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Rural health efforts in the urban-dominated political economy: three Third World examples.


 The theme of this paper is to demonstrate that the urban preference in governmental health delivery programs does exists in capitalist and socialist political economies and that efficient rural health programs exist in capitalist and socialist developing countries. The purpose of the article is to determine strategies to promote accessible rural health care by studying 3 examples. In the State of Kerala, India between 1956-1959, land reforms were carried out, and political parties and agrarian cooperatives involving rural people were organized. rural needs were given top priority in this capitalist economy which resulted in agrarian reform, education, and health delivery. In 1971, food production increased to 5.4 million tons. During this period, the nutritional status rose, the mortality rated declined, and the fertility rates decreased. Thus, the health status for the rural population improved. Bolivia's Montero health program was developed in 1975. This case demonstrates the urban/rural conflict in a capitalist economy with preference given to the urban side. This proposed health program resulted in the urban communities receiving greater resources compared to the rural population. This result is attributed to lack of organization within the rural population. The final case examined was Nicaragua which in 1979 was socialist. The National Unified Health System was established by the Sandinistas and had 4 priorities: revolution defense, economy, education, and health. This movement by the Sandinistas addressed rural health problems and challenged the urban medical organization. Health care workers were trained to deliver more curative and preventative services. The Popular Health Councils in Nicaragua is unique; it provides discussion regarding the urban/rural conflict. A change in the Minister of Health also indicated concern for rural health care delivery. Nicaragua's health status also improved as a result of rural organization. From the 3 cases, it was concluded that revolutions, reforms, and education were effective strategies in improving the health status in rural populations.
