An evaluation of funding challenges in the Malawian public healthcare delivery sector

Background: Reliable and adequate healthcare funding is crucial in public healthcare service delivery. However, district hospitals in Malawi, face funding challenges as evidenced by poor service delivery. Aim: This study aimed at investigating funding challenges experienced by public district hospitals of Malawi in the provision of healthcare services and proposing strategies for improved funding. Setting: The research presented in this article evaluates funding challenges in the public healthcare sector in Malawi, a developing country. Method: An exploratory sequential mixed method design was used. Qualitative data were collected through semi-structured interviews with 10 purposively selected individuals and were analysed thematically. Quantitative data were collected using questionnaires from 328 respondents. Quantitative data underwent factor and univariate analysis. Results: The study revealed that government funding is received late and is inadequate; donor funding was declining and earmarked for specific health activities; while income generation capacity of hospitals and Councils is weak. The study suggests that hospitals should introduce fees for service, government should be lobbied for increased funding allocations, and revenue–generating capacity of hospitals and Councils should be enhanced. Conclusion: The study concludes that there is an urgent need for government to prioritise the healthcare delivery sector and increase its funding. Hospitals and Councils should be innovative in order to generate additional funding for operations and the revenue generation capacity of hospitals and Councils should thus, be enhanced. Contribution: The study adds to the healthcare funding debate in developing countries by providing a context–specific analysis of healthcare funding challenges and suggesting improvement strategies

Relevance of the balanced scorecard model in Africa : shareholder-centred or stakeholder-centred?

The balanced scorecard model that was invented by Kaplan and Norton (1992) in the USA was designed for Western countries that operate within a capitalistic system. The capitalist systems focus on maximisation of wealth for the financial capital providers, shareholders. Africa is different in that its socio-cultural framework is socialist, community-based and humanist in nature. Thus, the balanced scorecard model is not fully reconcilable with an African environment. This study aimed at establishing whether or not the balanced scorecard model is relevant to an organisation operating in Africa. The study results reveal that the African social-cultural framework is inclusive in that its corporate governance embraces all stakeholders unlike an exclusive western framework of corporate governance that focuses on shareholders only. The current conceptualisation of the Norton and Kaplan balanced scorecard model is not ideal for an organisation operating in an African environment. There is a need to redesign the current balanced scorecard model to reflect realities of the African socio-cultural framework.http://www.academicjournals.org/AJBMam201

Analysis of International Financial Reporting Standards Content of Accounting Degree Curricula in Malawi

The move to adopt International Financial Reporting Standards (IFRS) has gained momentum worldwide. The massive adoption of IFRS is attributed to globalisation of business and finance. The global adoption of IFRS is aimed at providing a common set of accounting standards. This single set of IFRS enhances the investor’s ability to make informed decisions about investment alternatives. The academic institutions offering accounting education need to incorporate IFRS in their curricula. This study was intended to establish the extent to which IFRS have been incorporated in the curricula of universities and colleges offering accounting degree programmes in Malawi. The study involved a review of curriculum documents for the accountancy undergraduate degree programmes of academic institutions in Malawi. The results indicate that IFRS have been incorporated into the accounting curricula of the five universities and colleges. The results also indicated that the coverage of the standards was at different ranges. It is recommended that colleges and universities in Malawi should be continuously and frequently reviewing their curriculum materials

The development and validation of a scoring tool to predict the operative duration of elective laparoscopic cholecystectomy

Background: The ability to accurately predict operative duration has the potential to optimise theatre efficiency and utilisation, thus reducing costs and increasing staff and patient satisfaction. With laparoscopic cholecystectomy being one of the most commonly performed procedures worldwide, a tool to predict operative duration could be extremely beneficial to healthcare organisations. Methods: Data collected from the CholeS study on patients undergoing cholecystectomy in UK and Irish hospitals between 04/2014 and 05/2014 were used to study operative duration. A multivariable binary logistic regression model was produced in order to identify significant independent predictors of long (> 90 min) operations. The resulting model was converted to a risk score, which was subsequently validated on second cohort of patients using ROC curves. Results: After exclusions, data were available for 7227 patients in the derivation (CholeS) cohort. The median operative duration was 60 min (interquartile range 45–85), with 17.7% of operations lasting longer than 90 min. Ten factors were found to be significant independent predictors of operative durations > 90 min, including ASA, age, previous surgical admissions, BMI, gallbladder wall thickness and CBD diameter. A risk score was then produced from these factors, and applied to a cohort of 2405 patients from a tertiary centre for external validation. This returned an area under the ROC curve of 0.708 (SE = 0.013, p  90 min increasing more than eightfold from 5.1 to 41.8% in the extremes of the score. Conclusion: The scoring tool produced in this study was found to be significantly predictive of long operative durations on validation in an external cohort. As such, the tool may have the potential to enable organisations to better organise theatre lists and deliver greater efficiencies in care