Rural health (Public health)

Rural, Urban and International
Health
Fourth Semester
Brief Bio
Ashok Pandey, MPH/BPH, DGH
Associate Research Fellow
PRI

Unit 1: Rural public health 10 hours
1.1 Need for developing specific public health perspective to work in
rural settings
1.2 Definition of rural settings including operational meaning of village
municipalities in Nepal
1.3 Social, cultural, economic, occupational, geographical characteristic of
rural communities and their relation on the health.
1.4 Factors affecting rural-urban migration (push-pull factors) and its
effect on rural lives with particular instances of Nepal
1.5 Strength of rural setting in promoting public health
1.6 Adverse effect on health risk and disease in urban areas such as
inadequate and contaminated water supply, inadequate access to
sanitation, adverse climate, rural violence, physical work-pressure, loss of
productive population due to international labour migration, insecure
residential status, poor structural quality of housing, inadequate access
to public health medical facilities
4/25/2022 Ashok Pandey 2

1.7 Major health and disease issues in rural setting and their
determinants such as cultural, social, industrial, economic, political,
environmental
1.8 Rural health appraisal and identification of nature of public health
and medical care demand in rural setting
1.9 Overview of government, NGOs and private sector public health and
medical care services to meet the public health and medical care demand
in rural settings
a. Primary health care and essential health care through health facilities
b. Public health and medical care related services of health section of
Rural Municipalities
c. Role of Rural Municipalities in preventing disease and promoting the
health of rural population.
1.10 Expected outcomes of public health services in the rural settings
such as healthy village dwellers, healthy village, growth of rural economy

Definition of rural communities
There is no international standard for defining rural areas, and standards may vary
even within an individual country (WHO).
The most commonly used methodologies fall into two main camps:
• population-based factors and
• geography-based factors.
Rural is usually areas that are sparsely settled places away from the influence of large
cities and towns. People in rural areas live in villages, on farms and in other isolated
houses, as in pre-industrial societies.
Rural areas usually have an agriculture character though many areas are characterized
by an economy based on logging, mining, petroleum and natural gas exploration, or
tourism.

The methodologies used for identifying
rural areas include;
• population size,
• population density,
• distance from an urban center,
• settlement patterns,
• labor market influences,

Rural area
• English dictionary defined rural area as a geographic area that is
located outside cities and towns
• Usually those areas having fewer than 1000 persons per square mile
and less than 20,000 people.
The rural poor depend largely; on
• agriculture,
• fishing and forestry,
• and related small-scale industries and services.
People living in rural areas also have;
• poorer socioeconomic conditions, (high rates of poverty amongst)
• less education,
• higher mortality rates when compared to their urban counterparts

Why rural areas characterized by poverty?
Numerous characteristics of a country's economy and society, as
well as some external influences, create rural poverty
• political instability and civil war;
• systemic discrimination on the basis of gender, race, ethnicity,
religion, or class
• ill-defined property rights or unfair enforcement of rights to
agricultural land and other natural resources;
• high concentration of land ownership and irregular rental
arrangements;
• corrupt politicians

Contd..
• economic policies that discriminate against or exclude the rural
poor from the development process
• market imperfections owing high concentration of land and other
assets and imperfect public policies;
• natural causes (for example, climatic changes)
• The right to adequate land and water is importance in reducing
rural poverty in many developing countries.
• large and rapidly growing families

1.1 Need for developing specific public health
perspective to work in rural settings
1. Address a rural health issue. Evidence-informed practice
includes population health assessment, surveillance, research and
program evaluation to generate evidence (e.g., unaffordable food,
poverty, high rates of obesity and smoking rates, low uptake of flu
immunization).
2. Integrate multiple levels of community support (e.g., health
professionals, government, community organizations, consumers).
3. Adopt and modify existing programs (e.g., changing the
intensity, length and scope of a disease prevention program).

Contd..
4. Meet the cultural needs of the population (e.g., integrating healing
components in programs).
5. Deliver a flexible program responsive to the demands of rural
populations (e.g., home-based services, telemedicine, mobile
clinics).
6. Provide a no-cost, low-cost or subsidized program.
7. Provide simple, accurate educational materials, resources and
information for ease of reading (e.g., brochures, fact sheets,
posters).

8. Build on existing strengths in social capital (e.g., sense of
belonging, inclusion, trust, reciprocity, participation in community
life).
9. Build on existing physical environments (built and natural; e.g.,
delivering programs in schools and government buildings); promote
the natural environment (e.g., walking trails, lakes, walkable
communities).
10. Promote existing local programs, services and resources.
11. Use health professionals other than physicians and specialists to
provide clinical services.
12. Utilize and adopt a rural outreach model.
Contd..

2. Definition of rural settings including
operational meaning of village municipalities in
Nepal
The Federal Democratic Republic of Nepal (Nepali: संघीय लोकतान्त्रिक गणतरि
नेपाल Sanghīya Loktāntrik Ganatantra Nepāl) is a country situated in South Asia
between India and China.
Administratively Nepal is divided into Provinces, Districts and Municipalities.
Municipalities are classified as urban municipality and rural municipality. Rural
municipality called Gaun palika in Nepali.
Urban municipality categorized into 3 level:
1. Metropolitan city (Mahanagarpalika)
2. Sub metropolitan city (Upmahanagarpalika) and
3. Municipality (Nagarpalika)

• Fulfilling the requirement of the new constitution of Nepal 2015,
all old municipalities and villages (which were more than 3900 in
number) are restructured in total 753 new Municipalities and
Villages.
• All old 75 district development committees (DDC) are also
replaced by new 77 District Coordination Committee (DCC) which
will have much less power than DDC.
• At present there are 6 Metropolitan Cities,11 Sub-Metropolitan
Cities, 276 Municipalities and 460 GaunPalik (also referred to as
Rural Municipality).
• As of 20 September 2015 Nepal is divided into 7 provinces. They
are defined by schedule 4 of the new constitution, by grouping
together the existing districts.

Contd..
• Two districts however are split in two parts ending up in two
different provinces.
• Municipalities are the cities having at least some minimum criteria
of population and infrastructure and declared as a municipality by
the government.
• There are 283 municipalities in Nepal.
• The capital city Kathmandu is a Metropolitan city and there are
other five Metropolitan cities Bharatpur, Biratnagar, Pokhara,
Lalitpur & Birganj.
• There are 11 Sub-metropolitan Cities and 276 Municipalities.

3. Social, cultural, economic, occupational,
geographical characteristic of rural communities and
their relation on the health.
• Poverty (unstable income, unemployment, dependency on
spouses, low paying and seasonal jobs, poor public transportation,
non-affordable child care, housing and healthy foods).
• Limited health care and support services (fewer nurses, family
physicians and specialists available; little choice, it is difficult to
get relief when women are often the caregivers 24 hours a day).

• Economic conditions
lack of affordable housing and employment, those who leave often
end up in poverty, women on farms are often more financially
dependent as they do not receive a wage for their work and have no
unemployment insurance or pension and they leave behind their
lifetime investment for themselves and the legacy of their children.
• Lack of access to services
distant from many specialized services for family violence, services
have been centralized in urban areas, dispersed and complex
delivery and locations of services for needed lawyers, social
services, mental health, school counselors etc.
Contd..

Contd..
Geographical characteristic of rural communities and their relation
on the health.
• Geographic isolation (being far from neighbours makes it hard to
establish and maintain social networks, emergency services are
often delayed)
• Geographical location and isolation (it is easier to hide the abuse,
lengthy response times, lack of access to people to help in an
emergency and lack of public transportation).
• Stress of multiple roles (work long hours, juggle family, farm,
volunteering and caring for family members)

Contd..
• Lack of confidentiality
hard to preserve confidentiality, social stigma may be a deterrent to
getting help, fear of exposure, strong ethic of self-sufficiency, belief
that family matters are private and lack of trust in service providers.
• Attitudes
slow to admit that domestic violence is a serious problem, stigma
attached if they go to mental health services, hard to admit to abuse
because they feel it is their fault, leaving means leaving a way of life,
one’s home and one’s community, disruption of leaving is even
greater for farm women as there is no separation between home
and work.

Characteristics of rural life
• More space; greater distances between residents and services
• Cyclic/seasonal work and vacation activities
• Informal social/professional interactions
• Access to extended relationship systems
• Residents are related or acquainted
• Small enterprises
• fewer large industries
• Economic orientation to land and nature (e.g., agriculture, mining, fishing)
• High-risk occupations are more prevalent
• schools are social organizations
• Preference for interacting with localities
• Mistrust of newcomers to the community

• Push-Pull considerations
• Both are affecting rural-urban migrations.
• “Pull” of the cities may determine the destination.
• Migrants are pulled toward cities:
• Prospect of jobs and higher incomes.
• Most early urbanization was the result of pull considerations.
• Pushed out of rural areas:
• “Push” factors predominate as the motivation to move.
• Poverty, lack of land, declining agricultural work, war, and famine.
• Play more importance today than push considerations.
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4/25/2022 Ashok Pandey
1.4 Factors affecting rural-urban migration (push-pull
factors) and its effect on rural lives with particular
instances of Nepal

Factors affecting Migration
• The factors contributing to migration and movement both within and
outside a country have been broadly classified into four main groups
• 1) Push Factors,
• 2) Pull Factors,
• 3) Stick Factors and
• 4) Stay Factors.

PUSH PULL
Instability
Rural structures
Low employment
Demographic pressure
Employment market
Better services
Low barriers
Modernity
Migration
18-35
Rural Urban
22

Factor Condition Issues
Instability / Disasters
/ Wars / Famines
Push Creation of refugees. Cities as safe heavens.
Expectation of jobs Pull Higher wages but higher living costs. Large
labor markets. Informal sector dominant.
Deterioration of rural
life
Push Demographic growth. Land tenure (landless
peasants). Mechanization (surplus labor).
Transportation Intervening
opportunities
Increased mobility. Lower costs. Construction
of roads and rails. Access to rural markets.
More and better
services
Pull Better schools and health services. Access to
water and electricity. Overcrowding and
pollution.
24

Push and pull factors
• Economic migration - to find work or follow a particular career path.
• Social migration - for a better quality of life or to be closer to family or
friends.
• Political migration - to escape political persecution or war.
• Environmental - to escape natural disasters such as flooding.

Push factors Examples
• There is poor electricity
• Rural roads are bad
• There is no pipe borne water
• There is no good school
• There is no job opportunity
• There is poor health care service
• There is under development

Rural push factors include
• poverty,
• inequitable land distribution,
• environmental degradation,
• high vulnerability to natural disasters, and violent conflicts
• while urban pull factors include
• better employment and
• education opportunities,
• higher income,
• diverse services, and
• less social discrimination in the cities

Pull Factors
• Better opportunities in the city
• Better wage in the city
• Improved living condition
• There are good schools in the city
• Good electricity supply in the city
• There is pipe borne water
• There is better health care service

Urban Pull factors
• more jobs.
• higher wages.
• better living conditions.
• better education and health services.
• better facilities.
• less chance of natural disasters.

Stay factors
• in the cities, are those factors that prevent from returning to the rural
areas once they have moved to urban centers.
• There is usually a reluctance to disrupt their new lifestyle or risk the
disruption of their children’ education or break newly formed cultural
and social bonds.

stick factors
• These include levels of morale among health workers, rewards and
incentives, training/continuing education, social values and cultural
ties.

‘Push’ and ‘pull’ factors influencing health
workforce migration
• Low pay (absolute and/or relative)
• Poor/dangerous working
conditions
• Unemployment
• Lack of resources
• Limited career opportunities
• Limited educational opportunities
• Economic/political instability
• Higher pay, opportunities for
remittance
• Better working conditions
• Better resourced health system
• Career opportunities
• Provision for post-basic education
• Higher standard of living
• Travel opportunities
• Aid work, political stability
Push Factors Pull Factors

Schematic of the factors affecting migration
and movement of health workers.

1.5 Strength of rural setting in promoting
public health
• Less likely to be diagnosed with a new case of cancer than urban
counterparts.
• Better reported quality of life than urban counterparts.
• Lower stress levels and a stronger sense of community than urban
counterparts.
• Death rates due to cancer are lower in rural populations for some
specific cancers (e.g. breast cancer).

Contd..
• Strong social networks and connections
• Emphasis on relationships with family and neighbors
• Supportive communities
• Common shared values and collective interest in improving health
• Smaller scale and scope of programs, which may accelerate
opportunity
• Willingness and confidence to confront challenges
• Centralized communication channels
• Creativity and devotion to achieving success

1.6 Adverse effect on health risk and disease in urban areas such as
• inadequate and contaminated water supply,
• inadequate access to sanitation,
• adverse climate,
• rural violence,
• physical work-pressure,
• loss of productive population due to international labour migration,
• insecure residential status, poor structural quality of housing,
• inadequate access to public health medical facilities

1.7 Major health and disease issues in rural setting and
their determinants such as cultural, social, industrial,
economic, political, environmental
• Higher poverty rates, which can make it difficult for participants to pay
for services or programs
• Cultural and social norms surrounding health behaviors
• Low health literacy levels and incomplete perceptions of health
• Linguistic and educational disparities
• Limited affordable, reliable, or public transportation options
• Unpredictable work hours or unemployment
• Lower population densities for program economies of scale coverage
• Availability of resources to support personnel, use of facilities, and
effective program operation
• Lack of access to healthy foods and physical activity options

Major issues
The major problems in many rural areas are
• poverty,
• illiteracy,
• unemployment,
• crime,
• social evils,
• lower living standards,
• lack of facilities, services, and health.

The Five Barriers to Rural Healthcare Access
• Workforce Shortages.
• Distance, Transportation & Internet.
• Health Insurance Coverage.
• Social Stigma and Privacy Issues.
• Poor Health Literacy.

In Nepal, Contagious, infectious and waterborne diseases such
as diarrhoea, amoebiasis, typhoid, infectious hepatitis, worm
infestations, measles, malaria, tuberculosis, whooping cough,
respiratory infections, pneumonia and reproductive tract
infections dominate the morbidity pattern, especially in rural areas.

1.8 Rural health appraisal and identification of nature
of public health and medical care demand in rural
setting

Participatory Rural Appraisal (PRA)
• Participatory Rural Appraisal (PRA) is considered one of the popular
and effective approaches to gather information in rural areas.
• This approach was developed in early 1990s with considerable shift in
paradigm from top-down to bottom-up approach, and from
blueprint to the learning process.
• It is a shift from extractive survey questionnaires to experience
sharing by local people.
• It is used to gain in-depth understanding of community or situation

Traditional and Participatory Approach

• Participatory: people are involved in the process – a ‘bottom-up’
approach that requires good communication skills and attitude of
facilitator
• Rural: This techniques can be used in any situation, urban and rural
setting, with literature and illiterate people.
• Appraisal: Find out of information about problems, needs, and
potentiality of target groups/communities.

• PRA is intended to enable local communities to conduct their own
analysis and to plan and take action
• An approach and methods of learning about rural life and conduction,
from, with and by rural people.
• PRA extends into analysis, planning and action
• PRA closely involves villagers and local officials in the entire process
(Robert Chambers, 1992)

PRA – Key Principles
 Participation – participation by the communities
 Flexibility – time and resource available
 Teamwork – conduct by locals
 Optimal ignorance – both time and money
 Systematic – generated data, qualitative in nature

Key Terminology
 PRA (Participatory Rural Appraisal)
 RRA (Rapid Rural Appraisal)
 PLA (Participatory Learning and Action)
 PLA (Participatory Learning Appraisal)

PRA and RRA
RRA PRA
Learning rapidly and directly from
people/communities
Learning with people/communities
Researcher/Project Staffs learn and obtain
information
Communities also learn, sensitize and
capacitated
Information is gathered and used according
to the needs of the project (or assignment)
Facilitate community to analyze, and take
decision as per need of community

Relevant participatory tools
• PRA Tools:
• Mapping: Social / Resource Map, transect walks
• Ranking: Problem tree, Wellbeing ranking, matrix ranking
• Visualization: Venn diagrams, timelines, spider diagrams, seasonal calendar, mobility
map
• Social information: Citizen score card, records card,
• Beneficiaries assessment:
• Interviewing: Focus group discussion (FGD), semi-structured interview, Key informant
interview (KII)
• Participatory observation
• TOP:
• Focused conversation
• Workshop
• Other tools:
• Spider diagram
• SWOT analysis
• H-form of evaluation

Selection of appropriate tool
Purpose
People
Process
• Purpose – WHY
• Nature of information
• People/ stakeholder – WHO
• Nature of participants
• Level of participation – we expect
• Process – HOW
• Resource
• Facilitator/Team
• Setting

Social/Resource Map
Social mapping: Maps
usually drawn by a group of
villagers either on the
ground using chalk or on a
large sheet of paper. The
maps provide information
about the physical
characteristics of the
community, about the socio-
economic conditions and
how the participants
perceive their community.
A social map shows the social profile of a locality and provides insights into the social aspects and social life.

Transect Walk
Transect walk: Involves walking
with the villagers through an area
and discussing about different
aspects of land-use and agro-
ecological zones in the village
observed during the walk.

1.9 Overview of government, NGOs and private sector public health
and medical care services to meet the public health and medical
care demand in rural settings
a. Primary health care and essential health care through health
facilities
b. Public health and medical care related services of health section
of Rural Municipalities
c. Role of Rural Municipalities in preventing disease and promoting
the health of rural population.

Overview of government
Structure of Health System in Nepal
There is health
section in rural
municipality level
which include one
health coordinator
to supervise and
monitor the health
institutions and
program under
rural municipality
level.

Major activities under DoHS
• Under Natinal Immunization Programme :
• Rotavirus Vaccination guideline and Hygiene Promotion through Routine
Immunization guideline
• Conducted ToT and orientation on Rotavirus Vaccine introduction and
hygiene promotion
• Launched Rotavirus vaccine in National Immunization Program from 18
Ashad 2077 (02 July 2020) throughout the country
• Development and distribution of flipchart and stickers- BCC materials for
prevention of COVID-19 at EPI clinics
• Distribution of iron folic acid supplement to pregnant and post partum
women to reduce anemia and micronutrient (Baal vita) to infant under
National Nutrition Programme

• Under National safemoherhood programme:
• For the reduction in Maternal and neonatal mortality and morbidity Maintain
MNH activities at community level including the Birth Preparedness Package
(jeevansuraksha flipchart and card) and distribution of Matri SurakshaChakki
(misoprostol) to prevent postpartum haemorrhage (PPH) in home deliveries
• Under National Family planning programme
• Provision of regular comprehensive FP service including post-partum and post
abortion FP services
• Provision of long acting reversible services
• Permanent FP Methods or Voluntary Surgical Contraception (VSC)
• FP strengthening program through the use of decision-making tool (DMT)and
WHO medical eligibility for contraceptive (MEC) wheel
• Planning and addressing unmet need of FP

• National Adolescents sexual and Reproductive health
• Develop program guideline of cervical cancer screening, obstetric
fistula, pelvic organ prolapse
• Uterine prolapse surgery at federal hospital
• Vaccines against cervical cancer (vaccines)
• Free screening for cervical cancer, breast cancer and fistula at
provincial hospitals
• Surgery of Vault prolapse, fistula surgery at provincial hospitals
• Surgical treatment of uterine prolapse at provincial hospitals

Primary health care and essential health care
through health facilities in rural settings
• Primary Health Care centre
• Health Post
• Urban Health center
• Community Health unit
• Expanded program on immunization
• Community Outreach clinic
• Female community Health volunteer

Function of Primary Health Care
• Medical Care
• Maternal and Child health care including family planning
• Safe water supply and basic sanitation
• Prevention and control of locally endemic diseases
• Collection and reporting of vital statistics

Function of Health post
• To provide health services including basic health care and
preventive medication in remote rural areas.
• Active in various activities including health education on nutrition
improvement, maternal health service, child health service,Family
planning programme,immunization, Environmental cleaning,TB
and Leprosy control etc.
• Health post monitor the activities of FCHVs as well as community
based activities by PHC outreach clinics and EPI clinic

PHC/ORC clinic
• Primary Health Care Outreach (PHC/ORC) program was established in 1994
(2051 BS) with an aim to improve access to some basic health services
including family planning and safe motherhood services for rural households.
• PHC/ORC clinics are the extension of PHCCs, HPs at the community level.
• At PHCC and HP level, ANMs, AHW are responsible for carrying out the PHC
outreach services.

Role of FCHV
• The main role of FCHV will be concentrated on the health promotional activities of mothers
and children in their working area. Besides, they will also help in promoting utilization of
available health services and raise awareness on health through Mothers group.
• FCHV will help in various health programs such as family planning, safer motherhood,
newborn care, immunization, nutrition, communicable and epidemic diseases, acute
respiratory diseases and diarrheal diseases control, environmental sanitation, health
education and other national programs
• FCHVs distribute condoms and pills, ORS packets and vitamin A capsules, treat pneumonia
cases, refer serious cases to health institution and motivate and educate local people on
healthy behaviour.
• FCHV will also provide recommended services like drug distribution and diseases
management as directed by Nepal government based on community based approach

• NGOs fill the gaps, but their services are selective and cover
limited geographic areas
• NGOs, while being not-for-profit organizations, rarely give free
health care
• They do, on the other hand, have adequate staff, equipment, and
supplies
NGO

A non-governmental organization (NGO) is any non- profit,
voluntary citizens' group which is organized on a local, national or
international level
Include organizations engaged in public service, based on ethical,
social, religious
Formal/ Informal groups or organization ( Formal groups -military
units, corporations, churches, court systems, trade, universities,
sports teams and charities) (Informal groups - employees of an
organization who have a common interest)

The role of NGOS in development
• Providing goods and services
• Assisting the government achieve its development
• Helping citizens to voice their aspirations, concerns and alternatives for
consideration by policy makers
• Helping to enhance the accountability and transparency of government and
local government programs and of officials.
• Community health promotion and education (such as hygiene and waste
disposal)
• Managing emerging health crises (HIV/AIDS, Hepatitis B)
• Community social problems (juvenile crimes, run- away, street children,
prostitution)
• Environmental (sustainable water and energy resources)
• Economic (micro loans, skills training, financial education and consulting)
• Development and operation of infrastructure (construction of hospitals and
healthcares, school, public toilets etc. and infrastructure construction)

• Women's issues (women's and child health care, rights, counseling, literacy
issues)
• Maintaining the international health relations
• Conducting and funding the medical and public health research for
improvement of health service
• To maintain the intersectoral coordination in health care delivery system
• Supporting innovation, demonstration and pilot projects in healthcare
delivery system
• Conduct reviews and assessment of existing health programs
• Technical assistance and training for health care delivery
• Advocacy for and with the government programmes of health care from
partners and advisors as well as sponsors
• Can provide valuable resources in promoting health care
• Implementing the mutually agreed programme of collaboration
• Assist national policy formation in health care

• Action, research and training in service provision, outreach,
technical and research inputs in specific areas;
• Advocacy, lobbying and information sharing through networks and
building wider alliances for health goals and sharing information;
• Policy dialogue and development, policy strategy research and
analysis
• Monitoring and ‘watchdog’ roles and protection of consumer
interests.
• Fundraising, resource mobilisation and financial contributions.

NGOs play a crucial role in advancing and improving the
effectiveness of deworming in the context of School Health and
Nutrition (SHN) programmes.
With experienced staff, technical expertise and strong local and
national links, NGOs are able to pilot and scale-up model SHN
programmes (including deworming) and carry out operational
research. NGOs also influence national policy and advocate for and
support the development and implementation of national SHN
programmes.

1.10 Expected outcomes of public health services in the
rural settings such as healthy village dwellers, healthy
village, growth of rural economy
• Household habits and their contribution to health
• A house with appropriate sanitation, water and power has to be accompanied by
healthy and clean household habits.
• A basic requirement is a cooking option where smoke is kept out of the house, as are
measures for disposing of soiled water, separation of waste into appropriate
categories and disposal, avoiding stagnation of water, preventing the access of
mosquitoes to stagnant/stored water.
• In addition, habits like routine hand washing using soap, sterilization of utensils
used to feed babies, drinking boiled water, washing of food before cooking,
preventing access of vectors to the food, ensuring personal hygiene-periodic cutting
of nails and hair, regular bathing, wearing clean clothes, proper use and disposal of
sanitary napkins etc. are very much required for a healthy life.

Contd..
• Health of mothers and children in a village
• An enabling environment is required to be created for ensuring the
health of women and children.
• Each expectant mother must be able to avail the facilities of
immunization, better nutrition and regular health checkups as early as
possible.
• Apart from expectant mothers, absolute and uncompromising
individual attention is required for ensuring complete immunization
and breast feeding for each newborn and child.
• Marriage at an early age and early pregnancies may lead to multiple
issues related to health of mother and child.
• Consecutive pregnancies are another cause leading to poor health of
mother and child. Counseling service to couples along with affordable
family planning measures can be achieved by leveraging the existing
schemes.

Disease control
• Most communicable diseases are preventable.
• Life style diseases (diabetes, hypertension, high
cholesterol, stroke) are also on the rise even in rural areas.
• These diseases, collectively known as non-communicable
diseases, are important causes of premature death in the
young and middle-aged.
• The problem of substance abuse is also increasing, along
with alcohol intake and tobacco abuse.
• Most often accidents and diseases can change the status of
a family from a prosperous one to a destitute one.
• Disease control requires concerted effort and education.

Healthy Village
• Healthy Village as a concept was first proposed by WHO/EMRO in
1989, in a Technical Consultation on Urban Environmental Health,
which was held in the WHO Regional Office in Alexandria, Egypt.
• Healthy Village is a holistic approach intended to address the
critical environmental health problems in rural areas.

Healthy Village approaches
The Healthy Village concept has been developed to address the environmental and other
related health and social issues in an integrated fashion.
• They aim to promote and mobilize health and environmental measures and considerations
at the village and the local levels.
• They aim to facilitate collaboration between health and other sectors at the local level.
• They aim to raise community awareness and standards of health and hygiene education.
• They place a high priority on improving environmental services (water supply, sanitation,
village cleanliness, etc.).
• They aim to stimulate and strengthen local-level decision-making, community initiatives
and participation, and resource mobilization.
• They encourage and promote the use of appropriate technology and local know-how

Healthy Village activities
• The Healthy Village concept may include the following.
• Forming a village committee, made up of villagers, to oversee activities and
mobilize the community and facilitate their participation and contribution.
• Forming a compatible committee at the district or provincial/governorate level,
represented by the district or provincial local authorities and agencies, to
support village-level activities.
• Conducting diagnostic surveys with full community involvement to identify the
priority problems and available resources.
• Raising community awareness and conducting health and hygiene education.

Contd..
• Improving the water supply and sanitation systems, solid refuse collection and
disposal, and food safety.
• Evaluating housing conditions and providing advice for the improvement of houses.
• Training the locals in "do-it-yourself" house building that takes into account
appropriate health and environmental considerations.
• Surveying the economy and identifying/creating employment opportunities through
local-level income generation activities.
• Trying to maintain the natural ecology of the village and beautifying the surroundings
by planting trees and flowers, draining stagnant or septic waters, maintaining roads
and pathways, etc.

Expected outcomes of public health services in
the rural settings such as village dwellers
• Village dwellers: Village habitant
• Fulfillment of basic health services
• Regular organizing of PHC/ORC and EPI Clinic in community
level
• Referral to municipal, provincial and central level hospital in
emergency

Rural health (Public health)

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