Cost of TB services in healthcare facilities in Kenya (No 3).

BACKGROUND: The reduction of Kenya´s TB burden requires improving resource allocation both to and within the National TB, Leprosy and Lung Disease Program (NTLD-P). We aimed to estimate the unit costs of TB services for budgeting by NTLD-P, and allocative efficiency analyses for future National Strategic Plan (NSP) costing.METHODS: We estimated costs of all TB interventions in a sample of 20 public and private health facilities from eight counties. We calculated national-level unit costs from a health provider´s perspective using bottom-up (BU) and top-down (TD) approaches for the financial year 2017-2018 using Microsoft Excel and STATA v16.RESULTS: The mean unit cost for passive case-finding (PCF) was respectively US$38 and US$60 using the BU and TD approaches. The unit BU and TD costs of a 6-month first-line treatment (FLT) course, including monitoring tests, was respectively US$135 and US$160, while those for adult drug-resistant TB (DR-TB) treatment was respectively US$3,230.28 and US$3,926.52 for the 9-month short regimen. Intervention costs highlighted variations between BU and TD approaches. Overall, TD costs were higher than BU, as these are able to capture more costs due to inefficiency (breaks/downtime/leave).CONCLUSION: The activity-based TB unit costs form a comprehensive cost database, and the costing process has built-in capacity within the NTLD-P and international TB research networks, which will inform future TB budgeting processes

A Study on the Influence of Effective Structures on Agriculture Graduates’ Tendency Towards Cooperative Activities in Southern Khorasan Cooperation Sector

Employment & unemployment are among the main issues in economy, as increasing employment & decreasing unemployment rate are one of the most important factors of development in any society. This is ever more important in the issue of employment of university graduates. Specialized agricultural cooperatives as partnership organizations have remarkable potential in quantitative and qualitative improvement of agri-products as well as entrepreneurship for graduates of agriculture. As a result, development of these cooperatives seems to be a necessity. In the current study, the tendency of agriculture graduates towards participation in cooperative sector has been investigated to study the causes of their inclination towards joining this section. This study is a descriptive-analytic research and correlative and cooperative methods have been used. The subject group consist of 200 persons were selected according to proportional random sampling method out of graduates and senior students of agriculture in the academic year 2008-09 and data was collected by questionnaires. Spss 11.5 computer program was used to process both descriptive and analytic data.  The most important result of the descriptive approach was that nearly half of the subjects’ tendency towards cooperatives was moderate. The correlative analysis showed that the tendencies of the subjects for employment in cooperative section are significantly affected by their knowledge and awareness, incentives, barriers, educational needs, and age. Knowledge and incentives have positive effect on employment in this section while age, barriers and educational needs have negative impact. In addition, significant differences exist among subjects’ approaches from different universities, genders, as well as being student or graduate

Manipulation of task constraints is the most effective motor learning method for reducing risk factors for ACL injury during side-step cutting in both male and female athletes

This study compared the efficacy of linear, non-linear and differential methods on variables related to ACL injury risk of a side-step cutting task in male and female basketball players. Thirty males and thirty females practiced basketball skills in sixty 90-minute sessions across 5 months. Ten players trained in each of the LP, NLP and DL female/male groups separately. Before and after the intervention, each player was tested on a side-step cutting task. A repeated 3 × 2 × 2 factorial ANOVA with repeated measures was performed for each biomechanical variable. Variables (trunk, hip, and knee flexion angle, knee valgus angle, ankle dorsiflexion angle, hip, knee, and ankle ROM, peak VGRF and knee extension/flexion, knee moment and ankle dorsiflexion moment) all revealed significant test by group interactions (P  0.05). In both sex, biomechanical changes were better in the NLP, followed by the DL and LP. It is argued that the advantage of the NLP method results from increased exploration of movement solutions induced by the manipulation of task constraints. Therefore, according to the NLP, it is possible to manipulate the constraints without feedback and the model/pattern can keep the athlete away from possible risks

A Laboratory Study on Non-Invasive Soil Water Content Estimation Using Capacitive Based Sensors

Soil water content is an important parameter in many engineering, agricultural and environmental applications. In practice, there exists a need to measure this parameter rather frequently in both time and space. However, common measurement techniques are typically invasive, time-consuming and labour-intensive, or rely on potentially risky (although highly regulated) nuclear-based methods, making frequent measurements of soil water content impractical. Here we investigate in the laboratory the effectiveness of four new low-cost non-invasive sensors to estimate the soil water content of a range of soil types. While the results of each of the four sensors are promising, one of the sensors, herein called the “AOGAN„ sensor, exhibits superior performance, as it was designed based on combining the best geometrical and electronic features of the other three sensors. The performance of the sensors is, however, influenced by the quality of the sensor-soil coupling and the soil surface roughness. Accuracy was found to be within 5% of volumetric water content, considered sufficient to enable higher spatiotemporal resolution contrast for mapping of soil water content

Examining the unit costs of COVID-19 vaccine delivery in Kenya

Background Vaccines are considered the path out of the COVID-19 pandemic. The government of Kenya is implementing a phased strategy to vaccinate the Kenyan population, initially targeting populations at high risk of severe disease and infection. We estimated the financial and economic unit costs of procuring and delivering the COVID-19 vaccine in Kenya across various vaccination strategies. Methods We used an activity-based costing approach to estimate the incremental costs of COVID-19 vaccine delivery, from a health systems perspective. Document reviews and key informant interviews(n = 12) were done to inform the activities, assumptions and the resources required. Unit prices were derived from document reviews or from market prices. Both financial and economic vaccine procurement costs per person vaccinated with 2-doses, and the vaccine delivery costs per person vaccinated with 2-doses were estimated and reported in 2021USD. Results The financial costs of vaccine procurement per person vaccinated with 2-doses ranged from 2.89-13.09 US dollars in the 30% and 100% coverage levels respectively, however, the economic cost was 17.34 US dollars across all strategies. Financial vaccine delivery costs per person vaccinated with 2-doses, ranged from 4.28-3.29 US dollars in the 30% and 100% coverage strategies: While the economic delivery costs were two to three times higher than the financial costs. The total procurement and delivery costs per person vaccinated with 2-doses ranged from 7.34-16.47 US dollars for the financial costs and 29.7-24.68 US dollars for the economic costs for the 30% and 100% coverage respectively. With the exception of procurement costs, the main cost driver of financial and economic delivery costs was supply chain costs (47–59%) and advocacy, communication and social mobilization (29–35%) respectively. Conclusion This analysis presents cost estimates that can be used to inform local policy and may further inform parameters used in cost-effectiveness models. The results could potentially be adapted and adjusted to country-specific assumptions to enhance applicability in similar low-and middle-income settings

Exploring delays in Victoria-based Australian pipeline projects

Concerns for delays and disruptions are common in almost all projects including linear constructions such as pipeline projects. Due to various inherent complexities in such projects, delays could be resulting from several reasons and in most cases the resultant impacts are significantly detrimental. For example, delays could lead to some serious time and/or cost overrun issues thereby adversely affecting the contractors, clients and other stakeholders in different degrees. Consolidating useful knowledge from related research and lessons from recent projects will be beneficial for rationalized project management. Especially, identifying significant root causes of delays and accordingly developing suitable management methods (e.g. prevention measures) are essential to effectively ensuring successful project outcomes. Thus, an ongoing research by the authors aims to study specific cost overrun and time overrun issues in the linear construction projects in Victoria, Australia so as to develop suitable knowledge-based management by rational project planning protocols, control and prevention measures. The research methods considered include detailed literature reviews, targeted interviews with several project managers, and case-study based knowledge mining from some pipeline projects. This paper reports interim key findings from ongoing research, which includes discussions on root causes of delays and management approaches in linear construction projects

Examining health facility financing in Kenya in the context of devolution

Background How health facilities are financed affects their performance and health system goals. We examined how health facilities in the public sector are financed in Kenya, within the context of a devolved health system. Methods We carried out a cross-sectional study in five purposely selected counties in Kenya, using a mixed methods approach. We collected data using document reviews and in-depth interviews (no = 20). In each county, we interviewed county department of health managers and health facility managers from two and one purposely selected public hospitals and health center respectively. We analyzed qualitive data using thematic analysis and conducted descriptive analysis of quantitative data. Results Planning and budgeting: Planning and budgeting processes by hospitals and health centers were not standardized across counties. Budgets were not transparent and credible, but rather were regarded as “wish lists” since they did not translate to actual resources. Sources of funds: Public hospitals relied on user fees, while health centers relied on donor funds as their main sources of funding. Funding flows: Hospitals in four of the five study counties had no financial autonomy. Health centers in all study counties had financial autonomy. Flow of funds to hospitals and health centers in all study counties was characterized by unpredictability of amounts and timing. Health facility expenditure: Staff salaries accounted for over 80% of health facility expenditure. This crowded out other expenditure and led to frequent stock outs of essential health commodities. Conclusion The national and county government should consider improving health facility financing in Kenya by 1) standardizing budgeting and planning processes, 2) transitioning public facility financing away from a reliance on user fees and donor funding 3) reforming public finance management laws and carry out political engagement to facilitate direct facility financing and financial autonomy of public hospitals, and 4) assess health facility resource needs to guide appropriate levels resource allocation

The effects of linear, nonlinear, and differential motor learning methods on the emergence of creative action in individual soccer players

Objective: The purpose of this study was to compare the effects of linear (LP), nonlinear (NLP), and differential (DL) motor learning methods on the emergence of creative actions in soccer. Method: Sixty-six novice players were randomly allocated to one of three groups, which practiced soccer skills for three months, according to different motor learning methods. In the LP-group, attention was focused on acquiring movement patterns largely through prescriptive instructions and feedback and frequent repetitions. By contrast, in the NLP-group, the aim was to guide the players’ search for movement solutions. This was done by manipulating task constraints to induce practice variability. Finally, in the DL-group, prescriptive instructions were again used, but now to maximize random variation in the practice of movement patterns. Results: Behavioral analysis after the three-month training showed that the number of different actions (i.e., variability) was highest in the NLP-group, followed by DL-group, whereas the LP-group showed the lowest number of different actions. Similarly, the NLP-group and DL-group demonstrated more original and creative actions than the LP-group. Conclusion: In sum, the NLP and DL motor learning methods, which aim to promote motor variability in practice, are most conducive for the emergence of creative actions. Coaches are advised to design training environment that help learners increase their adaptive motor repertoire and creative actions