"Positive programming": the use of data in planning for the rural health initiative

A data-driven approach to allocating federal resources for primary care systems in rural areas is presented. This approach was developed and implemented by the Public Health Service (PHS) when it undertook its Rural Health Initiative Program. Nationally available small-area data were used to identify "priority counties" and PHS regional office staffs were asked to take an active role in developing rural health system projects in these counties. This approach was adopted to avoid the problem of the many communities eligible for and in need of funds that do not get them because they lack the organization and knowledgeable personnel required to develop a project grant application. The paper defines and discusses the "positive programming" approach (believed to be the first attempt to allocate federal health service delivery resources actively on the basis of small-area data), discusses the present shortcomings of the approach (including data limitations), and presents the results of implementing the approach. In the first year, 23% of the priority counties and 13% of the nonpriority counties were served, while in the second year 39% of the priority counties and 17% of the nonpriority counties were served. The substantial increase in the percentage of priority counties served reflects the effectiveness of the positive programming effort.