Modern monetary theory for the post-pandemic NHS: why budget deficits do not matter

NHS clinical directors are responsible for balancing departmental budgets, which can encompass staffing, equipment and operating theatres. As trust income is generally fixed, expenditure reduction is often attempted via recurrent cost improvement plans. In orthodox monetary theory, a departmental deficit contributes first to the hospital, then to the NHS, then to the national deficit. In the orthodox view, governments in deficit need to increase taxes and/or borrow money by issuing bonds (akin to mortgage loans), the interest on which is paid off for generations. Modern monetary theory offers a different perspective: government deficits do not matter as much as orthodox theory claims, if at all. This is because governments have the monopoly right to create the money in which the deficit is denominated (so do not ever need to borrow something that they can create). Therefore governments cannot default on debt in their own currency. Furthermore, government deficits equate to private surplus. This new perspective should influence microeconomic budget management at the clinical director level: the new emphasis being to deliver value and not just implement local savings to eliminate departmental deficits. This approach will become increasingly important in managing the huge surgical waiting lists that have accumulated during the COVID-19 pandemic.

Pilot of a Low-Cost Elementary School Handwashing Intervention in Bangladesh: Acceptability, Feasibility, and Potential for Sustainability

Schoolchildren frequently transmit respiratory and gastrointestinal infections because of dense person-to-person contact in schools. We piloted a low-cost handwashing intervention among elementary schoolchildren in Bangladesh. We trained teachers to lead behavior change communication sessions using flipcharts to encourage students’ handwashing before eating, after defecating, and after cleaning school toilets; provided handwashing stations (reservoirs with taps and stool + basin + soapy water solution [mix of 30 gm detergent with 1.5 L water] + pump top bottle with steel holder); and formed hygiene committees for maintenance and covering the recurrent cost of detergent. We evaluated intervention acceptability, feasibility, and potential for sustainability at 1 and 14 months after the intervention. At baseline, of 300 before eating events, no one washed hands with soap, and 99.7% (299) did not wash hands at all as soap was unavailable. Out of 269 after toileting events, 0.7% (2) washed hands with soap, and 88% (237) did not wash hands. After 4 weeks of the intervention, 45% (87/195 before eating events), 83% (155/186 after toileting events), and 100% (15/15 after cleaning toilet events) washed both hands with soapy water as children found it accessible, low cost, and child friendly. After 14 months, 9.4% (55/586 before eating events) and 37% (172/465 after toileting events) washed both hands with soapy water for health benefits. The intervention was acceptable and feasible; it overcame limited access to soap and water and was affordable as schools covered the recurrent costs of detergent. Further research should explore long-term habit adoption and impact on health and attendance.

INFLUENCE OF SOCIAL MEDIA IN POLITICAL AND TRIBAL CONFLICT IN KENYA

Purpose: Information communication and technology (ICT) has remained an innovation that has shifted attention from traditional working arrangement to a modern day of doing things in several organizations..The general objective of the study was to the study was to establish influence of integrated information communication technology on public education institution. Methodology: The paper used a desk study review methodology where relevant empirical literature was reviewed to identify main themes and to extract knowledge gaps. Findings: The study found out the use of ICT in schools, leads to educational and pedagogical outcomes which is useful to both the facilitators, teachers and the students. The use of ICT across educational institutions can promote collective, zealous and long-life learning, enhancing students’ enthusiasm, provide better convenience to information, enhance shared working resources, generating and deepen comprehension, and help learners reason and express communication creatively Recommendations: The study recommends that there should be more funding to particularly the public schools which are the most constrained, as well as all the others, so that the schools may afford to procure computer hardware, management software, and Internet connectivity which are critical in supporting management functions in the schools and also for the investments sustainability. Such funding will address the initial high cost of ICT infrastructure as well as the recurrent cost of maintenance and operations like hardware servicing, acquisition of requisite and updated software, printing and data

Cost of new born care interventions in four regions of Ghana: implications for health resource allocation.

Background Limited financial, human and material health resources coupled with increasing demand for new born care services require efficiency in health systems to maximize the available sources for improved health outcomes. Making Every Baby Count Initiative (MEBCI) implemented by local and international partners in 2003 in Ghana aimed at attaining neonatal mortality of 21 per 1,000 livebirths by 2018 in four administrative regions in Ghana. Objective Determine the cost of MEBCI interventions towards sustaining new born care best practices, and strengthening capacity for frontline clinical staff involved in new born care. Methods Cost of MEBCI interventions was evaluated on unit cost calculations. Expenditure items trainings, supervisions, monitoring and evaluation, advocacy, administrative costs and logistics. Data collection started in October 2017 and ended in September 2018. Key cost data sources were invoices, expense reports and ledger books at the national, regional and district levels of MEBCI implementation. Results Approximately GH₵ 24.5 million (US$ 5.5 million) expenditure data was recorded as overall cost of MEBCI interventions at the national and regional levels of project activities. Out of this figure, fixed cost constituted 71% and recurrent cost represented 29%. A total of GH₵ 1.6 million (US$ 372,727) expenditure values were expended in strengthening national leadership at the national health level; nearly 70% of this cost was spent on workshops and training related activities. Cost of implementing MEBCI at the various regional health directorates was approximately GH₵ 17.6 million (US$ 3.9 million). Out of this amount, direct provider training and related activities constituted 98% and indirect cost accounted for the remaining 2%. Overall, it was found that the MEBCI interventions covered 4,027 health providers, out of which 3,453 (86%) were clinical healthcare staff. Conclusion The MEBCI intervention had a wide coverage in terms of training for frontline healthcare providers albeit the associated cost may be potentially unsustainable for the Ghana’s health system. M-learning and e-learning platforms could be leveraged to reduce cost of the on-site batch-training approach.

Efficacy and Safety of Duckbill Valve Voice Prosthesis in Comparison to Provox

Introduction Voice rehabilitation is the most important issue after total laryngectomy as source of vibration is removed. Three options are there like esophageal voice, electrolarynx and surgical prosthetic voice. Best is the prosthetic speech as voice is generated by lung powered air column. Provox prosthesis is the standard on and most commonly used. But it is costly for the class of patients presenting to our government hospitals. Duckbill prosthesis is very economical and may be helpful for them. There is very limited number of studies with duckbill prosthesis. Materials and Methods Twenty two post-laryngectomy patients was selected for this study. Proper counselling was done regarding cost, pros and cons of Provox and Duckbill prosthesis. Fifteen patient selected Duckbill where as seven patient have chosen Provox prosthasis. Voice analysis was done after one month of speech therapy by perceptual voice analysis protocol. Safety and complications arising from prosthesis were also noted. Results There was no significant difference in quality of voice.Both prosthesis are safe if prolong use is avoided. Conclusion There is no significant difference in the quality and safety of both the prosthesis, but huge difference in cost is present. More over it is recurrent cost as it should be changed every year or earlier. One Provox costs around rupees fifty thousand whereas a duckbill prosthesis costs rupees one thousand approximately in Indian market.

Engine Operated Screwjack

Automobiles prove to be the heart of locomotion. Even after decades of this industry appearance, one issue which was never solved is the avoidance of flat tyres. A long drive might be a soothing one to the heart but a flat tyre on such a drive collapses everything. Even a flat tyre on the way to the office may cause the day sick. There is no way out but to call a mechanic or in case of barren roads, change the tyre ourselves. Present day methods for changing the tyre requires a lot of mechanical power which may prove to be difficult for the weak and old people. To overcome this problem, an automatic engine operated screw jack is designed which outweighs the pneumatic and electrical automatic system in various aspects like reliability, maintenance, cost etc. This device uses only the engine power to lift the car in any terrain and altitude. An engine was selected for this purpose to work on and its characteristics were studied. Based on the result it proves that the device will be a success upon installation on any type of vehicle. Even heavy duty vehicles like trucks, lorry, and buses can be lifted at a very minimal cost. The device will be of low maintenance and the initial cost is also low when regarding its use. It is a onetime installation and so no recurrent cost needed at the time of puncture.

Impact on public hospitals if private health insurance rates in Victoria declined

The additional cost of treating acute care type Victorian private patients as public patients in Victorian public hospitals based on the current public sector payment model and rates was calculated, as was the loss of health fund income to public hospitals. If all private cases became public the net recurrent cost would be $1.05 billion assuming all patients were still treated. If private health insurance (PHI) uptake had declined to 23.3% as was projected without Lifetime Health Cover and the 30% rebate, the additional operating cost and income loss would be $385 million. This compares to the Victorian cost of the 30% rebate for acute hospital cases of $383 million. This takes no account of capital costs and possible public sector access problems. The analysis suggests that 31 extra operating theatres would be needed in the public sector (had the transfer of surgical patients from the public sector to the private sector not occurred). This analysis suggests that without the PHI rebate the current stresses on Victorian public hospitals would be increased, not decreased.