The challenges outlined above are relevant for the operation of any government health service in areas of remote and widely dispersed mobile populations. Prospective medical staff at Haima Hospital face obstacles which include: the fear of professional isolation and a negative image of rural practice; a lack of incentives for staff; the distance from major medical centres; and the fear of deskilling, which is increasingly relevant in an age of medical superspecialism. The authors of this report believe that the problems faced by Haima Hospital are not unique but are rather common in similar physical and social geographies. Distance and dispersal in providing secondary health care are not insurmountable challenges. Establishing the specialism of rural and remote medicine in Oman and adopting incentives and rotational models are required elements of a strategy to build a sustainable rural health care system in the country. Such measures would go a long way towards alleviating current concerns and providing the framework for a sustainable system of secondary health care in places that are diffi cult to reach.
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