37 research outputs found
Use of social audits to examine unofficial payments in government health services: experience in South Asia, Africa, and Europe
<p>Abstract</p> <p>Background</p> <p>Unofficial payments in health services around the world are widespread and as varied as the health systems in which they occur. We reviewed the main lessons from social audits of petty corruption in health services in South Asia (Bangladesh, Pakistan), Africa (Uganda and South Africa) and Europe (Baltic States).</p> <p>Methods</p> <p>The social audits varied in purpose and scope. All covered representative sample communities and involved household interviews, focus group discussions, institutional reviews of health facilities, interviews with service providers and discussions with health authorities. Most audits questioned households about views on health services, perceived corruption in the services, and use of government and other health services. Questions to service users asked about making official and unofficial payments, amounts paid, service delivery indicators, and satisfaction with the service.</p> <p>Results</p> <p>Contextual differences between the countries affected the forms of petty corruption and factors related to it. Most households in all countries held negative views about government health services and many perceived these services as corrupt. There was little evidence that better off service users were more likely to make an unofficial payment, or that making such a payment was associated with better or quicker service; those who paid unofficially to health care workers were not more satisfied with the service. In South Asia, where we conducted repeated social audits, only a minority of households chose to use government health services and their use declined over time in favour of other providers. Focus groups indicated that reasons for avoiding government health services included the need to pay for supposedly free services and the non-availability of medicines in facilities, often perceived as due to diversion of the supplied medicines.</p> <p>Conclusions</p> <p>Unofficial expenses for medical care represent a disproportionate cost for vulnerable families; the very people who need to make use of supposedly free government services, and are a barrier to the use of these services. Patient dissatisfaction due to petty corruption may contribute to abandonment of government health services. The social audits informed plans for tackling corruption in health services.</p
Reducing corruption in a Mexican medical school: impact assessment across two cross-sectional surveys
<p>Abstract</p> <p>Background</p> <p>Corruption pervades educational and other institutions worldwide and medical schools are not exempt. Empirical evidence about levels and types of corruption in medical schools is sparse. We conducted surveys in 2000 and 2007 in the medical school of the Autonomous University of Guerrero in Mexico to document student perceptions and experience of corruption and to support the medical school to take actions to tackle corruption.</p> <p>Methods</p> <p>In both 2000 and 2007 medical students completed a self-administered questionnaire in the classroom without the teacher present. The questionnaire asked about unofficial payments for admission to medical school, for passing an examination and for administrative procedures. We examined factors related to the experience of corruption in multivariate analysis. Focus groups of students discussed the quantitative findings.</p> <p>Results</p> <p>In 2000, 6% of 725 responding students had paid unofficially to obtain entry into the medical school; this proportion fell to 1.6% of the 436 respondents in 2007. In 2000, 15% of students reported having paid a bribe to pass an examination, not significantly different from the 18% who reported this in 2007. In 2007, students were significantly more likely to have bribed a teacher to pass an examination if they were in the fourth year, if they had been subjected to sexual harassment or political pressure, and if they had been in the university for five years or more. Students resented the need to make unofficial payments and suggested tackling the problem by disciplining corrupt teachers. The university administration made several changes to the system of admissions and examinations in the medical school, based on the findings of the 2000 survey.</p> <p>Conclusion</p> <p>The fall in the rate of bribery to enter the medical school was probably the result of the new admissions system instituted after the first survey. Further actions will be necessary to tackle the continuing presence of bribery to pass examinations and for administrative procedures. The social audit helped to draw attention to corruption and to stimulate actions to tackle it.</p
Chemical Modification of Graphene Oxide by Nitrogenation: An X-ray Absorption and EmissionSpectroscopy Study
Nitrogen-doped graphene oxides (GO:Nx) were synthesized by a partial reduction of graphene oxide (GO) using urea [CO(NH2)2]. Their electronic/bonding structures were investigated using X-ray absorption near-edge structure (XANES), valence-band photoemission spectroscopy (VB-PES), X-ray emission spectroscopy (XES) and resonant inelastic X-ray scattering (RIXS). During GO:Nx synthesis, different nitrogen-bonding species, such as pyrrolic/graphitic-nitrogen, were formed by replacing of oxygen-containing functional groups. At lower N-content (2.7 at%), pyrrolic-N, owing to surface and subsurface diffusion of C, N and NH is deduced from various X-ray spectroscopies. In contrast, at higher N-content (5.0 at%) graphitic nitrogen was formed in which each N-atom trigonally bonds to three distinct sp2-hybridized carbons with substitution of the N-atoms for C atoms in the graphite layer. Upon nitrogen substitution, the total density of state close to Fermi level is increased to raise the valence-band maximum, as revealed by VB-PES spectra, indicating an electron donation from nitrogen, molecular bonding C/N/O coordination or/and lattice structure reorganization in GO:Nx. The well-ordered chemical environments induced by nitrogen dopant are revealed by XANES and RIXS measurements
An inter-country comparison of unofficial payments: results of a health sector social audit in the Baltic States
<p>Abstract</p> <p>Background</p> <p>Cross-country comparisons of unofficial payments in the health sector are sparse. In 2002 we conducted a social audit of the health sector of the three Baltic States.</p> <p>Methods</p> <p>Some 10,320 household interviews from a stratified, last-stage-random, sample of 30 clusters per country, together with institutional reviews, produced preliminary results. Separate focus groups of service users, nurses and doctors interpreted these findings. Stakeholder workshops in each country discussed the survey and focus group results.</p> <p>Results</p> <p>Nearly one half of the respondents did not consider unofficial payments to health workers to be corruption, yet one half (Estonia 43%, Latvia 45%, Lithuania 64%) thought the level of corruption in government health services was high. Very few (Estonia 1%, Latvia 3%, Lithuania 8%) admitted to making unofficial payments in their last contact with the services. Around 14% of household members across the three countries gave gifts in their last contact with government services.</p> <p>Conclusion</p> <p>This social audit allowed comparison of perceptions, attitudes and experience regarding unofficial payments in the health services of the three Baltic States. Estonia showed least corruption. Latvia was in the middle. Lithuania evidenced the most unofficial payments, the greatest mistrust towards the system. These findings can serve as a baseline for interventions, and to compare each country's approach to health service reform in relation to unofficial payments.</p
Profile and professional expectations of medical students from 11 Latin American countries: the Red-LIRHUS project
Background Latin America is undergoing a human resource crisis in health care in terms of labor shortage, misdistribution and poor orientation to primary care. Workforce data are needed to inform the planning of long-term strategies to address this problem. This study aimed to evaluate the academic and motivational profile, as well as the professional expectations, of Latin American medical students. Results We conducted an observational, cross-sectional, multi-country study evaluating medical students from 11 Spanish-speaking countries in 2011â2012. Motivations to study medicine, migration intentions, intent to enter postgraduate programs, and perceptions regarding primary care were evaluated via a self-administered questionnaire. Outcomes were measured with pilot-tested questions and previously validated scales. A total of 11,072 valid surveys from 63 medical schools were gathered and analyzed. Conclusions This study describes the profile and expectations of the future workforce being trained in Latin America. The obtained information will be useful for governments and universities in planning strategies to improve their current state of affairs regarding human resources for health care professions
Strong Interaction Physics at the Luminosity Frontier with 22 GeV Electrons at Jefferson Lab
This document presents the initial scientific case for upgrading the
Continuous Electron Beam Accelerator Facility (CEBAF) at Jefferson Lab (JLab)
to 22 GeV. It is the result of a community effort, incorporating insights from
a series of workshops conducted between March 2022 and April 2023. With a track
record of over 25 years in delivering the world's most intense and precise
multi-GeV electron beams, CEBAF's potential for a higher energy upgrade
presents a unique opportunity for an innovative nuclear physics program, which
seamlessly integrates a rich historical background with a promising future. The
proposed physics program encompass a diverse range of investigations centered
around the nonperturbative dynamics inherent in hadron structure and the
exploration of strongly interacting systems. It builds upon the exceptional
capabilities of CEBAF in high-luminosity operations, the availability of
existing or planned Hall equipment, and recent advancements in accelerator
technology. The proposed program cover various scientific topics, including
Hadron Spectroscopy, Partonic Structure and Spin, Hadronization and Transverse
Momentum, Spatial Structure, Mechanical Properties, Form Factors and Emergent
Hadron Mass, Hadron-Quark Transition, and Nuclear Dynamics at Extreme
Conditions, as well as QCD Confinement and Fundamental Symmetries. Each topic
highlights the key measurements achievable at a 22 GeV CEBAF accelerator.
Furthermore, this document outlines the significant physics outcomes and unique
aspects of these programs that distinguish them from other existing or planned
facilities. In summary, this document provides an exciting rationale for the
energy upgrade of CEBAF to 22 GeV, outlining the transformative scientific
potential that lies within reach, and the remarkable opportunities it offers
for advancing our understanding of hadron physics and related fundamental
phenomena.Comment: Updates to the list of authors; Preprint number changed from theory
to experiment; Updates to sections 4 and 6, including additional figure
Dengue occurrence relations and serology: cross-sectional analysis of results from the Guerrero State, Mexico, baseline for a cluster-randomised controlled trial of community mobilisation for dengue prevention
Health services reform in Bangladesh: hearing the views of health workers and their professional bodies
Effects of body size, sex, parental care and moult strategies on auk diving behaviour outside the breeding season
Information on seabird foraging behaviour outside the breeding season is currently limited. This knowledge gap is critical as this period is energetically demanding due to postâfledging parental care, feather moult and changing environmental conditions. Based on speciesâ body size, postâfledging parental strategy and primary moult schedule we tested predictions for key aspects of foraging behaviour (Maximum Dive Depth (MDD), Daily Time Submerged (DTS) and Diurnal Dive Activity (DDA)) using dive depth data collected from three seabird species (common guillemot Uria aalge, razorbill Alca torda and Atlantic puffin Fratercula arctica) from the end of the breeding season (July) to midâwinter (January). We found partial support for predictions associated with body size; guillemots had greater MDD than razorbills but MDD did not differ between razorbills and puffins, despite the former being 35% heavier. In accordance with sexual monomorphism in all three species, MDD did not differ overall between the sexes. However, in guillemots and razorbills there were sexâspecific differences, such that male guillemots made deeper dives than females, and males of both species had higher DTS. In contrast, there were no marked sex differences in dive behaviour of puffins in July and August in accordance with their lack of postâfledging parental care and variable moult schedule. We found support for the prediction that diving effort would be greater in midâwinter compared to the period after the breeding season. Despite reduced daylight in midâwinter, this increase in DTS occurred predominantly during the day and only guillemots appeared to dive nocturnally to any great extent. In comparison to diving behaviour of these species recorded during the breeding season, MDD was shallower and DTS was greater during the nonâbreeding period. Such differences in diving behaviour during the postâbreeding period are relevant when identifying potential energetic bottlenecks, known to be key drivers of seabird population dynamics