aimed to assess symptoms of children with reported malaria and treatment-seeking behaviour of their caretakers in rural and urban areas in the Bata District.A cross-sectional study was conducted in the district of Bata and 440 houses were selected from 18 rural villages and 26 urban neighbourhoods. Differences between rural and urban caregivers and children with reported malaria were assessed through the chi-squared test for independence of categorical variables and the t-Student or the non-parametric Mann-Whitney test for normally or not-normally distributed continuous variables, respectively.Differences between rural and urban households were observed in caregiver treatment-seeking patterns. Fever was the main symptom associated with malaria in both areas. Malaria was treated first at home, particularly in rural areas. The second step was to seek treatment outside the home, mainly at hospital and Health Centre for rural households and at hospital and private clinic for urban ones. Artemether monotherapy was the antimalarial treatment prescribed most often. Households waited for more than 24 hours before seeking treatment outside and delays were longest in rural areas. The total cost of treatment was higher in urban than in rural areas in Bata.The delays in seeking treatment, the type of malaria therapy received and the cost of treatment are the principal problems found in Bata District. Important steps for reducing malaria morbidity and mortality in this area are to provide sufficient supplies of effective antimalarial drugs and to improve malaria treatment skills in households and in both public and private sectors.

Mapping the availability and accessibility of healthy food in rural and urban New Zealand--Te Wai o Rona: Diabetes Prevention Strategy.

Science.gov (United States)

Wang, Jing; Williams, Margaret; Rush, Elaine; Crook, Nic; Forouhi, Nita G; Simmons, David

2010-07-01

Uptake of advice for lifestyle change for obesity and diabetes prevention requires access to affordable 'healthy' foods (high in fibre/low in sugar and fat). The present study aimed to examine the availability and accessibility of 'healthy' foods in rural and urban New Zealand. We identified and visited ('mapped') 1230 food outlets (473 urban, 757 rural) across the Waikato/Lakes areas (162 census areas within twelve regions) in New Zealand, where the Te Wai O Rona: Diabetes Prevention Strategy was underway. At each site, we assessed the availability of 'healthy' foods (e.g. wholemeal bread) and compared their cost with those of comparable 'regular' foods (e.g. white bread). Healthy foods were generally more available in urban than rural areas. In both urban and rural areas, 'healthy' foods were more expensive than 'regular' foods after adjusting for the population and income level of each area. For instance, there was an increasing price difference across bread, meat, poultry, with the highest difference for sugar substitutes. The weekly family cost of a 'healthy' food basket (without sugar) was 29.1% more expensive than the 'regular' basket ($NZ 176.72 v. $NZ 136.84). The difference between the 'healthy' and 'regular' basket was greater in urban ($NZ 49.18) than rural areas ($NZ 36.27) in adjusted analysis. 'Healthy' foods were more expensive than 'regular' choices in both urban and rural areas. Although urban areas had higher availability of 'healthy' foods, the cost of changing to a healthy diet in urban areas was also greater. Improvement in the food environment is needed to support people in adopting healthy food choices.

Urban-rural inequality regarding drug prescriptions in primary care facilities - a pre-post comparison of the National Essential Medicines Scheme of China.

Science.gov (United States)

Yao, Qiang; Liu, Chaojie; Ferrier, J Adamm; Liu, Zhiyong; Sun, Ju

2015-07-30

To assess the impact of the National Essential Medicines Scheme (NEMS) with respect to urban-rural inequalities regarding drug prescriptions in primary care facilities. A stratified two-stage random sampling strategy was used to sample 23,040 prescriptions from 192 primary care facilities from 2009 to 2010. Difference-in-Difference (DID) analyses were performed to test the association between NEMS and urban-rural gaps in prescription patterns. Between-Group Variance and Theil Index were calculated to measure urban-rural absolute and relative disparities in drug prescriptions. The use of the Essential Medicines List (EML) achieved a compliance rate of up to 90% in both urban and rural facilities. An overall reduction of average prescription cost improved economic access to drugs for patients in both areas. However, we observed an increased urban-rural disparity in average expenditure per prescription. The rate of antibiotics and glucocorticoids prescription remained high, despite a reduced disparity between urban and rural facilities. The average incidence of antibiotic prescription increased slightly in urban facilities (62 to 63%) and reduced in rural facilities (67% to 66%). The urban-rural disparity in the use of parenteral administration (injections and infusions) increased, albeit at a high level in both areas (44%-52%). NEMS interventions are effective in reducing the overall average prescription costs. Despite the increased use of the EML, indicator performances with respect to rational drug prescribing and use remain poor and exceed the WHO/INRUD recommended cutoff values and worldwide benchmarks. There is an increased gap between urban and rural areas in the use of parenteral administration and expenditure per prescription.

Nutritionally Optimized, Culturally Acceptable, Cost-Minimized Diets for Low Income Ghanaian Families Using Linear Programming.

Science.gov (United States)

Nykänen, Esa-Pekka A; Dunning, Hanna E; Aryeetey, Richmond N O; Robertson, Aileen; Parlesak, Alexandr

2018-04-07

The Ghanaian population suffers from a double burden of malnutrition. Cost of food is considered a barrier to achieving a health-promoting diet. Food prices were collected in major cities and in rural areas in southern Ghana. Linear programming (LP) was used to calculate nutritionally optimized diets (food baskets (FBs)) for a low-income Ghanaian family of four that fulfilled energy and nutrient recommendations in both rural and urban settings. Calculations included implementing cultural acceptability for families living in extreme and moderate poverty (food budget under USD 1.9 and 3.1 per day respectively). Energy-appropriate FBs minimized for cost, following Food Balance Sheets (FBS), lacked key micronutrients such as iodine, vitamin B12 and iron for the mothers. Nutritionally adequate FBs were achieved in all settings when optimizing for a diet cheaper than USD 3.1. However, when delimiting cost to USD 1.9 in rural areas, wild foods had to be included in order to meet nutritional adequacy. Optimization suggested to reduce roots, tubers and fruits and to increase cereals, vegetables and oil-bearing crops compared with FBS. LP is a useful tool to design culturally acceptable diets at minimum cost for low-income Ghanaian families to help advise national authorities how to overcome the double burden of malnutrition.

The economic burden of smoking and secondhand smoke exposure in rural South-West China.

Science.gov (United States)

Cai, Le; Cui, Wenlong; He, Jianhui; Wu, Xinan

2014-06-01

To estimate the direct and indirect costs of chronic diseases attributed to smoking and exposure to secondhand smoke (SHS) in a given year (2011) in rural southwest China. A prevalence-based, disease-specific attributable-risk approach was used to estimate the economic burden of chronic diseases attributable to both smoking and exposure to secondhand smoke (SHS). A cross-sectional questionnaire survey of 17 158 consenting adults aged ≥18 years was used to derive prevalence of smoking and exposure to SHS, as well as direct and indirect costs of chronic diseases. In the study population, the prevalence rates of smoking and exposure to SHS are 73.1 and 38.2% for males and 1.4 and 43.4% for females, respectively. The total costs of illness are $25.85 million for COPD, $18.80 million for asthma, $37.25 million for CHD, $17.91 million for stroke, $264.35 million for hypertension and $17.11 million for peptic ulcer. The estimated costs attributable to smoking and exposure to SHS are $95.51 million and $79.35 million, accounting for 7.15 and 5.94% of local healthcare costs, respectively. Of the total costs of tobacco, direct costs and indirect costs are $94.66 million and $0.85 million for smoking, and $78.22 million and $1.36 million for exposure to SHS. Smoking contributes more cost of illness than exposure to SHS in men, whereas exposure to SHS contributes more cost of illness than smoking in women. Smoking and exposure to SHS produce substantial economic burden as well as have a considerable public health impact in rural southwest China.

The Role of Institutional Support in Energy Technology Diffusion in Rural China

NARCIS (Netherlands)

Zhang, X.L.; van Groenendaal, W.J.H.

2001-01-01

In the past China's rural areas, home to 70% of its population, suffered energy shortages.China's indigenous energy resources are limited, with the exception of coal.The widespread use of coal requires large investments in production and transport -making it costly-, and degrades the environment.As

Pregnancy experiences of women in rural Romania: understanding ethnic and socioeconomic disparities.

Science.gov (United States)

LeMasters, Katherine; Baber Wallis, Anne; Chereches, Razvan; Gichane, Margaret; Tehei, Ciprian; Varga, Andreea; Tumlinson, Katherine

2018-05-15

Women in rural Romania face significant health disadvantages. This qualitative pilot study describes the structural disadvantage experienced during pregnancy by women in rural Romania, focusing on the lived experiences of Roma women. We explore how women in rural communities experience pregnancy, their interactions with the healthcare system, and the role that ethnic and social factors play in pregnancy and childbearing. We conducted 42 semi-structured interviews with health and other professionals, seven narrative interviews with Roma and non-Roma women and a focus group with Roma women. Data were analysed using thematic analysis. We identified intersectional factors associated with women's pregnancy experiences: women perceiving pregnancy as both unplanned and wanted, joyful, and normal; women's and professionals' differing prenatal care perceptions; transport and cost related barriers to care; socioeconomic and ethnic discrimination; and facilitators to care such as social support, having a health mediator and having a doctor. Talking directly with professionals and Roma and non-Roma women helped us understand these many factors, how they are interconnected, and how we can work towards improving the pregnancy experiences of Roma women in rural Romania.

Red Rural, Blue Rural: The Geography of Presidential Voting in Rural America

Science.gov (United States)

Scala, Dante J.; Johnson, Kenneth M.

2016-01-01

Political commentators routinely treat rural America as an undifferentiated bastion of strength for Republicans. In fact, rural America is a deceptively simple term describing a remarkably diverse collection of places encompassing nearly 75 percent of the U.S. land area and 50 million people. Voting trends in this vast area are far from…

Measuring the economic cost of malaria to households in Sri Lanka

DEFF Research Database (Denmark)

Konradsen, F; Hoek, Wim van der; Amerasinghe, P H

1997-01-01

. In estimating the socioeconomic impact of malaria and in measuring cost-benefits of malaria control interventions, these costs have to be considered together with direct expenditures incurred by households such as on treatment and travel and with costs for the service providers.......The economic cost at the household level of labor days lost due to malaria and other illnesses was estimated in a rural community in Sri Lanka. Over a one-year period, 223 episodes of malaria were recorded from the 298 inhabitants of the village. Based on daily activity records, the economically...

Teaching pathology via online digital microscopy: positive learning outcomes for rurally based medical students.

Science.gov (United States)

Sivamalai, Sundram; Murthy, Shashidhar Venkatesh; Gupta, Tarun Sen; Woolley, Torres

2011-02-01

Technology has revolutionised teaching. Teaching pathology via digital microscopy (DM) is needed to overcome increasing student numbers, a shortage of pathology academics in regional medical schools, and difficulties with teaching students on rural clinical placement. To identify whether an online DM approach, combining digital pathology software, Web-based slides and classroom management software, delivers effective, practical pathology teaching sessions to medical students located both on campus and on rural placement. An online survey collected feedback from fourth and fifth year undergraduate James Cook University medical students on the importance of 16 listed benefits and challenges of using online DM to teach pathology, via a structured five-point Likert survey. Fifty-three students returned the survey (response rate = 33%). Benefits of online DM to teach pathology rated as 'very important' or 'extremely important' by over 50% of students included: higher quality images; faster learning; more convenient; better technology; everyone sees the same image; greater accessibility; helpful annotations on slides; cost savings; and more opportunity for self-paced learning out-of-hours and for collaborative learning in class. Challenges of online DM rated as 'very important' or 'extremely important' by over 50% of students included: Internet availability in more remote locations and potential problems using online technology during class. Nearly all medical students welcomed learning pathology via online digital technology. DM should improve the quantity, quality, cost and accessibility of pathology teaching by regional medical schools, and has significant implications for the growing emphasis in Australia for decentralised medical education and rural clinical placements. © 2011 The Authors. Australian Journal of Rural Health © National Rural Health Alliance Inc.

Economies of scale and firm size optimum in rural water supply

Science.gov (United States)

Sauer, Johannes

2005-11-01

This article is focused on modeling and analyzing the cost structure of water-supplying companies. A cross-sectional data set was collected with respect to water firms in rural areas of former East and West Germany. The empirical data are analyzed by applying a symmetric generalized McFadden (SGM) functional form. This flexible functional form allows for testing the concavity required by microeconomic theory as well as the global imposition of such curvature restrictions without any loss of flexibility. The original specification of the SGM cost function is modified to incorporate fixed factors of water production and supply as, for example, groundwater intake or the number of connections supplied. The estimated flexible and global curvature correct cost function is then used to derive scale elasticities as well as the optimal firm size. The results show that no water supplier in the sample produces at constant returns to scale. The optimal firm size was found to be on average about three times larger than the existing one. These findings deliver evidence for the hypothesis that the legally set supplying areas, oriented at public administrative criteria as well as local characteristics of water resources, are economically inefficient. Hence structural inefficiency in the rural water sector is confirmed to be policy induced.

The one-year attributable cost of post-stroke dysphagia.

Science.gov (United States)

Bonilha, Heather Shaw; Simpson, Annie N; Ellis, Charles; Mauldin, Patrick; Martin-Harris, Bonnie; Simpson, Kit

2014-10-01

With the recent emphasis on evidence-based practice and healthcare reform, understanding the cost of dysphagia management has never been more important. It is helpful for clinicians to understand and objectively report the costs associated with dysphagia when they advocate for their services in this economy. Having carefully estimated cost of illness, inputs are needed for cost-effectiveness analyses that help support the value of treatments. This study sought to address this issue by examining the 1-year cost associated with a diagnosis of dysphagia post-stroke in South Carolina. Furthermore, this study investigated whether ethnicity and residence differences exist in the cost of dysphagia post-stroke. Data on 3,200 patients in the South Carolina Medicare database from 2004 who had ICD-9 codes for ischemic stroke, 434 and 436, were retrospectively included in this study. Differences between persons with and without dysphagia post-stroke were compared with respect to age, gender, ethnicity, mortality, length of stay, comorbidity, rurality, discharge disposition, and cost to Medicare. Univariate analyses and a gamma-distributed generalized linear multivariable model with a log link function were completed. We found that the 1-year cost to Medicare for persons with dysphagia post ischemic stroke was $4,510 higher than that for persons without dysphagia post ischemic stroke when controlling for age, comorbidities, ethnicity, and proportion of time alive. Univariate analysis revealed that rurality, ethnicity, and gender were not statistically significantly different in comparisons of individuals with or without dysphagia post-stroke. Post-stroke dysphagia significantly increases post-stroke medical expenses. Understanding the expenditures associated with post-stroke dysphagia is helpful for optimal allocation and use of resources. Such information is needed to conduct cost-effectiveness studies.

The One-Year Attributable Cost of Post-Stroke Dysphagia

Science.gov (United States)

Bonilha, Heather Shaw; Simpson, Annie N.; Ellis, Charles; Mauldin, Patrick; Martin-Harris, Bonnie; Simpson, Kit

2014-01-01

With the recent emphasis on evidence-based practice and healthcare reform, understanding the cost of dysphagia management has never been more important. It is helpful for clinicians to understand and objectively report the costs associated with dysphagia when they advocate for their services in this economy. Having carefully estimated cost of illness, inputs are needed for cost-effectiveness analyses that help support the value of treatments. This study sought to address this issue by examining the 1-year cost associated with a diagnosis of dysphagia post-stroke in South Carolina. Furthermore, this study investigated whether ethnicity and residence differences exist in the cost of dysphagia post-stroke. Data on 3,200 patients in the South Carolina Medicare database from 2004 who had ICD-9 codes for ischemic stroke, 434 and 436, were retrospectively included in this study. Differences between persons with and without dysphagia post-stroke were compared with respect to age, gender, ethnicity, mortality, length of stay, comorbidity, rurality, discharge disposition, and cost to Medicare. Univariate analyses and a gamma-distributed generalized linear multivariable model with a log link function were completed. We found that the 1-year cost to Medicare for persons with dysphagia post ischemic stroke was $4,510 higher than that for persons without dysphagia post ischemic stroke when controlling for age, comorbidities, ethnicity, and proportion of time alive. Univariate analysis revealed that rurality, ethnicity, and gender were not statistically significantly different in comparisons of individuals with or without dysphagia post-stroke. Post-stroke dysphagia significantly increases post-stroke medical expenses. Understanding the expenditures associated with post-stroke dysphagia is helpful for optimal allocation and use of resources. Such information is needed to conduct cost-effectiveness studies. PMID:24948438

Knowledge of heart attack and stroke symptomology: a cross-sectional comparison of rural and non-rural US adults

Directory of Open Access Journals (Sweden)

Swanoski Michael T

2012-06-01

Full Text Available Abstract Background Understanding the signs and symptoms of heart attacks and strokes are important not only in saving lives, but also in preserving quality of life. Findings from recent research have yielded that the prevalence of cardiovascular disease risk factors are higher in rural populations, suggesting that adults living in rural locales may be at higher risk for heart attack and/or stroke. Knowledge of heart attack and stroke symptomology as well as calling 911 for a suspected heart attack or stroke are essential first steps in seeking care. This study sought to examine the knowledge of heart attack and stroke symptoms among rural adults in comparison to non-rural adults living in the U.S. Methods Using multivariate techniques, a cross-sectional analysis of an amalgamated multi-year Behavioral Risk Factor Surveillance Survey (BRFSS database was performed. The dependent variable for this analysis was low heart attack and stroke knowledge score. The covariates for the analysis were: age, sex, race/ethnicity, annual household income, attained education, health insurance status, having a health care provider (HCP, timing of last routine medical check-up, medical care deferment because of cost, self-defined health status and geographic locale. Results The weighted n for this study overall was 103,262,115 U.S. adults > =18 years of age. Approximately 22.0% of these respondents were U.S. adults living in rural locales. Logistic regression analysis revealed that those U.S. adults who had low composite heart attack and stroke knowledge scores were more likely to be rural (OR = 1.218 95%CI 1.216-1.219 rather than non-rural residents. Furthermore, those with low scores were more likely to be: male (OR = 1.353 95%CI 1.352-1.354, >65 years of age (OR = 1.369 95%CI 1.368-1.371, African American (OR = 1.892 95%CI 1.889-1.894, not educated beyond high school (OR = 1.400 955CI 1.399-1.402, uninsured (OR = 1.308 95%CI 1

Connecting College Learners with Rural Entrepreneurship Opportunities: The Rural Entrepreneurship Teaching Unit

Science.gov (United States)

Frazier, Barbara J.; Niehm, Linda S.; Stoel, Leslie

2012-01-01

The Rural Entrepreneurship Teaching Unit (RETU) is designed to acquaint university retailing and hospitality majors with rural entrepreneurship opportunities. The unit is an outcome of a federal grant focused on the contribution of the local retail sector to rural community resilience. The RETU integrates knowledge regarding rural development,…

Final Report for Harvesting a New Wind Crop: Innovative Economic Approaches for Rural America

Energy Technology Data Exchange (ETDEWEB)

Susan Innis; Randy Udall; Project Officer - Keith Bennett

2005-09-30

Final Report for ''Harvesting a New Wind Crop: Innovative Economic Approaches for Rural America'': This project, ''Harvesting a New Wind Crop'', helped stimulate wind development by rural electric cooperatives and municipal utilities in Colorado. To date most of the wind power development in the United States has been driven by large investor-owned utilities serving major metropolitan areas. To meet the 5% by 2020 goal of the Wind Powering America program the 2,000 municipal and 900 rural electric cooperatives in the country must get involved in wind power development. Public power typically serves rural and suburban areas and can play a role in revitalizing communities by tapping into the economic development potential of wind power. One barrier to the involvement of public power in wind development has been the perception that wind power is more expensive than other generation sources. This project focused on two ways to reduce the costs of wind power to make it more attractive to public power entities. The first way was to develop a revenue stream from the sale of green tags. By selling green tags to entities that voluntarily support wind power, rural coops and munis can effectively reduce their cost of wind power. Western Resource Advocates (WRA) and the Community Office for Resource Efficiency (CORE) worked with Lamar Light and Power and Arkansas River Power Authority to develop a strategy to use green tags to help finance their wind project. These utilities are now selling their green tags to Community Energy, Inc., an independent for-profit marketer who in turn sells the tags to consumers around Colorado. The Lamar tags allow the University of Colorado-Boulder, the City of Boulder, NREL and other businesses to support wind power development and make the claim that they are ''wind-powered''. This urban-rural partnership is an important development for the state of Colorado's rural communities

Lack of CT scanner in a rural emergency department increases inter-facility transfers: a pilot study.

Science.gov (United States)

Bergeron, Catherine; Fleet, Richard; Tounkara, Fatoumata Korika; Lavallée-Bourget, Isabelle; Turgeon-Pelchat, Catherine

2017-12-28

Rural emergency departments (EDs) are an important gateway to care for the 20% of Canadians who reside in rural areas. Less than 15% of Canadian rural EDs have access to a computed tomography (CT) scanner. We hypothesized that a significant proportion of inter-facility transfers from rural hospitals without CT scanners are for CT imaging. Our objective was to assess inter-facility transfers for CT imaging in a rural ED without a CT scanner. We selected a rural ED that offers 24/7 medical care with admission beds but no CT scanner. Descriptive statistics were collected from 2010 to 2015 on total ED visits and inter-facility transfers. Data was accessible through hospital and government databases. Between 2010 and 2014, there were respectively 13,531, 13,524, 13,827, 12,883, and 12,942 ED visits, with an average of 444 inter-facility transfers. An average of 33% (148/444) of inter-facility transfers were to a rural referral centre with a CT scan, with 84% being for CT scan. Inter-facility transfers incur costs and potential delays in patient diagnosis and management, yet current databases could not capture transfer times. Acquiring a CT scan may represent a reasonable opportunity for the selected rural hospital considering the number of required transfers.

Influência do capital social no mercado de crédito rural

Directory of Open Access Journals (Sweden)

Roberto Arruda de Souza Lima

2005-03-01

Full Text Available O trabalho analisa o efeito do capital social sobre o volume de negócios no mercado de crédito rural. No caso do crédito rural, o intermediário financeiro maximizador de lucro depara com uma importante restrição a este objetivo: historicamente, a taxa de juros nesse mercado tem sido fixada, pelo governo, abaixo do equilíbrio de mercado. Assim, o problema relevante para o intermediário financeiro é a minimização do seu custo. A hipótese, que foi verificada econometricamente (utilizando, para isso, um modelo de lógite, é que, ao contribuir para a redução dos custos transacionais, o nível de capital social afeta o volume de crédito rural. Assim, incentivos, em especial com apoio do setor público, para formação e manutenção de capital social permitiriam aumento da eficiência da intermediação financeira e, em conseqüência, maior desenvolvimento do setor rural.This study analyses the effect of social capital on the volume of contracts in the rural credit market. It discusses how social capital contributes to the reduction of financial intermediation's transaction costs. A logit regression model was used to empirically test the effect of social capital on the volume of rural credit. The results indicate that the level of social capital affects the amount of rural credit. Thus, incentives to further increase and maintain social capital would increment the efficiency of financial intermediation and, as a consequence, help the rural sector's development.

Rural Non-Farm Sector and Labor Market in Rural Vietnam: Trends and Determinants

OpenAIRE

Nguyen , Trung Hung

2016-01-01

This dissertation aims to investigate the Trends and Determinants of the Rural Non-Farm Sector and Labor Market in Rural Vietnam since the global economic crisis occurred in 2007 with the focus on the household's diversification; the involvement of rural individuals in Rural Non-Farm Employment; Rural Labor Market development; and assessment of a specific labor market policy.

ElectroChemical Arsenic Removal (ECAR) for Rural Bangladesh--Merging Technology with Sustainable Implementation

Energy Technology Data Exchange (ETDEWEB)

Addy, Susan E.A.; Gadgil, Ashok J.; Kowolik, Kristin; Kostecki, Robert

2009-12-01

Today, 35-77 million Bangladeshis drink arsenic-contaminated groundwater from shallow tube wells. Arsenic remediation efforts have focused on the development and dissemination of household filters that frequently fall into disuse due to the amount of attention and maintenance that they require. A community scale clean water center has many advantages over household filters and allows for both chemical and electricity-based technologies to be beneficial to rural areas. Full cost recovery would enable the treatment center to be sustainable over time. ElectroChemical Arsenic Remediation (ECAR) is compatible with community scale water treatment for rural Bangladesh. We demonstrate the ability of ECAR to reduce arsenic levels> 500 ppb to less than 10 ppb in synthetic and real Bangladesh groundwater samples and examine the influence of several operating parameters on arsenic removal effectiveness. Operating cost and waste estimates are provided. Policy implication recommendations that encourage sustainable community treatment centers are discussed.

Low-cost rural surface alternatives : literature review and recommendations.

Science.gov (United States)

2013-12-01

Freezing and thawing action induces damage to unbound gravel roads in Iowa resulting in maintenance costs for secondary road departments. Some approaches currently used by County Engineers to deal with this problem include temporarily spreading rock ...

Teaching undergraduate students in rural general practice: an evaluation of a new rural campus in England.

Science.gov (United States)

Bartlett, Maggie; Pritchard, Katie; Lewis, Leo; Hays, Richard B; Mckinley, Robert K

2016-01-01

structured clinical examination performance and that of their peers in other locations. Some students had difficulty with the isolation from peers and academic activities, and travel was a problem despite their accommodation close to the practices. Students valued the learning opportunities offered by the rural practice placements. The general practice tutors, patients and community hospital staff found teaching to be a positive experience overall and perceived a value to the health system and broader community in students learning locally for substantial periods of time. The evaluation has identified some student concerns about transport times and costs, social isolation, and access to resources and administrative tasks, and these are being addressed.

Rural hospital ownership: medical service provision, market mix, and spillover effects.

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Horwitz, Jill R; Nichols, Austin

2011-10-01

To test whether nonprofit, for-profit, or government hospital ownership affects medical service provision in rural hospital markets, either directly or through the spillover effects of ownership mix. Data are from the American Hospital Association, U.S. Census, CMS Healthcare Cost Report Information System and Prospective Payment System Minimum Data File, and primary data collection for geographic coordinates. The sample includes all nonfederal, general medical, and surgical hospitals located outside of metropolitan statistical areas and within the continental United States from 1988 to 2005. We estimate multivariate regression models to examine the effects of (1) hospital ownership and (2) hospital ownership mix within rural hospital markets on profitable versus unprofitable medical service offerings. Rural nonprofit hospitals are more likely than for-profit hospitals to offer unprofitable services, many of which are underprovided services. Nonprofits respond less than for-profits to changes in service profitability. Nonprofits with more for-profit competitors offer more profitable services and fewer unprofitable services than those with fewer for-profit competitors. Rural hospital ownership affects medical service provision at the hospital and market levels. Nonprofit hospital regulation should reflect both the direct and spillover effects of ownership. © Health Research and Educational Trust.

Rural maternity care.

Science.gov (United States)

Miller, Katherine J; Couchie, Carol; Ehman, William; Graves, Lisa; Grzybowski, Stefan; Medves, Jennifer

2012-10-01

To provide an overview of current information on issues in maternity care relevant to rural populations. Medline was searched for articles published in English from 1995 to 2012 about rural maternity care. Relevant publications and position papers from appropriate organizations were also reviewed. This information will help obstetrical care providers in rural areas to continue providing quality care for women in their communities. Recommendations 1. Women who reside in rural and remote communities in Canada should receive high-quality maternity care as close to home as possible. 2. The provision of rural maternity care must be collaborative, woman- and family-centred, culturally sensitive, and respectful. 3. Rural maternity care services should be supported through active policies aligned with these recommendations. 4. While local access to surgical and anaesthetic services is desirable, there is evidence that good outcomes can be sustained within an integrated perinatal care system without local access to operative delivery. There is evidence that the outcomes are better when women do not have to travel far from their communities. Access to an integrated perinatal care system should be provided for all women. 5. The social and emotional needs of rural women must be considered in service planning. Women who are required to leave their communities to give birth should be supported both financially and emotionally. 6. Innovative interprofessional models should be implemented as part of the solution for high-quality, collaborative, and integrated care for rural and remote women. 7. Registered nurses are essential to the provision of high-quality rural maternity care throughout pregnancy, birth, and the postpartum period. Maternity nursing skills should be recognized as a fundamental part of generalist rural nursing skills. 8. Remuneration for maternity care providers should reflect the unique challenges and increased professional responsibility faced by providers in

ROLE OF RURAL TOURISM FOR DEVELOPMENT OF RURAL AREAS

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Andrej Udovč

2001-09-01

Full Text Available The paper analyse the role of rural tourism for the development of rural areas, on the comparison of two regions with different types of rural tourism. One area is of highly diversifi ed rural tourism with wide range of tourist products (rafting, hiking, cycling, farm tourism, skiing …. The tourism offer in the second area is much more uniform (mainly farm tourism and some spa. The study analysed how the two different types of tourist product diversifi cations influence the development possibilities of studied rural areas. We analysed how different systems are able to maintain its functions in the context of identifi ed perturbations (socio-economic and geophysical. We analysed the infl uence of different factors on systems stability, its resilience, robustness and integrity. The gained results show that only the higher level of diversifi cation is not a guarantee for systems higher stability, resilience, robustness and integrity, but there also other

Distribution costs -- the cost of local delivery

International Nuclear Information System (INIS)

Winger, N.; Zarnett, P.; Carr, J.

2000-01-01

Most of the power transmission system in the province of Ontario is owned and operated as a regulated monopoly by Ontario Hydro Services Company (OHSC). Local distribution systems deliver to end-users from bulk supply points within a service territory. OHSC distributes to approximately one million, mostly rural customers, while the approximately 250 municipal utilities together serve about two million, mostly urban customers. Under the Energy Competition Act of 1998 local distribution companies will face some new challenges, including unbundled billing systems, a broader range of distribution costs, increased costs, made up of corporate taxes or payments in lieu of taxes and added costs for regulatory affairs. The consultants provide a detailed discussion of the components of distribution costs, the three components of the typical budget process (capital expenditures, (CAPEX), operating and maintenance (O and M) and administration and corporate (GA and C), a summary of some typical distribution costs in Ontario, and the estimated impacts of the Energy Competition Act (ECA) compliance on charges and rates. Various mitigation strategies are also reviewed. Among these are joint ventures by local distribution companies to reduce ECA compliance costs, re-examination of controllable costs, temporary reduction of the allowable return on equity (ROE) by 50 per cent, and/or reducing the competitive transition charge (CTC). It is estimated that either one of these two reductions could eliminate the full amount of the five to seven per cent uplift in delivered energy service costs. The conclusion of the consultants is that local distribution delivery charges will make up a greater proportion of end-user cost in the future than it has in the past. An increase to customers of about five per cent is expected when the competitive electricity market opens and unbundled billing begins. The cost increase could be mitigated by a combination of actions that would be needed for about

Implications of rural tourism and agritourism in sustainable rural development

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Flavia-Lorena Cut-Lupulescu

2014-10-01

Full Text Available Romania shows: a variety of historical cultural values ​​- folk art, ethnography, folklore, traditions, historical artifacts - a natural harmoniously combined with a varied and picturesque landscape background. All these are facets of Romanian rural tourism in particular. Occurred and developed by the various forms of relief since the time of the Thracian-Dacian, Romanian rural settlements kept and still keeps in good measure ancient customs and traditions, a rich and varied folklore, ethnography and folk original elements that can be travel exploited in a strategy for the organization and development of rural tourism. Rural tourism in our country always practical, but spontaneous, sporadic, random, and mostly unorganized form of manifestation is the beginning of the '20s and '30s, the casual visitor accommodation citizens of rural settlements.

The influences of Taiwan's National Health Insurance on women's choice of prenatal care facility: Investigation of differences between rural and non-rural areas

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Chen Chi-Liang

2008-03-01

Full Text Available Abstract Background Taiwan's National Health Insurance (NHI, implemented in 1995, substantially increased the number of health care facilities that can deliver free prenatal care. Because of the increase in such facilities, it is usually assumed that women would have more choices regarding prenatal care facilities and thus experience reduction in travel cost. Nevertheless, there has been no research exploring these issues in the literature. This study compares how Taiwan's NHI program may have influenced choice of prenatal care facility and perception regarding convenience in transportation for obtaining such care for women in rural and non-rural areas in Taiwan. Methods Based on data collected by a national survey conducted by Taiwan's National Health Research Institutes (NHRI in 2000, we tried to compare how women chose prenatal care facility before and after Taiwan's National Health Insurance program was implemented. Basing our analysis on how women answered questionnaire items regarding "the type of major health care facility used and convenience of transportation to and from prenatal care facility," we investigated whether there were disparities in how women in rural and non-rural areas chose prenatal care facilities and felt about the transportation, and whether the NHI had different influences for the two groups of women. Results After NHI, women in rural areas were more likely than before to choose large hospitals for prenatal care services. For women in rural areas, the relative probability of choosing large hospitals to choosing non-hospital settings in 1998–1999 was about 6.54 times of that in 1990–1992. In contrast, no such change was found in women in non-rural areas. For a woman in a non-rural area, she was significantly more likely to perceive the transportation to and from prenatal care facilities to be very convenient between 1998 and 1999 than in the period between 1990 and 1992. No such improvement was found for women in

Multi criteria analysis for sustainability assessments of electricity generation systems in a rural community in South Africa

Energy Technology Data Exchange (ETDEWEB)

Amigun, B.; Mehlwana, M. [Council for Scientific and Industrial Research, Pretoria (South Africa). Sustainable Energy Futures, Natural Resources and the Environment; Musango, J.K. [Department of Energy (DoE), Pretoria (South Africa); Brent, A.C. [Stellenbosch Univ. (South Africa). Centre for Renewable and Sustainable Energy Studies

2011-07-01

One of the key challenges of the energy policy in South Africa is to ensure that rural areas have access to electricity. This is reflected in the key energy policy documents (the 1998 Energy White Paper and the 2002 Renewable Energy White Paper). Both these documents identified renewable energy resources as immediate alternatives to grid electricity in especially remote rural communities that are characterised by low population densities. Centralised energy generation and transmission is very costly and inefficient in these areas due to greater transmission and distribution losses. While the cost of electricity in South Africa is relatively cheaper, it is not accessible for many rural households. There are still over two million households in rural areas without access to electricity. This paper presents a multi-criteria decision analysis (MCDA) using the Analytical Hierarchy Process (AHP) technique to compare various electricity technologies (mainly renewables) in a specific rural community of South Africa using social, economic, environment and technical indicators. These technologies were than ranked against each indicator assuming that the high-level criteria have equal importance for sustainable development. It is demonstrated that energy from wind is the most sustainable, followed by photovoltaic, anaerobic digestion (biogas) and then gasification. A sensitivity analysis was also performed to verify the stability of the priority ranking. The outcome of this study will specifically assist energy planners and decision-makers to choose the best alternative from a range of technology alternatives in a milieu of conflicting and competing criteria. (orig.)

Rural-to-urban migration and the shadow wage in LDCs.

Science.gov (United States)

Renard, R

1984-04-01

"This paper discusses the amount of rural-to-urban migration which will be forthcoming when a new urban job is created for which an institutionally fixed wage above the market-clearing level is offered. A simple formula is proposed to estimate migration response. It can be used to calculate the shadow wage in cost-benefit analysis (CBA) in less developed countries (LDCs)." excerpt

Rural women caregivers in Canada.

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Crosato, Kay E; Leipert, Beverly

2006-01-01

Informal caregiving within rural contexts in Canada is increasing. This is due in part to a number of factors related to the restructuring of the Canadian health care system, the regionalization of services to urban locations, the increased population of people 65 years and older, and the desire of this population to age within their rural homes. Most often, the informal caregiving role is assumed by rural women. Women tend to fall into the role of informal caregiver to elders because of the many societal and gender expectations and values that are present within the rural culture. The purpose of this literature review is to identify the context in which women provide care for an elder in rural Canada. Illustrating these issues will help to uncover challenges and barriers rural women face when providing care and highlight recommendations and implications for rural women caregivers and nurses employed within rural settings. Many rural women share similar caregiving experiences as urban informal caregivers, but rural women are faced with additional challenges in providing quality care for an elder. Rural women caregivers are faced with such issues as limited access to adequate and appropriate healthcare services, culturally incongruent health care, geographical distance from regionalized centers and health services, transportation challenges, and social/geographical isolation. In addition to these issues, many rural women are faced with the multiple role demands that attend being a wife, mother, caregiver and employee. The pile up of these factors leaves rural women caregivers susceptible to additional stresses and burn out, with limited resources on which to depend. Through reviewing pertinent literature, appropriate implications and recommendations can be made that may assist rural women caregivers and rural nurses. Nurses working within rural communities are in ideal settings to work collaboratively in building supportive relationships with rural women in order to

RURAL TOURISM AS AN IMPORTANT SOURCE OF INCOME FOR RURAL PLACES

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Mariana IATAGAN

2009-06-01

Full Text Available Tourism is the most important economic branch, worldwide, owning 12% of all areas of activity and revenue of approximately 530 billion dollars per year. In the past 10 years we could see an increasing demand for rural tourism and ecotourism, many of the international travel agencies offering ecotourism packages. Our country is attractive from the perspective of international travel agencies, because of unpolluted nature, the authenticity of traditions, the Danube Delta, old forests and not least, because the Romanian hospitality.Rural tourism had been practiced for a long time in Romania but for the past 15-20 years, it was casual and without any form of organization. Tourism activities in rural areas are carried out when agricultural activities takeplace and contribute to the welfare of rural communities that practice it.The development of tourism activities requires attention to the quality of the environment by preserving and developing the quality in the areas that have entered the tourist circuit, controlling the activity quality for a rational use of tourism resources.Our country benefits from EU funding through several programs including SAPARD, taking one of the measures, Measure 3.4, which is called the development and diversification of economic activities that generate multiple activities and alternative incomes.A deciding role in the development of rural tourism is held by the general infrastructure, requiring subsidies from the budget for tourism attraction areas for sustaining, by public administrations, programs to support tourism in rural areas.Rural tourism contributes to the sustainable development of the Romanian rural environment by proper use of local resources, establishing youth in rural areas, reducing the number of unemployed, women's involvement in economic and social life of rural settlements, raising living standards, growth in household rural areas, increasing the industry's contribution to the formation of gross

Empowering Distributed Solar PV Energy for Malaysian Rural Housing: Towards Energy Security and Equitability of Rural Communities

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N.A. Ahmad

2013-02-01

Full Text Available This paper illustrates on how Malaysia’s development landscapes has been poweredby cheap oil and gas making it dependent and addicted on using large amounts of fossil fuels. As acountry that is primarily depended on fossil fuels for generating power supply, Malaysia needs tocogitate of long-term energy security due to fossil fuel depletion and peak oil issues. Loss of theseresources could leadto thereduction of power generation capacitywhich will threaten the stabilityof the electricity supply in Malaysia. This could potentially influence in an increase in electricitycosts which lead to a phase of power scarcity and load shedding for the country. With the risk ofinterrupted power supplies, rural households, especially those of low-income groups areparticularly vulnerable to the post-effects of a power outage and an inequitable distribution to thepeople. Distributed generation of electricity by solar PVs diminishes the vulnerability of thesehouseholds and can also offer an income to them by feeding the power supply to the national gridthrough Feed-in Tariff scheme. At the moment, the deployment of solar PV installations is still inthe introductory stage in Malaysia, where roof-mounted PV panels are only available to commercialand urban residential buildings. This is due to the lack of a suitable renewable energy policy forrural households and the high cost of the solar PV technology. This paper will put forward ananalysis for incorporating solar photovoltaic on roofs of rural houses by identifying the energyconsumption of these households and the extent to which PVs can alleviate electricity insecurity.The results present significant potential for distributed PV power generation in rural areas inMalaysia which shown a considerable amount of electricity needed to be harvested from roofmountedsolar PV for rural people in Malaysia.

Municipal consultation key to understanding haul road maintenance agreements for Saskatchewan rural municipalities

International Nuclear Information System (INIS)

Leibel, R.E.A.

1998-01-01

Current municipal perspectives regarding the oil and gas industry in Saskatchewan were described. Municipal jurisdiction and authority regarding road development and heavy haul road maintenance agreements were defined. Based on actual work experience, collaborative working relationships between the oil and gas industry and the municipal sector is well worth some industry time and effort since it will result in cost savings for the industry. In general, rural municipalities receive very limited tax benefits to recapture the costs of road reconstruction and maintenance caused by heavy industry traffic. Road servicing costs can be recaptured only if companies respect the weight limits, hauling regulations and road bans. On the whole, municipalities in Saskatchewan are favourably disposed towards the oil and gas industry, and have done well in the past to accommodate industry's needs. It is not unreasonable therefore to expect that industry show sensitivity to the impact of its activities on the local municipality, and does its level best to be on good terms with the municipalities through early two-way communication. Text of some relevant acts of the Legislature respecting the powers and authorities of rural municipalities are appended

Measuring the Economic Impact of Rural Tourism Membership on Local Economy: A Korean Case Study

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Hio-Jung Shin

2017-04-01

Full Text Available The implementation of rural tourism membership can aid in boosting economic growth in rural areas. This study examines households’ preferences for rural tourism experience in association with sales of local agricultural products. Using a choice experiment method developed by experimental designs, this paper examines households’ preferences to trade off purchasing costs of local agricultural products against various benefits provided by the rural tourism membership. The methods utilized in this paper represent an effective approach to evaluate the value of local tourism resources and the influence of these resources on the local economy. In empirical estimation we applied econometric approaches that allow for different preferences by incorporating income and residence effects into the models. Findings reveal that respondents place a premium on tourism attributes such as invitation seats and outdoor adventure tickets when choosing a tourism membership. We also find that the economic impacts associated with inducing higher-level tourism membership are substantial. This paper illustrates the potential for the development of a strategy associated with rural tourism management to enhance the local economy.

43 CFR 404.40 - What is the non-Federal share of operation, maintenance, and replacement costs?

Science.gov (United States)

2010-10-01

... Cost-Sharing § 404.40 What is the non-Federal share of operation, maintenance, and replacement costs? You are required to pay 100 percent of the operation, maintenance, and replacement costs of any rural... 43 Public Lands: Interior 1 2010-10-01 2010-10-01 false What is the non-Federal share of operation...

Managing energy vulnerability and resilience for rural communities in Northern Denmark by means of energy atlases

DEFF Research Database (Denmark)

Möller, Bernd

Denmark has targets of developing a 100% renewable energy supply within the next 4 decades, while the country is facing polarization between urban areas and the rural countryside. Energy vulnerability develops as low income groups move to areas with poor building stock and no access to collective...... heat supply. With little room for extending mortgage, investments in added insulation or efficient heating technology become less affordable. About a quarter of the Danish population lives in rural areas where energy efficient heat supply and low-energy buildings are outside reach. Typical current...... problems are high energy costs, which contribute to the unattractiveness of rural areas, driven by centralization and the dismantling of public infrastructure. On the other hand, most renewable energy sources like wind and biomass are located in rural areas, where they could create resilience: income, jobs...

Adherence to a Mediterranean diet in a rural Appalachian food desert.

Science.gov (United States)

Hardin-Fanning, F

2013-01-01

Rural Appalachian food deserts have disproportionately high cardiovascular disease (CVD) rates. The Mediterranean diet, consisting of plant-based dishes prepared with unsaturated fatty acids, contributes to decreased risk of CVD. Several factors can affect dietary choices in rural food deserts. The purpose of this exploratory study was to identify predisposing, reinforcing and enabling factors that affect eating a Mediterranean diet in a rural Appalachian food desert with disproportionately high rates of cardiovascular disease. The PRECEDE-PROCEED model was used as an assessment framework in this study. Volunteers (n=43) were recruited from four churches in a rural Appalachian county to participate in this mixed methods convergent parallel design study. During each of four sessions with 8-12 participants each, a Mediterranean-style meal was prepared by a local caterer and included plant-based dishes prepared with unsaturated fatty acids. The nature of a Mediterranean diet was explained to participants using an illustrated pamphlet. Nominal group process was used to determine predisposing, reinforcing and enabling factors that would affect adherence to a Mediterranean diet. Multivariate ANOVA and t-tests, using SPSS 18, were performed to determine factors associated with potential future adoption and adherence to a Mediterranean diet among a sample of rural residents and assess whether the factors varied based on age, gender and socioeconomic status. All p values of ≤0.05 were considered significant. Factors affecting future adherence to a Mediterranean diet included difficulty changing personal habits, limited access to healthy foods, cost, difficulty of preparation, limited knowledge of the health benefits of foods, family attitudes toward food and difficulty determining how to incorporate healthy foods into meals. Younger participants and those with lower incomes were more likely to identify food cost as a barrier to adherence compared to those who were older

Rural Airports

Data.gov (United States)

Department of Transportation — The Rural Airports database is the list of rural airports compiled annually by BTS for the Treasury Department/IRS. It is used by airlines to assist in establishing...

Balancing medicine prices and business sustainability: analyses of pharmacy costs, revenues and profit shed light on retail medicine mark-ups in rural Kyrgyzstan

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Maddix Jason

2010-07-01

Full Text Available 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

Techno-economic evaluation of various electric energy supply for rural areas Pakistan

International Nuclear Information System (INIS)

Nagdev, A.J.; Samo, S.R.

1994-01-01

A diagnostic study was carried out to evaluate the techno-economic viability of various electric supply sources for electrification of rural areas in Pakistan in present socio-economic conditions. The important influencing factors considered were: social needs, electric requirement and availability of energy resources. The electric requirements of model rural village were established at 20431 kw h per year. Prudent evaluations reveal that hydroelectric, photovoltaic and diesel systems are better options than an electric grid extension of more than 2 km. In order to become an economically meritorious energy source, photovoltaic system should attain cost level Rs. 100 per watt-peak of installed system. (author)

Rural Cultural Houses (A New Approach to Rural Youth Work in Iran).

Science.gov (United States)

Salmanzadeh, Cyrus

Based on field work in rural areas of Khuzestan Province in southwestern Iran in 1973-74, an examination of the nature of rural cultural houses in Iran was undertaken. Set up by royal decree in 1968, the rural cultural houses have had as their objective to assist peasantry in general and rural youth in particular to achieve a socially enriched…

Measuring User Compliance and Cost Effectiveness of Safe Drinking Water Programs: A Cluster-Randomized Study of Household Ultraviolet Disinfection in Rural Mexico.

Science.gov (United States)

Reygadas, Fermín; Gruber, Joshua S; Dreizler, Lindsay; Nelson, Kara L; Ray, Isha

2018-03-01

Low adoption and compliance levels for household water treatment and safe storage (HWTS) technologies have made it challenging for these systems to achieve measurable health benefits in the developing world. User compliance remains an inconsistently defined and poorly understood feature of HWTS programs. In this article, we develop a comprehensive approach to understanding HWTS compliance. First, our Safe Drinking Water Compliance Framework disaggregates and measures the components of compliance from initial adoption of the HWTS to exclusive consumption of treated water. We apply this framework to an ultraviolet (UV)-based safe water system in a cluster-randomized controlled trial in rural Mexico. Second, we evaluate a no-frills (or "Basic") variant of the program as well as an improved (or "Enhanced") variant, to test if subtle changes in the user interface of HWTS programs could improve compliance. Finally, we perform a full-cost analysis of both variants to assess their cost effectiveness (CE) in achieving compliance. We define "compliance" strictly as the habit of consuming safe water. We find that compliance was significantly higher in the groups where the UV program variants were rolled out than in the control groups. The Enhanced variant performed better immediately postintervention than the Basic, but compliance (and thus CE) degraded with time such that no effective difference remained between the two versions of the program.

43 CFR 404.55 - Who is responsible for the operation, maintenance, and replacement costs?

Science.gov (United States)

2010-10-01

... Miscellaneous § 404.55 Who is responsible for the operation, maintenance, and replacement costs? You will be responsible for 100 percent of the operation, maintenance, and replacement costs for any rural water facility... 43 Public Lands: Interior 1 2010-10-01 2010-10-01 false Who is responsible for the operation...

Stakeholder views of rural community-based medical education: a narrative review of the international literature.

Science.gov (United States)

Somporn, Praphun; Ash, Julie; Walters, Lucie

2018-03-30

Rural community-based medical education (RCBME), in which medical student learning activities take place within a rural community, requires students, clinical teachers, patients, community members and representatives of health and government sectors to actively contribute to the educational process. Therefore, academics seeking to develop RCBME need to understand the rural context, and the views and needs of local stakeholders. The aim of this review is to examine stakeholder experiences of RCBME programmes internationally. This narrative literature review of original research articles published after 1970 utilises Worley's symbiosis model of medical education as an analysis framework. This model proposes that students experience RCBME through their intersection with multiple clinical, social and institutional relationships. This model seeks to provide a framework for considering the intersecting relationships in which RCBME programmes are situated. Thirty RCBME programmes are described in 52 articles, representing a wide range of rural clinical placements. One-year longitudinal integrated clerkships for penultimate-year students in Anglosphere countries were most common. Such RCBME enables students to engage in work-integrated learning in a feasible manner that is acceptable to many rural clinicians and patients. Academic results are not compromised, and a few papers demonstrate quality improvement for rural health services engaged in RCBME. These programmes have delivered some rural medical workforce outcomes to communities and governments. Medical students also provide social capital to rural communities. However, these programmes have significant financial cost and risk student social and educational isolation. Rural community-based medical education programmes are seen as academically acceptable and can facilitate symbiotic relationships among students, rural clinicians, patients and community stakeholders. These relationships can influence students' clinical

The personal costs and convenience of screening mammography.

Science.gov (United States)

Suter, Lisa Gale; Nakano, Connie Y; Elmore, Joann G

2002-09-01

Few studies have examined the impact of women's personal costs on obtaining a screening mammogram in the United States. All women obtaining screening mammograms at nine Connecticut mammography facilities during a 2-week study period were asked to complete a questionnaire. Facilities included urban and rural fixed sites and mobile sites. The survey included questions about insurance coverage, mammogram payment, and personal costs in terms of transportation, family care, parking, and lost work time from the women's perspective. The response rate was 62% (731 of 1189). Thirty-two percent of respondents incurred some type of personal cost, including lost work time, family care, and parking. Women incurring personal costs were more likely than those without personal costs to attend an urban facility (46% vs. 23%, p convenience and 17% listed cost as a reason for choosing a mammography facility; 23% reported that cost might prevent them from obtaining a future mammogram. One third of women obtaining mammograms may be incurring personal costs. These personal costs should be considered in future cost-effectiveness analyses.

Rural nurse job satisfaction.

Science.gov (United States)

Molinari, D L; Monserud, M A

2008-01-01

The lack of rural nursing studies makes it impossible to know whether rural and urban nurses perceive personal and organizational factors of job satisfaction similarly. Few reports of rural nurse job satisfaction are available. Since the unprecedented shortage of qualified rural nurses requires a greater understanding of what factors are important to retention, studies are needed. An analysis of the literature indicates job satisfaction is studied as both an independent and dependent variable. In this study, the concept is used to examine the intention to remain employed by measuring individual and organizational characteristics; thus, job satisfaction is used as a dependent variable. One hundred and three rural hospital nurses, from hospitals throughout the Northwest region of the United States were recruited for the study. Only nurses employed for more than one year were accepted. The sample completed surveys online. The McCloskey/Mueller Satisfaction Scale, the Gerber Control Over Practice Scale, and two open-ended job satisfaction questions were completed. The qualitative analysis of the open-ended questions identified themes which were then used to support the quantitative findings. Overall alphas were 0.89 for the McCloskey/Mueller Scale and 0.96 for the Gerber Control Over Practice Scale. Rural nurses indicate a preference for rural lifestyles and the incorporation of rural values in organizational practices. Nurses preferred the generalist role with its job variability, and patient variety. Most participants intended to remain employed. The majority of nurses planning to leave employment were unmarried, without children at home, and stated no preference for a rural lifestyle. The least overall satisfied nurses in the sample were employed from 1 to 3 years. Several new findings inform the literature while others support previous workforce studies. Data suggest some job satisfaction elements can be altered by addressing organizational characteristics and by

Cost-of-illness of cholera to households and health facilities in rural Malawi.

Directory of Open Access Journals (Sweden)

Patrick G Ilboudo

Full Text Available Cholera remains an important public health problem in many low- and middle-income countries. Vaccination has been recommended as a possible intervention for the prevention and control of cholera. Evidence, especially data on disease burden, cost-of-illness, delivery costs and cost-effectiveness to support a wider use of vaccine is still weak. This study aims at estimating the cost-of-illness of cholera to households and health facilities in Machinga and Zomba Districts, Malawi. A cross-sectional study using retrospectively collected cost data was undertaken in this investigation. One hundred patients were purposefully selected for the assessment of the household cost-of-illness and four cholera treatment centres and one health facility were selected for the assessment conducted in health facilities. Data collected for the assessment in households included direct and indirect costs borne by cholera patients and their families while only direct costs were considered for the assessment conducted in health facilities. Whenever possible, descriptive and regression analysis were used to assess difference in mean costs between groups of patients. The average costs to patients' households and health facilities for treating an episode of cholera amounted to US$65.6 and US$59.7 in 2016 for households and health facilities, respectively equivalent to international dollars (I$ 249.9 and 227.5 the same year. Costs incurred in treating a cholera episode were proportional to duration of hospital stay. Moreover, 52% of households used coping strategies to compensate for direct and indirect costs imposed by the disease. Both households and health facilities could avert significant treatment expenditures through a broader use of pre-emptive cholera vaccination. These findings have direct policy implications regarding priority investments for the prevention and control of cholera.

Cost-of-illness of cholera to households and health facilities in rural Malawi.

Science.gov (United States)

Ilboudo, Patrick G; Huang, Xiao Xian; Ngwira, Bagrey; Mwanyungwe, Abel; Mogasale, Vittal; Mengel, Martin A; Cavailler, Philippe; Gessner, Bradford D; Le Gargasson, Jean-Bernard

2017-01-01

Cholera remains an important public health problem in many low- and middle-income countries. Vaccination has been recommended as a possible intervention for the prevention and control of cholera. Evidence, especially data on disease burden, cost-of-illness, delivery costs and cost-effectiveness to support a wider use of vaccine is still weak. This study aims at estimating the cost-of-illness of cholera to households and health facilities in Machinga and Zomba Districts, Malawi. A cross-sectional study using retrospectively collected cost data was undertaken in this investigation. One hundred patients were purposefully selected for the assessment of the household cost-of-illness and four cholera treatment centres and one health facility were selected for the assessment conducted in health facilities. Data collected for the assessment in households included direct and indirect costs borne by cholera patients and their families while only direct costs were considered for the assessment conducted in health facilities. Whenever possible, descriptive and regression analysis were used to assess difference in mean costs between groups of patients. The average costs to patients' households and health facilities for treating an episode of cholera amounted to US$65.6 and US$59.7 in 2016 for households and health facilities, respectively equivalent to international dollars (I$) 249.9 and 227.5 the same year. Costs incurred in treating a cholera episode were proportional to duration of hospital stay. Moreover, 52% of households used coping strategies to compensate for direct and indirect costs imposed by the disease. Both households and health facilities could avert significant treatment expenditures through a broader use of pre-emptive cholera vaccination. These findings have direct policy implications regarding priority investments for the prevention and control of cholera.

Rural bioenergy: innovative integrated biosystem design for fuel and food from agrowastes

Energy Technology Data Exchange (ETDEWEB)

Selvam, Pagandai V. Pannir; Santiago, Brunno Henrique de S. [Universidade Federal de Alagoas (UFAL), Maceio, AL (Brazil)], email: pannirbr@gmail.com; Almeida, Louizy Minora C.A. de; Israel, Samy B.S. [Universidade Federal do Rio Grande do Norte (DEQ/CT/UFRN), Natal, RN (Brazil). Centro de Tecnologia. Dept. de Engenharia Quimica

2008-07-01

Brazil is the leader known for its ethanol biofuel development, but also for biomass charcoal, yet lacks in clean rural biofuel production. This paper deals with the system design for sustainable rural projects developments based on the the bioenergy production from biomass wastes using Innovative process equipment design and the process optimization. With the economic objective towards sustainable clean small scale rural energy production, and also the co-production of hot, cold thermal energy, at first, several preliminary projects had been developed and analysed. Then, a detailed project engineering and the results on economical viability were obtained. The dynamic material, energy and cash flow models of the complex integrated food processing and small scale energy productions, were at first constructed using excel electronic spread sheet for Windows. Computer aided system for process modeling and simulation using SUPERPRO, Intelligent Inc. Economic feasibilities studies using genetics algorithms are under developments. The preliminary analysis of cost and investments of the the integrated biomass utilisation projects which are included for this study are: biological aerobic treatment process, methane gas production using anaerobic digestion process, aerobic composting, drying of tropical fruits, effluent treatments, biogas and syngas production as well as cogeneration of energy production for drying and cooling using biogas. These models allowed us the identification of tech economical and scale up problems. The results obtained with several preliminary project development with few case studies are reported for integrated project developments for fuel and food using process and cost simulation models. Several economic problems related with implementation of the small scale rural energy system for sustained local developments based on tropical fruit producing rural areas are analysed and a concept of the integrated bio system for micro enterprise has been

Benefits of a telepsychiatry consultation service for rural nursing home residents.

Science.gov (United States)

Rabinowitz, Terry; Murphy, Katharine M; Amour, Judith L; Ricci, Michael A; Caputo, Michael P; Newhouse, Paul A

2010-01-01

Psychiatric care for nursing home residents is difficult to obtain, especially in rural areas, and this deficiency may lead to significant morbidity or death. Providing this service by videoconference may be a helpful, cost-effective, and acceptable alternative to face-to-face treatment. We analyzed data for 278 telepsychiatry encounters for 106 nursing home residents to estimate potential cost and time savings associated with this modality compared to in-person care. A total of 843.5 hours (105.4 8-hour work days) of travel time was saved compared to in-person consultation for each of the 278 encounters if they had occurred separately. If four resident visits were possible for each trip, the time saved would decrease to 26.4 workdays. Travel distance saved was 43,000 miles; 10,750 miles if four visits per trip occurred. More than $3,700 would be spent on gasoline for 278 separate encounters; decreased to $925 for four visits per roundtrip. Personnel cost savings estimates ranged from $33,739 to $67,477. Physician costs associated with additional travel time ranged from $84,347 to $253,040 for 278 encounters, or from $21,087 to $63,260 for four encounters per visit. The telepsychiatry approach was enthusiastically accepted by virtually all residents, family members, and nursing home personnel, and led to successful patient management. Providing psychiatric care to rural nursing home residents by videoconference is cost effective and appears to be a medically acceptable alternative to face-to-face care. In addition, this approach will allow many nursing homes to provide essential care that would not otherwise be available.

Surgical specialty procedures in rural surgery practices: implications for rural surgery training.

Science.gov (United States)

Sticca, Robert P; Mullin, Brady C; Harris, Joel D; Hosford, Clint C

2012-12-01

Specialty procedures constitute one eighth of rural surgery practice. Currently, general surgeons intending to practice in rural hospitals may not get adequate training for specialty procedures, which they will be expected to perform. Better definition of these procedures will help guide rural surgery training. Current Procedural Terminology codes for all surgical procedures for 81% of North Dakota and South Dakota rural surgeons were entered into the Dakota Database for Rural Surgery. Specialty procedures were analyzed and compared with the Surgical Council on Resident Education curriculum to determine whether general surgery training is adequate preparation for rural surgery practice. The Dakota Database for Rural Surgery included 46,052 procedures, of which 5,666 (12.3%) were specialty procedures. Highest volume specialty categories included vascular, obstetrics and gynecology, orthopedics, cardiothoracic, urology, and otolaryngology. Common procedures in cardiothoracic and vascular surgery are taught in general surgical residency, while common procedures in obstetrics and gynecology, orthopedics, urology, and otolaryngology are usually not taught in general surgery training. Optimal training for rural surgery practice should include experience in specialty procedures in obstetrics and gynecology, orthopedics, urology, and otolaryngology. Copyright © 2012 Elsevier Inc. All rights reserved.

Coroners' records of rural and non-rural cases of youth suicide in New South Wales.

Science.gov (United States)

Dudley, M; Kelk, N; Florio, T; Waters, B; Howard, J; Taylor, D

1998-04-01

The aim of this study is to compare the frequency of certain putative risk factors for youth suicide in New South Wales (especially use of alcohol, social class, unemployment, and internal migration) in metropolitan and rural settings. A review of 137 files for 10-19-year-old subjects judged by the Coroner to have committed suicide in 1988-1990 was carried out. One hundred and fifteen males and 21 females were identified (one subjects sex was unavailable). The male-female ratio was higher in rural (13.0) areas than non-rural (4.9 chi 2 = 12.14, p Australia, most migrated in a rural direction, and most to rural shires. Unemployment was somewhat more common among rural (38.5%) than non-rural (28.9%) subjects (chi 2 = 0.75, p = 0.39). Eleven of 50 non-rural parents of the deceased, but none of the 11 rural parents, were ranked as being in social classes 2 or 3. Alcohol consumption appeared more common in rural shires (44%) than metropolitan areas (32.9%), but this was not statistically significant. Medical services were less utilised prior to death in rural (15%) than non-rural (25%) areas (chi 2 = 1.69, p = 0.19), and a psychiatric diagnosis was recorded more commonly in non-rural areas. Incomplete coronial file data and relatively small numbers limit this study's conclusions. Male suicides, principally by firearms, predominated in rural areas. Youth firearm access remains highly relevant to rural communities. Possible trends among rural subjects toward rural migration, higher unemployment, lower social class and lower medical attendance may point to resource deprivation among this group; these matters require further investigation.

Youth retention in rural areas, a prerequisite for sustainable rural entrepreneurship and employment

Directory of Open Access Journals (Sweden)

Ali Ghasemi Ardahaee

2017-07-01

Full Text Available Entrepreneurship and sustainable rural employment are the main concerns of rural planners. One of the most basic requirements for this is that young people remain in the rural areas. Accordingly, the aim of this paper is to identify individual and structural factors that are effective in keeping young people in rural areas. Statistical results of the bivariate and multilevel modeling (HLM shows that rural youth are not willing to stay in rural regions. One may cite the following individual factors contributing to this lack of interest in staying in rural areas: age, marital status, education, communication with relatives in the city, as well as employment status and job skills. People with higher human capital who have technical skills and building related non-agricultural skills are not interested in staying in rural areas. Moreover, the increased population in the villages and lack of social welfare facilities in village are highly effective in reducing the tendency of young people to stay in the villages.

Collaborative innovations with rural and regional secondary teachers: enhancing student learning in mathematics

Science.gov (United States)

Pegg, John; Panizzon, Debra

2011-06-01

When questioned, secondary mathematics teachers in rural and regional schools in Australia refer to their limited opportunities to engage and share experiences with peers in other schools as an under-utilised and cost-effective mechanism to support their professional learning and enhance their students' learning. The paper reports on the creation and evaluation of a network of learning communities of rural secondary mathematics teachers around a common purpose—enhancement and increased engagement of student learning in mathematics. To achieve this goal, teams of teachers from six rural schools identified an issue hindering improved student learning of mathematics in their school. Working collaboratively with support from university personnel with expertise in curriculum, assessment and quality pedagogy, teachers developed and implemented strategies to address an identified issue in ways that were relevant to their teaching contexts. The research study identifies issues in mathematics of major concern to rural teachers of mathematics, the successes and challenges the teachers faced in working in learning communities on the issue they identified, and the efficacy of the professional learning model.

Oral Health in Rural Communities

Science.gov (United States)

... people with partial edentulism when compared to urban (Urban, 38.4%, High Poverty Rural 51.3%, Other Rural, 45%). Counties with high rates of full edentulism are also rural (Urban, 4.3%, High-Poverty Rural 10.5%, Other Rural, 8.2%). ( Mitchell, ...

Previdência social rural e gênero Rural Social Welfare and gender

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Anita Brumer

2002-06-01

Full Text Available O trabalho apresenta uma análise das principais transformações da previdência social rural no Brasil, que culminaram com a inclusão das mulheres trabalhadoras rurais como beneficiárias (direito à aposentadoria por idade e salário-maternidade na legislação aprovada pelo Congresso Nacional em 1988. Paralelamente, faz-se um exame do papel do Estado e da sociedade civil na evolução da legislação relativa à previdência social rural, procurando-se evidenciar seu caráter de "doação" por parte do Estado ou da "conquista" polos próprios trabalhadores(as. Finalmente, são examinados alguns impactos da implantação da previdência social rural no Sul do Brasil, ressaltando-se seu papel na diminuição da pobreza rural e da desigualdade na distribuição da renda, assim como sua importância material e simbólica na mudança de relações de gênero no meio rural.The work analyzes the main transformations in the rural Social Welfare in Brazil. The outcome of these transformations has been the inclusion of rural hard-working women in the welfare system as of the legislation approved by the National Congress in 1988. Rural-work women in Brazil have become entitled to the benefits of paid maternity leave and retirement accordant to a legal age limit. Concurrently, the article examines the role played by the State and the civil society in the unfolding of the legislation related to rural Social Welfare, in an attempt of exposing its character of either a "donation" given by the State or the workers' own "conquest". Finally, the author queries the impact of rural Social Welfare implementation in the South of Brazil, emphasizing its achievements in the decrease of rural poverty and unequal income distribution, as well as its material and symbolic importance in the gender relationship shift in rural areas.

Expanding health insurance to increase health care utilization: will it have different effects in rural vs. urban areas?

Science.gov (United States)

Erlyana, Erlyana; Damrongplasit, Kannika Kampanya; Melnick, Glenn

2011-05-01

This study investigates the importance of medical fee and distance to health care provider on individual's decision to seek care in developing countries. The estimation method used a mixed logit model applied to data from the third wave of the Indonesian family life survey (2000). The key variables of interest include medical fee and distance to different types of health care provider and individual characteristic variables. Urban dweller's decision to choose health care providers are sensitive to the monetary cost of medical care as measured by medical fee but they are not sensitive to distance. For those who reside in rural area, they are sensitive to the non-medical component cost of care as measured by travel distance but they are not sensitive to medical fee. As a result of those findings, policy makers should consider different sets of policy instruments when attempting to expand health service's usage in urban and rural areas of Indonesia. To increase access in urban areas, we recommend expansion of health insurance coverage in order to lower out-of-pocket medical expenditures. As for rural areas, expansion of medical infrastructures to reduce commuting distance and costs will be needed to increase utilization. Copyright © 2010 Elsevier Ireland Ltd. All rights reserved.

The role of Decentralized Distributed Generation in achieving universal rural electrification in South Asia by 2030

International Nuclear Information System (INIS)

Narula, Kapil; Nagai, Yu; Pachauri, Shonali

2012-01-01

This study is motivated by the goal of achieving ‘Universal Energy Access’ by 2030 and looks at electricity access for rural households in the South Asian region. The ‘MESSAGE-Access’ model is employed to assess the cost effectiveness of centralized and Decentralized Distributed Generation (DDG) technologies. Delivery mechanisms are modelled to include mini-grid and stand-alone systems and the analysis includes an estimation of rural household electricity demand from lighting and appliances. We assume two future demand scenarios with a ‘minimum threshold’ and a ‘higher threshold’ of electricity consumption of 65 and 420 kW h per household per year, respectively. We find that the cost of delivering electricity by centralized generation and grid distribution is up to four times the cost of stand-alone and mini-grid DDG options in the case of ‘minimum threshold’ demand scenario. These results are robust to alternate assumptions regarding costs of technologies. We also estimate that public subsidy bill for kerosene can be substantially reduced if all households switch to electricity as their primary source of lighting. Thus, promoting DDG options can reduce capital investments needed to meet access goals significantly and have an important role to play, in meeting the goal of universal electrification by 2030. - Highlights: ► We model and assess DDG options for rural electrification in South Asia. ► Particularly, when demand is low, off-grid and mini-grid are least cost options for electrification. ► DDG options can be 3–4 times cheaper than extending a central grid. ► Kerosene lighting is up to 6 times as expensive as electric lighting. ► If electricity replaces kerosene for lighting, large subsidy savings can be realized.

The costs of preventing and treating chagas disease in Colombia.

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Marianela Castillo-Riquelme

Full Text Available The objective of this study is to report the costs of Chagas disease in Colombia, in terms of vector disease control programmes and the costs of providing care to chronic Chagas disease patients with cardiomyopathy.Data were collected from Colombia in 2004. A retrospective review of costs for vector control programmes carried out in rural areas included 3,084 houses surveyed for infestation with triatomine bugs and 3,305 houses sprayed with insecticide. A total of 63 patient records from 3 different hospitals were selected for a retrospective review of resource use. Consensus methodology with local experts was used to estimate care seeking behaviour and to complement observed data on utilisation.The mean cost per house per entomological survey was $4.4 (in US$ of 2004, whereas the mean cost of spraying a house with insecticide was $27. The main cost driver of spraying was the price of the insecticide, which varied greatly. Treatment of a chronic Chagas disease patient costs between $46.4 and $7,981 per year in Colombia, depending on severity and the level of care used. Combining cost and utilisation estimates the expected cost of treatment per patient-year is $1,028, whereas lifetime costs averaged $11,619 per patient. Chronic Chagas disease patients have limited access to healthcare, with an estimated 22% of patients never seeking care.Chagas disease is a preventable condition that affects mostly poor populations living in rural areas. The mean costs of surveying houses for infestation and spraying infested houses were low in comparison to other studies and in line with treatment costs. Care seeking behaviour and the type of insurance affiliation seem to play a role in the facilities and type of care that patients use, thus raising concerns about equitable access to care. Preventing Chagas disease in Colombia would be cost-effective and could contribute to prevent inequalities in health and healthcare.

Accessibility of public libraries by rural dwellers in rural areas of ...

African Journals Online (AJOL)

In conclusion, public libraries are essential to rural dwellers; therefore it is recommended that all types of information be made available to public libraries. Sensitization programmes should be encouraged. This will in turn bring about positive impact on the rural dwellers. Key words: Accessibility, Public, Library, rural, ...

Changes in Veterinary Students' Attitudes Toward the Rural Environment and Rural Veterinary Practice: A Longitudinal Cohort Study.

Science.gov (United States)

Hashizume, Cary T; Woloschuk, Wayne; Hecker, Kent G

2015-01-01

There is a paucity of research regarding veterinary students' attitudes toward the rural environment and rural veterinary practice and how these attitudes might change over the course of a veterinary medicine program that includes rural clinical experience. Using a 23-item questionnaire, attitudes toward rural lifestyle, rural work-life balance, opportunities for career and skill development in rural veterinary practice, and inter-professional teamwork in the rural environment were assessed at the beginning and completion of a four-year veterinary medicine program. Eighty-six students (74.4% female) were included in this Canadian study over a six-year period. Thirty-one participants (36.1%) were rural students. Overall, students' attitudes toward the rural lifestyle, rural work-life balance, and inter-professional teamwork in rural veterinary practice all significantly decreased (pstudents, rural students had significantly higher rural lifestyle scores at both the beginning (pworking in a rural environment could influence students to exclude rural veterinary practice as a career choice. Rural clinical experiences designed to sustain or increase veterinary student interest in rural practice may not be sufficient to support positive rural attitudes. Given the demand for rural veterinary services in developed countries, the implications of this study may extend beyond Canada.

Reaching Rural Handicapped Children: The Transportation Situation in Rural Service Delivery. Making It Work in Rural Communities. A Rural Network Monograph.

Science.gov (United States)

Tucker, Jamie; And Others

Almost everyone who responded to three transportation surveys of rural Handicapped Children's Early Education Program (HCEEP) projects identified transportation as a critical problem in the delivery of services to handicapped children in rural areas. Transportation problems encountered were attributed to environmental/geographic factors,…

What do beginning students, in a rurally focused medical course, think about rural practice?

Science.gov (United States)

Young, Louise; Lindsay, Daniel B; Ray, Robin A

2016-12-07

Medical schools may select students for their attitudes towards rural medical practice, yet the rural-urban disparity in availability of medical practitioners and services has not diminished in recent times despite government initiatives and increasing numbers being trained for a career in medicine. One medical school, with a focus on rural and remote medicine, aims to select students with positive perceptions for rural medical practice. A research project collected data on the perceptions of these medical students in the first week of their medical studies. Students completed a low stakes essay on the life and work of a rural doctor. Initially, this formed part of a literacy assessment to determine any students requiring remediation. All students were asked if they would consent to their essay being reviewed for a research project. Data was obtained from those students who consented and handed their essays in for review. The 103 student essays underwent thematic analysis and sentences were coded into three main themes of rural lifestyle, doctor role and rural practice. Second level themes were further elicited and results were quantified according to whether they were positive or negative. Positive themes included rural lifestyle, doctor role, views of doctor, impact on community, broader work and skills knowledge, and better relationships with community and patients. Negative themes included doctor's health, pressure on doctor, family problems, greater workload, privacy and confidentiality issues, cultural issues, isolation, limited resources and financial impacts. Quantitisation of this data was used to transform essay sentences into a numerical form which allowed statistical analysis and comparison of perceptions using Z tests. No significant differences on the number of positive and negative responses for rural lifestyle and rural practice were found. The rural doctor role had a significantly more positive than negative views. Significant differences were

Improving Sanitation and Health in Rural Alaska

Science.gov (United States)

Bubenheim, David L.

2013-01-01

In rural Alaskan communities personal health is threatened by energy costs and limited access to clean water, wastewater management, and adequate nutrition. Fuel-­-based energy systems are significant factors in determining local accessibility to clean water, sanitation and food. Increasing fuel costs induce a scarcity of access and impact residents' health. The University of Alaska Fairbanks (UAF) School of Natural Resources and Agricultural Sciences (SNRAS), NASA's Ames Research Center, and USDA Agricultural Research Service (ARS) have joined forces to develop high-efficiency, low­-energy consuming techniques for water treatment and food production in rural circumpolar communities. Methods intended for exploration of space and establishment of settlements on the Moon or Mars will ultimately benefit Earth's communities in the circumpolar north. The initial phase of collaboration is completed. Researchers from NASA Ames Research Center and SNRAS, funded by the USDA­-ARS, tested a simple, reliable, low-energy sewage treatment system to recycle wastewater for use in food production and other reuse options in communities. The system extracted up to 70% of the water from sewage and rejected up to 92% of ions in the sewage with no carryover of toxic effects. Biological testing showed that plant growth using recovered water in the nutrient solution was equivalent to that using high-purity distilled water. With successful demonstration that the low energy consuming wastewater treatment system can provide safe water for communities and food production, the team is ready to move forward to a full-scale production testbed. The SNRAS/NASA team (including Alaska students) will design a prototype to match water processing rates and food production to meet rural community sanitation needs and nutritional preferences. This system would be operated in Fairbanks at the University of Alaska through SNRAS. Long­-term performance will be validated and operational needs of the

What Is Rural? Revised

Science.gov (United States)

US Department of Agriculture, 2016

2016-01-01

Many people have definitions for the term rural, but seldom are these rural definitions in agreement. For some, rural is a subjective state of mind. For others, rural is an objective quantitative measure. In this brief report the United States Department of Agriculture presents the following information along with helpful links for the reader: (1)…

Rural and Urban Youth Programs.

Science.gov (United States)

Backman, Kenneth; And Others

This publication provides a variety of information on prevention and intervention programs for rural and urban children and adolescents. Drawing from a rural sociological perspective, the introductory paper defines "rural," discusses rural-urban economic and social differences, and lists indicators of risk for rural youth. It discusses the extent…

Duration and setting of rural immersion during the medical degree relates to rural work outcomes.

Science.gov (United States)

O'Sullivan, Belinda; McGrail, Matthew; Russell, Deborah; Walker, Judi; Chambers, Helen; Major, Laura; Langham, Robyn

2018-04-19

Providing year-long rural immersion as part of the medical degree is commonly used to increase the number of doctors with an interest in rural practice. However, the optimal duration and setting of immersion has not been fully established. This paper explores associations between various durations and settings of rural immersion during the medical degree and whether doctors work in rural areas after graduation. Eligible participants were medical graduates of Monash University between 2008 and 2016 in postgraduate years 1-9, whose characteristics, rural immersion information and work location had been prospectively collected. Separate multiple logistic regression and multinomial logit regression models tested associations between the duration and setting of any rural immersion they did during the medical degree and (i) working in a rural area and (ii) working in large or smaller rural towns, in 2017. The adjusted odds of working in a rural area were significantly increased if students were immersed for one full year (odds ratio [OR], 1.79; 95% confidence interval [CI], 1.15-2.79), for between 1 and 2 years (OR, 2.26; 95% CI, 1.54-3.32) and for 2 or more years (OR, 4.43; 95% CI, 3.03-6.47) relative to no rural immersion. The strongest association was for immersion in a mix of both regional hospitals and rural general practice (OR, 3.26; 95% CI, 2.31-4.61), followed by immersion in regional hospitals only (OR, 1.94; 95% CI, 1.39-2.70) and rural general practice only (OR, 1.91; 95% CI, 1.06-3.45). More than 1 year's immersion in a mix of regional hospitals and rural general practices was associated with working in smaller regional or rural towns (immersion programmes. Longer rural immersion and immersion in both regional hospitals and rural general practices are likely to increase rural work and rural distribution of early career doctors. © 2018 John Wiley & Sons Ltd and The Association for the Study of Medical Education.

Improvements in Care and Reduced Self-Management Barriers Among Rural Patients With Diabetes

Science.gov (United States)

Dettori, Nancy; Flook, Benjamin N.; Pessl, Erich; Quesenberry, Kim; Loh, Johnson; Harris, Colleen; McDowall, Janet M.; Butcher, Marcene K.; Helgerson, Steven D.; Gohdes, Dorothy; Harwell, Todd S.

2005-01-01

Improved preventive care and clinical outcomes among patients with diabetes can reduce complications and costs; however, diabetes care continues to be suboptimal. Few studies have described effective strategies for improving care among rural populations with diabetes. In 2000, the Park County Diabetes Project and the Montana Diabetes Control…

Rural Policy and the New Regional Economics: Implications for Rural America.

Science.gov (United States)

Quigley, John M.

This paper discusses gross economic and demographic trends in rural and urban America during the past 30 years, the kinds of competitive advantages enjoyed by urban and rural regions, and insights offered by the new regional economics concerning exploitation of those advantages. The importance of agriculture has declined in rural areas, while that…

Lay discourses of the rural and stated and revealed preferences for rural living; some evidence of the existence of a rural idyll in the Netherlands

NARCIS (Netherlands)

Dam, van F.; Heins, S.; Elbersen, B.S.

2002-01-01

Dutch rural areas have changed into a post-modern countryside and have become marketable commodities. The demand for rural space and rural amenities has increased, with concomitant tensions on the rural housing market, tensions which are enhanced by the restrictive spatial policy in Dutch rural

THE ROLE OF MICRO FINANCIAL INSTITUTION TO IMPROVE SOCIO-ECONOMIC OF THE RURAL COMMUNITIES

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Moh. Aziz Arisudi

2017-03-01

Full Text Available Micro f inancial inst itut ion had an important role to improve the socio-economicof the rural communit ies. However, in its effort , the result in improving the socio-economicof the rural communit ies, part icularly among the poor is st ill low. The access for the ruralcommunit ies for low interest credit was also limited. The object ives of this research were asfollows. First , to analyze the factors that drove the rural communit ies to borrow money f rommicro credit inst itut ions. Second, to analyze the role of micro credit inst itut ions and itsimpacts on the rural communit ies’ socio-economic, Third, to analyze the rural communit ies’coping st rategies, Fourth, to evaluate the rural communit ies’ percept ions on micro creditinterest rate. This research used both qualitat ive and quant itat ive methods. The results ofthis research were as follows. First , the factors causing rural communit ies to borrow moneyf rom micro credit inst itut ions were to cover their living cost , provision and addit ion of capital.The micro credit inst itut ion had considerably lower interest rate than rentener, and theprocedures were simple and fast . Second, the role of micro credit inst itut ions to improve therural communit ies socio-economic was st ill low. Third, the interest rate of the micro creditinst itut ions was comparably fair and lower than the unlicensed micro bank.

Thermal Assessment of Low-Cost Rural Housing—A Case Study in the Ecuadorian Andes

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Isabel Miño-Rodríguez

2016-09-01

Full Text Available The aim of this research is to assess the indoor thermal performance of rural dwellings in the Ecuadorian highlands through both experimental and numerical analysis. A three-step methodology was applied to conduct the research: (a field data collection, (b building thermal model development and calibration, and (c comparison analysis and assessment of traditional improvement strategies. Qualitative and quantitative data were collected from two representative rural dwellings under typical usage conditions. The first is a traditional construction, medium-exposed thermal mass dwelling (Case A. The second is a local common, uninsulated, lightweight construction (Case B. The thermal model was calibrated by comparing hourly temperature values of the observed and the predicted indoor air temperature. A high correlation level (R2 was achieved between the observed and predicted data; 0.89 in Case A and 0.94 in Case B. The results show that the roof, floor, and the airtightness are the critical building parameters affecting the indoor thermal environment. Likewise, the indoor air temperature is increased up to 4 °C through the implementation of traditional strategies. However, despite the rise in indoor air temperature, acceptable thermal comfort ranges were only reached for 25% of the total hours.

What is going to change in EU rural development policies after 2013? Main implications in different national contexts

Directory of Open Access Journals (Sweden)

Francesco Mantino

2013-09-01

Full Text Available This paper will address the changes the CAP post‐2013 may bring to its second pillar in EU countries. After the presentation of the legislative package put forward by the European Commission, a debate emerged in some countries on how to define rural development strategies for the period 2014‐2020. The paper will discuss positive innovations and main challenges of the new rural development policies with respect to what happened in the 2007‐2013 period. In particular, the paper intends to focus on the following issues: 1 which relevant changes have been introduced in the rural development framework; 2 how these changes can influence the preparation of the next programming period 2014-2020, looking more in depth at three countries (Italy, Spain and France; 3 what lessons can be drawn from this reform and the initial implementation in three countries in terms of institutional changes and their likely success and failure. This analysis concludes that the success or failure of the 2014-2020 reform of rural development will significantly depend on what types of transaction costs and incentive systems will be brought about within the programming system. These two factors in turn will strongly depend on the way the different actors will perceive the different costs and incentives, their expectations on the role of rural development programmes in a context where budget for agriculture is shrinking everywhere, and finally their capability to build new strategic alliances and cooperation at every level (national, regional and local with other economic and social actors. Future policy scenarios might bring new and heavy constraints to rural development policies and consequently might also reduce the opportunities of institutional innovations.

Pico hydro power for rural electrification in developing countries

International Nuclear Information System (INIS)

Maher, P.; Smith, N.P.A.; Williams, A.A.

1998-01-01

Pico hydro power is a renewable energy system which has the potential to provide millions of rural people world-wide with a cheap, sustainable source of electricity. The development of new, cost-reducing approaches, including local manufacture and implementation in developing countries, has increased the accessibility of this technology to large numbers of people. The new approaches are investigated and some of the present constraints to wider adoption of this technology are analysed. (Author)

Rural roadway safety perceptions among rural teen drivers living in and outside of towns.

Science.gov (United States)

Ramirez, Marizen; Roth, Lisa; Young, Tracy; Peek-Asa, Corinne

2013-01-01

To compare perceptions about rural road and general driving behaviors between teens who live in- and out-of-town from rural communities in Iowa. A cross-sectional survey was conducted with 160 teens anticipating their Intermediate License within 3 months upon enrollment into this study. Self-administered surveys were used to collect demographics and driving exposures (eg, frequency of driving, age when first drove unsupervised). Two Likert scales were included to measure agreement with safe driving behaviors on rural roads and general safe driving behaviors (eg, speeding, seat belt use). T-tests were calculated comparing mean composite scores between in- and out-of-town teens, and between mean rural road and general driving safety attitude scores. A linear regression multivariable model was constructed to identify predictors of the rural road score. While the majority of teens endorsed rural road and general safe driving behaviors, up to 40% did not. Thirty-two percent did not believe the dangers of animals on rural roads, and 40% disagreed that exceeding the speed limit is dangerous. In-town teens were less safety conscious about rural road hazards with a significantly lower mean composite score (4.4) than out-of-town teens (4.6); mean scores for general driving behaviors were similar. Living out-of-town and owning one's own car were significant predictors of increased rural road safety scores. Rural, in-town teens have poorer safety attitudes about rural roadway hazards compared with out-of-town teens. Interventions that involve education, parental supervision, and practice on rural roads are critical for preventing teen crashes on rural roads. No claim to original US government works.

Significant involvement of agricultural holdings in rural tourism development in Serbia

Directory of Open Access Journals (Sweden)

Gajić Tamara

2017-01-01

Full Text Available There are a large number of farms in Serbia, which survived with a little capital and labor, and today one of the perspectives they see in the integration with the rural tourism. Tourism development is an incentive for the introduction of improvements in agricultural production, processing and supply of food, as well as the introduction of modern standards that are difficult to apply on small farms because of the high costs of their implementation. Rural tourism in Serbia is not at a satisfactory level of development, although there are all preconditions for its intensive development. Due to unfavorable political and economic position of Serbia, rural tourism has not encountered the support of its favorable development among its competitors. The authors have tried to point out a study for the attitude of the hosts as a service providers on the current status and problems faced in providing services in rural tourism. Investigated in 15 municipalities in Vojvodina (Northern Serbia, Southwestern Serbia and Southeastern Serbia, and in a total of 46 owners of small farms. Using the tests methods questionnaires and processing in SPSS, version 19.0, and analysis of the data, authors led to the confirmation of certain hypotheses of which started in the investigation.

Culturally-adapted and audio-technology assisted HIV/AIDS awareness and education program in rural Nigeria: a cohort study

Directory of Open Access Journals (Sweden)

Lennox Jeffrey L

2010-02-01

Full Text Available Abstract Background HIV-awareness programs tailored toward the needs of rural communities are needed. We sought to quantify change in HIV knowledge in three rural Nigerian villages following an integrated culturally adapted and technology assisted educational intervention. Methods A prospective 14-week cohort study was designed to compare short-term changes in HIV knowledge between seminar-based education program and a novel program, which capitalized on the rural culture of small-group oral learning and was delivered by portable digital-audio technology. Results Participants were mostly Moslem (99%, male (53.5%, with no formal education (55%. Baseline HIV knowledge was low ( Conclusions Baseline HIV-awareness was low. Culturally adapted, technology-assisted HIV education program is a feasible cost-effective method of raising HIV awareness among low-literacy rural communities.

Evaluation of choices for sustainable rural electrification in developing countries: A multicriteria approach

International Nuclear Information System (INIS)

Rahman, Md. Mizanur; Paatero, Jukka V.; Lahdelma, Risto

2013-01-01

Rural electrification (RE) can be modelled as a multifactorial task connected to a large number of variables: decision makers need to choose the appropriate options by considering not only the techno-economic competitiveness but also socio-cultural dynamics and environmental consequences, making the task intricate. Many rural electrification projects have failed due to lack of attention to the issues beyond financial and technical dimensions. This paper presents a standardized approach for decision making concerning the extension of electricity services to rural areas. This approach first determines whether the supply provision should be grid expansion or off-grid on the basis of levelized cost of delivered electricity. If the grid expansion is found nonviable over off-grid options then a multicriteria decision aiding tool, SMAA-2 (Stochastic Multicriteria Acceptability Analysis), will evaluate off-grid technologies by aggregating 24 criteria values. While applying this approach, the delivered costs of electricity by the grid in remote areas within the 1–25 km distances vary in a range of 0.10–7.85 US$/kW h depending on the line lengths and load conditions. In the off-grid evaluation, the solar PV (photovoltaic) and biogas plants are found as the most preferable alternatives with 59% and 41% acceptability in their first rank, respectively. - Highlights: • Rural electrification involves a large number of socio-cultural issues in addition to technical and environmental considerations. • Decision makers need to choose the appropriate options by considering many criteria. • Many off-grid projects failed due to noncomplying of societal issues. • Multicriteria based decision choice can safeguard the projects from these issues. • SMAA analysis can select the alternatives based on merits

Financial Performance of Rural Medicare ACOs.

Science.gov (United States)

Nattinger, Matthew C; Mueller, Keith; Ullrich, Fred; Zhu, Xi

2018-12-01

The Centers for Medicare & Medicaid Services (CMS) has facilitated the development of Medicare accountable care organizations (ACOs), mostly through the Medicare Shared Savings Program (MSSP). To inform the operation of the Center for Medicare & Medicaid Innovation's (CMMI) ACO programs, we assess the financial performance of rural ACOs based on different levels of rural presence. We used the 2014 performance data for Medicare ACOs to examine the financial performance of rural ACOs with different levels of rural presence: exclusively rural, mostly rural, and mixed rural/metropolitan. Of the ACOs reporting performance data, we identified 97 ACOs with a measurable rural presence. We found that successful rural ACO financial performance is associated with the ACO's organizational type (eg, physician-based) and that 8 of the 11 rural ACOs participating in the Advanced Payment Program (APP) garnered savings for Medicare. Unlike previous work, we did not find an association between ACO size or experience and rural ACO financial performance. Our findings suggest that rural ACO financial success is likely associated with factors unique to rural environments. Given the emphasis CMS has placed on rural ACO development, further research to identify these factors is warranted. © 2016 National Rural Health Association.

Impacts of Rural Electrification Revisited: The African Context

International Nuclear Information System (INIS)

Peters, Jorg; Sievert, Maximiliane; Vincent, Nicolas

2015-12-01

The investment requirements to achieve the United Nations' universal electricity access goal by 2030 are estimated at 640 billion US Dollars. The assumption underlying this goal is that electrification contributes to poverty alleviation in many regards. In recent years, a body of literature has emerged that widely confirms this positive poverty impact assumption. Most of these studies, however, are based on data from Asia and Latin America. This paper challenges the transferability of impact findings in the literature to the African context. Using a unique data set that we collected in various African countries we suggest that impact expectations on income, education, and health should be discounted considerably for Africa. In many cases, the low levels of electricity consumption can also be served by low-cost solar alternatives. To ensure cost-effective usage of public investments into rural electrification, we call for careful cost-benefit comparisons of on-grid and off-grid solutions. (authors)

Medicaid and Rural Health

Science.gov (United States)

... State Guides Rural Data Visualizations Rural Data Explorer Chart Gallery Maps Case Studies & Conversations Rural Health Models & ... services provided by state Medicaid programs might include dental care, physical therapy, home and community-based services, ...

Assessing the costs and benefits of improved land management practices in three watershed areas in Ethiopia

Directory of Open Access Journals (Sweden)

Abonesh Tesfaye

2016-03-01

Full Text Available Unsustainable land use management and the resulting soil erosion are among the most pervasive problems in rural Ethiopia, where most of the country’s people live, jeopardizing food security. Despite various efforts to introduce soil conservation measures and assess their costs and benefits, it is unclear how efficient these measures are from an economic point of view in securing food production. This paper examines the costs and benefits of three soil conservation measures applied in the country in three different rural districts facing different degrees of soil erosion problems using survey data collected from 750 farm households. A production function is estimated to quantify the costs and benefits of more sustainable land use management practices. We show that the soil conservation measures significantly increase productivity and hence food security. Comparing the costs and benefits, the results indicate that implementing soil conservation measures would benefit farm communities in the case study areas through increased grain productivity and food security.

The Potential of Computer-Based Expert Systems for Special Educators in Rural Settings.

Science.gov (United States)

Parry, James D.; Ferrara, Joseph M.

Knowledge-based expert computer systems are addressing issues relevant to all special educators, but are particularly relevant in rural settings where human experts are less available because of distance and cost. An expert system is an application of artificial intelligence (AI) that typically engages the user in a dialogue resembling the…

Barriers to Rural Induced Abortion Services in Canada: Findings of the British Columbia Abortion Providers Survey (BCAPS)

Science.gov (United States)

Norman, Wendy V.; Soon, Judith A.; Maughn, Nanamma; Dressler, Jennifer

2013-01-01

Background Rural induced abortion service has declined in Canada. Factors influencing abortion provision by rural physicians are unknown. This study assessed distribution, practice, and experiences among rural compared to urban abortion providers in the Canadian province of British Columbia (BC). Methods We used mixed methods to assess physicians on the BC registry of abortion providers. In 2011 we distributed a previously-published questionnaire and conducted semi-structured interviews. Results Surveys were returned by 39/46 (85%) of BC abortion providers. Half were family physicians, within both rural and urban cohorts. One-quarter (17/67) of rural hospitals offer abortion service. Medical abortions comprised 14.7% of total reported abortions. The three largest urban areas reported 90% of all abortions, although only 57% of reproductive age women reside in the associated health authority regions. Each rural physician provided on average 76 (SD 52) abortions annually, including 35 (SD 30) medical abortions. Rural physicians provided surgical abortions in operating rooms, often using general anaesthesia, while urban physicians provided the same services primarily in ambulatory settings using local anaesthesia. Rural providers reported health system barriers, particularly relating to operating room logistics. Urban providers reported occasional anonymous harassment and violence. Conclusions Medical abortions represented 15% of all BC abortions, a larger proportion than previously reported (under 4%) for Canada. Rural physicians describe addressable barriers to service provision that may explain the declining accessibility of rural abortion services. Moving rural surgical abortions out of operating rooms and into local ambulatory care settings has the potential to improve care and costs, while reducing logistical challenges facing rural physicians. PMID:23840578

Rural Education as Rural Development: Understanding the Rural School-Community Well-Being Linkage in a 21st-Century Policy Context

Science.gov (United States)

Schafft, Kai A.

2016-01-01

Despite the significant proportions of rural Americans, schools, and public school students situated in the geographic peripheries of an increasingly urbanizing country, rural education in the United States has consistently occupied both scholarly and policy peripheries. This is to the detriment of rural America, especially to the extent that…

A qualitative study of medical students in a rural track: views on eventual rural practice.

Science.gov (United States)

Roseamelia, Carrie; Greenwald, James L; Bush, Tiffany; Pratte, Morgan; Wilcox, Jessica; Morley, Christopher P

2014-04-01

Rural tracks (RTs) exist within medical schools across the United States. These programs often target those students from rural areas and those with primary care career interests, given that these factors are robust predictors of eventual rural practice. However, only 26% to 64% of graduates from RTs enter eventual rural practice. We conducted a qualitative, exploratory study of medical students enrolled in one school's RT, examining their interests in rural training, specialization, and eventual rural practice, via open coding of transcripts from focus groups and in-depth individual interviews, leading to identification of emerging themes. A total of 16 out of 54 eligible first- and second-year preclinical medical students participated in focus group sessions, and a total of seven out of 17 eligible third- and fourth-year medical students participated in individual interviews. Analyses revealed the recognition of a "Rural Identity," typical characteristics, and the importance of "Program Fit" and "Intentions for Practice" that trended toward family medicine specialization and rural practice. However, nuances within the comments reveal incomplete commitment to rural practice. In many cases, student preference for rural practice was driven largely by a disinterest in urban practice. Students with rural and primary care practice interests are often not perfectly committed to rural practice. However, RTs may provide a haven for such students within medical school.

Are Physician Assistants Needed in Guatemala? A Survey of Potential Urban and Rural Users.

Science.gov (United States)

Luna-Asturias, Claudia; Apple, Jennifer; Bolaños, Guillermo A; Bowser, Jonathan M; Asturias, Edwin J

2017-09-01

The shortage of trained health care personnel has been increasing worldwide. With the physician assistant (PA) profession, created in the United States in the 1960s, expanding globally, this study sought to ascertain whether PAs can be an innovative solution to this crisis. We conducted a convenience sample survey to assess the need for and acceptability of future PA professionals in Guatemala. Eighty-nine doctors, nurses, and community members from rural and urban areas of Guatemala participated in the survey. More urban (70%) than rural (58%) respondents found it difficult to access a doctor, with cost being the major reason (34%). Access in rural areas was reportedly limited by lack of doctors and inaccessible office hours. Most survey respondents considered PAs to be suitable and potentially helpful providers for Guatemala, with a preference for competencies in the diagnosis of serious illnesses, drug prescription, labor and delivery attendance, and care for injuries and fractures, especially in rural locations. Belonging to the community was deemed very important for a PA who would practice in the country.

Ruralization of students' horizons: insights into Australian health professional students' rural and remote placements.

Science.gov (United States)

Smith, Tony; Cross, Merylin; Waller, Susan; Chambers, Helen; Farthing, Annie; Barraclough, Frances; Pit, Sabrina W; Sutton, Keith; Muyambi, Kuda; King, Stephanie; Anderson, Jessie

2018-01-01

Health workforce shortages have driven the Australian and other Western governments to invest in engaging more health professional students in rural and remote placements. The aim of this qualitative study was to provide an understanding of the lived experiences of students undertaking placements in various nonmetropolitan locations across Australia. In addition to providing their suggestions to improve rural placements, the study provides insight into factors contributing to positive and negative experiences that influence students' future rural practice intentions. Responses to open-ended survey questions from 3,204 students from multiple health professions and universities were analyzed using two independent methods applied concurrently: manual thematic analysis and computerized content analysis using Leximancer software. The core concept identified from the thematic analysis was "ruralization of students' horizons," a construct representing the importance of preparing health professional students for practice in nonmetropolitan locations. Ruralization embodies three interrelated themes, "preparation and support," "rural or remote health experience," and "rural lifestyle and socialization," each of which includes multiple subthemes. From the content analysis, factors that promoted students' rural practice intentions were having a "positive" practice experience, interactions with "supportive staff," and interactions with the "community" in general. It was apparent that "difficulties," eg, with "accommodation," "Internet" access, "transport," and "financial" support, negatively impacted students' placement experience and rural practice intentions. The study findings have policy and practice implications for continuing to support students undertaking regional, rural, and remote placements and preparing them for future practice in nonmetropolitan locations. This study may, therefore, further inform ongoing strategies for improving rural placement experiences and

Feasibility study of a hybrid plants (photovoltaic–LPG generator system for rural electrification

Directory of Open Access Journals (Sweden)

Adouane Mabrouk

2016-01-01

Full Text Available The present study investigates the possibility of using a stand-alone photovoltaic/LPG (liquid petroleum gas generator hybrid power system for low-cost electricity production which can satisfy the energy load requirements of a typical remote and isolated rural area. In this context, the optimal dimensions to improve the technical and economical performances of the hybrid system are determined according to the load energy requirements. The proposed system's installation and operating costs are simulated using the Hybrid Optimization Model for Electric Renewable (HOMER, the solar radiation and the system components costs as inputs; and then compared with those of other supply options such as diesel generation.

Ending Open Defecation in Rural Tanzania: Which Factors Facilitate Latrine Adoption?

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Stephen Sara

2014-09-01

Full Text Available Diarrheal diseases account for 7% of deaths in children under five years of age in Tanzania. Improving sanitation is an essential step towards reducing these deaths. This secondary analysis examined rural Tanzanian households’ sanitation behaviors and attitudes in order to identify barriers and drivers to latrine adoption. The analysis was conducted using results from a cross-sectional study of 1000 households in five rural districts of Tanzania. Motivating factors, perceptions, and constraints surrounding open defecation and latrine adoption were assessed using behavioral change theory. Results showed a significant association between use of improved sanitation and satisfaction with current sanitation facility (OR: 5.91; CI: 2.95–11.85; p = 0.008. Livestock-keeping was strongly associated with practicing open defecation (OR: 0.22; CI 0.063–0.75; p < 0.001. Of the 93 total households that practiced open defecation, 79 (85% were dissatisfied with the practice, 62 (67% had plans to build a latrine and 17 (18% had started saving for a latrine. Among households that planned to build a latrine, health was the primary reason stated (60%. The inability to pay for upgrading sanitation infrastructure was commonly reported among the households. Future efforts should consider methods to reduce costs and ease payments for households to upgrade sanitation infrastructure. Messages to increase demand for latrine adoption in rural Tanzania should integrate themes of privacy, safety, prestige and health. Findings indicate a need for lower cost sanitation options and financing strategies to increase household ability to adopt sanitation facilities.

Is There A Rural-Urban Technology Gap? Results of the ERS Rural Manufacturing Survey

OpenAIRE

Gale, H. Frederick, Jr.

1997-01-01

Advanced technology use is less prevalent in rural than in urban manufacturing plants, but plants of comparable size in the same industry use about the same level of technology, regardless of urban/rural location. The rural gap comes about because the mix of rural industries is more heavily weighted with "low-technology" industries. Both rural and urban businesses rate inadequate worker skills as the most important barrier to use of new production technologies and management practices, while ...

Rural electrification in Zambia: A policy and institutional analysis

International Nuclear Information System (INIS)

Haanyika, Charles M.

2008-01-01

Zambia is well endowed with hydropower and other energy resources, which could facilitate production of electricity for both urban and rural areas of the country. The country has an installed electricity generation capacity of 1786 MW and undeveloped hydropower potential of over 6000 MW. In the last few years, demand has been growing and it is anticipated to outstrip supply in 2008. The load growth is attributed to increased mining activities and development of the industrial base. The country is also endowed with abundant natural resources such as arable land, water, minerals and wildlife. With the available resource base, electricity along with other social and economic infrastructure such as roads and telecommunications could facilitate increased economic activities. In rural areas, electricity could be used for crop irrigation, agro-processing, small-scale mining and to facilitate tourism. However, rural electrification (RE) faces many challenges such as long distances from existing power stations to targeted rural areas, low population densities, high poverty levels and low skills availability. These and other factors have contributed to continued low levels of access to electricity in rural areas of the country. Measures so far undertaken to facilitate access to electricity in rural areas of Zambia include the adoption of a new National Energy Policy (NEP) in 1994. With regard to the electricity sector and RE in particular, the NEP was aimed at facilitating increased access by liberalising and restructuring the electricity market and promoting the use of low-cost technologies and decentralised renewable energies. To facilitate implementation of the new policy, the government established a legal and institutional framework by enacting new legislation, namely, the Electricity Act and the Energy Regulation Act in 1995. The Electricity Act provided for liberalisation and regulation of the electricity sector, while the Energy Regulation Act provided for the

Urban-rural migration and cultural transformation of rural areas

DEFF Research Database (Denmark)

Nørgaard, Helle

Rural areas are presently challenged by various restructuring processes; functionally and economically with changes in employment structure etc. as well as social and cultural transformations due to demographic change, population loss but also due to in-migration. This paper addresses how rural...

Some Enlightenments of "Beautiful Rural Construction" on Rural Energy Policy in Beijing—Applying Informatization Means

Science.gov (United States)

Zhi, Wang; Kongan, Wu

2018-06-01

"Beautiful rural construction" is a systematic project, rural energy is one of the important contents of its construction. In accordance with the concept of eco-friendly construction, Beijing carried out a thorough "structural adjustment of rural energy optimization," "Earthquake energy-saving projects of rural housing" and other measures. By conventional heating technology research in Beijing 13 counties and 142 villages, we predict the future of rural energy will further the implementation of solar heating, electric heating and other new green energy technologies. It is suggested to establish the "Beijing Rural Information Service Platform" and "Beautiful Rural Information Resource Bank" through the means of informatization, which will greatly strengthen the regulation and control of rural people-land relationship and realize the systematic optimization, making the cities and villages have. Space for human survival and sustainable development.

Reviewing the potential and cost-effectiveness of off-grid PV systems in Indonesia on a provincial level

NARCIS (Netherlands)

Veldhuis, A.J.; Reinders, Angelina H.M.E.

2015-01-01

In this study the amount and costs of off-grid PV systems required to electrify Indonesian rural households lacking electricity access are estimated. Due to the Indonesian geography large differences exist among different provinces, therefore this study evaluates the potential and costs of off-grid

Australia's rural medical workforce: Supply from its medical schools against career stage, gender and rural-origin.

Science.gov (United States)

McGrail, Matthew R; Russell, Deborah J

2017-10-01

The aim of this study was to explore the association between career stage and rural medical workforce supply among Australian-trained medical graduates. Descriptive analysis using the national Medicine in Australia: Balancing Employment and Life (MABEL) longitudinal study. Australian-trained GPs and other specialists who participated in the MABEL study, 2008-2013. Proportions of GPs and specialists working in rural locations, according to career stage (establishing, early, mid and late), gender and childhood-origin type (rural versus metropolitan). Logistic regression models revealed that establishing- and early-career GPs had significantly higher likelihood (OR 1.67 and 1.38, respectively) of working rurally, but establishing and early-career doctors were significantly less likely (OR 0.34 and 0.43, respectively) to choose general practice, contributing proportionally fewer rural GPs overall (OR 0.77 and 0.75, respectively) compared to late-career doctors. For specialists, there were no significant associations between career cohorts and rural practice. Overall, there was a significantly lower likelihood (OR 0.83) of establishing-career doctors practising rurally. Women were similarly likely to be rural GPs but less likely to be rural specialists, while rural-origin was consistently associated with higher odds of rural practice. The supply of Australia's rural medical workforce from its medical schools continues to be challenging, with these data highlighting both their source and associations with doctors at different career stages. Despite large investments through rural medical training and rural workforce recruitment and retention policies, these data confirm continued reliance on internationally trained medical graduates for large proportions of rural supply is likely. © 2016 National Rural Health Alliance Inc.

Culture and rural health.

Science.gov (United States)

Farmer, Jane; Bourke, Lisa; Taylor, Judy; Marley, Julia V; Reid, John; Bracksley, Stacey; Johnson, Nicole

2012-10-01

This paper considers the role of culture in rural health, suggesting that the concept and its impacts are insufficiently understood and studied. It reviews some of the ways that culture has been considered in (rural) health, and states that culture is either used ambiguously and broadly - for example, suggesting that there is a rural culture, or narrowly - indeed perhaps interchangeably with ethnicity, for example Aboriginal culture as a unity. The paper notes that, although culture is a dynamic social concept, it has been adopted into a biomedical research paradigm as though it is fixed. Culture is often treated as though it is something that can be addressed simplistically, for example, through cultural sensitivity education. Authors suggest that culture is an unaddressed 'elephant in the room' in rural health, and that exploring cultural differences and beliefs and facing up to cultural differences are vital in understanding and addressing rural health and health system challenges. © 2012 The Authors. Australian Journal of Rural Health © National Rural Health Alliance Inc.

Rural Hospital Mergers and Acquisitions: Which Hospitals Are Being Acquired and How Are They Performing Afterward?.

Science.gov (United States)

Noles, Marissa J; Reiter, Kristin L; Boortz-Marx, Jonathan; Pink, George

2015-01-01

The number of stand-alone rural hospitals has been shrinking as larger health systems target these hospitals for mergers and acquisitions (M and As). However, little research has focused specifically on rural hospital M and A transactions. Using data from Irving Levin Associates' Healthcare M and A Report and Medicare Cost Reports from 2005 to 2012, we examined two research questions: (1) What were the characteristics of rural hospitals that merged or were acquired, and (2) were there changes in rural hospital financial performance, staffing, or services after an M and A transaction? We used logistic regression to identify factors predictive of merger, and we used multiple regression to examine various hospital measures after an M or A. Study results showed that hospitals with weaker financial performance but lower staffing levels and staffing costs were more likely to merge or be acquired. Statistically weak evidence suggested that operating margins declined after the merger; stronger evidence suggested reductions in salary expense. There was no statistically significant evidence of changes to the number of full-time equivalent (FTE) employees, the service lines that were included in the study, capital expenditures, or the amount of debt financing among the hospitals that merged or were acquired. M and A may not result in a rapid influx of capital, a relief of debt burden, or an improvement in bottom-line profitability. However, M and A may be a viable option for maintaining the hospital and the access to care it provides.

Influence of household biogas digester use on household energy consumption in a semi-arid rural region of northwest China

International Nuclear Information System (INIS)

Ding, Wenguang; Niu, Hewen; Chen, Jinsong; Du, Jun; Wu, Yang

2012-01-01

Highlights: ► Rural household energy mainly derives from available biomass resources. ► Household energy consumption structure experiencing substantial transformation. ► Biogas energy plays an important roles in rural household energy consumption. ► Biogas digester construction has a profound implication for applied energy. -- Abstract: A comprehensive investigation was conducted to evaluate the efficiency of newly installed biogas digesters in saving biomass resources and addressing energy squandering. Compared with traditional coal-based or firewood dominated energy consumption, the biogas digesters economize on energy resources due to higher heat efficiency. Furthermore, since crop residues of straw and other domestic animal and human excreta are effectively recycled and reused as anaerobic fermentation materials of biogas digesters, greenhouse gas emissions are significantly reduced by converting the previous extensive combustion of such into a sustainable and highly efficient practice in the rural region. The results in this study show that total energy consumption is 412 kgce (kgce: 1 kg standard coal. 1 kgce = 29.31 MJ) in Xiyang Township in 2009. The construction of biogas digesters significantly contributes to the transformation of rural household energy consumption structure, though biogas as a renewable energy only accounts for 6.31% of the total household energy consumption. Per capita rural household energy consumption is 393.07 kgce in household with biogas digesters and 437.60 kgce in household without biogas digesters. In addition, application of biogas dregs, slurry, and marsh liquid to the agricultural crops have greatly reduced the expenditure of buying chemical fertilizers. The average commercial fertilizer per mu (0.067 ha) in rural households using biogas digesters is 12.43 kg and the cost per mu is 29.53 yuan (1 yuan = 0.1523 dollar), while rural households without biogas digesters use 25.22 kg of commercial fertilizers and cost 59

Can rural electric cooperatives survive in a restructured US electric market? An empirical analysis

International Nuclear Information System (INIS)

Greer, Monica Lynne

2003-01-01

This paper examines the ability of rural electric distribution cooperatives to continue operating in their present form in a restructured electricity market. More specifically, I develop and estimate a quadratic cost model, which, unlike many of the cost functions employed in studies of this nature, conforms to all of the properties of a proper cost function. Using 1996 data, I find that these firms are not operating in a cost-minimizing fashion. This finding seems to occur because each is too small in terms of the quantity of electricity distributed. As a result, mergers between these firms could yield substantial savings and help ensure their survival in their present form in a deregulated market

Rural entrepreneurship: Between place and space

DEFF Research Database (Denmark)

Korsgaard, Steffen; Müller, Sabine; Tanvig, Hanne Wittorff

for a better use of rural resource-bases as well as for sustainable economic development. On the basis of an exploration of the spatial dynamics of rural entrepreneurship we develop propositions concerning rural entrepreneurship as a distinct form of entrepreneurial activity, emphasising bricolage, mixed......This paper proposes a distinction between rural entrepreneurship and entrepreneurship in the rural. While the latter is incidentally located in a rural area, the former engages with the localised resources of the rural area. We argue that rural entrepreneurship in this form holds promise...

Ruralization of students’ horizons: insights into Australian health professional students’ rural and remote placements

Science.gov (United States)

Cross, Merylin; Waller, Susan; Chambers, Helen; Farthing, Annie; Barraclough, Frances; Pit, Sabrina W; Sutton, Keith; Muyambi, Kuda; King, Stephanie; Anderson, Jessie

2018-01-01

Introduction Health workforce shortages have driven the Australian and other Western governments to invest in engaging more health professional students in rural and remote placements. The aim of this qualitative study was to provide an understanding of the lived experiences of students undertaking placements in various nonmetropolitan locations across Australia. In addition to providing their suggestions to improve rural placements, the study provides insight into factors contributing to positive and negative experiences that influence students’ future rural practice intentions. Methods Responses to open-ended survey questions from 3,204 students from multiple health professions and universities were analyzed using two independent methods applied concurrently: manual thematic analysis and computerized content analysis using Leximancer software. Results The core concept identified from the thematic analysis was “ruralization of students’ horizons,” a construct representing the importance of preparing health professional students for practice in nonmetropolitan locations. Ruralization embodies three interrelated themes, “preparation and support,” “rural or remote health experience,” and “rural lifestyle and socialization,” each of which includes multiple subthemes. From the content analysis, factors that promoted students’ rural practice intentions were having a “positive” practice experience, interactions with “supportive staff,” and interactions with the “community” in general. It was apparent that “difficulties,” eg, with “accommodation,” “Internet” access, “transport,” and “financial” support, negatively impacted students’ placement experience and rural practice intentions. Conclusions The study findings have policy and practice implications for continuing to support students undertaking regional, rural, and remote placements and preparing them for future practice in nonmetropolitan locations. This study

Integrated approach to oral health in aged care facilities using oral health practitioners and teledentistry in rural Queensland.

Science.gov (United States)

Tynan, Anna; Deeth, Lisa; McKenzie, Debra; Bourke, Carolyn; Stenhouse, Shayne; Pitt, Jacinta; Linneman, Helen

2018-04-16

Residents of residential aged care facilities are at very high risk of developing complex oral diseases and dental problems. Key barriers exist in delivering oral health services to residential aged care facilities, particularly in regional and rural areas. A quality improvement study incorporating pre- and post chart audits and pre- and post consultation with key stakeholders, including staff and residents, expert opinion on cost estimates and field notes were used. One regional and three rural residential aged care facilities situated in a non-metropolitan hospital and health service in Queensland. Number of appointments avoided at an oral health facility Feedback on program experience by staff and residents Compliance with oral health care plan implementation Observations of costs involved to deliver new service. The model developed incorporated a visit by an oral health therapist for screening, education, simple intervention and referral for a teledentistry session if required. Results showed an improvement in implementation of oral health care plans and a minimisation of need for residents to attend an oral health care facility. Potential financial and social cost savings for residents and the facilities were also noted. Screening via the oral health therapist and teledentistry appointment minimises the need for a visit to an oral health facility and subsequent disruption to residents in residential aged care facilities. © 2018 National Rural Health Alliance Ltd.

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