Enterprising or Enterprise? Sustainable rural training centre models in the Solomon Islands

<p>This thesis assesses the educational relevance, impact and operational sustainability, of community rural training centres (RTCs) and external ‘development’ practice across the Solomon Islands over the last five years. It further legitimises RTCs as effective hubs of ‘development’ for informal livelihoods and rural community interests. The thesis adopts a post-development lens in its assessment of insights obtained from qualitative interviews with 87 participants, spanning four RTC locations and in consultation with other stakeholders. Particular attention is given to Escobar’s local models of practice (Escobar, 1995) in understanding processes of ‘development’ at the community level. It assessed the nature and purpose of RTCs for community conceptions of ‘development’ and ‘modernity’, identifying their impact in this regard. Alongside this, the thesis assessed the impact of external ‘development’ programming on the RTC model of practice, including considerations of output relevance and sustainability. Overall, a social enterprise model (Ridley-Duff & Bull, 2018) was found to be insufficient to understanding the RTC model of practice. Such a model failed to account for the varied conceptions of ‘modernity’ at the local level, and instead a more holistic model of RTC operation was proposed. This helps to expand discourses of localised practice in the context of ‘development’. Evidence from participants showed clear positive impacts of the model in supporting different stakeholders’ goals for ‘development’ at the community level. Mainstream discourses of ‘knowledge’ transfer were challenged by showing the agency and, at times, power, community actors possessed in localising new learnings into current understandings as they saw fit. While external programming played a key part in these processes, its role was as a facilitator of RTC models of practice rather than as the main driver of community ‘development’. Rather than simply replacing one set of ‘knowledge’ with another, this expands discourses of localised ‘knowledge’ to show community understandings as separate and adaptable domains of knowledge that should be supported rather than replaced. Finally, this thesis assessed the position of RTCs in wider discourses of Solomon Islands’ ‘sustainable development’, including wider outcomes and implications of this position on their ‘sustainability’, and for community education. National and global processes of ‘development’ we found to have great influence on the successes and challenges of RTCs, showing ongoing and evolving challenges to ‘informal’ livelihoods and practice. External expectations were shown to create a sustainability paradox for rural training centres (Devine, 2003), between conforming to external perceptions to support their ‘development’ or maintaining their relevance in informal settings with few options for growth. A case is therefore made to expand discourses of ‘sustainable development’ to conceive of sustainable outcomes in a more holistic way, acknowledging history and community-level intent over external economic ‘development’ pressures.</p>

Enterprising or Enterprise? Sustainable rural training centre models in the Solomon Islands

<p>This thesis assesses the educational relevance, impact and operational sustainability, of community rural training centres (RTCs) and external ‘development’ practice across the Solomon Islands over the last five years. It further legitimises RTCs as effective hubs of ‘development’ for informal livelihoods and rural community interests. The thesis adopts a post-development lens in its assessment of insights obtained from qualitative interviews with 87 participants, spanning four RTC locations and in consultation with other stakeholders. Particular attention is given to Escobar’s local models of practice (Escobar, 1995) in understanding processes of ‘development’ at the community level. It assessed the nature and purpose of RTCs for community conceptions of ‘development’ and ‘modernity’, identifying their impact in this regard. Alongside this, the thesis assessed the impact of external ‘development’ programming on the RTC model of practice, including considerations of output relevance and sustainability. Overall, a social enterprise model (Ridley-Duff & Bull, 2018) was found to be insufficient to understanding the RTC model of practice. Such a model failed to account for the varied conceptions of ‘modernity’ at the local level, and instead a more holistic model of RTC operation was proposed. This helps to expand discourses of localised practice in the context of ‘development’. Evidence from participants showed clear positive impacts of the model in supporting different stakeholders’ goals for ‘development’ at the community level. Mainstream discourses of ‘knowledge’ transfer were challenged by showing the agency and, at times, power, community actors possessed in localising new learnings into current understandings as they saw fit. While external programming played a key part in these processes, its role was as a facilitator of RTC models of practice rather than as the main driver of community ‘development’. Rather than simply replacing one set of ‘knowledge’ with another, this expands discourses of localised ‘knowledge’ to show community understandings as separate and adaptable domains of knowledge that should be supported rather than replaced. Finally, this thesis assessed the position of RTCs in wider discourses of Solomon Islands’ ‘sustainable development’, including wider outcomes and implications of this position on their ‘sustainability’, and for community education. National and global processes of ‘development’ we found to have great influence on the successes and challenges of RTCs, showing ongoing and evolving challenges to ‘informal’ livelihoods and practice. External expectations were shown to create a sustainability paradox for rural training centres (Devine, 2003), between conforming to external perceptions to support their ‘development’ or maintaining their relevance in informal settings with few options for growth. A case is therefore made to expand discourses of ‘sustainable development’ to conceive of sustainable outcomes in a more holistic way, acknowledging history and community-level intent over external economic ‘development’ pressures.</p>

Diverse Education for Diverse Economies: The relevance of Rural Training Centres in the Solomon Islands

<p>Education is considered the cornerstone of development, essential to achieving economic and social goals. Under the powerful global education agenda, the western model of formal education has been implemented hegemonically in developing countries. This model largely prepares young people for a role in the formal economy in an urban environment, overlooking fundamental questions of purpose and relevance for local context. In the Solomon Islands, where 85% of the population reside rurally, such opportunities often do not exist or reflect local livelihoods. Rural Training Centres (RTCs) are informal vocational institutions that sit outside of the dominant education paradigm by aiming to prepare young people for local livelihoods. Through informal and vocational learning, they offer an alternative to urbanisation, supporting self derived and locally based livelihoods. Paradoxically, for this very reasons they are often disregarded at the government and donor level. From a postdevelopment perspective, this thesis considers the roles and relevance of RTCs under a wider conceptualisation of economy and knowledge than is applied in mainstream development practice. Using qualitative and ethnographical methodologies, this research investigates local understandings of RTCs as an education alternative through the voices of young people, women and the wider community. The inter-related aspects: economy, education, and development, are considered in two case study communities, Gizo and Vatu, providing a semi-urban/rural comparison. Using a Diverse Economies Framework (Gibson-Graham, 2005), this thesis reveals a more realistic picture of the myriad of activities that support local livelihoods exists. The formal economy is found to play a secondary role to informal and direct economic practices. Similarly, under a pluralistic view of education that accepts the legitimacy of traditional, cultural and indigenous knowledge, the aspirations of young people are found to be deeply rooted ‘at home’. Yet, this research argues that they do not conform to a simplistic modern-traditional dichotomy. Rather they reflect cultural hybridity, a third space ‘in between’ where different knowledges are transformed and negotiated. Despite criticisms, RTCs were positively viewed at a community level. They were considered to fill a vital gap left by the formal education system, support local livelihoods and help stem the flow of urban migration. They also offer an opportunity to support women in existing gender roles, as well as expand existing cultural educational boundaries. However, RTCs are facing pressure to standardise and formalise in order to attract greater government and donor funding. This reflects wider tensions in development policy and practice that favour the universal and the global over the local, and brings to light the inherent power disparity in the aid relationship.</p>

Diverse Education for Diverse Economies: The relevance of Rural Training Centres in the Solomon Islands

<p>Education is considered the cornerstone of development, essential to achieving economic and social goals. Under the powerful global education agenda, the western model of formal education has been implemented hegemonically in developing countries. This model largely prepares young people for a role in the formal economy in an urban environment, overlooking fundamental questions of purpose and relevance for local context. In the Solomon Islands, where 85% of the population reside rurally, such opportunities often do not exist or reflect local livelihoods. Rural Training Centres (RTCs) are informal vocational institutions that sit outside of the dominant education paradigm by aiming to prepare young people for local livelihoods. Through informal and vocational learning, they offer an alternative to urbanisation, supporting self derived and locally based livelihoods. Paradoxically, for this very reasons they are often disregarded at the government and donor level. From a postdevelopment perspective, this thesis considers the roles and relevance of RTCs under a wider conceptualisation of economy and knowledge than is applied in mainstream development practice. Using qualitative and ethnographical methodologies, this research investigates local understandings of RTCs as an education alternative through the voices of young people, women and the wider community. The inter-related aspects: economy, education, and development, are considered in two case study communities, Gizo and Vatu, providing a semi-urban/rural comparison. Using a Diverse Economies Framework (Gibson-Graham, 2005), this thesis reveals a more realistic picture of the myriad of activities that support local livelihoods exists. The formal economy is found to play a secondary role to informal and direct economic practices. Similarly, under a pluralistic view of education that accepts the legitimacy of traditional, cultural and indigenous knowledge, the aspirations of young people are found to be deeply rooted ‘at home’. Yet, this research argues that they do not conform to a simplistic modern-traditional dichotomy. Rather they reflect cultural hybridity, a third space ‘in between’ where different knowledges are transformed and negotiated. Despite criticisms, RTCs were positively viewed at a community level. They were considered to fill a vital gap left by the formal education system, support local livelihoods and help stem the flow of urban migration. They also offer an opportunity to support women in existing gender roles, as well as expand existing cultural educational boundaries. However, RTCs are facing pressure to standardise and formalise in order to attract greater government and donor funding. This reflects wider tensions in development policy and practice that favour the universal and the global over the local, and brings to light the inherent power disparity in the aid relationship.</p>

Effectiveness of Educational Interventions on Internship Training in Community Medicine in a Tertiary Care Centre in Alappuzha District of Kerala, South India; A Quasi-Experimental Study

BACKGROUND India has been facing various challenges in the past decade, which include outbreaks of different communicable diseases and the rising of slow pandemics of non-communicable diseases. The current COVID 19 pandemic brings to light the need to revamp the training in public health during the internship. A standardized and outcome-based approach to internship training is the need of the hour for the Indian medical graduate (IMG). The internship program in community medicine should train the Indian medical graduate to develop patient management and administrative skills to promote health care through a health facility. The training provided is not standardized or evaluated across the medical colleges. Hence, it was aimed to study the effectiveness of educational interventions on internship training during the posting at the rural training health centre (RTHC). METHODS A quasi-experimental study was conducted among the interns posted in the rural training health centre using a validated semi-structured questionnaire as a pretest followed by a post-test after two weeks of training on the primary health care system. The perception of the students towards the training was assessed using the Likert 5 point scale. RESULTS The pre-test score was 5.30 (SD 2.105) and the post-test mean score was 9.35 (SD 2.033) [P < 0.01]. The gender-based analysis also showed significance within genders. Student perception revealed 80 % found the training useful, 90 % agreed that the guidance provided by the field staff helped them and 90 % agreed that the intervention changed their outlook towards the internship training in community medicine. CONCLUSIONS The study has brought a positive outlook towards giving adequate guidance to acquire knowledge and skills to interns by the active involvement of faculty. Rethinking and re-implementation of the existing internship training in the community is the need of the hour. KEYWORDS Internship Training, Community Medicine, Medical Education, Kerala, GMR 2019

Increasing doctors working in specific rural regions through selection from and training in the same region: national evidence from Australia

Background ‘Grow your own’ strategies are considered important for developing rural workforce capacity. They involve selecting health students from specific rural regions and training them for extended periods in the same regions, to improve local retention. However, most research about these strategies is limited to single institution studies that lack granularity as to whether the specific regions of origin, training and work are related. This national study aims to explore whether doctors working in specific rural regions also entered medicine from that region and/or trained in the same region, compared with those without these connections to the region. A secondary aim is to explore these associations with duration of rural training. Methods Utilising a cross-sectional survey of Australian doctors in 2017 (n = 6627), rural region of work was defined as the doctor’s main work location geocoded to one of 42 rural regions. This was matched to both (1) Rural region of undergraduate training (< 12 weeks, 3–12 months, > 1 university year) and (2) Rural region of childhood origin (6+ years), to test association with returning to work in communities of the same rural region. Results Multinomial logistic regression, which adjusted for specialty, career stage and gender, showed those with > 1 year (RRR 5.2, 4.0–6.9) and 3–12 month rural training (RRR 1.4, 1.1–1.9) were more likely to work in the same rural region compared with < 12 week rural training. Those selected from a specific region and having > 1-year rural training there related to 17.4 times increased chance of working in the same rural region compared with < 12 week rural training and metropolitan origin. Conclusion This study provides the first national-scale empirical evidence supporting that ‘grow your own’ may be a key workforce capacity building strategy. It supports underserviced rural areas selecting and training more doctors, which may be preferable over policies that select from or train doctors in ‘any’ rural location. Longer training in the same region enhances these outcomes. Reorienting medical training to selecting and training in specific rural regions where doctors are needed is likely to be an efficient means to correcting healthcare access inequalities.

An Exploratory Study of a Novel Approach to Improve Readiness for a Rural Family Medicine Residency

Background and Objectives: Transitioning from medical school to residency is challenging, especially in rural training programs where a comprehensive scope of practice is needed to address rural health disparities. Oregon Health &amp; Science University partnered with Cascades East Family Medicine Residency in Klamath Falls, Oregon to create an integrated fourth-year medical student experience (Oregon Family medicine Integrated Rural Student Training (Oregon FIRST). Participants may then enter this residency to complete their training with the intention to practice in rural underresourced settings. Methods: In this exploratory study, we conducted key informant interviews with 9 of ten Oregon FIRST participants to determine how Oregon FIRST contributed both to their readiness for residency training and their choice to practice in rural underserved locations. Interviews were conducted between June 10, 2020 and July 8, 2020. We analyzed field notes taken during interviews for emergent themes using classical content analysis. Results: Emergent themes included logistical ease, relationship development, key curricular elements, and commitment to rural practice. Overwhelmingly, Oregon FIRST participants reported the experience had many challenging and demanding components because they served as subinterns for their entire fourth year of medical school, but this prepared them very well for internship. When asked if they would choose to enroll in Oregon FIRST again, given what they now know about physician training and patient care, all nine (100%) said they would. Conclusions: This study demonstrated that Oregon FIRST students felt better prepared for the rigors of residency and are committed to practicing in rural areas.

Interventions for health workforce retention in rural and remote areas: a systematic review

Background Attracting and retaining sufficient health workers to provide adequate services for residents of rural and remote areas has global significance. High income countries (HICs) face challenges in staffing rural areas, which are often perceived by health workers as less attractive workplaces. The objective of this review was to examine the quantifiable associations between interventions to retain health workers in rural and remote areas of HICs, and workforce retention. Methods The review considers studies of rural or remote health workers in HICs where participants have experienced interventions, support measures or incentive programs intended to increase retention. Experimental, quasi-experimental and observational study designs including cohort, case–control, cross-sectional and case series studies published since 2010 were eligible for inclusion. The Joanna Briggs Institute methodology for reviews of risk and aetiology was used. Databases searched included MEDLINE (OVID), CINAHL (EBSCO), Embase, Web of Science and Informit. Results Of 2649 identified articles, 34 were included, with a total of 58,188 participants. All study designs were observational, limiting certainty of findings. Evidence relating to the retention of non-medical health professionals was scant. There is growing evidence that preferential selection of students who grew up in a rural area is associated with increased rural retention. Undertaking substantial lengths of rural training during basic university training or during post-graduate training were each associated with higher rural retention, as was supporting existing rural health professionals to extend their skills or upgrade their qualifications. Regulatory interventions requiring return-of-service (ROS) in a rural area in exchange for visa waivers, access to professional licenses or provider numbers were associated with comparatively low rural retention, especially once the ROS period was complete. Rural retention was higher if ROS was in exchange for loan repayments. Conclusion Educational interventions such as preferential selection of rural students and distributed training in rural areas are associated with increased rural retention of health professionals. Strongly coercive interventions are associated with comparatively lower rural retention than interventions that involve less coercion. Policy makers seeking rural retention in the medium and longer term would be prudent to strengthen rural training pathways and limit the use of strongly coercive interventions.