scholarly journals Does Social Franchising Private Health Facilities Shift Consumers Budget Line? An Econometric Analysis of the Average Treatment Effect within Private Health Facilities in Embu County, Kenya

2020 ◽  
Vol 6 ◽  
pp. 1
Author(s):  
Stephen Nyag ◽  
Susan Okeri ◽  
◽  
Keyword(s):  
Average Treatment Effect ◽  
Health Facilities ◽  
Sub Saharan Africa ◽  
Social Franchising ◽  
Cost Variance ◽  
Matching Criteria ◽  
The Cost ◽  
The Impact ◽  
Radius Matching

The Kenyan private health sector is one of the most developed in Sub-Saharan Africa and is highly critical in healthcare delivery. It is estimated 47 percent of the first quintile of income earners utilize the private facility for healthcare needs and 33 percent of women seek family planning (FP) services in this sector. However, the cost of healthcare services has been a great impediment to service utilization. To improve service quality and increase access, social franchising, interventions on the demand side such as the use of insurance and vouchers, and supply of subsidized medical products on the supply side are intended to reduce the cost of services. This study sought to investigate the impact of interventions of social franchisors on the cost of healthcare in private facilities in Kenya. The study used primary data collected from 215 individuals living within catchment areas with private health facilities using researcher-administered questionnaire. The main franchisors included in this study were Sustainable Health Foundation (CFW) and Population Services Kenya (Tunza). Results revealed that women whose primary motivation to visit private facilities included FP services, need of a lower cost of treatments, and quality services had higher odds of choosing franchised health facilities. Propensity score matching (PSM) using three matching criteria—nearest neighbor, kernel matching, and radius matching of 0.01—indicated that individuals seeking children’s health services and 3-month FP methods paid similar amounts in either franchised or nonfranchised health facilities. However, there was a huge cost variance for long-term FP methods where women paid significantly less, implying that social franchisors’ main impact is on long-term FP methods. The cost variance was due to vouchers utilized by some respondents hence, incurring zero cost in franchised facilities. Therefore, the study recommends the expansion of social franchising membership and the use of the voucher system for financially incapable consumers.

Cost determination and sustainable financing for rural water services in sub-Saharan Africa

Water Policy ◽  
2007 ◽  
Vol 9 (4) ◽  
pp. 373-391 ◽  
Author(s):  
Peter A. Harvey
Keyword(s):  
Sub Saharan Africa ◽  
Water Services ◽  
Innovative Strategies ◽  
Water Users ◽  
Sub Saharan ◽  
The Cost ◽  
National Governments ◽  
Cost Determination ◽  
Sustainable Financing

Access to safe, sufficient and affordable water in rural Africa will not increase unless sustainable financing strategies are developed which ensure the sustainability of existing water services. There is a strong need for international donors and national governments to confront the true costs associated with sustained service provision in order to develop practicable long-term financing mechanisms. This paper presents a systematic approach that can be applied to determine the overall cost of service delivery based on respective cost estimates for operation and maintenance, institutional support, and rehabilitation and expansion. This can then be used to develop a tariff hierarchy which clearly indicates the cost to water users of different levels of cost recovery, and which can be used as a planning tool for implementing agencies. Community financing mechanisms to ensure sustained payment of tariffs must be matched to specific communities and their economic characteristics; a blanket approach is unlikely to function effectively. Innovative strategies are also needed to ensure that the rural poor are adequately served, for which a realistic, targeted and transparent approach to subsidy is required.

FC 096THE EFFECT OF INCREMENTAL START OF HAEMODIALYSIS ON BLOOD PRESSURE AND INTERDIALYTIC WEIGHT GAIN: PRELIMINARY FINDINGS FROM THE ENDURE STUDY

2021 ◽  
Vol 36 (Supplement_1) ◽  
Author(s):  
Adil Hazara ◽  
Victoria Allgar ◽  
Maureen Twiddy ◽  
Sunil Bhandari
Keyword(s):  
Blood Pressure ◽  
Propensity Scores ◽  
Phase 1 ◽  
Tertiary Care ◽  
Residual Renal Function ◽  
Care Hospital ◽  
Interdialytic Weight Gain ◽  
Matching Criteria ◽  
The Impact

Abstract Background and Aims Mortality rates are high in patients starting haemodialysis/haemodiafiltration (HD) therapy. Incremental HD may help reduce this risk by reducing the burden of early treatment whilst patients are still adapting to long-term HD therapy. A feasibility study (ENDURE study – Clinical trials ID: NCT04268264) is being conducted with the primary objectives of evaluating the acceptability and tolerance of a new incremental HD regime. Its secondary aims are to evaluate the impact of this form of incremental HD on indicators of patient safety and wellbeing. These indicators include blood pressure (BP) control and interdialytic weight gains (IDWG) which are independently associated with adverse cardiovascular outcomes in patients on long-term HD. We present preliminary findings from the study related to systolic BP and IDWG. Method The ENDURE study is being carried out at a tertiary care hospital in the United Kingdom. Patients aged > 18 years known to renal services for at least 90 days, referred for start of HD, were eligible for participation. Following approved consenting procedures, they are started on a new regime of incremental HD starting dialysis twice weekly with progressive increases in the duration and frequency of sessions over 15 weeks. This period is split in to four phases; phase 1 representing the first two days of dialysis (baseline) whereas phases 2 – 4 representing the pre-specified incremental steps. Propensity scores were calculated to match each participant (incremental HD group) with two controls from a database of patients who previously started HD at our centres using the standard protocol of 3 times weekly, 4hr long sessions. The matching criteria accounted for 14 key demographic, clinical and laboratory characteristics. Results were analysed as intention to treat. In comparing BP and IDWG between the two groups, only readings taken pre-dialysis at the first session of the week was considered. This study has been approved by the West of Scotland Research Ethics committee-4 (Ref: 19/WS/0019). Results Baseline characteristics of the first 15 participants (target 20) and their matched controls are presented in table 1. The proportion of females and duration of previous specialist input was higher in the incremental HD group. Conclusion The ENDURE study tests the feasibility of starting patients on a novel incremental HD regime. Early data suggest that control of systolic BP and IDWG are comparable to patients who start dialysis at 3 times weekly. Further work is needed to understand the impact of reducing dialysis frequency on BP control correlating the findings with changes residual renal function and objective measures of fluid overload.

Perinatal Care at the Threshold of Viability

PEDIATRICS ◽  
1995 ◽  
Vol 96 (5) ◽  
pp. 974-976
Author(s):  
◽  
◽  
◽  
Keyword(s):  
Perinatal Care ◽  
Survival Rates ◽  
Extremely Low Birth Weight ◽  
Low Birth Weight Infants ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Obstetric Management ◽  
The Cost ◽  
The Impact

The survival rate for infants at the threshold of viability has been improving. However, there are insufficient data regarding the cost(s) of initial and ongoing care of these infants and the long-term outcome of survivors. Furthermore, there has been little study of the impact of obstetric management on the survival rates of extremely low birth weight infants and on long-term morbidities. Continued research on these issues is imperative, and physicians need to remain informed of changing statistics.

scholarly journals Aging, Health, and Quality of Life for Older People Living With HIV in Sub-Saharan Africa: A Review and Proposed Conceptual Framework

2017 ◽  
Vol 31 (1) ◽  
pp. 109-138 ◽  
Author(s):  
Mark J. Siedner
Keyword(s):  
Quality Of Life ◽  
Conceptual Framework ◽  
Care Delivery ◽  
Sub Saharan Africa ◽  
People Living With Hiv ◽  
Sub Saharan ◽  
Living With Hiv ◽  
The Impact

Objective: The number of people living with HIV (PLWH) over 50 years old in sub-Saharan Africa is predicted to triple in the coming decades, to 6-10 million. Yet, there is a paucity of data on the determinants of health and quality of life for older PLWH in the region. Methods: A review was undertaken to describe the impact of HIV infection on aging for PLWH in sub-Saharan Africa. Results: We (a) summarize the pathophysiology and epidemiology of aging with HIV in resource-rich settings, and (b) describe how these relationships might differ in sub-Saharan Africa, (c) propose a conceptual framework to describe determinants of quality of life for older PLWH, and (d) suggest priority research areas needed to ensure long-term gains in quality of life for PLWH in the region. Conclusions: Differences in traditional, lifestyle, and envirnomental risk factors, as well as unique features of HIV epidemiology and care delivery appear to substantially alter the contribution of HIV to aging in sub-Saharan Africa. Meanwhile, unique preferences and conceptualizations of quality of life will require novel measurement and intervention tools. An expanded research and public health infrastructure is needed to ensure that gains made in HIV prevention and treamtent are translated into long-term benefits in this region.

scholarly journals The Impact of Green Credit on the Green Innovation Level of Heavy-Polluting Enterprises—Evidence from China

2022 ◽  
Vol 19 (2) ◽  
pp. 650
Author(s):  
Zhifeng Zhang ◽  
Hongyan Duan ◽  
Shuangshuang Shan ◽  
Qingzhi Liu ◽  
Wenhui Geng
Keyword(s):  
Natural Experiment ◽  
Double Difference ◽  
Credit Policy ◽  
Green Innovation ◽  
Innovation Activities ◽  
Corporate Credit ◽  
Credit Financing ◽  
The Cost ◽  
The Impact

This article uses the “Green Credit Guidelines” promulgated in 2012 as an example to construct a quasi-natural experiment and uses the double difference method to test the impact of the implementation of the “Green Credit Guidelines” on the green innovation activities of heavy-polluting enterprises. The study found that, in comparison to non-heavy polluting enterprises, the implementation of green credit policies inhibited the green innovation of all heavy-polluting enterprises. In the analysis of heterogeneity, this restraint effect did not differ significantly due to the nature of property rights and the company’s size. The mechanism test showed that green credit policy limits the efficiency of business investment and increases the cost of financing business debt. Eliminating corporate credit financing, particularly long-term borrowing, negatively impacts the green innovation behavior of listed companies.

Long-term reproductive patterns and sighting bias in Weddell seals (Leptonychotes weddelli)

1987 ◽  
Vol 65 (5) ◽  
pp. 1091-1099 ◽  
Author(s):  
J. Ward Testa
Keyword(s):  
Reproductive Performance ◽  
Age At First Reproduction ◽  
Reproductive Patterns ◽  
Weddell Seals ◽  
Signy Island ◽  
First Reproduction ◽  
Reproductive Rates ◽  
The Cost ◽  
The Impact

The reproductive performance of tagged Weddell seals (Leptonychotes weddelli) was monitored at McMurdo Sound, Antarctica, from 1970 to 1984. An age-specific reproductive schedule revealed the major onset of pupping at age 6 years, and a mean age of first birth of 7.1 years. The average asymptotic pupping rate of 0.61 is reached by age 10. The cost of pupping in a given year is reflected in a 0.05 drop in the probability of pupping the following year. This cost is not evident in females over 7 years old, suggesting that postweaning condition affects newly mature females more than those that are fully mature. Annual adult reproductive rates ranged from 0.46 to 0.79, with a possible periodicity of 5 to 6 years. Simulations were conducted to determine the impact on reproductive estimates of sighting biases associated with seals having had at least one pup (Parous) or having pupped that season (With-Pup). Age at first reproduction as deduced from an age-specific pupping schedule is strongly affected by both forms of sighting bias, but bias in sighting Parous females was the more important. Estimates of adult reproduction were affected minimally. Comparisons of reproductive estimates with those of Weddell seals at Signy Island are discussed with regard to the effects of sighting biases.

Infrastructure, Accessibility and Growth in Tuscany: A Macroeconomic Impact Evaluation

2010 ◽  
pp. 75-100
Author(s):  
Giuseppe Francesco Gori ◽  
Patrizia Lattarulo ◽  
Renato Panicciŕ
Keyword(s):  
Economic Impact ◽  
Regional Growth ◽  
Agglomeration Economies ◽  
Regional Mobility ◽  
Macroeconomic Impact ◽  
Productivity Differentials ◽  
The Cost ◽  
The Impact ◽  
Cost Of Transportation

The purpose of the paper is to assess the impact of the Regional Mobility and Logistic Plan (RMLP) of Tuscany on regional growth and spatial disparities between the Tuscan provinces. In order to evaluate its economic impact, we first quantify the impact in terms of changes in travel time and variations in the cost of transportation per unit of delivered output. We then make use of the Remi-Irpet model. The latter explains the agglomeration economies and productivity differentials. We find that, despite the fact that the RMLP does not solve the structural problem of mobility within Tuscany, it does make it possible to get rid of some potential constraints for long-term regional growth, even if the economic impact across the provinces is disequalizing.

Can Information on Cost Improve Clinicians' Behavior?: Lessons from Health Care Trials and Management

1997 ◽  
Vol 13 (4) ◽  
pp. 553-561 ◽  
Author(s):  
Peter F. Lowet ◽  
John M. Eisenberg
Keyword(s):  
Health Care ◽  
Price Competition ◽  
Educational Interventions ◽  
Cost Information ◽  
Improved Outcomes ◽  
Practice Variations ◽  
The Cost ◽  
The Impact

AbstractFacing intense price competition and societal pressures, health care provider organizations have focused increasingly on the cost-effectiveness of medical services. In instances when there is insufficient evidence that a more expensive treatment course generates improved outcomes, the lower cost option is often encouraged. Yet, with resource utilization still determined principally by individual physicians, large practice variations often persist. This paper reviews the literature and explores the impact of sharing cost information on physicians' practice patterns utilizing management theory concepts. More research should be conducted to determine long-term benefits of educational interventions, physicians' fundamental views on the relationship between cost and quality and its effect on their responsiveness to cost information, and the role of leadership in changing clinical behavior.

scholarly journals African agriculture in the context of COVID-19: Finding salvation in the devil

2020 ◽  
Vol 15 (4) ◽  
pp. 302-310
Author(s):  
Guy Blaise Nkamleu ◽  
Keyword(s):  
Agricultural Development ◽  
Agricultural Sector ◽  
Food System ◽  
Free Trade Area ◽  
Sub Saharan Africa ◽  
African Countries ◽  
Agriculture Sector ◽  
Sub Saharan ◽  
The Impact

The world is facing unprecedented challenges from COVID-19, which is disrupting lives and livelihoods. The pandemic could profoundly affect the African continent and wipe out hard-won development gains, as sub-Saharan Africa heads into its first recession in 25 years. Beyond the multispatial impact of the coronavirus in Africa, its effects on the agriculture and food system is of particular interest, as food security could be the most affected area and, at the same time, agriculture could be the sector that could help African economies recover quicker from the impact of COVID19. This paper supports the view that COVID-19, as devilish as it may be, offers an opportunity to revive interest in the agricultural sector. The COVID-19 pandemic has placed immense pressures on African countries to raise additional resources, and consequently Africa’s growing public debt is again coming back to the centre stage of the global debate. The conversation on African debt sustainability has begun to dominate the scene and will flood the debate in the near term. While the observed, growing calls for debt relief for African countries are legitimate, we support in this paper that one should not divert attention from the long-term solutions needed to strengthen Africa’s resilience. These long-term solutions lie where they always have: in agriculture. With COVID-19, shipping agricultural inputs and food products from other continents to Africa has become disrupted and is accelerating the trend towards shortening supply chains. This will leave a potential market for inputs and food produced on the continent. COVID-19, together with the launching of the African Continental Free Trade Area (AfCFTA), have aligned the stars in favour of a decisive transformation of the agriculture sector on the continent. Agriculturalists and development experts need to be aware of their responsibility at this time, as they need to advocate for the topic of agricultural development to return to the centre and the heart of the agenda of discussions on how to respond to the consequences of Covid-19 in Africa. In this sense, and unexpectedly, COVID-19 is an opportunity for the agricultural sector.

scholarly journals The impact of equitization on financial and operating performance of state-owned enterprises (SOEs) in Vietnam: An approach using propensity score matching

2020 ◽  
Vol 4 (2) ◽  
pp. First
Author(s):  
Nguyen Van Tan
Keyword(s):  
Large Scale ◽  
Operating Performance ◽  
Comparison Method ◽  
Average Treatment Effect ◽  
Operating Efficiency ◽  
Investment Strategies ◽  
Industry Group ◽  
Using Data ◽  
The Impact

This paper examines the impact of equitization on financial and operating performance of state-owned enterprises (SOEs) in Vietnam. Previous related privatization theories have not explained whether there is an improvement in financial and operating performance of equitized SOEs compared to non-equitized SOEs or not. This study proposes to use with-without comparison method through the average treatment effect measuring the impact of equitization on financial and operating performance of SOEs. By using data of 114 SOEs equitized in the period from 2012 to 2014, the author finds that equitized SOEs can not improve profitability, operating efficiency, and output when considering non-equitized SOEs. There is also no evidence for a reduction in the number of employees of equitized SOEs after equitization. These findings are in contrast to previous studies in Vietnam, but there are similarities with the results of studies in China. This is because equitized SOEs in the early post-equitization period in Vietnam are still monitored by the Vietnamese government, as well as the equitized enterprises in the period 2012-2014 are mainly large-scale ones with slow change of operating objectives, monitoring mechanism and weak competitiveness after equitization. However, equitization can help equitized SOEs operate more efficiently than non–equitized SOEs when considering non-listing status or industry group. This research provides implications for the Vietnamese government to encourage non-equitized enterprises to participate in the equitization program actively. The research results also help investors to have appropriate long-term investment strategies in equitized SOEs. This paper also has some limitations for further research.

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