The financial protection effect of Ghana National Health Insurance Scheme: evidence from a study in two rural districts

<p>Abstract</p> <p>Background</p> <p>One of the key functions of health insurance is to provide financial protection against high costs of health care, yet evidence of such protection from developing countries has been inconsistent. The current study uses the case of Ghana to contribute to the evidence pool about insurance's financial protection effects. It evaluates the impact of the country's National Health Insurance Scheme on households' out-of-pocket spending and catastrophic health expenditure.</p> <p>Methods</p> <p>We use data from a household survey conducted in two rural districts, Nkoranza and Offinso, in 2007, two years after the initiation of the Ghana National Health Insurance Scheme. To address the skewness of health expenditure data, the absolute amount of out-of-pocket spending is estimated using a two-part model. We also conduct a probit estimate of the likelihood of catastrophic health expenditures, defined at different thresholds relative to household income and non-food consumption expenditure. The analysis controls for chronic and self-assessed health conditions, which typically drive adverse selection in insurance.</p> <p>Results</p> <p>At the time of the survey, insurance coverage was 35 percent. Although the benefit package of insurance is generous, insured people still incurred out-of-pocket payment for care from informal sources and for uncovered drugs and tests at health facilities. Nevertheless, they paid significantly less than the uninsured. Insurance has been shown to have a protective effect against the financial burden of health care, reducing significantly the likelihood of incurring catastrophic payment. The effect is particularly remarkable among the poorest quintile of the sample.</p> <p>Conclusions</p> <p>Findings from this study confirm the positive financial protection effect of health insurance in Ghana. The effect is stronger among the poor group than among general population. The results are encouraging for many low income countries who are considering a similar policy to expand social health insurance. Ghana's experience also shows that instituting insurance by itself is not adequate to remove fully the out-of-pocket payment for health. Further works are needed to address the supply side's incentives and quality of care, so that the insured can enjoy the full benefits of insurance.</p

ITChallengeYou: a realidade virtual aplicada no contexto de seleção na área das tecnologias de informação

As práticas de Recursos Humanos confrontam-se com novos desafios decorrentes da evolução tecnológica. No domínio das Tecnologias de Informação (TI), as características do mercado e dos próprios especialistas tornam o processo de recrutamento e seleção particularmente desafiante. A Realidade Virtual (RV) tem sido alvo de investimento e desenvolvimento e tem vindo a ser aplicada em diversos setores. Contudo, a partir da pesquisa efetuada, revelou-se que existe pouca investigação sobre a aplicação da RV em contextos de seleção, particularmente na avaliação de competências. A presente dissertação visa responder à seguinte questão de investigação: Quais os benefícios, limitações e requisitos da implementação da RV em contextos de seleção? Tomando partido das potencialidades da RV desenvolveu-se uma aplicação imersiva para o processo de Recrutamento e Seleção, em particular na avaliação de competências de especialistas de TI. Nesta aplicação simula-se uma situação real que testa as competências lógicas, técnicas e interpessoais. A partir de uma amostra de 30 utilizadores da aplicação e seis entrevistas, concluiu-se que a RV é aplicável e útil no contexto de seleção. Apresentando valor acrescentado e inovador no contexto organizacional, sendo facilitador do processo de recrutamento e seleção e otimizando os seus recursos. A tecnologia, combinada com uma estratégia de Gamificação, permite uma maior atratividade do processo.Human Resources practices face new challenges arising from technological evolution. In the field of Information Technology (IT), the characteristics of both the market and the experts themselves render the recruitment and selection process particularly challenging. Virtual Reality (VR) has been the subject of extensive development and has being applied to several areas. However, the research on the state of the art has revealed that there is a shortage of research on the application of VR in selection contexts and in skills assessment. This dissertation aims to answer the following research question: What are the benefits, limitations and requirements of VR implementation in selection contexts? By taking advantage of VR’s potential, an immersive application has been developed to be applied in the Recruitment and Selection process, particularly in the assessment of IT skills. The application simulates a real situation and concomitantly tests subjects’ logical, technical and interpersonal skills. From a sample of 30 users and six interviews, we have concluded that VR is applicable and useful in the context of selection. Presenting itself as an innovative novelty in the organizational context, facilitating the recruitment and selection process and optimizing its resources. Combined with a gamification structure, VR confers greater attractiveness to the process

No. 1: Migration and Development in Africa: An Overview

Migration is clearly a major issue across Africa. Indeed, migration – both within countries and across borders – can be seen as an integral part of labour markets and livelihoods across much of the continent for at least the last century. Over time, and in different places, migration has taken a number of different forms. It has cut across class and skill boundaries, and exists in widely different geographical and demographic contexts. Migration represents an important livelihood strategy for poor households seeking to diversify their sources of income, but is also characteristic of the better off, and indeed of many African elites. In practice, however, the link between migration and poverty is often viewed more negatively. It is assumed across much of the continent that it is poverty that forces poor people to migrate, rather than migration being a potential route out of poverty. The poor are also generally seen as those worst affected by conflict-induced migration, itself a prominent feature in Africa. The movement of skilled and/or wealthy Africans is also generally viewed negatively (e.g. there is long-standing concern on the African continent with the impact of the ‘brain drain’ of African professionals). Only slowly, and in relatively few quarters, is understanding emerging of the potentially positive role that migration itself can play in reducing poverty, or of the possibilities for ‘mobilisation’ of the African diaspora in the fight against poverty. Meanwhile, public policy remains a long way from building effectively on such understanding. The aim of this study is to synthesise existing research on migration in Africa, and its relationship to development policy. The report focuses on the relationship between migration, poverty and pro-poor development policy. Pro-poor policy is taken here to mean policies that are context-specific, listen and react to poor people’s voices, and/or seek to assist poor people to become less vulnerable and build up their income and assets. Government health and education policies might not be considered intrinsically pro-poor, but become so where they are targeted at widening access to health and education services, and especially basic health and education services (e.g. primary care, vaccination campaigns, primary schooling), or at responding to the specific needs of the poor. Pro-poor policies might also seek to identify and support poor people’s livelihoods, through the promotion of social protection mechanisms (ranging from pensions, health insurance, maternity benefit and unemployment benefits to food aid and other social assistance) or enhancement and enforcement of poor people’s rights. In turn, our focus is not only on the policies of developing country governments, but also on those of non-government and intergovernmental organisations, and of donor nations. In terms of migration, the study covers both international and internal migration. In the sections that follow, issues are dealt with first in relation to sub-Saharan Africa as a whole, and then in detail for three regions – West Africa, East Africa and Southern Africa. The sections on Africa as a whole, and on West and East Africa were completed by researchers at the Sussex Centre for Migration Research at the University of Sussex, whilst the section on Southern Africa was written by researchers at the Southern African Migration Project

Directed Carbapenemase Testing Is No Longer Just for Enterobacterales: Cost, Labor, and Workflow Assessment of Expanding Carbapenemase Testing to Carbapenem-Resistant \u3cem\u3eP. aeruginosa\u3c/em\u3e

Molecular carbapenem-resistance testing, such as for the presence of carbapenemases genes, is commonly implemented for the detection of carbapenemase-producing Enterobacterales. Carbapenemase-producing P. aeruginosa is also associated with significant morbidity and mortality, although; prevalence may be underappreciated in the United States due to a lack of carbapenemase testing. The present study sought to compare hands-on time, cost and workflow implementation of carbapenemase gene testing in Enterobacterales and P. aeruginosa isolates versus sending out isolates to a public health laboratory (PHL) for testing to assess if in-house can provide actionable results. The time to carbapenemase gene results were compared. Differences in cost for infection prevention measures were extrapolated from the time of positive carbapenemase gene detection in-house versus PHL. The median time to perform carbapenemase gene testing was 7.5 min (range 5–14) versus 10 min (range 8–22) for preparation to send isolates to the PHL. In-house testing produced same day results compared with a median of 6 days (range 3–14) to receive results from PHL. Cost of in-house testing and send outs were similar ($46.92 versus$40.53, respectively). If contact precautions for patients are implemented until carbapenemase genes are ruled out, in-house testing can save an estimated $76,836.60 annually. Extension of in-house carbapenemase testing to include P. aeruginosa provides actionable results 3–14 days earlier than PHL Standard Pathway testing, facilitating guided therapeutic decisions and infection prevention measures. Supplemental phenotypic algorithms can be implemented to curb the cost of P. aeruginosa carbapenemases testing by identifying isolates most likely to harbour carbapenemases

Performance-based financing kick-starts motivational “feedback loop”: findings from a process evaluation in Mozambique

Background: Performance-based financing (PBF) reforms aim to directly influence health worker behavior through changes to institutional arrangements, accountability structures, and financial incentives based on performance. While there is still some debate about whether PBF influences extrinsic or intrinsic motivators, recent research finds that PBF affects both. Against this backdrop, our study presents findings from a process evaluation of a PBF program in Mozambique, exploring the perceived changes to both internal and external drivers of health worker motivation associated with PBF. Methods: We used a qualitative research design with in-depth, semi-structured interviews with health workers, which included a rank order exercise and focus group discussions. Interviews were analyzed by two researchers using thematic analysis techniques. Rank order frequency was calculated using weighted average methodology. Results: Health workers reported that PBF, overall, positively influenced their motivation by introducing or reinforcing both internal and external motivational drivers. Internal drivers included enhanced self-efficacy driven by goal orientation, healthy competition among colleagues, and job satisfaction. External drivers included an organized work environment, enhanced access to equipment and supplies, financial incentives, teamwork, and regular consultations with verifiers (a type of supervision). PBF stimulates an interactive relationship between internal and external motivational drivers, creating a feedback loop involving responsibility, achievement, and recognition, which increased perceived motivation. Conclusions: The PBF program helped workers feel that they had well-defined and achievable goals and that they received recognition from verification teams, management committees, and colleagues due to enhanced accountability and governance. Our paper shows that financial incentives could serve as the “driver” to kick-start the feedback loop, of responsibility, achievement, and recognition, in environments that lack other drivers. Understanding how PBF programs can be designed and refined to reinforce this feedback loop could be a powerful tool to further enhance and track positive motivational changes. For countries thinking about PBF, we recommend that policymakers assess the loop in their contexts, identify drivers, determine whether these drivers are sufficient, and consider PBF if they are not. Trial registration: We obtained ethical approval for the study protocol, data collection instruments, and informed consent forms from the Ethics Review Committee of the Centers for Disease Control and Prevention (CDC) [IRB 2015–190] and the Ethics Review Committee of the Mozambique Ministry of Health

Interspecies interactions and potential Influenza A virus risk in small swine farms in Peru

<p>Abstract</p> <p>Background</p> <p>The recent avian influenza epidemic in Asia and the H1N1 pandemic demonstrated that influenza A viruses pose a threat to global public health. The animal origins of the viruses confirmed the potential for interspecies transmission. Swine are hypothesized to be prime "mixing vessels" due to the dual receptivity of their trachea to human and avian strains. Additionally, avian and human influenza viruses have previously been isolated in swine. Therefore, understanding interspecies contact on smallholder swine farms and its potential role in the transmission of pathogens such as influenza virus is very important.</p> <p>Methods</p> <p>This qualitative study aimed to determine swine-associated interspecies contacts in two coastal areas of Peru. Direct observations were conducted at both small-scale confined and low-investment swine farms (n = 36) and in open areas where swine freely range during the day (n = 4). Interviews were also conducted with key stakeholders in swine farming.</p> <p>Results</p> <p>In both locations, the intermingling of swine and domestic birds was common. An unexpected contact with avian species was that swine were fed poultry mortality in 6/20 of the farms in Chancay. Human-swine contacts were common, with a higher frequency on the confined farms. Mixed farming of swine with chickens or ducks was observed in 36% of all farms. Human-avian interactions were less frequent overall. Use of adequate biosecurity and hygiene practices by farmers was suboptimal at both locations.</p> <p>Conclusions</p> <p>Close human-animal interaction, frequent interspecies contacts and suboptimal biosecurity and hygiene practices pose significant risks of interspecies influenza virus transmission. Farmers in small-scale swine production systems constitute a high-risk population and need to be recognized as key in preventing interspecies pathogen transfer. A two-pronged prevention approach, which offers educational activities for swine farmers about sound hygiene and biosecurity practices and guidelines and education for poultry farmers about alternative approaches for processing poultry mortality, is recommended. Virological and serological surveillance for influenza viruses will also be critical for these human and animal populations.</p

A Stress Analysis of Circular Cylindrical Shell Intersections, Including the Influences of Reinforcement, Cyclic Plasticity and Fatigue

The intersection of cylinders is an unavoidable· element in many engineering installations such as nozzle to cylinder connections in nuclear reactors or pressure vessels, pipe intersections in offshore platforms etc The region of intersection presents a sharp geometric discontinuity in the structure which produces a stress field with very high stress concentration. A unified in depth study of the behavior of cylinder intersections is presented in this document. This study consists of numerical evaluations of the stress fields in the vicinity of the cylindrical shell intersections. Included in the study are variations of reinforcement configurations around the curve of intersection, variations of nozzle to cylinder diameter ratios, variations of angles of intersection, and cyclic plasticity. The finite element method is employed for this stress analysis. An algorithm is developed for an automated mesh generation covering the region of the cylinder intersection. A kinematic strain hardening material model is formulated for application to cases with cyclic plasticity. The results of the nonlinear analysis are incorporated with existing numerical techniques to.predict the fatigue life of the components involved.Office of Naval Research. Department of the Navy.Contract No. N00014-75-C-0164Project NR 064-18