The Limerick Declaration on Rural Health Care 2022.

The 19th World Rural Health Conference, hosted in rural Ireland and the University of Limerick, with over 650 participants coming from 40 countries and an additional 1600 engaging online, has carefully considered how best rural communities can be empowered to improve their own health and the health of those around them. The conference also considered the role of national health systems and all stakeholders, in keeping with the commitments made through the Sustainable Development Goals and the enjoyment of the highest attainable standard of health as one of the fundamental rights of every human being. This conference declaration, the Limerick Declaration on Rural Healthcare, is designed to inform rural communities, academics and policymakers about how to achieve the goal of delivering high quality health care in rural and remote areas most effectively, with a particular focus on the Irish healthcare system. Congruent with current evidence and best international practice, the participants of the conference endorsed a series of recommendations for the creation of high quality, sustainable and cost-effective healthcare delivery for rural communities in Ireland and globally. The recommendations focused on four major themes: rural healthcare needs and delivery, rural workforce, advocacy and policy, and research for rural health care. Equal access to health care is a crucial marker of democracy. Hence, we call on all governments, policymakers, academic institutions and communities globally to commit to providing their rural dwellers with equitable access to health care that is properly resourced and fundamentally patient-centred in its design.

Rural health activism over two decades: the Wonca Working Party on Rural Practice 1992-2012.

The Wonca Working Party on Rural Practice (WWPRP) was formed in 1992 in response to the realization that rural healthcare faced many serious and similar challenges around the world. Over the years the members of the committee have come from many different countries but found inspiration and strength in developing and sharing educational and health system innovations that could be modified and applied to different rural settings. The 11 world rural health conferences organized by the WWPRP over the first two decades since it was founded brought together a range of people, from rural doctors and other front-line healthcare workers to administrators and educational leaders, who connected with and learned from each other to advance rural health care around the world. The WWPRP policy documents and conference consensus statements have been important in shaping rural health care in a number of different contexts, and have led to issues of rural health care rising to prominence on the world stage. The WWPRP has throughout been an activist lobby group with a focus on the rural communities it serves rather than its members, and enters its third decade with much left to be done.

A Checklist for Implementing Rural Pathways to Train, Develop and Support Health Workers in Low and Middle-Income Countries.

Background: There is an urgent need to scale up global action on rural workforce development. This World Health Organization-sponsored research aimed to develop a Rural Pathways Checklist. Its purpose was to guide the practical implementation of rural workforce training, development, and support strategies in low and middle-income countries (LMICs). It was intended for any LMICs, stakeholder, health worker, context, or health problem. Method: Multi-methods involved: (1) focus group concept testing; (2) a policy analysis; (3) a scoping review of LMIC literature; (4) consultation with a global Expert Reference Group and; (5) field-testing over an 18-month period. Results: The Checklist included eight actions for implementing rural pathways in LMICs: establishing community needs; policies and partners; exploring existing workers and scope; selecting health workers; education and training; working conditions for recruitment and retention; accreditation and recognition of workers; professional support/up-skilling and; monitoring and evaluation. For each action, a summary of LMICs-specific evidence and prompts was developed to stimulate reflection and learning. To support implementation, rural pathways exemplars from different WHO regions were also compiled. Field-testing showed the Checklist is fit for purpose to guide holistic planning and benchmarking of rural pathways, irrespective of LMICs, stakeholder, or health worker type. Conclusion: The Rural Pathways Checklist provides an agreed global conceptual framework for the practical implementation of "grow your own" strategies in LMICs. It can be applied to scale-up activity for rural workforce training and development in LMICs, where health workers are most limited and health needs are greatest.

Perceptions of UK medical students on rural clinical placements.

INTRODUCTION: Rural clinical placements are now commonly used to both promote awareness of rural health careers and expand clinical placement networks in Australia, North America and elsewhere. However in the United Kingdom (UK) there is no clear workforce or health education policy that encourages rural background student recruitment, rural clinical placements, rural oriented curricula or rural health education infrastructure, because deprivation and poor health status are regarded as urban phenomena. The question for one new medical school in regional/rural UK is: can increasing the utilisation of rural primary care practices both resolve teaching capacity constraints and offer students valuable learning opportunities about rural health? This article reports an exploration of students' views on the value of rural clinical placements in a new curriculum designed to address regional deprivation and workforce needs. METHODS: Medical students in Year 1 and Year 3 of a regional medical school were invited to attend focus group discussions that explored their understanding of rural health and life and the attractions of and barriers to expanding rural clinical placements. The Year 1 students were in the new curriculum and therefore more likely to be allocated a rural clinical placement in their more senior years. The discussions were audio-recorded, transcribed and thematically analysed. RESULTS: Themes that emerged were: what is rural? how different is rural from urban?; differences in rural and urban learning, logistic issues, and choosing a rural placement. Student perceptions in both groups were rather negative about rural placements. Rural practices were thought to provide a narrow range of patient contact and learning opportunities, and rural life was thought to be unattractive, especially out of formal placement hours. Even relatively small distances from friends and social outlets were regarded as barriers. Year 1 students were more positive about the possibility of a rural placement, although they knew at admission that the school would be expanding into rural communities and may therefore have been more open to the concept. CONCLUSION: Ruralization of health professional education in the UK faces substantial challenges. More may need to be done to increase recruitment of rural-interested students, foster rural career interest during courses, recruit rural role models, develop rural curricula and establish the infrastructure to support rural clinical placements. These initiatives will require greater political will and some investment by education, heath and community development agencies.

Education for rural practice in rural practice.

Despite the substantial differences between developing and developed countries, access is the major rural health issue. Studies in many countries have shown that the three factors most strongly associated with entering rural practice are: (1) a rural upbringing; (2) positive clinical and educational experiences in rural settings as part of undergraduate medical education; (3) targeted training for rural practice at the postgraduate level. This paper presents examples of successful rural primary care-based education in different parts of the world, then introduces the Wonca Rural Medical Education Guidebook which was launched at the 2014 Wonca Rural Health World Conference and concludes with a brief report of the 2015 conference held in Dubrovnik Croatia.

Rural proofing for health: a commentary.

CONTEXT: Health services policies in the UK have traditionally been developed as a 'one size fits all' approach usually based on urban models. This approach can be problematic for primary care agencies involved in the delivery of services in rural and remote areas, due to difficulties with access and also the differences in the nature of urban and rural communities. The Countryside Agency in England has developed a rural proofing framework which will assess the impact that new policies may have in rural areas. This process is currently being applied across all government departments. This article sets out the context of the National Health Service (NHS) in the UK and describes the process of Rural Proofing for Health and how it can be used to improve equity of access to care for people living in rural and remote communities in Britain and across the international healthcare community. ISSUES: There has been a considerable increase in investment in the NHS in recent years with consequent improvements such as reductions in waiting times for treatment. Despite tangible improvements there are still inequalities in health and inequities in healthcare provision, which include parts of the population who live in rural areas. The Rural Proofing for Health project has been developed and carried out by the Institute of Rural Health as a methodology to help Primary Care Organisations implement policies and methods of service delivery that take into account the needs of people living in rural and remote areas. A toolkit has been developed that adopts a solutions-based approach to healthcare delivery in rural areas and which will help people living in rural areas to have equity of access to care with their counterparts living in urban Britain. Rural proofing policies before implementation ensures that the possible impacts of the policy are measured and so that adjustments can be made to ensure that the service will be appropriate for rural communities, and that it can be delivered effectively and efficiently in a rural context. LESSONS: It is important that development of new healthcare policies includes a process that ensures such policies are rurally sensitive. Involving stakeholders at a strategic level ensures that the initiative becomes embedded into policy-making within each department. Rural proofing is a systematic methodology that will help policy makers take account of health needs in rural areas and will hold public bodies accountable to their rural communities.

Research and rural; EGPRN and EURIPA­finding common ground. October 2013, Malta.

The European General Practice Research Network (EGPRN) and the European Rural and Isolated Practitioner Association (EURIPA) convened a historic joint meeting in Malta in October 2013. Speakers reviewed the inadequacies of the current system and conduct of clinical science research and the use and misuse of the resulting findings. Rural communities offer extraordinary opportunities to conduct more holistic, integrative, and relevant research using new methods and data sources. Investigators presented exciting research findings on questions important to the health of those in rural areas. Participants discussed several strategies to enhance the capacity and stature of rural health research and practice. EGPRN and EURIPA pledged to work together to develop rural research courses, joint research projects, and a European Rural Research Agenda based on the most urgent priorities and the European definition of general practice research in rural health care.

It is time for rural training in family medicine in Brazil / Es hora de la capacitación rural en medicina familiar en Brasil / Está na hora do treinamento em saúde rural para médicos de família no Brasil

The gap between health needs and the training of human resources for health is much more evident in rural areas. In Brazil, a country of continental dimensions, these differences become more challenging. The diversity of geographical and administrative barriers to access makes the health indicators of rural and remote populations worse than those of the urban population. Family Medicine could address the social determinants of health through the provision of human services and play an important role in low-income rural residents' health status. This essay is an urgent call for the debate on models for projecting heath workforce supply and requirements for rural areas in Brazil.(AU)

La brecha entre las necesidades de salud y la capacitación de los recursos humanos para la salud es mucho más evidente en las zonas rurales. En Brasil, un país de dimensiones continentales, estas diferencias se vuelven más desafiantes. La diversidad de las barreras geográficas y administrativas de acceso hace que los indicadores de salud de las poblaciones rurales y remotas sean peores que los de la población urbana. La Medicina Familiar podría abordar los determinantes sociales de la salud a través de la provisión de servicios humanos y desempeñar un papel importante en el estado de salud de los residentes rurales de bajos ingresos. Este ensayo es un llamado urgente para el debate sobre los modelos para proyectar el suministro de mano de obra de salud y los requisitos para las áreas rurales en Brasil.(AU)

A discrepância entre as necessidades de saúde e o treinamento de recursos humanos para a saúde é muito mais evidente nas áreas rurais. No Brasil, um país de dimensões continentais, essas diferenças se tornam mais desafiadoras. A diversidade das barreiras geográficas e administrativas de acesso torna os indicadores de saúde das populações rurais e remotas piores que os da população urbana. A medicina de família e comunidade pode abordar os determinantes sociais da saúde por meio da prestação de serviços humanos e desempenhar um papel importante no estado de saúde dos residentes rurais de baixa renda. Este ensaio é um apelo urgente para o debate sobre as necessidades das áreas rurais no Brasil e os modelos de projeção para o provimento de força de trabalho de saúde nesses cenários.(AU)