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Background: Rural healthcare providers encounter multifaceted barriers including geographic isolation, resource limitations, and provider shortages that impede optimal patient care delivery. The Barriers Experienced in Providing Healthcare Instrument (BTCPI) was designed to assess provider challenges; however, concerns regarding its psychometric properties necessitated comprehensive validation. The primary purpose of the study was to evaluate the structural validity of the instrument using confirmatory factor analysis with a sample of Idaho healthcare professionals. Because the model failed to meet criteria, the study identified a more parsimonious model that then underwent multi-group invariance testing. Methods: A survey consisting of a modified Barriers to Providing Optimal Healthcare instrument and a demographic questionnaire was distributed to Idaho healthcare providers across 22 clinical sites in the state. The structural validity of the modified 41-item, 9-factor instrument was assessed using confirmatory factor analysis (CFA), exploratory structural equation modeling (ESEM), and exploratory factor analysis (EFA). Multi-group invariance testing was also conducted to assess measurement equivalence across provider profession, practice setting (rural vs. urban), and years of experience. Results: A total of 373 healthcare providers completed the survey and were used for analysis. The proposed BTCPI model did not meet model fit criteria. An ESEM analysis was conducted and identified a 9-factor, 14-item model. However, due to fit concerns, an exploratory factor analysis was subsequently conducted and identified the 4-factor, 12-item (BPOC-12) that also met invariance criteria across groups. A group mean and variance differences were found between nurses and primary care providers as well as between rural and urban practitioners on several barrier factors. Conclusions: The BTCPI did not meet model fit criteria. Subsequent model refinement resulted in the BPOC-12, which had preliminary psychometric validity. Although the refined model offered a more condensed and preliminarily valid psychometric framework, future research should be done to assess this model. Future research should also collect responses from different healthcare professions to enhance its applicability.

Background: Provision of essential surgery is important in achieving Universal Health Coverage. However, data on the capacity of first-level hospitals to provide surgical care are currently unavailable in Sindh Province, Pakistan. Aim: To assess surgical care services and needs in public sector hospitals in Sindh Province, Pakistan. Methods: Between May and August 2021, we examined surgical care in 15 public sector district and subdistrict headquarters hospitals in Sindh Province, using the consolidated hospital assessment tool adapted from the WHO tool for assessing emergency and essential surgical care. We analysed the data using STATA version 15 and calculated the frequency of essential surgical procedures per 100 000 population for each health facility. Results: Overall surgical beds density was 0.22 per 100 000 population, with 0.7 certified specialists and 1.4 combined certified and non-specialist physicians offering surgical and anaesthesia care per 100 000 population. Clinical support services were deficient, and only 76% of drugs for anaesthetic and surgical care were available. Outpatient procedures were performed in all facilities, while obstetrics/gynaecology, surgical and trauma-related procedures were performed in 87%, 60% and 53% of facilities, respectively. Three of the 15 hospitals performed the 3 Bellwether procedures. Conclusion: This study identified multiple deficiencies in infrastructure, workforce, governance, management, and support services for essential surgical services in Sindh Province of Pakistan. To achieve Universal Health Coverage in Pakistan, there is a need for more research on surgical services in Sindh Province to identify other gaps and implement strategies to bridge the gaps.

Quality in healthcare service is essential in giving rural dwellers a good standard of living. It has been established that many rural locations in Sub-Saharan Africa away from the grid connection have difficulty accessing electricity. The inaccessibility of reliable energy and essential medical equipment was the leading barrier to improved healthcare delivery in these rural locations. The deficiency of basic medical equipment to power essential services due to limited or unreliable electricity access has reduced rural healthcare workers’ care capabilities, resulting in higher mortality rates. This paper, therefore, reviews the existing energy solutions for rural healthcare facilities, thereby analysing different approaches and the geographical energy mix and ascertaining the effectiveness of various techniques and energy mix as solutions to effective healthcare delivery in healthcare centres. Hybrid Renewable Energy Sources (HRES) microsystems, like microgrids incorporated with solar panels and battery, is identified to ensure higher and more reliable energy access in rural healthcare centres. At the same time, the adoption of Demand Side Management (DSM) in the HRES deployment in countryside healthcare facilities is reported to decrease the initial cost of installation and improve efficiency. Lastly, in improving energy access, rural electrification planning is achieved through modelling tools related to energy access modelling.

This dialogue examines rural health and healthcare by putting rhetoricians who study rural communities in direct conversation with healthcare professionals who practice in and advocate for rural communities. Thematic analysis of the dialogue revealed that conversations about healthcare in rural communities can simultaneously address what rural communities lack, how rural communities are exploited, and how strong and resilient rural communities are, while also emphasizing what opportunities there are for scholars and practitioners to partner together for the benefit of rural communities. The dialogue demonstrates how working directly with key stakeholders like medical providers can be both practically and intellectually fruitful when addressing complex issues like rural health and RHM. 

Introduction: Cloud-based telemedicine holds promise for improving healthcare accessibility and delivery, particularly in rural areas of developing countries like Tanzania. However, little is known about its determinants and benefits in such contexts. This study investigates the factors influencing the usage of telemedicine in Mvomero district, Morogoro region, Tanzania, focusing on both supply and demand sides. Method: Using structured interviews and key informant interviews, the study examines various cloud-based telemedicine platforms, including remote monitoring, electronic health records, cloud-based storage, and machine learning algorithms. The study used descriptive statistics to analyze quantitative data, while thematic analysis was used to analyze qualitative data. Results: Results reveal several factors influencing telemedicine usage. On the demand side, perceived benefits (53.96%), technology cost (62.79%), legal practices (62.79%), and resource availability and affordability (49.77%) are crucial. On the supply side, technological innovation (35%) and access to financial resources (43%) play pivotal roles. Environmental and institutional factors such as political willingness (38%) and regulatory support (34%) also impact telemedicine usage. Moreover, results reveal that cloud-based telemedicine platforms in rural healthcare facilities have several benefits including improved access (32.74% to 57.44%), cost efficiency (37.88% to 54.82%), timely consultations (56.83% to 65.21%), health monitoring, and prescription management (43.89% to 75.90%). Private facilities particularly emphasize health monitoring. Conclusion: Adopting telemedicine technologies can revolutionize rural healthcare by providing customized and easily accessible services. Policymakers can use these findings to develop targeted strategies, including subsidized infrastructure, innovative financing models, and clear regulatory frameworks. Clear guidelines on data transfer and privacy are essential to ensure legal compliance and equitable access to telemedicine benefits. Simplifying registration requirements and implementing explicit consent mechanisms are recommended to address data privacy concerns. These measures aim to promote operational efficiency, data safety, and enhanced health outcomes in resource-limited settings.

Introduction Rural placements are an important component of rural medical education programs seeking to develop rural practice pathways for medical students. These placements are usually domestic, but James Cook University in Australia developed an international rural placement program in the first half of the medical course that was funded through bursaries. This study explores how the international rural placement helped to shape the lives (personal development and learning) of the participants, using Transformational Learning Theory as a framework for identifying and describing the transformational elements, process and impact of the program. Methods Sixty-five students received a bursary for an international rural placement between 2001–2019. All were contacted by email and invited to participate in a short survey and a follow-up interview. Fifteen participants agreed and twelve were able to participate in individual semi-structured interviews which were recorded, transcribed and analysed using inductive thematic analysis. Results Participants reported that the bursary provided a “once in a lifetime opportunity” to “experience eye-opening and culturally rich difference”. Nonetheless, some elements of the placement experience presented disorientating dilemmas that triggered deep reflections and shifts in perceptions. The bursary recipients realised that “being open-minded” allowed them “enjoy good company”. They were also able to assume “outsider view which allowed reassessment of their own country” and the “isolation experiences gingered desire to right health wrongs”. The triggers and mental shifts had significant impact on the bursary recipients and fostered the development of “inspirational new horizons” based on an appreciation of the “value of rural practice” and “role-modelling for life-long learning.” These findings are consistent with Transformational Learning Theory. Conclusion Participants in this study reported meaningful and strongly positive impacts from the experiences gained during an international rural clinical placement early in their course. They described transformative experiences which appear to contribute strongly to personal development. This finding supports maintaining opportunities for international experiences during rurally-oriented medical programs as these may impact longer term career choice.

Globally, effective and efficient healthcare is critical to the wellbeing and standard of living of any society. Unfortunately, several distant communities far from the national grid do not have access to reliable power supply, owing to economic, environmental, and technical challenges. Furthermore, unreliable, unavailable, and uneconomical power supply to these communities contributes significantly to the delivery of substandard or absence of qualitative healthcare services, resulting in higher mortality rates and associated difficulty in attracting qualified healthcare workers to the affected communities. Given these circumstances, this paper aims to conduct a comprehensive review of the status of renewable energy available to rural healthcare clinics around the globe, emphasizing its potential, analysis, procedures, modeling techniques, and case studies. In this light, several renewable energy modeling techniques were reviewed to examine the optimum power supply to the referenced healthcare centers in remote communities. To this end, analytical techniques and standard indices for reliable power supply to the isolated healthcare centers are suggested. Specifically, different battery storage systems that are suitable for rural healthcare systems are examined, and the most economical and realistic procedure for the maintenance of microgrid power systems for sustainable healthcare delivery is defined. Finally, this paper will serve as a valuable resource for policymakers, researchers, and experts in rural power supply to remote healthcare centers globally.

Introduction: There is a gap in our knowledge of the place and contribution of rural hospitals in the New Zealand health system. There is no current description of rural hospital services, no national policies and little published research regarding their value.Aim: To explore rural hospital leader perspectives of the role of rural hospitals.Methods: An on-line survey of rural hospital leaders conducted to capture perspectives on areas including facility nomenclature; access and equity; funding and the health reforms.Results: Fifty-five rural hospital leaders representing 19/24 rural hospitals responded. ‘Rural Hospital’ was the most common term used to describe facilities with 80% of respondents indicating this as their preferred term. Other descriptive terms varied widely from primary through to secondary care. Respondents indicated that the loss of rural hospital in-patient beds would be unacceptable to communities (median 0, IQR 0, 1). Scores on questions about ‘range of services’ (median 7, IQR 6, 8), ‘accessibility’ (median 7, IQR 6, 8) and how rural hospitals were addressing health equity (median 6, IQR 5, 7) were variable. The process for allocating funds to rural hospitals was perceived as lacking transparency (median 3, IQR 2, 5). National strategy and ‘local governance and control’ were both rated as important (median 9, IQR 7, 10 and median 9, IQR, 8, 10) for a rural hospital’s future.Discussion: By capturing a collective national rural hospital leadership voice, this study facilitates the understanding of the rural hospital concept. The findings inform subsequent research needed to gain a clearer picture of New Zealand rural hospital provision.

Background: The transition from student to professional nurse is often overwhelming for newly qualified registered nurses, especially in rural and resource-limited settings. Systemic barriers such as staff shortages, limited resources, and lack of mentorship hinder their ability to gain effective clinical experiences. This gap threatens both the professional development of newly qualified registered nurses and the quality of patient care, justifying the need for this study. Aim: This study aimed to explore how the shortage of resources and functional infrastructure affects the clinical experiences of newly qualified registered nurses. Methods: A descriptive qualitative design was employed, grounded in an interpretivist paradigm. Data were collected through three semi-structured focus group interviews with a purposive sample of 25 NQRNs. A rigorous thematic analysis, following the Braun and Clarke framework, was used to identify, analyze, and report patterns within the data. Results: The analysis revealed a complex interplay of six interconnected themes that define the NQRNs’ experiences: (1) an institutional void of clinical support and mentorship; (2) systemic failures in management and leadership; (3) crippling resource constraints and infrastructure decay; (4) pervasive emotional and psychological distress; (5) a trajectory towards professional burnout; and (6) profound job dissatisfaction and disillusionment. These barriers were found to collectively undermine clinical confidence, compromise patient safety, and threaten nurse retention. Conclusions: NQRNs in the Chris Hani District are navigating a “perfect storm” of systemic failures that hinder their professional development and personal well-being. The findings highlight an urgent need for multi-level interventions, including the implementation of standardized mentorship programs, leadership development for nurse managers, strategic investment in rural health infrastructure, and the establishment of formal mental health support systems. Addressing these foundational issues is paramount to building a resilient nursing workforce and ensuring equitable healthcare delivery.

Adequately staffed rural health services improve healthcare delivery and health outcomes, yet this is lacking in rural Ghana. We used a descriptive qualitative design to understand the contextual issues that affect rural practice, in the Upper East Region, Ghana. Sixty-eight in-depth interviews were conducted with healthcare workers and analysed thematically. Four themes were identified: types of postings to rural settings, healthcare workers’ perceptions of their rural postings, perceived enablers and motivators for rural practice, and perceived challenges and barriers to rural practice. While adequate supervision and family proximity are needed to improve the feelings of loneliness, isolation and neglect in rural areas, challenges and barriers such as inadequate security, unstable electricity supply, language barrier, lack of equipment and transport/ambulance have been identified to have negative influence on healthcare workers. The findings highlight the need for healthcare managers to improve fairness and transparency in the posting and reshuffling processes of healthcare workers.