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The rural transport infrastructure sector is a critical force for sustainable development that is interwoven with many other sectors. Rural transportation is an underlying driver of many of the Sustainable Development Goals (SDGs) and a crucial contributor to many socioeconomic benefits for rural people around the world. This review paper expands upon, enhances, and cross-references the perspectives outlined in previous rural infrastructure-focused review papers. Firstly, this work gives a thorough look into the progress of the rural transportation sector in recent years by focusing on the thematic relationships between infrastructure and other components of sustainable development, namely, economics and agriculture, policy and governance, health, gender, education, and climate change and the environment. Secondly, several strategies, approaches, and tools employed by governments and practitioners within the rural transport sector are analyzed and discussed for their contributions to the wellbeing of rural dwellers in low- and middle-income countries (LMICs). These include rural roads, bridges, maintenance, and non-infrastructural approaches that include concepts such as advanced technological innovations, intermediate modes of transport (IMTs), and transport services. This paper concludes that enhancement, improvement, and extension of rural transportation infrastructure brings significant benefits to rural dwellers. However, this paper also calls for additional integration of the sector and increased usage of systems approaches that view rural transport as an active part of many other sectors and a key leverage point within rural development as a whole. Further, this paper notes areas for future research and investigation, including increased investigation of the relationship between rural transportation infrastructure and education, improved data collection and management in support of improved policymaking, improved prioritization of interventions and institutionalization of maintenance, and expansion of pro-poor transportation strategies and interventions.

Energy access remains a challenge for many countries, as recognized by sustainable development goal 7 of the United Nations Development Programme. Although the Myanmar government has set a target of 100% electrification by 2030, less than half of the households are currently connected to the national grid. To expedite electrification, decentralized approaches should be considered. Mini-grids are an effective alternative that can fill the gap between a solar home system and the national grid; however, many of the existing mini-grids in Myanmar are powered by diesel generators. Diesel fuel is significantly more expensive in rural areas than in urban areas due to high transportation costs. Although mini-grids powered by solar photovoltaics and batteries are cost-competitive with diesel generators, the deployment of renewable energy-based mini-grids is slow. In this study, we analyzed the barriers to mini-grid deployment and prioritized the barriers. We conducted a questionnaire survey with stakeholders using the analytic hierarchy process to identify the prioritization of each barrier factor. The K-means clustering method was used to determine tendencies and showed that there was no single, dominant solution. Our results confirm the difficulty of mini-grid deployment and suggest multi-pronged approaches that go beyond economic considerations.

The South African government has made the development of rural roads a primary policy focus. Approximately 74% of all the roads in the North West province are unpaved, which underlines the problem of poor rural road investment practices. The Rural Access Index (RAI) has been widely adopted as a global development indicator for transport accessibility. The RAI is defined by the proportion of the rural population who live within 2 km of the nearest road in good condition. This paper aimed to develop a methodological framework for quantifying the North West province‘s RAI, including the district and local municipalities. The urban/rural divide is also manifested in the RAI scores of the NW Province. The RAI of the province was estimated at 43.433%, meaning less than 50% of the province's population is located within 2 km of a good-condition road. The RAI scores of urban areas vary between 46% and 76%. Thus, the findings confirmed that accessibility is significantly better for the urban population than the province's rural population. Regarding the district municipalities, the Ngaka Modiri Molema DM and Ruth Segomotsi Mompati DM had RAIs of 27.2% and 31.57% respectively. Policymakers need to reprioritise rural road investment practices based on RAI results to improve the accessibility of rural communities and to improve the urban-rural divide.

Access to healthcare is a crucial factor in achieving health equity. In rural South Africa, geographical isolation and inadequate transportation systems continue to hinder access to healthcare services, despite the existence of progressive national health policies. This study examines the impact of transportation on healthcare access in Mt Elias, uMshwathi Municipality, KwaZulu-Natal. Using a qualitative, exploratory design, semi-structured interviews were conducted with 52 community members. The data were analyzed thematically using ATLAS.ti. The findings reveal several structural barriers, including high transportation costs, long distances to clinics, unreliable ambulance services, poorly maintained roads, and unsafe travel conditions. In Mt. Elias, even when mobile clinics are available, their infrequent visits and fixed locations prevent access for individuals who are sick or those with a disability or living in widely scattered homesteads. Access to healthcare in rural communities is fundamentally shaped by transportation. To achieve universal health coverage, it is essential to improve rural road infrastructure, expand mobile clinic services, subsidize transportation costs, and integrate transportation planning into healthcare policies. Addressing these transportation barriers is not only a matter of service delivery but also of equity, justice, and human rights.

Geographic, social, political, and economic factors shape access to advanced neurotechnologies, yet little previous research has explored the barriers, enablers, and areas of opportunity for equitable and meaningful access for diverse patient communities across Canada. We applied a mixed-mode approach involving semi-structured interviews and rating scale questions to consult with 24 medical experts who are involved in the care of patients who undergo functional neurosurgery targeting the brain. Seven major themes emerged from the qualitative analysis: Health care system, Neurotechnology features, Patient demographics, Target condition features, Ethics, Upstream barriers and enablers, and Areas of opportunity. Descriptive statistics of the Likert-scale responses suggest that interviewees perceive a disparity between the imperative of access to advanced neurotechnologies for people living in rural and remote areas and the likelihood of achieving such access. The results depict a complex picture of access to functional neurosurgery in Canada with pockets of excellence and a motivation to improve the availability of care for vulnerable populations through the expansion of distributed care models, improved health care system efficiencies, increasing funding and support for patient travel, and increasing awareness about and advocacy for advanced neurotechnologies.

How rurality relates to women's abortion decision-making in the United States remains largely unexplored in existing literature. The present study relies on qualitative methods to analyze rural women's experiences related to pregnancy decision-making and pathways to abortion services in Central Appalachia. This analysis examines narratives from 31 participants who disclosed experiencing an unwanted pregnancy, including those who continued and terminated a pregnancy. Results suggest that women living in rural communities deal with unwanted pregnancy in three phases: (1) the simultaneous assessment of the acceptability of continuing the pregnancy and the acceptability of terminating the pregnancy, (2) deciding whether to seek services, and (3) navigating a pathway to service. Many participants who experience an unwanted pregnancy ultimately decide not to seek abortion services. When women living in rural communities assess their pregnancy as unacceptable but abortion services do not appear feasible to obtain, they adjust their emotional orientation towards continuing pregnancy, shifting the continuation of pregnancy to be an acceptable outcome. The framework developed via this analysis expands the binary constructs around abortion access - for example, decide to seek an abortion/decide not to seek an abortion, obtain abortion services/do not obtain abortion services - and critically captures the dynamic, often internal, calculations women make around unwanted pregnancy. It captures the experiences of rural women, a gap in the current literature.

This study proposes an improvement to the measurement of Sustainable Development Goal (SDG) Indicator 9.1.1 which quantifies the proportion of the rural population living within 2 kilometers of an all-season road through the development of the Integrated Rural Access Index (iRAI). While the conventional Rural Access Index (RAI) measures solely road proximity, it fails to incorporate access to essential services. To address this limitation, the iRAI integrates the proximity to three critical facilities – healthcare, education, and service – using data from the Philippine Statistics Authority’s Community-Based Monitoring System. Gridded population datasets from WorldPop and LandScan were evaluated to determine suitability for computing RAI and iRAI. WorldPop demonstrated superior performance, with a lower mean absolute error (MAE = 18.60), root mean square error (RMSE = 36.41), and a higher correlation coefficient (r = 0.94), and was thus used for calculating both RAI and iRAI. In the provinces of Cavite and Batanes, Sentinel-2 imagery and Maximum Likelihood Classification (MLC) were utilized to delineate rural boundaries. Error metrics (MAE = 0.52, RMSE = 0.65) show strong agreement and practical interchangeability between conventional and satellite-based RAI/iRAI values. Regression analyses revealed that the iRAI exhibited stronger explanatory power (R2 = 0.4878) and statistical significance (p = 0.0396) compared to RAI. A scenario simulation suggested that improvements in poverty, education, and healthcare access could result in a perfect iRAI score. Additionally, a network-based methodology was developed and applied in three areas to overcome the limitations of planar distance, demonstrating the potential for more accurate, household-level accessibility assessments.

During the 2001 UK FMD outbreak, local authorities restricted rural access to try to prevent further disease spread by people and animals, which had major socio-economic consequences for rural communities. This study describes the results of qualitative veterinary risk assessments to assess the likelihood of different recreational activities causing new outbreaks of foot and mouth disease, as part of contingency planning for future outbreaks. For most activities, the likelihood of causing new outbreaks of foot and mouth disease is considered to vary from very low to medium depending on the control zone (which is based on distance to the nearest infected premises), assuming compliance with specified mitigation strategies. The likelihood of new outbreaks associated with hunting, shooting, stalking, and equestrian activities is considered to be greater. There are areas of significant uncertainty associated with data paucity, particularly regarding the likelihood of transmission via fomites. This study provides scientific evidence to underpin refinement of rural access management plans and inform decision-making in future disease outbreaks.

Safe and consistent access to essential services is critical for poverty alleviation in rural communities, but even significant physical transportation barriers, such as pedestrian water crossings, are poorly mapped, leaving the scope of need for rural trailbridges largely unknown. Field-based efforts to catalogue those barriers can be effective but are costly and time-consuming. The study described here details field-based methods for identifying pedestrian water crossings in rural Liberia and Rwanda, as well as remote methods, to evaluate their effectiveness and potential application for assessing future rural infrastructure networks. The work highlights challenges, addresses components of the field-based method that limit scalability on a global level, and outlines a way forward for future endeavors to identify pedestrian water crossings. Overall, the most effective remote method applied in this study identified 16 percent of the crossings identified using field-based methods in the same area of interest in Liberia, and 72 percent of the crossings identified using field-based methods in the same area of interest in Rwanda. The field-based method remains the most effective method for bridge site identification, though the significant resources required for an effective field study underscore the need for greater investment in remote methods. Additionally, as neither method alone yields results that fully encapsulate bridge need, the authors recommend a blended approach that incorporates a more sophisticated remote method with streamlined field-based methods that leverage existing local knowledge and expertise.