Rural Health Introduction

Introduction to Rural Health

• Countries are divided into urban and rural areas based on specific features.
• Rural areas are communities where agriculture is the primary occupation.
• Egypt has approximately 4,200 villages and over 25,000 small localities.
• Approximately 58% of Egypt's total population resides in rural areas, and 42% in urban areas.
• The rural population includes diverse cultural and ethnic groups and spans all economic boundaries.
• Rural is often synonymous with "countryside" and is considered the opposite of urban.

Definitions

• Rural Community: An area where farming is the primary occupation.
• Rural Nursing: Professional nursing practice within the physical and socio-cultural context of the rural environment.

Objectives of Rural Health

• Ensure the rural population has a good social life, comparable to urban standards.
• Maximize the use of available manpower to increase productivity.
• Improve access to healthcare workers in underserved areas, guided by primary health care principles.
• Enhance the overall health status of rural communities.
• Improve the delivery of rural health services.
• Direct resources to sustain opportunities in rural communities, focusing on areas with poor outcomes and limited service access.
• Deliver local services through outreach clinics and technology, empowering general practitioners to expand their service range.
• Promote nurse-led clinics and expand the roles of paramedics.
• Establish Integrated Family Health Centers in convenient locations for rural patients.
• Support primary healthcare providers, ensuring accessibility.
• Enhance technology availability, including cell phone coverage, high-speed internet, and other health technologies.
• Improve public health infrastructure, such as housing quality, drinking water, and waste disposal.
• Enhance rural capacity through health service governance training.

Social and Health Issues in Rural Areas

• Lack of suitable housing
• Limited job and training opportunities, compounded by lower education levels
• Inadequate public transport, creating challenges for residents who live and work in rural areas
• Low incomes leading to financial hardship
• Social isolation and lack of secure housing
• Difficulty accessing essential healthcare services
• Powerlessness and breakdown of social support networks
• High levels of poverty and its negative implications
• General deprivation and social exclusion
• Prevalence of low-paying jobs and overall low income

Problems in Rural Communities

• Health problems include high morbidity and mortality rates.
• Lack of satisfactory effectiveness of available health services.
• Related health problems include socioeconomic and educational issues, as well as cultural factors and accidents.

Health Problems

• High Morbidity: Rural populations experience endemic, communicable, and nutritional deficiency diseases.
• Endemic and infectious diseases are common.
• Parasitic diseases such as bilharzia are prevalent.
• Zoonotic diseases (transmitted from animals) are a concern.
• Nutritional deficiencies include iron deficiency anemia, rickets, pellagra, and vitamin A deficiency.
• High Mortality: Rural mortality rates are higher due to high morbidity, low socioeconomic status, and inadequate health services.
• High child mortality disproportionately effects those under five years.
• Inadequate Health Services: Many rural areas lack access to medical care, including hospitals, outpatient clinics, and laboratory services.
• Shortage of healthcare staff.
• Health units or centers are often too far away.

Socio-Economic Problems

• Dependence on agriculture with limited resources.
• High fertility and birth rates.
• Illiteracy and prevalence of diseases, lowers productivity.
• Low socioeconomic standards contributes to poor living conditions, unsanitary environments, and malnutrition, especially in groups.
• Solutions to socioeconomic problems include rural industrialization and social agriculture reform.

Education and Culture Problems

• Illiteracy: Higher in rural areas and more prevalent among females; around 50% of the population over 15 is illiterate.
• Culture: A way of life shaped by behaviors, ideas, and values learned from family, helping adaptation the environment.
• Rural culture: Often marked by underdevelopment and a lack of knowledge passed through generations, including beliefs, customs, habits, rules, morals, religion, music, knowledge, art, and philosophy.

Cultural Aspects in Rural Areas

• Fatalism: Belief that events are predetermined by supernatural powers.
• Relative Values: Different values on things:
  • Some communities view smoking as a status symbol.
  • Preferential treatment of sons over daughters is common.
• Norms: Sense of dignity and pride.
• Beliefs
• Traditions and customs e.g. female circumcision
• Group Solidarity
• Loci of Authority

Environmental Problems

• Sanitation: Rural environments in developing countries often have unsatisfactory sanitation, leading to communicable diseases and health hazards.
• Lack of village planning results in primitive, narrow houses with scattered refuse, manure heaps, and wastewater.
• Water sources are both individual and public.
• Environmental concerns:
  • Poor housing conditions.
  • Insufficient water supply and reliance on deep wells.
  • Inadequate waste and refuse disposal.
  • Prevalence of insects and rodents.
  • Poor food sanitation practices.
  • Presence of animals and dung near residential areas.

Accidents

• Common accidents:
  • Fire-related incidents.
  • Accidents involving agricultural machinery.

Factors Influencing Rural Health

• Availability of services: The existence of sufficient services and personnel.
• There are generally fewer physicians and nurses in rural areas.
• Accessibility of services: A person's ability to obtain and afford needed services.
• Challenges to healthcare accessibility for rural families include:
  • Long travel distances.
  • Lack of public transportation.
  • Absence of telephone services.
  • Shortage of healthcare providers.
  • Inequitable reimbursement policies (e.g., Medicare, Drugs).
  • Unpredictable weather conditions.
  • Inability to get entitlements.
• Acceptability of services: Whether a given service aligns with the values of the population.
• Rural community nursing service acceptability is affected by:
• Traditions for handling personal problems (e.g., self-care practices).
• Beliefs about causes of disorders and appropriate healers (e.g., medicine man, medicine woman).
• Lack of knowledge about physical/emotional disorders and the value of formal services.
• Difficulty maintaining confidentiality in closely knit communities.

Rural Health Services

• Rural health institutions provide basic health services through integrated programs.
• Rural health centers offer both preventive and curative medical care.

Preventive Services

• Maternal and child health care: Including prenatal, natal, postnatal care, childcare through school age, and home visits.
• Communicable disease control: Early detection, prevention, control, and mandatory immunizations in the first year of life.
• Family planning services: Contraceptive methods such as pills, IUDs, and local methods.
• Endemic and parasitic disease control: Regular examinations for early detection and treatment.
• Environmental sanitation services: Water and food sanitation, detection of faulty habits, and sewage disposal methods.
• Health office services: Birth and death registration maintenance for statistical records.
• Health education: Achieved through various activities, school health services, survey studies, and dental care services which include preventive and curative cares.

Curative Services

• Outpatient care for early diagnosis and treatment.
• First aid emergency services.
• Laboratory services for simple investigations.
• Pharmacy services.

Rural Health Facilities

• Rural Health Unit: Serves populations up to 9,000, providing MCH services (family planning, immunization), public health supervision, curative care (primarily for children), and a ORT unit.
• Acute services are available 24/7.
• Rural Health Center: A primary care level facility for populations up to 20,000 with six to ten beds and 24-hour availability.
• Services are similar to the rural health unit, with more curative work, a pharmacy, and a laboratory.
• Rural Hospital: Care for populations up to 40,000; aims to provide preventive and curative services, secondary care, and reduce transfers to district hospitals.
• Includes specialties, a radiology department, operating theater (30-50 beds), ambulances for all rural hospitals and some rural health centers.

Functions of a Rural Health Unit

• Health office:
  • Population enumeration.
  • Registration of births and deaths.
  • Records morbidity, communicable disease control, referral for isolation, terminal disinfecting, and preventive actions like immunization and health education.
• Maternal and child health services:
  • Provides antenatal, natal, postnatal care, family planning, infant welfare, preschool, and school health services.
• Environmental health:
  • Supervises/inspects the environment to improve sanitary conditions, including water supply, latrines, ponds, snail/rodent control, food sanitation, and vector control.
• Regular family examinations and record-keeping.
• Health education.
• Offers nursing services.

Barriers to Effective Healthcare in Rural Areas

• Lower income levels among rural residents.
• Increased unemployment rates.
• Lower levels of education.
• Higher poverty rates compared to urban areas.
• Low health insurance coverage.
• Limited availability of services.
• Transportation challenges due to distance, isolation, and low population density.

Role of Community Health Nursing in Rural Areas

• Characteristics of a Rural Nurse:
  • Expert generalists with skills to meet varied client needs across the lifespan.
  • Independent and self-reliant.
  • Fulfill social and professional roles.
  • Build trust by providing close client contact.
  • Maintain a positive community presence and self-esteem.
  • Serve as role models.
  • Assess client, family, and community health needs through assessment practices.
  • Provide primary care, counseling, health education, and advocacy.
• Roles of a Rural Community Health Nurse:
  • Direct care provider: Offers suitable healthcare according to needs, requiring diverse clinical skills.
  • Advocate: Supports rural clients and families in obtaining optimal healthcare.
  • Coordinator/Case Manager: Connects clients with relevant health and social services; needs details about individual lifestyles (diet, activity, habits) and social determinants (culture, poverty, employment, exclusion, living/working conditions, and economic/environmental factors).
  • Teacher/Educator: Provides education on health promotion topics (e.g., parenting).
  • Referral Agent: Links rural clients to urban service providers.
  • Monitor: Mentors new community health nurses and students.
  • Researcher: Suggests patient/community care approaches-based research, professional literature, and community assessments.
  • Activist: Takes calculated risks to improve community health; maintains patient confidentiality; understands that rural communities exhibit traditional defined gender roles.