scholarly journals Assessment of hospitalization costs and its determinants in infants with clinical severe infection at a public tertiary hospital in Nepal

PLoS ONE ◽  
2021 ◽  
Vol 16 (11) ◽  
pp. e0260127
Author(s):  
Suchita Shrestha ◽  
Ram Hari Chapagain ◽  
Debjani Ram Purakayastha ◽  
Srijana Basnet ◽  
Nitya Wadhwa ◽  
...  
Keyword(s):  
Newborn Care ◽  
Severe Infection ◽  
Direct Costs ◽  
Public Hospitals ◽  
Successful Implementation ◽  
Clinical Criteria ◽  
Young Infants ◽  
Hospitalization Costs ◽  
The Government ◽  
Maximum Limit

Sepsis, an important and preventable cause of death in the newborn, is associated with high out of pocket hospitalization costs for the parents/guardians. The government of Nepal’s Free Newborn Care (FNC) service that covers hospitalization costs has set a maximum limit of Nepalese rupees (NPR) 8000 i.e. USD 73.5, the basis of which is unclear. We aimed to estimate the costs of treatment in neonates and young infants fulfilling clinical criteria for sepsis, defined as clinical severe infection (CSI) to identify determinants of increased cost. This study assessed costs for treatment of 206 infants 3–59 days old, enrolled in a clinical trial, and admitted to the Kanti Children’s Hospital in Nepal through June 2017 to December 2018. Total costs were derived as the sum of direct costs for bed charges, investigations, and medicines and indirect costs calculated by using work time loss of parents. We estimated treatment costs for CSI, the proportion exceeding NPR 8000 and performed multivariable linear regression to identify determinants of high cost. Of the 206 infants, 138 (67%) were neonates (3–28 days). The median (IQR) direct costs for treatment of CSI in neonates and young infants (29–59 days) were USD 111.7 (69.8–155.5) and 65.17 (43.4–98.5) respectively. The direct costs exceeded NPR 8000 (USD 73.5) in 69% of neonates with CSI. Age <29 days, moderate malnutrition, presence of any sign of critical illness and documented treatment failure were found to be important determinants of high costs for treatment of CSI. According to this study, the average treatment cost for a newborn with CSI in a public tertiary level hospital is substantial. The maximum limit offered for free newborn care in public hospitals needs to be revised for better acceptance and successful implementation of the FNC service to avert catastrophic health expenditures in developing countries like Nepal. Trial Registration: CTRI/2017/02/007966 (Registered on: 27/02/2017).

E-Projects Challenges in India – Role of Human Resource Management and Technology

2018 ◽  
Vol 6 (8) ◽  
pp. 263
Author(s):  
Ramnik Kaur
Keyword(s):  
Developing Countries ◽  
Public Administration ◽  
Paradigm Shift ◽  
Successful Implementation ◽  
The Public ◽  
Government Services ◽  
The Past ◽  
The Government ◽  
Traditional Approaches

E-governance is a paradigm shift over the traditional approaches in Public Administration which means rendering of government services and information to the public by using electronic means. In the past decades, service quality and responsiveness of the government towards the citizens were least important but with the approach of E-Government the government activities are now well dealt. This paper withdraws experiences from various studies from different countries and projects facing similar challenges which need to be consigned for the successful implementation of e-governance projects. Developing countries like India face poverty and illiteracy as a major obstacle in any form of development which makes it difficult for its government to provide e-services to its people conveniently and fast. It also suggests few suggestions to cope up with the challenges faced while implementing e-projects in India.

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

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.

scholarly journals To stop or not to stop ‘culture’: determining the essential behavior of the government, church and public in fighting against COVID-19

2021 ◽  
Author(s):  
Dalmacito A Cordero
Keyword(s):  
Public Health ◽  
Contributory Factor ◽  
Successful Implementation ◽  
Health It ◽  
Way Of Life ◽  
The World ◽  
The Government ◽  
The Church

Abstract Culture is a way of life. A recent correspondence emphasizes that it is a contributory factor in combatting the COVID-19 pandemic, and this must be considered by each government around the world. However, I argue that various elements in culture do not need to stop or else it will create public outrage. I therefore propose a win–win solution for both parties with the inclusion of the church that can serve as a framework for the sake of public health. It is primarily based on a kind of behavior that is needed to be embodied by the involved groups—‘supportive’ government, ‘creative’ church and an ‘adaptive’ public. These essential behaviors of all groups are possible to embody for a successful implementation of public health.

scholarly journals Immediate newborn care and breastfeeding: EN-BIRTH multi-country validation study

2021 ◽  
Vol 21 (S1) ◽  
Author(s):  
Tazeen Tahsina ◽  
◽  
Aniqa Tasnim Hossain ◽  
Harriet Ruysen ◽  
Ahmed Ehsanur Rahman ◽  
...  
Keyword(s):  
Newborn Care ◽  
Health Indicators ◽  
Newborn Health ◽  
Public Hospitals ◽  
Maternal And Newborn Health ◽  
Delayed Cord Clamping ◽  
Cord Clamping ◽  
Improve Measurement ◽  
Immediate Newborn Care ◽  
Skin To Skin

Abstract Background Immediate newborn care (INC) practices, notably early initiation of breastfeeding (EIBF), are fundamental for newborn health. However, coverage tracking currently relies on household survey data in many settings. “Every Newborn Birth Indicators Research Tracking in Hospitals” (EN-BIRTH) was an observational study validating selected maternal and newborn health indicators. This paper reports results for EIBF. Methods The EN-BIRTH study was conducted in five public hospitals in Bangladesh, Nepal, and Tanzania, from July 2017 to July 2018. Clinical observers collected tablet-based, time-stamped data on EIBF and INC practices (skin-to-skin within 1 h of birth, drying, and delayed cord clamping). To assess validity of EIBF measurement, we compared observation as gold standard to register records and women’s exit-interview survey reports. Percent agreement was used to assess agreement between EIBF and INC practices. Kaplan Meier survival curves showed timing. Qualitative interviews were conducted to explore barriers/enablers to register recording. Results Coverage of EIBF among 7802 newborns observed for ≥1 h was low (10.9, 95% CI 3.8–21.0). Survey-reported (53.2, 95% CI 39.4–66.8) and register-recorded results (85.9, 95% CI 58.1–99.6) overestimated coverage compared to observed levels across all hospitals. Registers did not capture other INC practices apart from breastfeeding. Agreement of EIBF with other INC practices was high for skin-to-skin (69.5–93.9%) at four sites, but fair/poor for delayed cord-clamping (47.3–73.5%) and drying (7.3–29.0%). EIBF and skin-to-skin were the most delayed and EIBF rarely happened after caesarean section (0.5–3.6%). Qualitative findings suggested that focusing on accuracy, as well as completeness, contributes to higher quality with register reporting. Conclusions Our study highlights the importance of tracking EIBF despite measurement challenges and found low coverage levels, particularly after caesarean births. Both survey-reported and register-recorded data over-estimated coverage. EIBF had a strong agreement with skin-to-skin but is not a simple tracer for other INC indicators. Other INC practices are challenging to measure in surveys, not included in registers, and are likely to require special studies or audits. Continued focus on EIBF is crucial to inform efforts to improve provider practices and increase coverage. Investment and innovation are required to improve measurement.

A Human Resource Development Strategy for Primary Health Care: an Exploratory Study of Mixed Methods

2021 ◽  
Author(s):  
Huanhuan Jia ◽  
Hairui Jiang ◽  
Jianxing Yu ◽  
Jingru Zhang ◽  
Zhou Zheng ◽  
...  
Keyword(s):  
Health Care ◽  
Primary Health Care ◽  
Human Resource Development ◽  
Structural Equation ◽  
External Environment ◽  
Medical Personnel ◽  
Public Hospitals ◽  
Individual Development ◽  
Primary Health ◽  
The Government

Abstract Background: The serious shortage of primary health care (PHC) providers is a common issue in the health reforms worldwide, including in China. The government of China have proposed that encouraging and guiding qualified medical personnel to work in primary medical and health care institutions (PMHCIs) is an effective way to improve the overall quality and efficiency of PHC, but it has not produced good results. The problem of insufficient human resources of PHC has not been substantially ameliorated.Methods: Based on implicit theory and lexical approach, pre-investigation was conducted to collect the items that influence the medical personnel to seek employment at PMHCIs from the perspective of guided objects. Through a three-phase investigation of 1,160 doctors in 29 public hospitals in 9 cities, the items were categorized, and a structural equation model was established and verified to explore the interrelationship of influencing factors.Results: A total of 5 factors were rotated, including Sense of Gain (SG), Internal Organization Development (IOD), Remuneration and Development (RD), Condition of the City Where the PMHCI Is Located (CCPL), Job Responsibilities (JR) and Family Support (FS). The results of the model showed that IOD, RD, JR and FS had a significantly positive effect on the SG, whereas CCPL had no significant direct effect. In addition, the FS, RD and JR significantly mediated the relationship between the internal and external environment of the institution and the willing of medical personnel to seek employment at PMHCIs. The values of fit index indicated an acceptable-fitting model.Conclusion: Family, remuneration, individual development, and job responsibility are closely related with the willingness of medical personnel to seek employment at PMHCIs, and the internal and external environment of PMHCIs is also an important factor. Based on this, targeted measures can be proposed to promote the development of PHC providers.

scholarly journals The Regulation of Ownership of Agricultural Land Rights that Exceeds the Maximum Limit

Jurnal Akta ◽  
2020 ◽  
Vol 7 (3) ◽  
pp. 323
Author(s):  
Ana Rubiyani
Keyword(s):  
Agricultural Land ◽  
Land Rights ◽  
Land Area ◽  
Land Registration ◽  
The Government ◽  
Ownership Rights ◽  
And Control ◽  
Maximum Limit

Land is a form of gift given by God, but human has given brain to think the challenges of live like the land problems, so that the government tries to regulate it properly. The problems in this thesis are: 1) How to regulate ownership of agricultural land rights that exceeds the maximum limit based on Act No. 56 (Prp) of 1960 concerning the Determination of Agricultural Land Areas? 2) How is the action taken by the Land Office towards ownership of agricultural land rights that exceeds the maximum limit? The method used is juridical empirical, with descriptive analytical specifications. The method used in this research is an empirical juridical approach. The results of this study are: (1) The regulation of ownership of agricultural land rights that exceeds the maximum limit is based on Act No. 56 (Prp) of 1960, namely that the provisions regarding land restrictions state that the application for ownership rights as referred to in Article 4 paragraph 1 of Act No. 56 (Prp) 1960 was limited to a maximum land area of 2000 m2. 2) The steps of the Land Office in implementing Act No. 56 (Prp) of 1960, namely the need for a concept of supervision and control over control of land rights, given the various problems that often arise such as in land registration activities.

scholarly journals Confronting the Moscow Healthcare System with the Shocks of COVID-19

2021 ◽  
Vol 2 (1) ◽  
pp. 41-46
Author(s):  
Aleksandr N. Tsibin ◽  
Munira F. Latypova ◽  
Olga I. Ivanushkina
Keyword(s):  
Public Health ◽  
Large Scale ◽  
Virus Disease ◽  
Laboratory Diagnosis ◽  
Capital City ◽  
Laboratory Diagnostics ◽  
Successful Implementation ◽  
Laboratory Service ◽  
The Government ◽  
Challenging Situation

Introduction. Transmissible coronavirus SARS-CoV-2I is the seventh known coronavirus that causes an acute infectious disease predominantly affecting the lungs (Corona Virus Disease 2019, COVID-19). The COVID-19 pandemic exposed serious gaps in health systems preparedness. The epidemic urgently required priority organizational measures to contain and reduce the spread of COVID-19. Public health authorities had to make decisions in a challenging situation where there was a lack of knowledge, experience, and great confidence, and the number of infected was steadily increasing. Purpose. The purpose of this article is to present the unique experience of Moscow in organizing a large-scale laboratory examination of the population of a metropolis with about 12.6 million inhabitants to meet the needs of the capital in testing for SARS-CoV-2 virus and combating its circulation in conditions of the COVID-19 pandemic. Materials and Methods. The decisions made and the measures taken by the Government of Moscow, the Moscow Operational Staff, the DZM and the DZM Laboratory Service to slow the growth of the COVID-19 epidemic among the population of the capital are listed step-by-step. Results. In the course of organizational activities, sufficient capacity to maintain the public health infrastructure in terms of laboratory diagnosis of the new coronavirus infection was ensured by the joint efforts. Safe laboratory diagnostics for detecting, treating, and isolating COVID-19 cases and contacts have been established in the capital city. Thanks to the successful implementation of timely decisions, the spread of infection in the city of Moscow has been slowed. The Moscow government has reported a steady decline in cases of the new coronavirus disease and most hospitals have switched to a safe treatment regimen for patients requiring hospitalization. Centralized laboratories with readiness to perform screening and referral studies for COVID-19 outbreaks have been established within the structure of the DZM.

scholarly journals Endowment as a Fundraising Tool of the Research University

2020 ◽  
Vol 9 (2) ◽  
pp. 366-374
Author(s):  
Alla Stepanova ◽  
Iryna Horbas’ ◽  
Oksana Derkach ◽  
Tetyana Ovcharenko
Keyword(s):  
Higher Education ◽  
Research Universities ◽  
Research University ◽  
Swot Analysis ◽  
Educational Services ◽  
Successful Implementation ◽  
Scientific Discussion ◽  
The World ◽  
The Government ◽  
Alternative Sources

The article summarizes the arguments within the scientific discussion about the search of alternative sources of research universities funding in the absence of sufficient support from the government. The main objective of the research is to define the possibility of using the endowment as a fundraising tool to attract alternative sources of funding for research universities in Ukraine. The relevance of solving this scientific issue lies in the fact that modern research universities are independent entities, which according to the Bologna Declaration assume the entire load on the future of the state and have to do it at the highest professional level. This can be ensured through a combination of traditional and modern sources of funding. The world experience of successful implementation of the endowment has been presented. The level of knowledge intensity of GDP, which is one of the key indicators that reflects the level of quality of higher education, has been analyzed. The endowment as one of the most effective fundraising tools is poorly developed in Ukraine. This fact has prompted us to research the main provisions of this phenomenon and to define the conditions for its implementation in Ukrainian research-based institutions of higher education by means of the strategic analysis. The conducted SWOT analysis has made it possible to systematize problem areas of the domestic market of educational services in the direction of creating and using the endowment and predicting possible strategies for its development. Since the Research Universities are considered to be the core of creation of intellectual and innovative products and the crucial mover of scientific and technological progress in the country and in the world, they have been chosen as the research object.  Keywords: fundraising, endowment, Research University, market of educational services, investment, alternative sources of funding

scholarly journals Implementing an Individual-Centric Discharge Process across Singapore Public Hospitals

2021 ◽  
Vol 18 (16) ◽  
pp. 8700
Author(s):  
Reuben Ng ◽  
Kelvin Bryan Tan
Keyword(s):  
Hospital Admissions ◽  
Public Hospitals ◽  
Gradient Boosting ◽  
Care Utilization ◽  
Public Healthcare ◽  
Successful Implementation ◽  
Discharge Process ◽  
Gradient Boosting Machine ◽  
Cumulative Length ◽  
Risk Patients

Singapore is one of the first known countries to implement an individual-centric discharge process across all public hospitals to manage frequent admissions—a perennial challenge for public healthcare, especially in an aging population. Specifically, the process provides daily lists of high-risk patients to all public hospitals for customized discharge procedures within 24 h of admission. We analyzed all public hospital admissions (N = 150,322) in a year. Among four models, the gradient boosting machine performed the best (AUC = 0.79) with a positive predictive value set at 70%. Interestingly, the cumulative length of stay (LOS) in the past 12 months was a stronger predictor than the number of previous admissions, as it is a better proxy for acute care utilization. Another important predictor was the “number of days from previous non-elective admission”, which is different from previous studies that included both elective and non-elective admissions. Of note, the model did not include LOS of the index admission—a key predictor in other models—since our predictive model identified frequent admitters for pre-discharge interventions during the index (current) admission. The scientific ingredients that built the model did not guarantee its successful implementation—an “art” that requires the alignment of processes, culture, human capital, and senior management sponsorship. Change management is paramount, otherwise data-driven health policies, no matter how well-intended, may not be accepted or implemented. Overall, our study demonstrated the viability of using artificial intelligence (AI) to build a near real-time nationwide prediction tool for individual-centric discharge, and the critical factors for successful implementation.

scholarly journals Penyempurnaan Hukum Formal Perpajakan Terkait Tata Cara Perpajakan

2020 ◽  
Vol 22 (2) ◽  
pp. 215-240
Author(s):  
Haula Rosdiana ◽  
Maria R.U.D. Tambunan ◽  
Inayati Hifni
Keyword(s):  
Law Enforcement ◽  
Focus Group ◽  
Group Discussion ◽  
Successful Implementation ◽  
Group Discussions ◽  
Strategic Role ◽  
The Government ◽  
Taxation System

Dalam mengoptimalkan penerimaan pajak, pemerintah selayaknya mendesain sistem perpajakan yang berpegang prinsip efisiensi dengan tetap memperhatikan aspek keadil-an dan kesederhana. Dalam sistem perpajakan, hukum formal mempunyai peranan penting dalam mengejawantahkan hukum material, karena itu Undang-undang Ketentu-an Umum dan Tata Cara Perpajakan (KUP) menjadi salah satu kunci keberhasilan implementasi kebijakan pajak. Mengingat strategisnya peran UU KUP, perlu untuk mereview kembali UU KUP yang saat ini berlaku serta perlu dilakukan suatu penyempurnaan. Penelitian ini menggunakan pendekatan kualitatif dengan teknik pengumpulan data kualitatif yang terdiri dari studi literatur dan focus group discussion. Penelitian bertujuan memberikan masukan atas KUP yang saat ini masih dalam proses pembahasan dengan menekankan pada aspek kemudahan (ease of administration), keadilan (equity) dan kepastian hukum (law enforcement). Hasil penelitian ini menekan-kan pada hal-hal terkait (i) perlunya meningkatkan basis data perpajakan, (ii) perlunya menjalankan kemudahan administrasi yang berdasarkan ketentuan yang tegas, jelas, dan sederhana, (iii) penegakan hukum yang tegas, (iv) adanya sanksi yang sebanding dengan pelanggaran yang dilakukan oleh wajib pajak, dan (v) peningkatan kualitas layanan dan profesionalisme petugas pajak. Kajian ini diharapkan mampu mendorong terwujudnya regulasi perpajakan pro terhadap optimalisasi penerimaan tanpa mencede-rai hak-hak wajib pajak. Proposal for Amendment of Formal Law on Taxation Procedure  In optimizing tax revenue, the government should design a taxation system that adheres to the principle of efficiency, justice and simplicity. In the taxation system, formal law has an important role in manifesting laws, therefore laws and taxation procedures (KUP) are one of the keys to the successful implementation of tax policies. Considering the strategic role of the KUP Law, it is necessary to review the KUP Law which is currently in force and needs to be improved. This study uses a qualitative approach with qualitative data collection techniques consisting of literature studies and focus group discussions. The research aims to provide input on KUP which is currently still in the process of discussion by emphasizing aspects of ease (ease of administration), justice (equity) and legal certainty (law enforcement). The results emphasize issues related to (i) the need to increase the taxation database, (ii) the need to carry out administrative facilities based on firm, clear and simple provisions, (iii) strict law enforcement, (iv) comparable sanctions with violations committed by taxpayers and (v) improving the quality of service and professionalism of tax officials. This study is expected to be able to encourage the realization of tax regulations that are pro to the optimization of revenue without harming the rights of taxpayers.

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