Cost of integrating assisted partner services in HIV testing services in Kisumu and Homa Bay counties, Kenya: a microcosting study

Background HIV assisted partner services (aPS), or provider notification and testing for sexual and injecting partners of people diagnosed with HIV, is shown to be safe, effective, and cost-effective and was scaled up within the national HIV testing services (HTS) program in Kenya in 2016. We estimated the costs of integrating aPS into routine HTS within an ongoing aPS scale-up project in western Kenya. Methods We conducted microcosting using the payer perspective in 14 facilities offering aPS. Although aPS was offered to both males and females testing HIV-positive (index clients), we only collected data on female index clients and their male sex partners (MSP). We used activity-based costing to identify key aPS activities, inputs, resources, and estimated financial and economic costs of goods and services. We analyzed costs by start-up (August 2018), and recurrent costs one-year after aPS implementation (Kisumu: August 2019; Homa Bay: January 2020) and conducted time-and-motion observations of aPS activities. We estimated the incremental costs of aPS, average cost per MSP traced, tested, testing HIV-positive, and on antiretroviral therapy, cost shares, and costs disaggregated by facility. Results Overall, the number of MSPs traced, tested, testing HIV-positive, and on antiretroviral therapy was 1027, 869, 370, and 272 respectively. Average unit costs per MSP traced, tested, testing HIV-positive, and on antiretroviral therapy were $34.54, $42.50, $108.71 and $152.28, respectively, which varied by county and facility client volume. The weighted average incremental cost of integrating aPS was $7,485.97 per facility per year, with recurrent costs accounting for approximately 90% of costs. The largest cost drivers were personnel (49%) and transport (13%). Providers spent approximately 25% of the HTS visit obtaining MSP contact information (HIV-negative clients: 13 out of 54 min; HIV-positive clients: 20 out of 96 min), while the median time spent per MSP traced on phone and in-person was 6 min and 2.5 hours, respectively. Conclusion Average facility costs will increase when integrating aPS to HTS with incremental costs largely driven by personnel and transport. Strategies to efficiently utilize healthcare personnel will be critical for effective, affordable, and sustainable aPS.

ANALYSIS OF THE GAINS IN THE WORKSTATIONS OF AN AUTOMOTIVE INDUSTRY FROM AN ERGONOMICS-BASED TIME AND MOTION STUDY

High-efficiency manufacturing has been one of the main goals of companies, requiring the use of adequate techniques and tools with high value and low cost to increase productivity. In this case, industrial companies focus on increasing productivity without losing quality in services and products, using adequate techniques without high investments to avoid compromising the final result. This study applies time and motion study techniques to two workstations of a specific automotive industry. Accordingly, ergonomics data on specific tasks are collected, with satisfactory results. The method proposed simplifications in workstations, reduces times, and, therefore, increases productivity.

Time and motion assessment of pit-emptying operations in Kigali, Rwanda

To ensure sanitation for all by 2030, fecal sludge collection services in low-income urban areas with no sewer connections need improvement. One of the major issues is the gap between low-income household's willingness to pay and the cost of emptying services in low-income areas. One way of lowering the cost of these services is through process optimization. In this regard, we conducted a time and motion study to better understand the bottlenecks associated with the collection of fecal waste from different types of on-site sanitation facilities. Our results show that emptying pit latrines, which make up 53% of the market for emptying services in Kigali, takes twice longer than emptying septic tanks. 33% of households that requested the service were located in an informal settlement with no access to road and could only be served by a semi-mechanized method which required use of barrels, and a portable pump. In general, interventions related to minimizing trash disposal in pits and septic tanks can go a long way in making the emptying process more time and cost-efficient. Additionally, developing effective and efficient pumping technologies that are suitable for use in inaccessible areas should be prioritized.

Comparison of Forwarder Productivity and Optimal Road Density in Thinning and Clearcutting of Pine Plantation in Southern Brazil

The prescription of forest management determines the number of trees to be cut and, consequently, the harvested wood volume, which directly influences the forest operations dynamic. The objectives of this paper were (i) to analyze the effect of process factors on wood extraction performance with forwarder in first thinning and clearcutting of Pinus taeda L. plantations; and (ii) to economically determine the optimal road density to manage these plantations. Time and motion studies at the cycle element level were conducted to quantify and model the time consumption, productivity, and operational costs of the extraction. The optimal road density (ORD) for both operation types (OT) was determined based on the transport geometry model, considering the minimization of the sum of unitary costs with construction and maintenance of roads, loss of productive area, and wood extraction. The extraction distance (ED), slope (SL), average log volume (LV), and OT had a significant effect on the time consumed in travels, and therefore, on productivity (PPMH). In clearcutting, the average PPMH was 12.17 m3ob PMH0-1, while, in thinning, it was 10.94 m3ob PMH0-1; however, as the ED increased, the difference of PPMH and the cost of extraction between the operations decreased, which highlighted a greater effect of this factor on forwarder’s work in clearcutting. For this reason, the ORD for clearcutting (37.76 m ha-1) was higher than for thinning (27.84 m ha-1). Therefore, we demonstrated in this study that the type of operation and forest management regime, as well as their interaction with process factors, affect the sizing of the number of roads per unit area, and also the costs of the forest activity.

Interruption of Initial Patient Assessment in the Emergency Department and its Effect on Patient Perception of Care Quality

ABSTRACT Background Triage is a critical first step in appropriately caring for patients in the emergency department. Patients’ assumptions of the care they will receive can be established in triage. Interruptions to this process can disrupt patient flow, cause errors and lead to patient dissatisfaction. The purpose of this study was to determine how the frequency and duration of interruptions during triage are associated with errors, patient satisfaction, and patient’s perception of the care they received. Methods Prospective, observational, cohort study conducted in the emergency department of a Level 1 trauma center. Interruptions were measured using time-and-motion observations of triage interviews performed by nurses and physicians. Patients were surveyed immediately after triage interviews were complete. Results Surveys were completed for 178 observations. 62.9% of the observations were interrupted between 1 and 5 times. While interruptions did not significantly influence patient satisfaction directly, interruptions positively influenced triage duration, which was negatively associated with patient satisfaction. Increased errors were associated with increasing frequency of triage interruptions. Triage interruptions were not associated with either patient satisfaction or perceived caregiver competence. Overall, the majority (76.6%) of patients were satisfied with their care; patient satisfaction was associated with the perceived competency of caregivers but was not associated with errors. Conclusion Interruptions are associated with increased errors and delays in patient care. Although increased triage duration adversely affected patient satisfaction, patients’ perceptions were not influenced by interruptions. While patient satisfaction is essential, the lack of association between patient satisfaction and errors suggests that using patient satisfaction as a measure of care quality may omit important safety information.

Application of Time and Motion study for Brickwork activity in Residential building

Construction industry is one of the largest industries in any economy whether gauged in currency volume or workforce quantity but still it is not attentive in appealing it. Human resource plays a vital role in increasing economy and enhancing productivity. Labor productivity is the key driving factor in burgeoning thrift. Various labors possess distinct productivity levels, thus ultimately affects time and profit of construction. Construction activities performed by workers are usually repetitive and demands physical attention, which can be examined by time and motion study followed by evaluation through statistical analysis. A time and motion study are a work measurement technique that involves recording the time spent on a specific job. A time keeping system can be used to record time, while a motion study can be used to eliminate waste. In this research work, a total of seven residential building sites were selected for performing time and motion study considering brick masonry work as main domain where vision-based approach is followed to collect data, i.e., video record study followed by statistical analysis applied to the observed and collected data on site to determine the time parameters, work efficiency and labor productivity construing to the hassles and its reasons. This study focused on only residential buildings limiting the crew designation to mason and helpers aged 25-35 years with 10-16 years of work experience working under traditional method with conditioned tools like hand trowel, mason square, spirit level, plumb rule, etc.

Performance of a whole tree mechanised timber harvesting system when clear-felling a 32-year-old Pinus taeda L. stand

Background: Work studies are fundamental for the development and assessment of timber harvesting systems aimed at rationalising and improving forest management activities. Methods: This study evaluated the operational performance of a mechanised whole-tree harvesting system in 32-year-old Pinus taeda L. stands producing multiple timber products. A time and motion study at the cycle element level was conducted to evaluate the operational performance of each component of the harvesting system. Equations were developed to estimate the productivity of tree extraction activity with a wheeled skidder and log loading with a mechanical loader. Results: Tree felling with an excavator-based harvester had the highest mean productivity (135 m3 per productive machine hour), followed by tree extraction with a wheeled skidder (117 m3 per productive machine hour), while manually processing larger logs with a chainsaw had the lowest productivity (25.7 m3 per productive machine hour). Operator, extraction distance and mean log volume had a significant effect on the performance of different activities and were included in productivity models. Conclusions: Operational performance of equipment was variable and dependent on the effect of the operator, extraction distance and log volume. Thus, the use of models to estimate productivity considering such factors, coupled with reduced delays to increase utilisation of equipment, will contribute to the better management and planning of forest harvesting operations under the evaluated conditions.