Skip to main content

Table 3 Summary of strengths and weaknesses of rural area definitions

From: A critical review of definitions of rural areas in Indonesia and implications for health workforce policy and research

Norm Description MoH definition Presidential definition CBS definition
Explicit Taxonomy criteria are clear Strengths:
The definition has a clear set of criteria and scoring systems
Based on 12 criteria, with a score range of 0 to 12, those scored 3+ are classified as remote health facilities
Criteria include topography (e.g. mountain, coast, inland, small island), transportation and access to the nearest district centre, susceptibility to conflict or natural disaster (volcano eruption, earthquake, landslide), security conditions and access to food-related staples
Strengths:
The definition has a clear set of criteria and scoring systems
Based on 27 criteria, each weighted 1.43–10%. The higher the score, the less developed the district. The top 60% of districts are classified as less developed
Criteria include economic development indicators (per capita consumption, proportion of people living in poverty); local fiscal capacity; human development measures (life expectancy, population literacy, length of schooling); geographic accessibility (distance to the district centre and health and education facilities; health facilities, doctors, schools per 1000 population); road infrastructure; and vulnerabilities to natural disaster or conflict
Strengths:
The definition has a clear set of criteria and scoring systems
Based on eight criteria, with a score range of 2–22. Villages with a score of less than 10 are classified as rural
Criteria comprise population density; agricultural-based household income; availability of schooling, health and business facilities; and access to electricity and a phone landline
Meaningful Has at least one criterion that is associated with higher doctor density in a previous study Weaknesses:
It does not account for population characteristics that are associated with doctor supply
Strengths:
Accounts for social determinants of health (e.g. literacy and per capita income), associated with higher doctor supply in other nations
Strengths:
Accounts for population characteristics (e.g. population density) strongly associated with doctor supply in other nations
Replicable The taxonomy can be applied at another level of government or can be applied again in the future Weaknesses:
The classification is at the facility level with no clear geographic boundary. Hence, it would be difficult to apply to another level. However, it may be possible to reclassify districts with these characteristics
Weaknesses:
The classification is at the district level; hence, it cannot be applied at the subdistrict or village level
Strengths:
Yes, the classification is at the village level and available to be reclassified at the subdistrict, district or provincial level
Derived from available, high-quality data The taxonomy is based on high-quality, accessible data Weaknesses:
It relies on local and national government’s information on the selected criteria, thus was not derived from available high-quality data
Strengths:
Derived from population census, national survey and fiscal data
Strengths:
Derived from population census data
Quantifiable and not subjective The taxonomy is based on objective measurement Weaknesses:
Provincial and district health authorities can nominate facilities that meet remoteness criteria, and the MoH then reviews the nominations prior to approval. Therefore, this process could be subjective based on local area knowledge/justification of facility remoteness, thus may overlook health facilities located in a district with less proactive provincial or district health authorities
Strengths:
Scores are calculated by the national government based on objective and thorough assessment of demographic, economic, infrastructure and access, thus objective, with formal national status, aiding interpretation
Strengths:
Scores are calculated by the national government based on objective and thorough assessment of demographic, economic, infrastructure and access, thus objective, with formal national status, aiding interpretation
Has on-the-ground validity The taxonomy is valid in demonstrating the rurality or remoteness of a selected area Strengths:
Based on local area knowledge/justification of facility remoteness, thus offers a better nuance in describing the area’s limited geographic accessibility
Weaknesses:
It is measured at a larger geographical (district) level, potentially missing nuances of geographically isolated villages and population access
The composite index produced by the criteria has a wide range, but the final classification only groups areas into two categories: less/more developed districts
Strengths:
Measured at a smaller geographical (village) level, thus could have greater validity in describing geographic and accessibility conditions in a localized area
Weaknesses:
There is high weighting proportion for population density for this scoring. For example, areas with high population density (> 8500/km2 get 8 points, with a hairdresser available get 1 point and household with electricity ≥ 90% get 1 point, making a total of 10 points, hence classified as urban. Meanwhile, such a place, when having no hospital within 5 km or primary health facilities with no doctors, might have been classified as urban. Therefore, there might be several urban villages with poor public and health facilities, thus overlooked when government needs to support areas with such characteristics. Any increased resources would be spread thinly between a large number of rural villages
The scoring ranges from 2 to 22, but the final classification only groups areas into two categories: urban/rural villages
Boundary Has a clear area boundary, either geographical or political Weaknesses:
Each facility covers one or more villages, making the area boundary unclear
Strengths:
The boundaries, both geographical and governmental (political), between districts are clear
Weaknesses:
The boundary between villages is unclear. And a doctor may live in one village while working in others, thus distorting the actual supply of doctors
Update frequency Data used for taxonomy are updated periodically Weaknesses:
The MoH update the list of remote facilities yearly; however, the classification of a remote facility can be done any time based on request approval
Strengths:
It is regularly updated (every 5 years) using the latest census or survey (linking it with population and infrastructure development)
Strengths:
It is regularly updated (every 10 years) with the latest population census (linking it with population and infrastructure development)