Evaluation of direct costs associated with the management of clinical stage of malaria in children under five years old in Gabon

Abstract Background Malaria is one of the leading causes of morbidity and mortality in African countries. It is one of the leading causes of hospital visits and hospitalization in pediatric wards for children under 5 years old. Interestingly however, the economic burden of this disease remains unknown in these endemic countries including Gabon. The purpose of this study is to assess the direct hospital cost for the management of malaria in children under 5 years old at the Libreville University Hospital Centre (CHUL, Centre Hospitalier Universitaire de Libreville) in Gabon. Methods This research work is a retrospective study using a comprehensive review of medical records of patients seen at the CHUL over a two-year period extending from January 2018 through December 2019. The study focused on children under 5 years old, admitted for malaria in the paediatric ward of the CHUL. The analysis targeted specifically direct hospital costs, which excluded salary and wages of health care workers. The monetary currency used in this study was the CFA francs, as that currency is the one used in Central Africa (as reference, 1 Euro = 656 CFA francs). Results For the set timeframe, 778 patient records matched the study criteria. Thus, out of 778 admitted patients, 58.4% were male while 41.5% were female. Overall, the average age was 13.2 months (± 13.8 months). The total cost incurred by the hospital for the management of these 778 malaria patients was 94,922,925 CFA francs (144,699.58 €), for an average expense per patient topping at 122,008 CFA francs (185.99 €). The highest expenditure items were hospitalizations (44,200,000 CFA francs, 67,378.1 €), followed by drugs (26,394,425 CFA francs, 40,235.4 €) and biomedical examinations (14,036,000 CFA francs, 21,396.34 €). Conclusion The financial burden for managing malaria in the paediatric ward seems to be very high, not only for the hospital, but also for families in spite of the government medical insurance coverage in some cases. These findings bring new insights as to the urgency to develop policies that foster preventive initiatives over curative approaches in the management of malaria in children in endemic countries.

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Access to care and financial burden for patients with breast cancer in Ghana, Kenya, and Nigeria.

Journal of Clinical Oncology ◽

10.1200/jco.2019.37.15_suppl.6562 ◽

2019 ◽

Vol 37 (15_suppl) ◽

pp. 6562-6562

Author(s):

Majid Twahir ◽

Rasaaq Adisa Oyesegun ◽

Joel Yarney ◽

Andrew Gachii ◽

Clement Edusa ◽

...

Keyword(s):

Breast Cancer ◽

Financial Burden ◽

Insurance Coverage ◽

Diagnostic Testing ◽

Growth Factor Receptor ◽

University Hospital ◽

Cancer Center ◽

Breast Cancer Patients ◽

National Hospital ◽

African Countries

6562 Background: Breast cancer is the most frequently diagnosed malignancy and the most common cause of cancer-related death in women in Ghana, Kenya, and Nigeria. We evaluated healthcare resource use and financial burden for patients treated at tertiary cancer centers in these countries. Methods: Records of breast cancer patients treated at the following government/private tertiary centers were included – Ghana: Korle-Bu Teaching Hospital and Sweden Ghana Medical Centre; Kenya: Kenyatta National Hospital and Aga Khan University Hospital; Nigeria: National Hospital Abuja and Lakeshore Cancer Center. Patients presenting within a prespecified 2-year period were followed until death or loss to follow-up. Results: The study included 299 patient records from Ghana, 314 from Kenya, and 249 from Nigeria. The use of common screening modalities (eg, mammogram, breast ultrasound) was < 45% in all 3 countries. Use of core needle biopsy was 76% in Kenya and Nigeria, but only 50% in Ghana. Across the 3 countries, 91-98% of patients completed blood count/chemistry, whereas only 78-88% completed tests for hormone receptor and human epidermal growth factor receptor 2 (HER2). Most patients underwent surgery: mastectomy (64-67%) or breast-conserving Most patients in Ghana and Nigeria (87-93%) paid for their diagnostic tests entirely out of pocket (OOP) compared with 30-32% in Kenya. Similar to diagnostic testing, the proportion of patients paying OOP only for treatments was high: 72-89% in Nigeria, 45-79% in Ghana, and 8-20% in Kenya. Among those receiving HER2-targeted therapy, average number of cycles was 5 for patients paying OOP only vs 14 for patients with some level of insurance coverage. Conclusions: Patients treated in tertiary facilities in sub-Saharan African countries lack access to common imaging modalities and systemic therapies. Most patients in Ghana and Nigeria bore the full cost of their breast cancer care, suggestive of privileged financial status. Access to screening/diagnosis and appropriate care is likely to be substantively lower for the general population.

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Bridging the Funding Gap for Oncology Services in LMIC: The BWS Cancer Patient Treatment Intervention Fund Project

Journal of Global Oncology ◽

10.1200/jgo.18.58200 ◽

2018 ◽

Vol 4 (Supplement 2) ◽

pp. 184s-184s

Author(s):

A. Nnamani ◽

N. Iloanusi ◽

C. Okwuosa ◽

A. Lasebikan ◽

I. Okoye

Keyword(s):

Cancer Patient ◽

Cancer Treatment ◽

Financial Burden ◽

Insurance Coverage ◽

Large Population ◽

Health Insurance Coverage ◽

Patient Treatment ◽

Direct Result ◽

Treatment Intervention ◽

The Government

Amount raised: #1,627,000 (Nigerian Naira) Background and context: With a large population and very limited resources, the economic burden of cancer in our country is enormous and cannot be tackled solely by the government. A high mortality rate among newly diagnosed patients is a direct result of poverty and lack of an effective health insurance coverage for cancer, among other reasons. Breast cancer accounts for two out of five women cancers, with a 70% mortality. Aim: To alleviate the financial burden of cancer treatment on indigent patients. Strategy/Tactics: We constituted the Cancer Patient Treatment Intervention Fund (CPTIF) board of partners and funders. We also inaugurated a fundraising event, the annual Go Pink Day Ball, and instituted crowd-funding schemes. Program process: Indigent patients diagnosed at BWS and designated health facilities are referred to CPTIF for financial support. The patient is reviewed for eligibility by the medical board. If approved by the CPTIF Board of Directors, the required funds are paid directly to the designated tertiary health facility where patient will be receiving the oncology services. Costs and returns: Between December 2017 and March 2018 a total of #1,627,000 (Nigerian Naira) was raised, a total of #750,950 has been spent on 7 patients at different levels of oncology services. The cost covered included laboratory tests, ultrasounds, biopsies chemotherapy and radiotherapy. What was learned: Financial assistance gave these patients a lifeline and zeal to go through the usually overwhelming cancer treatment process.

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Power Market Equilibrium under the Joint FIP-RPS Renewable Energy Incentive Mechanism in China

Sustainability ◽

10.3390/su11184964 ◽

2019 ◽

Vol 11 (18) ◽

pp. 4964

Author(s):

Cai ◽

Chen ◽

Dong ◽

Li ◽

Lin ◽

...

Keyword(s):

Renewable Energy ◽

Incentive Mechanism ◽

Financial Burden ◽

Research Work ◽

Energy Transition ◽

Transitional Period ◽

Chinese Government ◽

Renewable Portfolio Standard ◽

Renewable Energy Consumption ◽

The Government

In order to support the development of renewable energy, countries around the world have adopted certain renewable energy incentive mechanisms, including feed-in tariff (FIT) and renewable portfolio standard (RPS). Based on the official report concerning renewable energy consumption issued by the Chinese government in 2018, FIT is no longer an ideal renewable incentive mechanism for China. The increasing financial burden of renewable subsidies on the government has prompted a transition from FIT to a more market-based RPS mechanism. However, the abrupt transformation from FIT to RPS without any transitions might potentially cause problems, including a lack of incentives for market participants and a high market risk. Feed-in premium (FIP), which is a transformation based on FIT, can increase the flexibility of the mechanism and play an important role in the transitional period. However, to date, there has only been limited research work that has explored the effect of implementing FIP-RPS in the development of renewable energy in China. It is still not clear how this transition could be carried out smoothly. Therefore, this research was aimed to devise a joint FIP-RPS mechanism and further develop the optimal combination ratio of the two, so as to obtain a socially optimal mechanism design. The simulation results showed that, at different stages of renewable energy development, FIP and RPS should be implemented according to their distinct characteristics, and the joint FIP-RPS mechanism should be combined with different ratios. It could be indicated that the proposed joint FIP-RPS mechanism not only excels at promoting renewable energy, but is also capable of maintaining desirable market prices and social welfare in this transitional period, as compared to FIP and RPS implemented alone. In the future, a certain degree of FIP-RPS implementations to this type of energy transition would be one of the preferred methods that could be implemented to have a considerable influence on China’s national energy plan. This is because the combination of the two mechanisms not only reduces the financial burden of the government, but also plays an active role in the renewable energy market.

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Health insurance policies for magnetic resonance imaging tests in Korea

Journal of Korean Medical Association ◽

10.5124/jkma.2021.64.3.172 ◽

2021 ◽

Vol 64 (3) ◽

pp. 172-176

Author(s):

Dong Ah Shin

Keyword(s):

Magnetic Resonance Imaging ◽

Health Insurance ◽

Magnetic Resonance ◽

Medical Care ◽

Financial Burden ◽

Insurance Coverage ◽

Health Insurance Coverage ◽

Coverage Rate ◽

Resonance Imaging ◽

The Government

On August 9, 2017, the government announced a policy to strengthen health insurance coverage. The main goal is to increase the health insurance coverage rate and lower the national medical expense burden by an average of 18% by 2022. This policy was proposed without consulting doctors, a major medical care provider, and raised the impression of populism. It is a concern that this policy may place an additional financial burden on the medical clinics, which are already suffering due to poor financial circumstances. Although the policy is already in progress, it is necessary to carefully review whether the government and the medical community can afford it in terms of the national healthcare financial burden and the implementation possibility of this policy. There is no disagreement on the efficient supply of qualified medical care. However, it must be a sustainable system in Korea. Simply increasing the coverage rate does not increase the quality of healthcare. This study aims to analyze the government's health insurance policy for magnetic resonance imaging tests and suggest proper countermeasures.

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Stakeholder role in tourism sustainability: the case of Kwame Nkrumah Mausoleum and centre for art and culture in Ghana

International Hospitality Review ◽

10.1108/ihr-09-2020-0057 ◽

2021 ◽

Vol ahead-of-print (ahead-of-print) ◽

Author(s):

George Kofi Amoako ◽

Theresa Obuobisa-Darko ◽

Sylvia Ohene Marfo

Keyword(s):

Competitive Advantage ◽

Research Work ◽

Structured Interview ◽

Tourism Industry ◽

Capital City ◽

Sustainable Competitive Advantage ◽

African Countries ◽

Content Type ◽

Business Sustainability ◽

The Government

PurposeThe paper examines the role of stakeholders in tourism and hospitality industry to ensure sustainability. This study focuses on investigating how stakeholders view can influence business sustainability in the tourism industry in Ghana and Africa. The study also looks at the future of sustainable tourism activities in Ghana and Africa.Design/methodology/approachA qualitative approach was adopted and interviewees were purposively selected. Using the semi-structured interview 12 people were interviewed and NVivo used to analyse the data. The study was carried out in Accra the capital city of Ghana. Using the stakeholder based theory and resource based theory (RBT) the study addresses how sustainable competitive advantage can be developed.FindingsResults shows how stakeholders involved such employees, government, community/society, private sector and individual shop owners perceive factors that enhance or limit progress in tourism. Some challenges they encounter include high level of illiteracy, lack of education for upcoming youth, low funding and publicity, lack of the enforcement of laws in the sector. The findings also indicated that to ensure sustainability in the industry the products should be unique, valuable, rare, non-substitutable and non-imitable and has to be advertised.Research limitations/implicationsResearchers encountered difficulties in eliciting answers from stakeholders who are experts and managers in the industry because of their busy schedules. The researcher admits that this research work which is carried out only in Ghana cannot be used to generalise an assumption for the entire industry sectors in Africa and beyond. The sample size could be improved and the study could be conducted in other African countries for the purposes of comparison.Practical implicationsThis study reveals how stakeholders view developments in the tourism sector and this can be used as a guide in developing policies and marketing strategies in the tourism industry. Both theoretical and managerial implications are discussed.Originality/valueVery little literature has been written on stakeholders' view on business sustainability in the tourism industry in Ghana. Moreover the use of stakeholder and resource based view theories application in developing competitive advantage in the developing country perspective is unique. The findings in no small way will somehow benefit the government and industry stakeholders by providing the latest views and perspectives in Ghana.

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The Use of Social Media by the Botswana Government and Governance of Liquid Communication

Mousaion ◽

10.25159/2663-659x/5967 ◽

2019 ◽

Vol 37 (1) ◽

Author(s):

Tshepho Lydia Mosweu

Keyword(s):

Social Media ◽

Customer Service ◽

Community Involvement ◽

Media Content ◽

Service Access ◽

Communication Tool ◽

African Countries ◽

The World ◽

The Government ◽

Use Of Social Media

Social media as a communication tool has enabled governments around the world to interact with citizens for customer service, access to information and to direct community involvement needs. The trends around the world show recognition by governments that social media content may constitute records and should be managed accordingly. The literature shows that governments and organisations in other countries, particularly in Europe, have social media policies and strategies to guide the management of social media content, but there is less evidence among African countries. Thus the purpose of this paper is to examine the extent of usage of social media by the Botswana government in order to determine the necessity for the governance of liquid communication. Liquid communication here refers to the type of communication that goes easily back and forth between participants involved through social media. The ARMA principle of availability requires that where there is information governance, an organisation shall maintain its information assets in a manner that ensures their timely, efficient and accurate retrieval. The study adopted a qualitative case study approach where data were collected through documentary reviews and interviews among purposively selected employees of the Botswana government. This study revealed that the Botswana government has been actively using social media platforms to interact with its citizens since 2011 for increased access, usage and awareness of services offered by the government. Nonetheless, the study revealed that the government had no official documentation on the use of social media, and policies and strategies that dealt with the governance of liquid communication. This study recommends the governance of liquid communication to ensure timely, efficient and accurate retrieval when needed for business purposes.

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Ghana: the State of Agriculture and Prospects for Food Security in the Context of Achieving SDGs

10.31132/2412-5717-2018-45-4-16-31 ◽

2018 ◽

pp. 16-31

Author(s):

Tatyana Denisova

Keyword(s):

Food Security ◽

Socioeconomic Development ◽

Agricultural Sector ◽

Well Being ◽

The State ◽

Successful Implementation ◽

Careful Study ◽

African Countries ◽

Development Goals ◽

The Government

For the first time in Russian African studies, the author examines the current state of agriculture, challenges and prospects for food security in Ghana, which belongs to the group of African countries that have made the most progress in achieving the Sustainable Development Goals (SDGs). The SDGs are a collection of 17 global goals adopted by UN member states in 2015 with a view of achieving them by 2030. The SDGs include: ending poverty in all its forms everywhere (Goal 1); ending hunger, achieving food security and improved nutrition, and promoting sustainable agriculture (2); ensuring healthy lives and promoting well-being for all at all ages (3), etc. These goals are considered fundamental because the achievement of a number of other SDGs – for example, ensuring quality education (4), achieving gender equality (5), ensuring sustainable consumption and production patterns (12), etc. – largely depends on their implementation. Ghana was commended by the world community for the significant reduction in poverty, hunger and malnutrition between 2000 and 2014, i.e. for the relatively successful implementation of the first of the Millennium Development Goals (MDGs, 2000–2015) – the eradication of extreme poverty and hunger. However, SDGs require more careful study and planning of implementation measures. In order to achieve the SDGs, the Government of Ghana has adopted a number of programs, plans and projects, the successful implementation of which often stumbles upon the lack of funding and lack of coordination between state bodies, private and public organizations, foreign partners – donors and creditors, etc., which are involved in the processes of socioeconomic development of Ghana. The author determines the reasons for the lack of food security in Ghana, gives an assessment of the state of the agricultural sector, the effective development of which is a prerequisite for the reduction of poverty and hunger, primarily due to the engagement of a significant share (45%) of the economically active population in this sector. The study shows that the limited growth in food production is largely due to the absence of domestic markets and necessary roads, means of transportation, irrigation and storage infrastructure, as well as insufficient investment in the agricultural sector, rather than to a shortage of fertile land or labor.

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Protocol for establishing an Adaptive Diseases control Expert Programme in Tanzania (ADEPT) for integrating care of communicable and non-communicable diseases using tuberculosis and diabetes as a case study

BMJ Open ◽

10.1136/bmjopen-2020-041521 ◽

2021 ◽

Vol 11 (4) ◽

pp. e041521

Author(s):

Stellah G Mpagama ◽

Kaushik Ramaiya ◽

Troels Lillebæk ◽

Blandina T Mmbaga ◽

Marion Sumari-de Boer ◽

...

Keyword(s):

Operational Research ◽

Communicable Diseases ◽

Health Facilities ◽

Learning System ◽

Management Approach ◽

African Countries ◽

Non Communicable Diseases ◽

Research Outcomes ◽

The Government

IntroductionMost sub-Saharan African countries endure a high burden of communicable infections but also face a rise of non-communicable diseases (NCDs). Interventions targeting particular epidemics are often executed within vertical programmes. We establish an Adaptive Diseases control Expert Programme in Tanzania (ADEPT) model with three domains; stepwise training approach, integration of communicable and NCDs and a learning system. The model aims to shift traditional vertical programmes to an adaptive diseases management approach through integrating communicable and NCDs using the tuberculosis (TB) and diabetes mellitus (DM) dual epidemic as a case study. We aim to describe the ADEPT protocol with underpinned implementation and operational research on TB/DM.Methods and analysisThe model implement a collaborative TB and DM services protocol as endorsed by WHO in Tanzania. Evaluation of the process and outcomes will follow the logic framework. A mixed research design with both qualitative and quantitative approaches will be used in applied research action. Anticipated implementation research outcomes include at the health facilities level for organising TB/DM services, pathways of patients with TB/DM seeking care in different health facilities, factors in service delivery that need deimplementation and the ADEPT model implementation feasibility, acceptability and fidelity. Expected operational research outcomes include additional identified patients with dual TB/DM, the prevalence of comorbidities like hypertension in patients with TB/DM and final treatment outcomes of TB/DM including treatment-related complications. Findings will inform the future policies and practices for integrating communicable and NCDs services.Ethics and disseminationEthical approval was granted by The National Research Health Ethical Committee (Ref-No. NIMR/HQ/R.8a/Vol.IX/2988) and the implementation endorsed by the government authorities. Findings will be proactively disseminated through multiple mechanisms including peer-reviewed journals, and engagement with various stakeholders’ example in conferences and social media.

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The Normalization of Sino-French Diplomatic Relations in 1964 and the Formation of the “One-China” Principle: Negotiations over Breaking French Diplomatic Relations with the Republic of China Government and the Recognition of the People’s Republic of China as the Sole Legitimate Government

World Political Science ◽

10.1515/wpsr-2012-0013 ◽

2012 ◽

Vol 8 (1) ◽

pp. 252-271

Author(s):

Madoka Fukuda

Keyword(s):

The United States ◽

People’S Republic Of China ◽

Diplomatic Relations ◽

People's Republic Of China ◽

African Countries ◽

Republic Of China ◽

The Republic Of China ◽

The Republic ◽

The Government ◽

The One

AbstractThis article examines the substance and modification of the “One-China” principle, which the government of the People’s Republic of China (PRC) pursued in the mid 1960s. Under this principle, a country wishing to establish diplomatic relations with the PRC was required first to break off such relations with the Republic of China (ROC). In 1964 the PRC established diplomatic relations with France. This was its first ambassadorial exchange with a Western government. The PRC, in the negotiations over the establishment of diplomatic relations, attempted to achieve some consensus with France on the matter of “One-China”. The PRC, nevertheless, had to abandon these attempts, even though it demanded fewer conditions of France than of the United States (USA), Japan and other Western countries in the 1970s. The PRC had demanded adherence to the “One-China” principle since 1949. France, however, refused to accept this condition. Nevertheless, the PRC established diplomatic relations with France before the latter broke off relations with the ROC. Subsequently, the PRC abandoned the same condition in negotiations with the African governments of the Republic of Congo, Central Africa, Dahomey and Mauritania. After the negotiations with France, the PRC began to insist that the joint communiqué on the establishment of diplomatic relations should clearly state that “the Government of the People’s Republic of China is the sole legal government of China”. However, France refused to insert these words into the communiqué. Afterwards, the PRC nevertheless insisted on putting such a statement into the joint communiqués or exchanges of notes on the establishment of diplomatic relations with the African countries mentioned above. This was done in order to set precedents for making countries accede to the “One-China” principle. The “One-China” principle was, thus, gradually formed in the process of the negotiation and bargaining between the PRC and other governments.

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The Innovation of Government Bonds in the Growth of an Emergent Capital Market

Journal of Open Innovation Technology Market and Complexity ◽

10.3390/joitmc7010103 ◽

2021 ◽

Vol 7 (1) ◽

pp. 103

Author(s):

Cordelia Onyinyechi Omodero ◽

Philip Olasupo Alege

Keyword(s):

Capital Market ◽

Research Work ◽

Government Bonds ◽

Market Capitalization ◽

Market Growth ◽

Explanatory Variables ◽

The Government ◽

The Impact ◽

Total Market ◽

The Capital Market

The growth of an emerging capital market is necessary and requires all available resources and inputs from various sources to realize this objective. Several debates on government bonds’ contribution to Nigeria’s capital market developmental growth have ensued but have not triggered comprehensive studies in this area. The present research work seeks to close the breach by probing the impact of government bonds on developing the capital market in Nigeria from 2003–2019. We employ total market capitalization as the response variable to proxy the capital market, while various government bonds serve as the independent variables. The inflation rate moderates the predictor components. The research uses multiple regression technique to assess the explanatory variables’ impact on the total market capitalization. At the same time, diagnostic tests help guarantee the normality of the regression model’s data distribution and appropriateness. The findings reveal that the Federal Government of Nigeria’s (FGN) bond is statistically significant and positive in influencing Nigeria’s capital market growth. The other predictor variables are not found significant in this study. The study suggests that the Government should improve on the government bonds’ coupon, while still upholding the none default norm in paying interest and refunding principal to investors when due.

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