How much healthcare is wasted? A cross-sectional study of outpatient overprovision in private-for-profit and faith-based health facilities in Tanzania

2021 ◽  
Author(s):  
Jessica J C King ◽  
Timothy Powell-Jackson ◽  
Christina Makungu ◽  
James Hargreaves ◽  
Catherine Goodman
Keyword(s):  
Public Health ◽  
Rural Areas ◽  
Antimicrobial Agents ◽  
Health Facilities ◽  
Health Coverage ◽  
Upper Respiratory Tract ◽  
For Profit ◽  
Faith Based ◽  
Not For Profit ◽  
Geographical Regions

Abstract Overprovision—healthcare whose harm exceeds its benefit—is of increasing concern in low- and middle-income countries, where the growth of the private-for-profit sector may amplify incentives for providing unnecessary care, and achieving universal health coverage will require efficient resource use. Measurement of overprovision has conceptual and practical challenges. We present a framework to conceptualize and measure overprovision, comparing for-profit and not-for-profit private outpatient facilities across 18 of mainland Tanzania’s 22 regions. We developed a novel conceptualization of three harms of overprovision: economic (waste of resources), public health (unnecessary use of antimicrobial agents risking development of resistant organisms) and clinical (high risk of harm to individual patients). Standardized patients (SPs) visited 227 health facilities (99 for-profit and 128 not-for-profit) between May 3 and June 12, 2018, completing 909 visits and presenting 4 cases: asthma, non-malarial febrile illness, tuberculosis and upper respiratory tract infection. Tests and treatments prescribed were categorized as necessary or unnecessary, and unnecessary care was classified by type of harm(s). Fifty-three percent of 1995 drugs prescribed and 43% of 891 tests ordered were unnecessary. At the patient-visit level, 81% of SPs received unnecessary care, 67% received care harmful to public health (prescription of unnecessary antibiotics or antimalarials) and 6% received clinically harmful care. Thirteen percent of SPs were prescribed an antibiotic defined by WHO as ‘Watch’ (high priority for antimicrobial stewardship). Although overprovision was common in all sectors and geographical regions, clinically harmful care was more likely in for-profit than faith-based facilities and less common in urban than rural areas. Overprovision was widespread in both for-profit and not-for-profit facilities, suggesting considerable waste in the private sector, not solely driven by profit. Unnecessary antibiotic or antimalarial prescriptions are of concern for the development of antimicrobial resistance. Option for policymakers to address overprovision includes the use of strategic purchasing arrangements, provider training and patient education.

ACEnet

2011 ◽  
pp. 336-357
Author(s):  
Craig Van Slyke ◽  
France Belanger ◽  
Marcy Kittner
Keyword(s):  
Economic Development ◽  
Rural Areas ◽  
Small Businesses ◽  
Successful Implementation ◽  
Economic Networks ◽  
Business Training ◽  
Web Based ◽  
For Profit ◽  
Not For Profit ◽  
Computer Labs

With the advent of Web-based electronic commerce (e-commerce), businesses of all sizes rushed to take advantage of the potential of e-commerce technologies. While large organizations often have ready access to the resources necessary to implement ecommerce strategies, smaller organizations may lack some or all of these resources. Conversely, the increased reach facilitated by e-commerce may allow some small businesses to be viable in areas where limited access to customers might otherwise prevent success. This increased reach may be particularly beneficial in economically depressed rural areas, which may stand to gain greatly from the economic development potential of small businesses. Small businesses in general, and rural small businesses in particular, face a number of hurdles that must be overcome if they are to benefit from e-commerce. This case describes how a not-for-profit agency, the Appalachian Center for Economic Networks (ACEnet), facilitates the use of e-commerce by rural small businesses as a part of an overall strategy for spurring economic development through small businesses. ACEnet provides a number of resources that help small businesses take advantage of e-commerce, including computer labs, Web site hosting, consultative services, and technical and business training. This case illustrates how these services help rural small businesses overcome many of the barriers to successful implementation of e-commerce.

ACEnet

2011 ◽  
pp. 1-20
Author(s):  
Craig Van Slyke ◽  
Frank Belanger ◽  
Marcy Kittner
Keyword(s):  
Economic Development ◽  
Rural Areas ◽  
Small Businesses ◽  
Successful Implementation ◽  
Economic Networks ◽  
Business Training ◽  
Web Based ◽  
For Profit ◽  
Not For Profit ◽  
Computer Labs

With the advent of Web-based electronic commerce (e-commerce), businesses of all sizes rushed to take advantage of the potential of e-commerce technologies. While large organizations often have ready access to the resources necessary to implement e-commerce strategies, smaller organizations may lack some or all of these resources. Conversely, the increased reach facilitated by e-commerce may allow some small businesses to be viable in areas where limited access to customers might otherwise prevent success. This increased reach may be particularly beneficial in economically depressed rural areas, which may stand to gain greatly from the economic development potential of small businesses. Small businesses in general, and rural small businesses in particular, face a number of hurdles that must be overcome if they are to benefit from e-commerce. This case describes how a not-for-profit agency, the Appalachian Center for Economic Networks (ACEnet), facilitates the use of e-commerce by rural small businesses as a part of an overall strategy for spurring economic development through small businesses. ACEnet provides a number of resources that help small businesses take advantage of e-commerce, including computer labs, Web site hosting, consultative services, and technical and business training. This case illustrates how these services help rural small businesses overcome many of the barriers to successful implementation of e-commerce.

scholarly journals Paediatric and obstetric outcomes at a faith-based hospital during the 100-day public sector physician strike in Kenya

2018 ◽  
Vol 3 (2) ◽  
pp. e000665 ◽  
Author(s):  
Mary Beth Adam ◽  
Sarah Muma ◽  
Jecinter Achieng Modi ◽  
Mardi Steere ◽  
Nate Cook ◽  
...  
Keyword(s):  
Public Sector ◽  
Healthcare Delivery ◽  
Time Frame ◽  
Obstetric Outcomes ◽  
The Public ◽  
For Profit ◽  
Faith Based ◽  
Patient Admissions ◽  
Not For Profit ◽  
Physician Care

Published reviews of national physician strikes have shown a reduction in patient mortality. From 5 December 2016 until 14 March 2017, Kenyan physicians in the public sector went on strike leaving only private (not-for-profit and for-profit) hospitals able to offer physician care. We report on our experience at AIC-Kijabe Hospital, a not-for-profit, faith-based Kenyan hospital, before, during and after the 100-day strike was completed by examining patient admissions and deaths in the time periods before, during and after the strike. The volume of patients increased and exceeded the hospital’s ability to respond to needs. There were substantial increases in sick newborn admissions during this time frame and an additional ward was opened to respond to this need. Increased need occurred across all services but staffing and space limited ability to respond to increased demand. There were increases in deaths during the strike period across the paediatric medical, newborn, paediatric surgical and obstetric units with an OR (95% CI) of death of 3.9 (95% CI 2.3 to 6.4), 4.1 (95% CI 2.4 to 7.1), 7.9 (95% CI 3.2 to 20) and 3.2 (95% CI 0.39 to 27), respectively. Increased mortality across paediatric and obstetrical services at AIC-Kijabe Hospital correlated with the crippling of healthcare delivery in the public sector during the national physicians’ strike in Kenya.

scholarly journals Determining Variations in Access to Public Hospitals in Makkah, Kingdom of Saudi Arabia: A GIS-Based Approach

2021 ◽  
Vol 1 (1) ◽  
pp. 26-32
Author(s):  
Mazen Baazeem ◽  
Marc Tennant ◽  
Estie Kruger
Keyword(s):  
Public Health ◽  
Saudi Arabia ◽  
Urban Areas ◽  
Population Distribution ◽  
Health Facilities ◽  
Public Hospitals ◽  
Spatial Accessibility ◽  
Geographical Information ◽  
Health Coverage ◽  
Gis Technology

Background: Variation in gaining accessibility to public hospitals in Makkah, Saudi Arabia, has not been investigated before. Good access to public health facility will lead to improvements in the population’s health. Maps and geographical information system (GIS) technology can provide assistance to address public health coverage issues. Aims: This study aimed to use GISs to identify spatial accessibility to hospitals in Makkah, based on the radius and drive-time analysis technique. Method: Using Quantum GIS (QGIS), a geodatabase was created to include 8 public hospitals’ locations and data of population distribution across the city. Buffer zones at 2.5, 5, 7, and 10 km radius from the public hospitals were identified and examined. Results: The findings revealed that most of the health facilities across the suburbs of Makkah were located in urban areas, while rural and remote areas were neglected. Conclusion: Public health facilities were distributed relative to high population density. One-third of the city’s population does not have proper access to healthcare services.

A Waqf-Integrated Reporting (WAQIR) Model

2020 ◽  
pp. 281-300
Author(s):  
Rosnia Masruki ◽  
Mustafa Mohd Hanefah ◽  
Muhammad Iqmal Hisham Kamaruddin
Keyword(s):  
Economic Impact ◽  
Information Disclosure ◽  
Management Practices ◽  
Integrated Reporting ◽  
Reporting Practices ◽  
For Profit ◽  
Faith Based ◽  
Not For Profit ◽  
Reporting Tool ◽  
Socio Economic Impact

This chapter proposes the best reporting practices for waqf institutions, concerning information disclosure on performance, governance, and socio-economic impact using the waqf integrated reporting (WAQIR) model. The WAQIR model is viewed as a comprehensive reporting tool for waqf institutions. This study reviewed previous literature and reporting guidelines for waqf and similar organisations, such as not-for-profit and faith-based organisations, to identify the appropriate measurements for disclosure, limited not only to the input and output of the waqf project, but also its governance and socio-economic impact. Based on the review, the WAQIR model is explicated with four pillars of disclosure: (i) waqf financial and non-financial; (ii) waqf governance; (iii) waqf performance; and (iv) waqf socio-economic impact. The proposed WAQIR model would be useful for waqf institutions in implementing best waqf reporting practices. This could help them to enhance their accountability and to promote transparency, enabling the sustainability of the entire waqf management practices.

Internet Portals in Rural Areas

2010 ◽  
pp. 104-117
Author(s):  
Laura Galloway ◽  
David Deakins ◽  
John Sanders
Keyword(s):  
Ownership Structure ◽  
Rural Areas ◽  
Operating Characteristics ◽  
For Profit ◽  
Internet Portal ◽  
Not For Profit ◽  
Part Time ◽  
Internet Portals ◽  
Privately Owned ◽  
Depth Interviews

This paper investigates the ownership structure, operating characteristics and sustainability of six rural internet portals located in Scotland. It builds upon a previous study conducted by Deakins et al. (2003), which examined the characteristics of internet portals. In-depth interviews were conducted with six owners or the operators responsible for maintaining and developing the internet portal. The study discovered that two distinct forms of ownership structure existed. The first form of ownership structure involved dedicated private individuals who self-funded their internet portal activities, while the second form were managed by not-for-profit organisations, such as charitable trusts, that either hired part-time staff or employed volunteer staff to operate their internet portal. The privately owned portals were most effective because they demonstrated a higher degree of commitment via content richness, fullness of the services offered, and the extent of community and local business usage. In contrast, the not-for profit owned internet portals suffered from limited content, a narrow selection of services, some political infighting, low employee commitment, and modest community and business usage. Despite the differences both forms of ownership structure struggled to achieve commercial viability.

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