Issues in rural health programming: A center perspective

The purpose of this conceptual paper is to review select issues associated with rural health programs that have a number of satellite sites (periphery) coordinated through a primary supervisory body (center). The paper provides suggestions for fostering more effective programming to rural populations and generating further dialogue about center-periphery issues from diverse perspectives. Based on literature and interviews with four rural health professionals who administer programs from a central location, three common center-periphery challenges are identified and discussed: control, communication, and competency. To address these challenges and facilitate high-quality programming, suggestions, including the effective use of dialogue and discussion, consensual decision-making, a communication of care, and a center's role in staff recruitment and retention, are discussed.