Efficiency of TB service provision in the public and private health sectors in Ethiopia.

BACKGROUND: The Ethiopian Government has identified efficiency of TB services as a key priority in planning and budgeting. Understanding the magnitude and sources of inefficiencies is key to ensuring value for money and improved service provision, and a requirement from donors to justify resource needs. This study identifies the cost of providing a wide range of TB services in public and private facilities in Ethiopia.METHODS: Financial and economic unit costs were estimated from a health provider´s perspective, and collected retrospectively in 26 health facilities using both top-down (TD) and bottom-up (BU) costing approaches for each TB service output. Capacity inefficiency was assessed by investigating the variation between TD and BU unit costs where the factor was 2.0 or more.RESULTS: Overall, TD unit costs were two times higher than BU unit costs. There was some variation across facility ownership and level of care. Unit costs in urban facilities were on average 3.8 times higher than in rural facilities.CONCLUSION: We identified some substantial inefficiencies in staff, consumable and capital inputs. Addressing these inefficiencies and rearranging the TB service delivery modality would be important in ensuring the achievement of the country´s End TB strategy

Tracking working status of HIV/AIDS-trained service providers by means of a training information monitoring system in Ethiopia

Abstract Background The Federal Ministry of Health of Ethiopia is implementing an ambitious and rapid scale-up of health care services for the prevention, care and treatment of HIV/AIDS in public facilities. With support from the United States President's Emergency Plan for AIDS Relief, 38 830 service providers were trained, from early 2005 until December 2007, in HIV-related topics. Anecdotal evidence suggested high attrition rates of providers, but reliable quantitative data have been limited. Methods With that funding, Jhpiego supports a Training Information Monitoring System, which stores training information for all HIV/AIDS training events supported by the same funding source. Data forms were developed to capture information on providers' working status and were given to eight partners who collected data during routine site visits on individual providers about working status; if not working at the facility, date of and reason for leaving; and source of information. Results Data were collected on 1744 providers (59% males) in 53 hospitals and 45 health centres in 10 regional and administrative states. The project found that 32.6% of the providers were no longer at the site, 57.6% are still working on HIV/AIDS services at the same facility where they were trained and 10.4% are at the facility, but not providing HIV/AIDS services. Of the providers not at the facility, the two largest groups were those who had left for further study (27.6%) and those who had gone to another public facility (17.6%). Of all physicians trained, 49.2% had left the facility. Regional and cadre variation was found, for example Gambella had the highest percent of providers no longer at the site (53.7%) while Harari had the highest percentage of providers still working on HIV/AIDS (71.6%). Conclusion Overall, the project found that the information in the Training Information Monitoring System can be used to track the working status of trained providers. Data generated from the project are being shared with key stakeholders and used for planning and monitoring the workforce, and partners have agreed to continue collecting data. The attrition rates found in this project imply an increased need to continue to conduct in-service training for HIV/AIDS in the short term. For long-term solutions, retention strategies should be developed and implemented, and opportunities to accelerate the incorporation of HIV/AIDS training in pre-service institutions should be explored. Further study on reasons why providers leave sites and why providers are not working on HIV at the sites where they were trained, in addition to our project findings, can provide valuable data for development of national and regional strategies and retention schemes. Project findings suggest that the development of national and region-specific human resources for health strategy and policies could address important human resources issues found in the project.</p

Checking the effectiveness of dynamic simulation systems overturning of tractors equipped with ROPS

El presente Proyecto Fin de Carrera se ha realizado en la Universidad Politécnica de Cartagena dentro del ámbito del proyecto de investigación “Nuevos Dispositivos de Seguridad en Máquinas” financiado por la Dirección General de Trabajo de la Comunidad Autónoma de la Región de Murcia y supone un avance en el desarrollo de un sistema de accionamiento automático del arco antivuelco de tractores. En el contexto del proyecto de NDSM se están desarrollando trabajos de investigación relativos al desarrollo electrónico, mecánico e hidráulico del sistema de accionamiento antivuelco de tractores. De forma paralela y complementaria se están desarrollando trabajos de simulación dinámica del vuelco del tractor, que se exponen en el presente trabajo. Este PFC se muestra cómo se ha validado el uso de técnicas de modelado y de simulación dinámica computacional para llevar a cabo ensayos del comportamiento ante el vuelco de un ROPS (Roll Over Protection Structure) desplegable automáticamente construido para tractores agrícolas. Las etapas de este proyecto son: 1. Selección de un vehículo a escala 1:16. 2. Modelado del vehículo elegido. 3. Construcción de una superficie de revolución sobre la que practicar los ensayos de vuelco. 4. Modelado de la superficie de ensayo. 5. Realización de ensayos con la maqueta del tractor y la plataforma con la superficie de ensayo construida. 6. Simulación de los citados ensayos. 7. Comparación de resultados.Escuela Técnica Superior de Ingeniería IndustrialUniversidad Politécnica de Cartagen

Drinking risk varies within and between Australian Aboriginal and Torres Strait Islander samples: a meta-analysis to identify sources of heterogeneity

Background and Aims: To reduce health and social inequities, it is important to understand how drinking patterns vary within and between Indigenous peoples. We aimed to assess variability in estimates of Indigenous Australian drinking patterns and to identify demographic and methodological factors associated with this. Design: A three-level meta-analysis of Australian Aboriginal and Torres Strait Islander (‘Indigenous’) drinking patterns [International Prospective Register of Systematic Reviews (PROSPERO) no. CRD42018103209]. Setting: Australia. Participants: Indigenous Australians. Measurements: The primary outcomes extracted were drinking status, single-occasion risk and life-time risk. Moderation analysis was performed to identify potential sources of heterogeneity. Moderators included gender, age, socio-economic status, local alcohol restrictions, sample population, remoteness, Australian state or territory, publication year, Indigenous involvement in survey design or delivery and cultural adaptations. Findings: A systematic review of the literature revealed 41 eligible studies. For all primary outcomes, considerable heterogeneity was identified within ((Formula presented.) = 51.39–68.80%) and between ((Formula presented.) = 29.27–47.36%) samples. The pooled proportions (P) of current drinkers [P\ua0=\ua00.59, 95% confidence interval (CI)\ua0=\ua00.53–0.65], single-occasion (P\ua0=\ua00.34, 95% CI\ua0=\ua00.24–0.44) and life-time (P\ua0=\ua00.21, 95% CI\ua0=\ua00.15–0.29) risk were all moderated by gender, age, remoteness and measurement tool. Reference period moderated proportions of participants at single-occasion risk. Conclusions: Indigenous Australian drinking patterns vary within and between communities. Initiatives to reduce high-risk drinking should take account of this variability