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Annu Rev Public Health. 2016;37:395-412. doi: 10.1146/annurev-publhealth-032315-021507. Epub 2016 Jan 6.

Rural Health Care Access and Policy in Developing Countries.

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Northern Ontario School of Medicine, Sudbury and Thunder Bay, Ontario, Canada; email:
School of Rural and Northern Health, Laurentian University, Sudbury, ON P3E 2C6 Canada.


Compared to their urban counterparts, rural and remote inhabitants experience lower life expectancy and poorer health status. Nowhere is the worldwide shortage of health professionals more pronounced than in rural areas of developing countries. Sub-Saharan Africa (SSA) includes a disproportionately large number of developing countries; therefore, this article explores SSA in depth as an example. Using the conceptual framework of access to primary health care, sustainable rural health service models, rural health workforce supply, and policy implications, this article presents a review of the academic and gray literature as the basis for recommendations designed to achieve greater health equity. An alternative international standard for health professional education is recommended. Decision makers should draw upon the expertise of communities to identify community-specific health priorities and should build capacity to enable the recruitment and training of local students from underserviced areas to deliver quality health care in rural community settings.


community engagement; local training and retention; primary health care; rural health workforce; social accountability

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