The Limerick Declaration on Rural Health Care 2022

Abstract

The 19th World Rural Health Conference, hosted in rural Ireland and the University of Limerick, with over 650 participants coming from 40 countries and an additional 1600 engaging online, has carefully considered how best rural communities can be empowered to improve their own health and the health of those around them. The conference also considered the role of national health systems and all stakeholders, in keeping with the commitments made through the Sustainable Development Goals and the enjoyment of the highest attainable standard of health as one of the fundamental rights of every human being. This conference declaration, the Limerick Declaration on Rural Healthcare, is designed to inform rural communities, academics and policymakers about how to achieve the goal of delivering high quality health care in rural and remote areas most effectively, with a particular focus on the Irish healthcare system. Congruent with current evidence and best international practice, the participants of the conference endorsed a series of recommendations for the creation of high quality, sustainable and cost-effective healthcare delivery for rural communities in Ireland and globally. The recommendations focused on four major themes: rural healthcare needs and delivery, rural workforce, advocacy and policy, and research for rural health care. Equal access to health care is a crucial marker of democracy. Hence, we call on all governments, policymakers, academic institutions and communities globally to commit to providing their rural dwellers with equitable access to health care that is properly resourced and fundamentally patientcentred in its design.

Recruitment and retention of staff in rural dispensing primary care practice: a qualitative inquiry

“…The importance of family and spousal factors in decisions to join a rural practice and family experiences of rurality and preferences of rural living were pertinent. 24 – 28 Many healthcare staff are embedded within their local communities, although for doctors this was not a universal aspect and views differed.…”

“…This is an area where flexibility, local consultation with stakeholders, and rural proofing of blanket national guidance is required in order to avoid discriminatory healthcare arrangements for rural staff. 24 , 40…”

“…The value placed on rural life as a means of achieving a balance between work and family life is a sentiment echoed in recent work. The importance of family and spousal factors in decisions to join a rural practice and family experiences of rurality and preferences of rural living were pertinent (24)(25)(26)(27)(28). Many healthcare staff are embedded within their local communities, although for doctors this was not a universal aspect and views differed.…”

“…Such arrangements are evidently valued and trusted by staff, however, doctors may find themselves consciously or unconsciously in breach of national guidance in offering these services. This is an area where flexibility, local consultation with stakeholders and rural-proofing of blanket national guidance is required, in order to avoid discriminatory healthcare arrangements for rural staff (24,41).…”

Refugee and migrants' involvement in participatory spaces in a US practice‐based research network study: Responding to unanticipated priorities

“…10,11 Given contemporary global migration patterns, refugees and other migrants in the United States and other resettlement countries bring increasing cultural and linguistic diversity to primary care settings, such that cross-cultural consultations are no longer confined to specialist refugee clinics but are increasingly a feature of mainstream clinical practice even in rural and remote areas. 12,13 There is thus an urgent need to attend to the suboptimal involvement of refugees and migrants in primary healthcare decision-making; to understand their health needs and to take action for equitable health outcomes. Yet, despite the policy and legal imperative, variability in the quality of care for migrants persists.…”