Main Reasons for Using of PPP Contracts in Health Sector: An Analytical Study

The health sector in Iraq had faced enormous challenges. The health care system suffered a catastrophic deterioration under the former regime. The 1991 Gulf war incurred Iraq’s major infrastructures huge damages; includes health centers, clinics, hospitals, etc. The United Nations economic sanctions aggravated the deterioration process. The level of health care in Iraq has dropped markedly as the government budget allocated to the Ministry of Health (MOH) had decreased from $450 million in 1970 to about$ 250 million in 1985 then the annual total health budget for the ministry, a decade after the sanctions had fallen to $ 22 million which is barely 5% of what it was in the 1970s. On the other hand, the conflict of 2003 destroyed an estimated 12 percent of hospitals. Moreover, the war at 2014 held on ISIS-led to almost total destruction in most hospitals in the Central and Northern provinces. All this requires a quick strategy to advance the health sector and create a sustainable health sector. The researchers in this study will demonstrate, what are the pros and cons of Public-Private Partnership (PPP) contracts, how can be used in the Iraqi health sector, the main causes of dependence the MOH to using the PPP contracts in the all existing and the unfinished hospitals

Public Procurement Crisis of Iraq and its Impact on Construction Projects

  The public procurement crisis in Iraq plays a fundamental role in the delay in the implementation of construction projects at different stages of project bidding (pre, during, and after). The procurement system of any country plays an important role in economic growth and revival. The paper aims to use the fuzzy logic inference model to predict the impact of the public procurement crisis (relative importance index and Likert scale) was carried out at the beginning to determine the most important parameters that affect construction projects, the fuzzy analytical hierarchy process (FAHP) to set up, and finally, the fuzzy decision maker's (FDM) verification of the parameter for comparison with reality. Sixty-five construction projects in Iraq have been selected, and the most crucial crisis variables were used for calculating the weights and their importance, using the fuzzy logic inference model to verify the crisis parameters and the extent of their impact in preparation for predicting the mathematical model of public procurement parameters. After the algorithm had been completed, it was noted that the fast, messy genetic algorithm produced a little difference between training and testing (0.012% and 0.0057%), which is more reliable for predicting mean results from models. The paper’s major conclusion is that 18 crisis factors in public procurement through different stages affect construction projects in Iraq.

Global variation in postoperative mortality and complications after cancer surgery: a multicentre, prospective cohort study in 82 countries

© 2021 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY-NC-ND 4.0 licenseBackground: 80% of individuals with cancer will require a surgical procedure, yet little comparative data exist on early outcomes in low-income and middle-income countries (LMICs). We compared postoperative outcomes in breast, colorectal, and gastric cancer surgery in hospitals worldwide, focusing on the effect of disease stage and complications on postoperative mortality. Methods: This was a multicentre, international prospective cohort study of consecutive adult patients undergoing surgery for primary breast, colorectal, or gastric cancer requiring a skin incision done under general or neuraxial anaesthesia. The primary outcome was death or major complication within 30 days of surgery. Multilevel logistic regression determined relationships within three-level nested models of patients within hospitals and countries. Hospital-level infrastructure effects were explored with three-way mediation analyses. This study was registered with ClinicalTrials.gov, NCT03471494. Findings: Between April 1, 2018, and Jan 31, 2019, we enrolled 15 958 patients from 428 hospitals in 82 countries (high income 9106 patients, 31 countries; upper-middle income 2721 patients, 23 countries; or lower-middle income 4131 patients, 28 countries). Patients in LMICs presented with more advanced disease compared with patients in high-income countries. 30-day mortality was higher for gastric cancer in low-income or lower-middle-income countries (adjusted odds ratio 3·72, 95% CI 1·70–8·16) and for colorectal cancer in low-income or lower-middle-income countries (4·59, 2·39–8·80) and upper-middle-income countries (2·06, 1·11–3·83). No difference in 30-day mortality was seen in breast cancer. The proportion of patients who died after a major complication was greatest in low-income or lower-middle-income countries (6·15, 3·26–11·59) and upper-middle-income countries (3·89, 2·08–7·29). Postoperative death after complications was partly explained by patient factors (60%) and partly by hospital or country (40%). The absence of consistently available postoperative care facilities was associated with seven to 10 more deaths per 100 major complications in LMICs. Cancer stage alone explained little of the early variation in mortality or postoperative complications. Interpretation: Higher levels of mortality after cancer surgery in LMICs was not fully explained by later presentation of disease. The capacity to rescue patients from surgical complications is a tangible opportunity for meaningful intervention. Early death after cancer surgery might be reduced by policies focusing on strengthening perioperative care systems to detect and intervene in common complications. Funding: National Institute for Health Research Global Health Research Unit

Effects of hospital facilities on patient outcomes after cancer surgery: an international, prospective, observational study

© 2022 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 licenseBackground: Early death after cancer surgery is higher in low-income and middle-income countries (LMICs) compared with in high-income countries, yet the impact of facility characteristics on early postoperative outcomes is unknown. The aim of this study was to examine the association between hospital infrastructure, resource availability, and processes on early outcomes after cancer surgery worldwide. Methods: A multimethods analysis was performed as part of the GlobalSurg 3 study—a multicentre, international, prospective cohort study of patients who had surgery for breast, colorectal, or gastric cancer. The primary outcomes were 30-day mortality and 30-day major complication rates. Potentially beneficial hospital facilities were identified by variable selection to select those associated with 30-day mortality. Adjusted outcomes were determined using generalised estimating equations to account for patient characteristics and country-income group, with population stratification by hospital. Findings: Between April 1, 2018, and April 23, 2019, facility-level data were collected for 9685 patients across 238 hospitals in 66 countries (91 hospitals in 20 high-income countries; 57 hospitals in 19 upper-middle-income countries; and 90 hospitals in 27 low-income to lower-middle-income countries). The availability of five hospital facilities was inversely associated with mortality: ultrasound, CT scanner, critical care unit, opioid analgesia, and oncologist. After adjustment for case-mix and country income group, hospitals with three or fewer of these facilities (62 hospitals, 1294 patients) had higher mortality compared with those with four or five (adjusted odds ratio [OR] 3·85 [95% CI 2·58–5·75]; p<0·0001), with excess mortality predominantly explained by a limited capacity to rescue following the development of major complications (63·0% vs 82·7%; OR 0·35 [0·23–0·53]; p<0·0001). Across LMICs, improvements in hospital facilities would prevent one to three deaths for every 100 patients undergoing surgery for cancer. Interpretation: Hospitals with higher levels of infrastructure and resources have better outcomes after cancer surgery, independent of country income. Without urgent strengthening of hospital infrastructure and resources, the reductions in cancer-associated mortality associated with improved access will not be realised. Funding: National Institute for Health and Care Research